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Scholars have argued that populists disproportionately benefit from social media, and there is evidence that they attract more engagement than other politicians and parties in several countries. We systematically evaluate the relationship between populism and online popularity using a novel dataset covering over four hundred parties active on Facebook and Twitter in thirty European countries between 2010 and 2020. We use Bayesian hierarchical models to assess the relationship between populism and three types of engagement on each platform. We find that populists received more engagement than other parties on Facebook, but there was no consistent relationship on Twitter. Among these parties, only right-wing populist parties had any widespread advantages. Our results highlight considerable heterogeneity across countries and over time, providing new insight into the scope and scale of populists’ online popularity. This includes evidence that left-wing and centrist parties attracted more engagement in a handful of countries. We evaluate several explanations for these results, finding that negative macroeconomic indicators and increased migration are positively correlated with populist engagement, while internet and social media adoption have mixed impacts that benefit right-wing populists. [ABSTRACT FROM AUTHOR]

With the retreat of glaciers, new ponds and lakes are often formed. These are gradually colonised and become more productive as vegetation develops in their catchments, creating more complex food webs. Near the Jakobshavn Isbræ in West Greenland, we studied trophic structure and food web complexity using stable isotopes in 26 lakes belonging to two different age groups (19 new lakes and 7 nearby older (> 150 years) ones). The older lakes had significantly higher total nitrogen and pelagic chlorophyll-a concentrations, as well as a higher organic matter content in the surface sediment. The biomass and richness of cladocerans, copepods and rotifers were higher in the older lakes and so was the zooplankton:phytoplankton biomass ratio. Multivariate analyses showed a marked difference between the zooplankton communities of new and older lakes. Layman food web metrics indicated higher food chain length and width of invertebrates (zooplankton and benthic macroinvertebrates) in the older lakes, being significantly higher in lakes with fish. Our findings highlight a potential sequence of succession occurring in lakes created by glacial retreat in the Arctic, implying an increase in food web complexity and higher taxonomic (and likely also functional) diversity following ageing and increased nutrient state. [ABSTRACT FROM AUTHOR]

We analysed long-term monitoring data on submerged macrophytes and water chemistry from 666 Danish lakes > 1 hectare and mean depth < 3 m, encompassing a total of 1447 lake years. Our aim was to describe how plant cover (COV), plant volume inhabited (PVI) and species richness related to physical and chemical and environmental variables. Boosted regression tree (BRT) analyses revealed that chlorophyll a, Secchi depth and depth were the strongest predictors of COV and PVI. Chlorophyll had a strong negative effect up to 50 µg/l, whereas the changes related to Secchi depth and depth were more gradual and covered more of the gradient. Macrophyte species richness was best predicted by lake area and alkalinity, with chlorophyll a, nutrients and colour having significant but less marked effects. For chlorophyll a, 78% of the observed variance could be explained by the BRT model, with the most powerful predictors being both phosphorus and nitrogen, but with significant additional effects of plant cover and alkalinity. Our analyses revealed limited direct effect of nutrients on macrophyte abundance, but an indirect hierarchical effect of nutrients mediated through chlorophyll a with additional interactive effects by plant cover itself, alkalinity, mean depth and colour. [ABSTRACT FROM AUTHOR]

Objectives: To (1) develop a simulation software environment to conduct prehospital research during the COVID-19 pandemic on paramedics' teamwork and use of mobile computing devices, and (2) establish its feasibility for use as a research and training tool. Background: Simulation-based research and training for prehospital environments has typically used live simulation, with highly realistic equipment and technology-enhanced manikins. However, such simulations are expensive, difficult to replicate, and require facilitators and participants to be at the same location. Although virtual simulation tools exist for prehospital care, it is unclear how best to use them for research and training. Methods: We present SPECTRa—Simulated Prehospital Emergency Care for Team Research—an online simulated prehospital environment that lets participants care concurrently for single or multiple patients remotely. Patient scenarios are designed using Laerdal's SimDesigner. SPECTRa records data about scenario states and participants' virtual interaction with the simulated patients. SPECTRa's supporting environment records participants' verbal communication and their visual and physical interactions with their interface and devices using Zoom conferencing and audiovisual recording. We discuss a pilot research implementation to assess SPECTRa's feasibility. Results: SPECTRa allows researchers to systematically test small-team interaction in single- or multipatient care scenarios and assess the impact of mobile devices on participants' assessment and care of patients. SPECTRa also supports pedagogical features that could allow prehospital educators to provide individual trainees or teams with online simulation training and evaluation. Conclusions: SPECTRa, an online tool for simulating prehospital patient care, shows potential for remote healthcare research and training. [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions. A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness. Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly. [ABSTRACT FROM AUTHOR]

