Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial

Objective: To assess the cost effectiveness of laparoscopic hysterectomy compared with conventional hysterectomy (abdominal or vaginal). Design: Cost effectiveness analysis based on two parallel trials: laparoscopic (n = 324) compared with vaginal hysterectomy (n = 163); and laparoscopic (n = 573) compared with abdominal hysterectomy (n = 286). Participants: 1346 women requiring a hysterectomy for reasons other than malignancy. Main outcome measure: One year costs estimated from NHS perspective. Health outcomes expressed in terms of QALYs based on women's responses to the EQ-5D at baseline and at three points during up to 52 weeks' follow up. Results: Laparoscopic hysterectomy cost an average of pound401 ($708; C571) more (95$471789; E380 437). The, probability that laparoscopic hysterectomy is cost effective was below 50% for a large range of values of willingness to pay for an additional QALY. Laparoscopic hysterectomy cost an average of pound186 ($328; E265) more than abdominal hysterectomy, although 95$46 893; E37 813). If the NHS is willing to pay pound30 0 00 for an additional QALY, the probability that laparoscopic hysterectomy is cost effective is 56%. Conclusions: Laparoscopic hysterectomy is not cost effective relative to vaginal hysterectomy. Its cost effectiveness relative to the abdominal procedure is finely balanced

The influence of risk factors associated with captive rearing on post-release survival in translocated cirl buntings Emberiza cirlus in the UK

Population decline resulting from agricultural intensification led to contraction of the range of the cirl bunting Emberiza cirlus in the UK to a small area of south Devon. As part of the UK Biodiversity Action Plan for the species, a project to re-establish a population in suitable habitat in Cornwall was undertaken during 2006–2011, in which chicks were removed from the nest in Devon, hand-reared and then delayed-released. The survival of the birds to four time points in the year after release was analysed in relation to the effect of rearing factors, using a multivariable logistic regression model. Individuals with higher body weight at capture were more likely to survive to 1 January and 1 May in the year following release, and individuals released in June and July were more likely to survive than those released in August. Individuals released in 2006 and 2011 had a higher survival rate than those released during 2007–2010. Timing of capture, time spent at each stage in captivity, medication and the detection of parasites in the brood had no significant effect. Immunosuppressive disease, weather factors and predator activity may have led to some of the observed differences in survival. This analysis provides evidence with which to plan future translocation projects for cirl buntings and other passerine birds

Place-based marketing and wine tourism: creating a point of difference and economic sustainability for small wineries

The purpose of this paper is to explore how small-scale wineries and wine regions create a point of difference and economic sustainability in a competitive marketplace through utilizing regional place branding and cellar door visitation. This research is based on qualitative, semi-structured, in-depth interviews with winery owners/managers and additional wine and tourism stakeholders in a single case study: The Central Otago wine region in the South Island of New Zealand. In total, 39 interviews were conducted in 2007 and 2010. Interviews were audio-recorded, transcribed verbatim, coded and categorized for analysis. Place marketing is a significant factor in the success of both regional and individual wine marketing initiatives, as it serves as a strategy of differentiation. Desirable regional attributes, as well as emotionally-appealing stories of the people and processes behind wine production, have been used deliberately by respondents in the marketing of Central Otago wine products and experiences. Respondents suggest that one of the most effective ways to facilitate a positive association between place and their product in the minds of consumers is through winery visitation, whereby visitors come to associate the region’s wines with the landscape and beauty of the area that they experience. Visitors also have the opportunity to experience the stories behind the wine, building emotional connections with the winery, and the region, which may ultimately lead to brand loyalty

Cross-Sectional Association of \u3ci\u3eToxoplasma gondii\u3c/i\u3e Exposure with BMI and Diet in US Adults

Toxoplasmosis gondii exposure has been linked to increased impulsivity and risky behaviors, which has implications for eating behavior. Impulsivity and risk tolerance is known to be related with worse diets and a higher chance of obesity. There is little known, however, about the independent link between Toxoplasma gondii (T. gondii) exposure and diet-related outcomes. Using linear and quantile regression, we estimated the relationship between T. gondii exposure and BMI, total energy intake (kcal), and diet quality as measured by the Health Eating Index-2015 (HEI) among 9,853 adults from the 2009–2014 National Health and Nutrition Examination Survey. Previous studies have shown different behavioral responses to T. gondii infection among males and females, and socioeconomic factors are also likely to be important as both T. gondii and poor diet are more prevalent among U.S. populations in poverty. We therefore measured the associations between T. gondii and diet-related outcomes separately for men and women and for respondents in poverty. Among females \u3c 200% of the federal poverty level Toxoplasmosis gondii exposure was associated with a higher BMI by 2.0 units (95% CI [0.22, 3.83]) at median BMI and a lower HEI by 5.05 units (95% CI [-7.87, -2.24]) at the 25th percentile of HEI. Stronger associations were found at higher levels of BMI and worse diet quality among females. No associations were found among males. Through a detailed investigation of mechanisms, we were able to rule out T. gondii exposure from cat ownership, differing amounts of meat, and drinking water source as potential confounding factors; environmental exposure to T. gondii as well as changes in human behavior due to parasitic infection remain primary mechanisms

