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Background: Since the advent of laparoscopic surgery, many studies have shown the advantages of laparoscopic surgery over open surgery for ventral hernia repair (VHR). As robotic surgery is gaining popularity, we sought to compare the outcomes of this newer robotic-assisted technique to the outcomes of established open and laparoscopic techniques to assess for any additional benefit. Methods: A meta-analysis research design was employed. Multiple databases were queried for publications over the past 10 years and 23 articles were selected based on pre-determined selection criteria. Data were extracted and the arm-based network meta-analysis method was utilised to examine the effect difference for the three arms of our study: Open, laparoscopic and robotic-assisted VHR. Results: As expected, laparoscopy had an advantage over open VHR in terms of infection rates. This advantage was also observed in the robotic group over the open group; however, there was no statistical difference between the laparoscopic and robotic groups when infection rates were compared head-to-head. The robotic group had a significant advantage over both the open and more importantly, the laparoscopic groups in recurrence rates. Conclusions: The results of this study suggest that robotic surgery maintains some of the advantages of laparoscopic surgery and may also provide the additional advantage of recurrence rate reduction. This may be explained by the ability to perform a more complex hernia repair with robotic assistance secondary to the ease of closure of the fascial defect. More research is needed to validate this finding.

Objective and background: The need for surgical resection of breast lesions of uncertain malignant potential diagnosed by core-needle biopsy (CNB) is not well established. Our study sought to determine the incidence of these lesions at CNB and to find the rate of pathologic upgrade at surgery. and during clinical follow-up. Method: A retrospective review of CNBs performed at our hospital covering the period from November 1999 to December 2008 was undertaken. In those patients diagnosed with lobular neoplasia (atypical lobular neoplasia (ALH) and lobular carcinoma in situ (LCIS)), atypical ductal hyperplasia (ADH) and radial scar (RS) the rates of pathologic upgrade at subsequent surgery were determined. Results: 9325 breast CNBs were performed during the period under review. There were 36 diagnoses of ALH (0.4%), 20 of LCIS (0.2%), 110 of ADH (1.2%) and 60 of RS (0.6%). Regarding lobular neoplasia, ALH surgical resection was performed with subsequent pathologic upgrade in only 1/31 patients (3.2%). 85% of LCIS diagnoses were followed by surgical resection with pathologic upgrade in 5/17 cases (29%). For patients with ADH, 51% (56/110) had surgical resection with an upgrade rate of 20% (11/56). 9/54 patients (17%) who did not undergo surgical resection subsequently developed a cancer at the biopsy site. Regarding RS, in 58% (35/60) of cases surgical resection was undertaken with a pathologic upgrade rate of 8% (3/35). In all three cases with an upgrade the biopsy had been performed on a hypoechogenic lesion. Conclusion: We conclude that the significant rate of pathologic upgrade in LCIS and ADH mandates a surgical excision when these lesions are found at CNB. The low rate of pathologic upgrade in RS in the absence of a hypoechogenic lesion and ALH may allow these cases to be observed.

Mycobacterium bovis (M. bovis) is a causative agent of bovine tuberculosis, a significant source of morbidity and mortality in the global cattle industry. The Randomised Badger Culling Trial was a field experiment carried out between 1998 and 2005 in the South West of England. As part of this trial, M. bovis isolates were collected from contemporaneous and overlapping populations of badgers and cattle within ten defined trial areas. We combined whole genome sequences from 1,442 isolates with location and cattle movement data, identifying transmission clusters and inferred rates and routes of transmission of M. bovis. Most trial areas contained a single transmission cluster that had been established shortly before sampling, often contemporaneous with the expansion of bovine tuberculosis in the 1980s. The estimated rate of transmission from badger to cattle was approximately two times higher than from cattle to badger, and the rate of within-species transmission considerably exceeded these for both species. We identified long distance transmission events linked to cattle movement, recurrence of herd breakdown by infection within the same transmission clusters and superspreader events driven by cattle but not badgers. Overall, our data suggests that the transmission clusters in different parts of South West England that are still evident today were established by long-distance seeding events involving cattle movement, not by recrudescence from a long-established wildlife reservoir. Clusters are maintained primarily by within-species transmission, with less frequent spill-over both from badger to cattle and cattle to badger., Author summary Bovine tuberculosis (bTB), predominantly caused by Mycobacterium bovis, is a significant cause of sickness and death amongst cattle globally. Due to its broad host range which includes a variety of wildlife species such as the Eurasian badger, control measures for bTB are often both ineffective and expensive. One method used to attempt to control the spread of bTB in Great Britain is to cull badgers in areas adjacent to infected herds. To assess the effect of badger culling on the prevalence of bTB in nearby herds, the Randomised Badger Culling Trial (RBCT) was set up by the British government and ran between 1998 and 2005. Here we use 1,442 whole genome sequences obtained from isolates collected as part of the RBCT to describe the population structure of Mycobacterium bovis in the trial areas, identify putative transmission clusters and estimate the directionality of transmission, and integrate the genomic data with associated cattle movement data to identify examples of recurrence, superspreading and long-distance transmission. We found that the transmission clusters identified were strongly associated with RBCT trial area and that, whilst badger to cattle transmission was broadly more common than vice versa, the majority of transmission was occurring within the herds or badger populations. Additionally, molecular dating of the transmission clusters showed that the clusters were likely seeded during the 1980s, a period during which the prevalence of bTB in Great Britain increased markedly. Our study provides novel insights into the transmission of bTB between cattle and badgers in Great Britain.

Refereed/Peer-reviewed Digital loyalty programmes are an increasingly common tool for business-to-business marketers hoping to increase repeat sales through deeper customer engagement. In consumer markets, such programmes do little to influence behavioural loyalty and disproportionately attract the firm's existing heavy buyers. Industrial buying, however, relies on direct sales channels and features negotiation and reciprocity. Loyalty effects may therefore differ in B2B, and although no clear picture yet exists, such knowledge is important as B2C digital loyalty programmes grow in popularity. Here, the authors describe programme membership's evolving characteristics over in a B2B scheme that was launched in the US metal-cutting tools manufacturer customer base. Findings are consistent with the idea that the scheme recruited the heaviest buyers earliest and had an insignificant effect on total revenue. The authors discuss managerial implications, particularly about (1) managing the rollout of similar schemes and (2) refocussing on the programme objectives to maintain sales from the lightest rather than the heaviest buyers.

PurposeTo evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers.MethodsA cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast cancer who had at least a 10% pretest BRCA mutation probability, and the cascade testing of first- and second-degree relatives of women who test positive.ResultsCompared with no testing, BRCA testing of affected women resulted in an incremental cost per quality-adjusted life-year (QALY) gained of AU$18,900 (incremental cost AU$1,880; incremental QALY gain 0.10) with reductions of 0.04 breast and 0.01 ovarian cancer events. Testing affected women and cascade testing of family members resulted in an incremental cost per QALY gained of AU$9,500 compared with testing affected women only (incremental cost AU$665; incremental QALY gain 0.07) with additional reductions of 0.06 breast and 0.01 ovarian cancer events.ConclusionBRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.231.