Study Question: What are the costs of live donor uterus transplantation in a European setting?Summary Answer: The total costs for preoperative investigations, including IVF, and live donor uterus transplantation including postoperative costs for 2 months, were calculated to be €74 564 (mean), with the costs of recipient being somewhat higher than for donor and the cost components of total costs distributed between sick leave (25.7%), postoperative hospitalization (17.8%), surgery (17.1%), preoperative investigations (15.7%), anaesthesia (9.7%), drugs (7.8%), tests after surgery (4.0%) and for re-hospitalization (2.2%).What Is Known Already: Uterus transplantation has proved to be successful by demonstrations of live births, both after live donor and deceased donor procedures. The transplantation is considered as a complex and expensive infertility treatment. There exist no analyses of costs involved in uterus transplantation.Study Design, Size, Duration: This prospective cohort study included nine uterus transplantations procedures, performed in Sweden in 2013. Study duration of this health economic study included 6-12 months of pre-transplantation investigations and the time interval from transplantation to 2 months after.Participants/materials, Setting, Methods: Nine triads of uterus recipient, partner of recipient and uterus donor participated. All prospective recipients were in stable relationships and performed IVF with their partners before transplantation. The nine donors were relatives or family friends. The recipients and donors underwent pre-transplantation investigations with imaging, laboratory tests and psychological/medical screening prior to transplantation. Transplantation was by laparotomy in both donor and recipient. Standard immunosuppression and postoperative medication were used. After discharge from the hospital, the recipients were followed frequently with laboratory tests and examinations.Main Results and the Role Of Chance: The mean costs for preoperative investigations, including IVF, and live donor uterus transplantation with postoperative costs for 2 months, were calculated to be €74 564 (range €50 960-€99 658), from a societal perspective. The four largest components were cost of sick leave (€19 164), cost of postoperative hospitalization (€13 246), surgery cost (€12 779) and costs for preoperative investigations, including IVF (€11 739). Smaller components were costs for anaesthesia (€7207), costs for drugs (€5821), costs for post-surgical tests (€2985) and costs for re-hospitalization (€1623). The costs of the recipient (€42 984) were somewhat higher than the costs of the donor (€31 580), but in terms of costs, they should be viewed as one entity. By using a health care perspective, excluding cost for productivity loss, the total costs would be reduced by 26%.Limitations, Reasons For Caution: A limitation is the restricted sample size and that this is in the experimental, clinical stage of development.Wider Implications Of the Findings: The results provide the first information concerning the costs for pre-transplantation investigations and uterus transplantation procedures with postoperative follow-up. We consider the total estimate to be in the higher interval, because of the extensive research protocol. It is likely that the cost of live donor uterus transplantation will vary between countries and that the costs will be lower in a future clinical setting.Study Funding/competing Interest(s): Funding was received from the Jane and Dan Olsson Foundation for Science; the Knut and Alice Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; and the Swedish Research Council. None of the authors have a conflict of interest with regard to the study.Trial Registration Number: NCT01844362. [ABSTRACT FROM AUTHOR]

