The Marasenna are a broken race. Centuries of subterranean slavery has shattered their hope and their way of life; Against all odds, they remain strong in their resolve to see change. Eldroth is the champion of his tribe, and by all means, the pride of his people. When visions of freedom fill his dreams, he must make the hardest decision of his life: Will he lead his people to freedom, or will he accept their fate? A harrowing tale of loyalty and loss in the face of impossible odds. Join Eldroth in his attempt to regain the freedom of his tribe, and eventually his entire race in the first book of the Marasenna series!

"In Northwestern Ontario, there are currently twenty-two highway construction projects underway. The effects of highway construction on stream benthic macroinvertebrate communities have been studied in the past, with impacts such as sediment loading and physical habitat alterations reported. However, there has been a lack of research undertaken in Northwestern Ontario. The recently completed expansion project of Highway 11/17 was chosen as a focus for this study, and three streams that pass directly underneath the highway through culverts were selected for sampling."-- from abstract.

Preface This thesis was inspired by a UK simulation study which concluded that everyone in the UK should take cardiovascular disease (CVD) preventive medications from age 55 years. The authors compared screening strategies that determined eligibility for preventive medications based on age-alone or on predicted CVD risk. They reported that age-alone screening was simpler and more cost-effective. Their conclusion was highly controversial as guidelines increasingly recommend more personalised CVD risk screening using multivariable prediction equations. The goal of this thesis was to undertake a New Zealand (NZ) version of the UK study, accounting for NZ-specific factors, and addressing a number of methodological issues and assumptions. This involved: (i) creating a synthetic NZ population based on the 2013 NZ population of 2,451,278 individuals 30-84 years, each with a CVD risk factor profile, which replaced the hypothetical UK study population; (ii) replacing the Framingham Study CVD risk prediction equation used in the UK study (and previously in NZ) with a newly developed NZ equation; and (iii) undertaking simulations to compare benefits, harms and cost-effectiveness of screening strategies based on age-alone versus predicted CVD risk. The candidate's simulations used NZ screening and medication costs, accounted for medication adverse effects, disutility and adherence not considered in the UK study, and used cost per quality adjusted life year gained instead of the UK study's cost per CVD-free life year outcome measure. Comparing the NZ population's CVD risk profile based on the Framingham and NZ risk equations demonstrated that the population eligible for preventive medications would fall by 80% using the NZ equations unless treatment thresholds were also lowered. Based on these findings, the Ministry of Health has now recommended lowering the treatment threshold. The thesis simulations broadly supported the UK study conclusions, if it was assumed that the screening strategy would not affect medication adherence. However, when adherence using the age-alone strategy was reduced by 5%, any potential benefits of this strategy were lost. As adherence is likely to be better when drugs are prescribed by GPs after comprehensive risk assessments and discussion, the candidate's findings call into question the UK study conclusions.