Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review

Background Paracetamol poisoning is implicated in about 150-200 poisoning deaths per year in England and Wales. We review previous studies assessing the effectiveness of regulations introduced in 1998 to restrict sales of paracetamol and reduce paracetamol poisoning. Methods We searched the following electronic databases: MEDLINE, EMBASE, CINHAL, HIMIC, COCH, APC, CENTRAL and DARE. English language publications between 1998 and 2003 were included. Studies were included if they took place in the United Kingdom and assessed changes in any aspect of paracetamol poisoning following the introduction of the 1998 regulations. Results Twelve studies were identified, which examined several different outcomes. Three studies examined admissions to liver transplant units; all reported reductions. Eight studies evaluated severity of paracetamol poisoning; three reported reductions but five did not. Five out of six studies reported reductions in hospital admissions. One study reported reduced mortality in England and Wales after 1 year while another found no difference in Scotland 2 years after the regulations were introduced. Two studies observed a significant reduction in over-the-counter sales. Studies suffered from several limitations including short follow-up periods, no case definition for paracetamol poisoning and lack of comparison groups. Conclusions The limitations of these studies makes it difficult to draw firm conclusions. They do, however, suggest that the 1998 regulations may have been associated with reduced admissions to liver units and liver transplants, reduced hospital attendance due to paracetamol poisoning and reduced sales of paracetamol. Further research is needed to fully evaluate the impact of the 1998 regulations. In the future, formal evaluation of the impact of similar interventions should be an integral part of policy formation

Disentangling Access and View Amenities in Access-Restricted Coastal Residential Communities

In coastal communities with uniform flood risk, amenity value is comprised of two components – view and access. Having controlled for view, it is assumed that any residual amenity value represents the benefit derived from accessing the beach for leisure/recreational purposes. However, as properties closer to the beach typically have improved viewsheds, the two amenities are highly correlated, and disentangling view and access is problematical. A spatial autoregressive hedonic model captures ease of beach access via a network distance parameter that varies independently from property viewshed, collinearity effects are mitigated, and access and view can be disentangled.beach access, property viewshed, spatial hedonic model, willingness to pay, Environmental Economics and Policy, Land Economics/Use, Q51, R12, R21, R23,

Using Revealed and Stated Preference Data to Estimate the Scope and Access Benefits Associated with Cave Diving

In a single-site travel cost model framework, revealed and stated preference data are jointly estimated to provide the first use value estimate associated with recreational cave diving. Focusing on one of Florida’s first magnitude springs, we estimate average per-person per-trip use values of approximately $165, generating annual cave diving use values in excess of$1,150. Further, in an investigation of potential site quality changes, we find that divers are sensitive to scope effects with an additional cave system increasing annual per-person use values by approximately $130, while improved access yields an additional$57 in per-person annual consumer surplus. Finally, three additional model specifications are estimated and indicate that divers use different travel cost preferences when assessing their revealed and stated preference trip counts but a single preference structure to evaluate site quality changes. Key Words: Revealed and Stated Behavior; Scope Effects; Access; Travel Cost Preferences

Disentangling Access and View Amenities in Access-restricted Coastal Residential Communities

In small coastal communities with uniform flood risk, amenity value is comprised of two components – view and access. Having controlled for view, it is assumed that any residual amenity value represents the benefit derived from households from accessing the beach for leisure or recreational purposes. However, as properties closer to the beach typically have improved viewsheds, the two amenities are highly correlated, and disentangling view and access is problematical. We posit that for many coastal communities, access is restricted to designated public access points, precluding local residents from accessing the beach area directly from their property. To appropriately account for restricted access, we incorporate a network distance access measure into a spatial autoregressive hedonic model to capture ease of beach access for local residents. Our findings suggest that, as network distance varies independently from property viewshed, collinearity effects are mitigated, and access and view can be disentangled. Key Words:

Measuring the Willingness to Pay for Fresh Water Cave Diving

Fresh water springs are unique natural resources that are contained within public lands across the United States. Natural resource management on public lands generates many interesting policy issues as the competing goals of conservation, recreational opportunity provision, and revenue generation often clash. As demand for recreational cave diving sites increases, the paper provides natural resource site managers with the first statistical estimate of divers’ willingness to pay to dive fresh water cave and cavern systems. Using a contingent valuation model approach and correcting for hypothetical bias, we find that divers’ median willingness to pay for cave diving opportunities at the site of interest is approximately $68 per dive. Model results also provide evidence of diver sensitivity with respect to scope as individuals are willing to pay more for dives that are higher in quality. Key Words: Contingent Valuation Model; Willingness to Pay; Cave Diving; Scope Sensitivity

Estimating a Payment Vehicle for Financing Nourishment of Residential Beaches using a Spatial-lag Hedonic Property Price Model

Beach nourishment projects are common methods for coastal states to protect beaches and property from the natural erosive process. However, while the beneficiaries of beach nourishment tend to be local property owners and recreators, projects are typically funded at the state level. Based on the benefit principle, as local residents receive more of the erosion protection benefits of the nourishment projects, we estimate a value capture tax, designed to levy the financing burden in a manner that approximates the distribution of benefits. The benefits of nourishment projects to coastal property owners are estimated using the results from a spatial-lag hedonic model that controls for viewshed effects. Key Words:

Prebiotics may alter bile salt hydrolase activity: Possible implications for cholesterol metabolism

Probiotics secrete bile salt hydrolase (BSH) which catalyses the deconjugation and excretion of bile salts in the GI tract altering cholesterol metabolism in the liver. Many probiotic preparations include prebiotics to promote probiotic growth but little is understood about how prebiotics affect BSH activity. In this study the ability of probiotic Lactobacilli species to deconjugate bile salts in the presence of various prebiotics was determined by measuring cholic acid release. The kinetic properties of BSH was assessed to determine the impact the prebiotics on bile salt deconjugation. When L. acidophilus NCTC 1723 was incubated with inulin (1%) there was a significant (p < 0.01) increase in cholic acid release by 0.16 nmol/min. Lactulose and lactobionic acid at 1% decreased cholic acid release to 0.2 nmol/min and 0.06 nmol/min respectively. In the presence of the pure BSH, inulin and lactulose (0-6%) altered Kₘ and Vₘₐₓ of the enzyme with a Kᵢ of 12% and 10.5% respectively. By contrast, lactobionic acid (2%) increased BSH activity two-fold (p < 0.01). These results confirm that prebiotics are capable of altering BSH activity in vitro. Similar changes in vivo could potentially affect the claimed health benefits of synbiotics particularly where the desired outcome is lowering of serum cholesterol