Suicide rates for adolescents and young adults (AYA) have risen dramatically in recent years – by almost 60% for Americans aged 10–24 years between 2007 and 2018. This increase has occurred for both whites and Blacks, with the rise in suicide among Black youth of particular note. Blacks historically exhibit lower rates of suicide relative to whites and thus, less is known about the etiology of Black suicide. To gain insight into the underlying causes of suicide among AYA, we examine medical examiner reports from the National Violent Death Reporting System (NVDRS) from 2013 to 2019 for over 26,000 Black and white suicide decedents ages 10–29. We apply structural topic modeling (STM) approaches to describe the broad contours of AYA suicide in the United States today. Our findings reveal distinct patterns by race. Guns, violence and the criminal justice system are prominent features of Black suicide, whether through the mechanism used in the suicide, either by firearm or other violent means such as fire or electrocution, the existence of criminal or legal problems/disputes, the location of death in a jail, or the presence of police. In contrast, the narratives of white AYA are more likely to reference mental health or substance abuse problems. Access to resources, as measured by county median household income, overlay these patterns. Themes more prevalent among Blacks are more common in poorer counties; those more prevalent among whites tend to be more common in wealthier counties. Our findings are consistent with other studies that suggest Black people experience greater exposure to violence and other traumas, systemic racism and interpersonal discrimination that may elevate the risk for suicidal behavior. • Latent themes in the narratives of Black and white suicide decedents aged 10–29 years are examined. • Guns, violence, and the criminal justice system are prominent features of Black suicide. • White suicide is more likely to be characterized by mental health or substance abuse problems. • Access to resources, as measured by county median household income, overlay these patterns. • Suicide prevention efforts must be culturally informed. [ABSTRACT FROM AUTHOR]

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the "low" subgroup, those with 1-3 into the "moderate" subgroup and those with ≥4 into the "high" subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12. [ABSTRACT FROM AUTHOR]

Objective: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program.Material and Methods: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented.Results: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high.Conclusions: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended.Trial Registration: www.controlled-trials.com (ISRCTN35086887). [ABSTRACT FROM AUTHOR]

Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries.Material and Methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices.Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment.Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries. [ABSTRACT FROM AUTHOR]

Background: We have previously reported inconclusive results from a randomized controlled trial in elderly with hip-fracture comparing intra-operative goal-directed therapy with routine fluid treatment. Now we aimed to describe and compare secondary outcomes at 4 months and 1 year follow-up and to analyze the cost-effectiveness.Methods: Patients with hip fracture (age ≥70) were randomized for GDT or routine fluid treatment (RFT). The secondary outcomes were long-term survival, complications, number of hospital readmissions, and quality of life (EQ-5D) changes. Additionally, cost effectiveness was analyzed by an analytic tool which combines the clinical effectiveness, quality of life changes and costs.Results: Patient data (GDT n = 74; RFT n = 75) were analyzed on an intention to treat basis. Statistically significant differences (GDT vs RFT) were not found considering survival (RR 0.76, 95%CI 0.45-1.28) and complications (RR 0.68, 95% CI 0.4-1.10) at 12 months. No statistically significant difference was found between hospital readmissions and quality of life changes.Conclusion: The statistical uncertainty of risk reduction of negative outcomes and the large variability of the collected data indicate the need of further research in large sample sizes. To enable future health economic evaluation for decision support surrounding implementation of GDT, we suggest adding patient-oriented outcomes in future trials. [ABSTRACT FROM AUTHOR]

Abstract Harmful algal blooms have become increasingly frequent due to the dual pressure of excessive nutrient loading and climate change in recent years. Algal-derived dissolved organic matter (DOM) is a potentially large component of the labile organic matter pool, and also climate warming may affect the DOM pool, although the results on the latter so far are equivocal. The question of how eutrophication and climate warming may drive the accumulation of autochthonous DOM is much debated. Here, we analysed published data on DOM world-wide and field data that we collected from 97 lakes and major rivers in China (> 4500 samples) as well as results from the longest running shallow-lake mesocosm climate experiment in the world at a research facility in Denmark. Our results indicated that dissolved organic carbon (DOC) concentrations decreased with increasing temperature and enrichment of δ13C-DOM. A negative relationship was found between latitude and %protein-like fluorescence, which increased significantly with increasing elevation and enrichment of δ13C-DOM. Specific ultraviolet absorbance at 254 nm (SUVA) decreased with increasing elevation and enrichment of δ13C-DOM. Fluorescence intensity of autochthonous microbial humic-like substances increased notably with eutrophication but decreased weakly with warming. DOC, biodegradable DOC, chlorophyll- a , δ13C-DOC and autochthonous substances identified using DOM fluorescence and high resolution mass spectrometry from the mesocosm experiment were notably elevated at the high nutrient levels, while the effect of temperature was insignificant. We conclude that while eutrophication promotes DOM, warming potentially suppresses the accumulation of autochthonous DOM in inland waters. Graphical abstract Principal component analysis of optical characteristics of the CDOM samples collected in the mesocosm experiment. Relationships between the microbial humic-like C3 and stable isotope δ2H, and between C3 and δ13C-DOC. Unlabelled Image [ABSTRACT FROM AUTHOR]