Processes controlling carbon cycling in Antarctic glacier surface ecosystems

Glacier surface ecosystems, including cryoconite holes and cryolakes, are significant contributors to regional carbon cycles. Incubation experiments to determine the net production (NEP) of organic matter in cryoconite typically have durations of 6-24 hours, and produce a wide range of results, many of which indicate that the system is net heterotrophic. We employ longer term incubations to examine the temporal variation of NEP in cryoconite from the McMurdo Dry Valleys, Antarctica to examine the effect of sediment disturbance on system production, and to understand processes controlling production over the lifetimes of glacier surface ecosystems. The shorter-term incubations have durations of one week and show net heterotrophy. The longer term incubations of approximately one year show net autotrophy, but only after a period of about 40 days (~1000 hours). The control on net organic carbon production is a combination of the rate of diffusion of dissolved inorganic carbon from heterotrophic activity within cryoconite into the water, the rate of carbonate dissolution, and the saturation of carbonate in the water (which is a result of photosynthesis in a closed system). We demonstrate that sediment on glacier surfaces has the potential to accumulate carbon over timescales of months to years

DIVERSITY OF STAPHYLOCOCCAL SPECIES CULTURED FROM CAPTIVE LIVINGSTONE’S FRUIT BATS (PTEROPUS LIVINGSTONII) AND THEIR ENVIRONMENT

Livingstone's fruit bats (Pteropus livingstonii) are critically endangered and a captive population has been established as part of the International Union for Conservation of Nature Species Action Plan. The largest colony, in Jersey Zoo, was sampled for staphylococcal carriage and at infection sites, as disease associated with staphylococci had previously been found. Staphylococci were cultured from swabs from 44 bats (skin, oropharynx, mouth ejecta, skin lesions) and from their enclosure. The isolates were identified by matrix-assisted laser desorption-ionization time of flight mass spectrometry; antimicrobial susceptibility testing was performed by disc diffusion and screening for mecA and mecC. Seventeen species of coagulase-negative staphylococci including Staphylococcus xylosus, S. kloosii, S. nepalensis, and S. simiae were isolated. Staphylococcus aureus was identified from both carriage and lesional sites. These findings suggest S. nepalensis may be part of the normal carriage flora of bats. Antimicrobial resistance rates were low and methicillin-resistant Staphylococcus aureus (MRSA) was not identified. Sampling of mouth ejecta for staphylococci may provide results representative for carriage sites

New calculations and measurements of the Coulomb cross-section for the production of direct electron pairs by high energy nuclei

Recently, new calculations were made of the direct Coulomb pair cross section that rely less in arbitrary parameters. More accurate calculations of the cross section down to low pair energies were made. New measurements of the total direct electron pair yield, and the energy and angular distribution of the electron pairs in emulsion were made for O-16 at 60 and 200 GeV/amu at S-32 at 200 GeV/amu which give satisfactory agreement with the new calculations. These calculations and measurements are presented along with previous accelerator measurements made of this effect during the last 40 years. The microscope scanning criteria used to identify the direct electron pairs is described. Prospects for application of the pair method to cosmic ray energy measurements in the region 10 (exp 13) to 10 (exp 15) eV/amu are discussed

GlacialWater: A Dynamic Microbial Medium

Microbial communities and nutrient dynamics in glaciers and ice sheets continuously change as the hydrological conditions within and on the ice change. Glaciers and ice sheets can be considered bioreactors as microbiomes transform nutrients that enter these icy systems and alter the meltwater chemistry. Global warming is increasing meltwater discharge, affecting nutrient and cell export, and altering proglacial systems. In this review, we integrate the current understanding of glacial hydrology, microbial activity, and nutrient and carbon dynamics to highlight their interdependence and variability on daily and seasonal time scales, as well as their impact on proglacial environments

The changing pattern of domestic cannabis cultivation in the UK and its impact on the cannabis market

With improvements in both technology and information cannabis is being increasingly grown indoors for domestic use, rather than being imported. This study examines 50 cannabis farms detected by an English police force, and examines the characteristics of the 61 suspects associated with them. The study highlights a UK pattern in domestic cultivation, that is moving away from large scale commercial cultivation, at times co-ordinated by South East Asian organised crime groups, to increased cultivation within residential premises by British citizens. Offenders range from those who have no prior criminal history to those who are serious and persistent offenders. The ramifications for law enforcement agencies and policy formers are discussed

Association Between Assisted Reproductive Technology Conception and Autism in California, 1997–2007

Objectives. We assessed the association between assisted reproductive technology (ART) and diagnosed autistic disorder in a population-based sample of California births. Methods. We performed an observational cohort study using linked records from the California Birth Master Files for 1997 through 2007, the California Department of Developmental Services autism caseload for 1997 through 2011, and the Centers for Disease Control and Prevention’s National ART Surveillance System for live births in 1997 through 2007. Participants were all 5 926 251 live births, including 48 865 ART-originated infants and 32 922 cases of autism diagnosed by the Department of Developmental Services. We compared births originated using ART with births originated without ART for incidence of autism.Results. In the full population, the incidence of diagnosed autism was twice as high for ART as non-ART births. The association was diminished by excluding mothers unlikely to use ART; adjustment for demographic and adverse prenatal and perinatal outcomes reduced the association substantially, although statistical significance persisted for mothers aged 20 to 34 years. Conclusions. The association between ART and autism is primarily explained by adverse prenatal and perinatal outcomes and multiple births