The North Water (NOW) polynya is one of the most productive marine areas of the Arctic and an important breeding area for millions of seabirds. There is, however, little information on the dynamics of the polynya or the bird populations over the long term. Here, we used sediment archives from a lake and peat deposits along the Greenland coast of the NOW polynya to track long-term patterns in the dynamics of the seabird populations. Radiocarbon dates show that the thick-billed murre (Uria lomvia) and the common eider (Somateria mollissima) have been present for at least 5500 cal. years. The first recorded arrival of the little auk (Alle alle) was around 4400 cal. years bp at Annikitsoq, with arrival at Qeqertaq (Salve Ø) colony dated to 3600 cal. years bp. Concentrations of cadmium and phosphorus (both abundant in little auk guano) in the lake and peat cores suggest that there was a period of large variation in bird numbers between 2500 and 1500 cal. years bp. The little auk arrival times show a strong accord with past periods of colder climate and with some aspects of human settlement in the area. [ABSTRACT FROM AUTHOR]

Group-based microcredit has become a globally adopted anti-poverty intervention. An important institutional variant of this is the self-help group (SHG) model, where non-commercialized lending is done through neighborhood-based savings and lending associations. We examine the effect of women's participation in SHGs in India on their social networks and social capital. We use household survey data, including rich social network information from seventy-five villages in rural Karnataka. In a context where women's interactions are largely restricted to their kinship networks and heavily constrained by rural life and patriarchal norms, participation in SHGs provides opportunities for socially isolated women to form new relationships. Descriptive analyses show that SHG participants, despite being more socioeconomically disadvantaged than non-participants, have significantly more incoming ties from nonkin than both non-participant women and men. After using propensity score matching to model selection into microcredit associations, we find consistent evidence that SHG participants have significantly more ties from nonkin and that these ties originate from other participants. We conclude that relationships formed within SHGs extend beyond the group and constitute important social capital, as women form friendships, give each other advice, and exchange vital basic needs resources. [ABSTRACT FROM AUTHOR]

The aim of the present study was to calculate non-medical costs during year 1 after diagnosis in two cohorts of patients with early rheumatoid arthritis enrolled 1996-1998 and 2006-2009. Clinical data were collected regularly in both cohorts. Besides information about healthcare utilization and days lost from work, patients reported non-medical costs for aids/devices, transportation, formal and informal care. Formal care was valued as full labour cost for official home help (€42.80/h) and informal care from relatives and friends as opportunity cost of leisure time, corresponding to 35% of labour cost (€15/h). In both cohorts, only 2% used formal care, while more than 50% used informal care. Prescription of aids/devices was more frequent in cohort 2 and more women than men needed aids/devices. Help with transportation was also more common in cohort 2. Women in both cohorts needed more informal care than men, especially with personal care and household issues. Adjusting for covariates in regression models, female sex remained associated with higher costs in both cohorts. Non-medical costs in cohort 2 were €1892, €1575 constituting informal care, corresponding to 83% of non-medical costs. Total non-medical costs constituted 25% of total direct costs and 11% of total direct and indirect costs. Informal care accounted for the largest part of non-medical costs and women had higher costs than men. Despite established social welfare system, it is obvious that family and friends, to a large extent, are involved in informal care of patients with early RA, and this may underestimate the total burden of the disease. [ABSTRACT FROM AUTHOR]

Summary Thalamic relay neurons have well-characterized dual firing modes: bursting and tonic spiking. Studies in brain slices have led to a model in which rhythmic synchronized spiking (phasic firing) in a population of relay neurons leads to hyper-synchronous oscillatory cortico-thalamo-cortical rhythms that result in absence seizures. This model suggests that blocking thalamocortical phasic firing would treat absence seizures. However, recent in vivo studies in anesthetized animals have questioned this simple model. Here we resolve this issue by developing a real-time, mode-switching approach to drive thalamocortical neurons into or out of a phasic firing mode in two freely behaving genetic rodent models of absence epilepsy. Toggling between phasic and tonic firing in thalamocortical neurons launched and aborted absence seizures, respectively. Thus, a synchronous thalamocortical phasic firing state is required for absence seizures, and switching to tonic firing rapidly halts absences. This approach should be useful for modulating other networks that have mode-dependent behaviors. [ABSTRACT FROM AUTHOR]

Fish kills are a common occurrence in shallow, eutrophic lakes, but their ecological consequences, especially in the long term, are poorly understood. We studied the decadal-scale response of two UK shallow lakes to fish kills using a palaeolimnological approach. Eutrophic and turbid Barningham Lake experienced two fish kills in the early 1950s and late 1970s with fish recovering after both events, whereas less eutrophic, macrophyte-dominated Wolterton Lake experienced one kill event in the early 1970s from which fish failed to recover. Our palaeo-data show fish-driven trophic cascade effects across all trophic levels (covering benthic and pelagic species) in both lakes regardless of pre-kill macrophyte coverage and trophic status. In turbid Barningham Lake, similar to long-term studies of biomanipulations in other eutrophic lakes, effects at the macrophyte level are shown to be temporary after the first kill (c. 20 years) and non-existent after the second kill. In plant-dominated Wolterton Lake, permanent fish disappearance failed to halt a long-term pattern of macrophyte community change (for example, loss of charophytes and over-wintering macrophyte species) symptomatic of eutrophication. Important implications for theory and restoration ecology arise from our study. Firstly, our data support ideas of slow eutrophication-driven change in shallow lakes where perturbations are not necessary prerequisites for macrophyte loss. Secondly, the study emphasises a key need for lake managers to reduce external nutrient loading if sustainable and long-term lake restoration is to be achieved. Our research highlights the enormous potential of multi-indicator palaeolimnology and alludes to an important need to consider potential fish kill signatures when interpreting results. [ABSTRACT FROM AUTHOR]

Fresh waters make a disproportionately large contribution to greenhouse gas ( GHG) emissions, with shallow lakes being particular hot spots. Given their global prevalence, how GHG fluxes from shallow lakes are altered by climate change may have profound implications for the global carbon cycle. Empirical evidence for the temperature dependence of the processes controlling GHG production in natural systems is largely based on the correlation between seasonal temperature variation and seasonal change in GHG fluxes. However, ecosystem-level GHG fluxes could be influenced by factors, which while varying seasonally with temperature are actually either indirectly related (e.g. primary producer biomass) or largely unrelated to temperature, for instance nutrient loading. Here, we present results from the longest running shallow-lake mesocosm experiment which demonstrate that nutrient concentrations override temperature as a control of both the total and individual GHG flux. Furthermore, testing for temperature treatment effects at low and high nutrient levels separately showed only one, rather weak, positive effect of temperature ( CH4 flux at high nutrients). In contrast, at low nutrients, the CO2 efflux was lower in the elevated temperature treatments, with no significant effect on CH4 or N2O fluxes. Further analysis identified possible indirect effects of temperature treatment. For example, at low nutrient levels, increased macrophyte abundance was associated with significantly reduced fluxes of both CH4 and CO2 for both total annual flux and monthly observation data. As macrophyte abundance was positively related to temperature treatment, this suggests the possibility of indirect temperature effects, via macrophyte abundance, on CH4 and CO2 flux. These findings indicate that fluxes of GHGs from shallow lakes may be controlled more by factors indirectly related to temperature, in this case nutrient concentration and the abundance of primary producers. Thus, at ecosystem scale, response to climate change may not follow predictions based on the temperature dependence of metabolic processes. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. Materials and methods. Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. Results. Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. Conclusions. Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment. [ABSTRACT FROM AUTHOR]

Multi-indicator palaeoecological studies have become increasingly popular over the last decade as the need for a more complete understanding of lake ecological histories has increased. However, the true potential of the full biological record for assessing the potential drivers of observed ecological shifts in lake sediment records has rarely been demonstrated., Here, we examine the remains of a range of food-web components including algae (diatoms), macrophytes (plant macrofossils), zooplankton (chitinous and ephippial Cladocera remains), invertebrates (including chironomids, bryozoans, Mollusca) and fish (fish scales and fish leech egg cocoons) in multiple sediment cores from Groby Pool, an enriched English shallow lake, to assess whole-ecosystem response to eutrophication over the last two centuries. We focus on three striking changes in the palaeorecord, namely the post-1900 increase in Daphnia spp., the post-1840 decline in Cristatella mucedo and the post-1940 increase in Cocconeis placentula, and utilise the multi-indicator palaeoecological data to evaluate possible explanations for these patterns., Principal curves analysis revealed marked and broadly simultaneous changes in the plant macrofossils, cladocerans, diatoms and chironomids (as well as in other animal remains such as bryozoans and Mollusca), indicating an early period of enrichment most likely associated with land-use change in the late 18th century, followed by a more recent eutrophication phase coincident with the discharge of sewage effluent to the lake from 1935., Ecological change, resulting from eutrophication, was shown to have progressed slowly and steadily and to have occurred at all trophic levels with a shift from a relatively diverse 'mesotrophic' macrophyte assemblage, dominance by benthic diatoms and plant-associated Chydoridae and chironomids towards a relatively species-poor, 'eutrophic' macrophyte community with dominance by planktonic algae (e.g. Cyclostephanoid diatom taxa), planktonic Cladocera ( Bosmina, Daphnia) and a chironomid fauna dominated by mud-associated taxa. The inferred shift in the macrophyte community from charophyte to fine-leaved pondweed and Callitriche truncata suggests a reduction in the seasonal duration of plant dominance., The multi-indicator analysis indicates that a combination of increased phytoplankton biomass and low zooplanktivorous fish predation is likely to explain the recent increases in Daphnia spp., while loss of plant habitat and increased competition for food appear to be the most likely causes of the observed decline in C. mucedo, and resistance to increased grazing pressure from invertebrates is the most probable driver of the C. placentula increase., Our study illustrates the potential of using the full array of fossil groups preserved in lake sediment cores to infer ecosystem dynamics over centennial timescales and to contribute to our understanding of the mechanisms that may link biological assemblages to a range of forcing factors. Further, this paper provides methodological guidance by demonstrating the ability of amalgamated records from three cores to reveal a strong sequence of events and coherent patterns. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n=55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n=48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society. [ABSTRACT FROM AUTHOR]

Zooplankton community response to the combined effects of nutrients and fish (hereafter N + F) at contrasting temperatures was studied in a long-term experiment conducted in 24 shallow lake mesocosms with low and high nutrient levels. We found a positive effect of N + F on zooplankton biomass, chlorophyll- a and turbidity. In contrast, zooplankton species and size diversity decreased with added N + F, as did submerged macrophyte plant volume inhabited (PVI). The community composition of zooplankton in high N + F mesocosms was related to chlorophyll- a and turbidity and to macrophyte PVI in the low N + F mesocosms. Macrophytes can protect zooplankton from fish predation. Compared to N + F effects, temperature appeared to have little effect on the zooplankton community. Yet analysis of community heterogeneity among treatments indicated a significant temperature effect at high N + F levels. The results indicate an indirect temperature effect at high N + F levels that can be attributed to temperature-dependent variation in fish density and/or chlorophyll- a concentration. [ABSTRACT FROM AUTHOR]

Ponds have significant conservation value due to their potentially high contribution to local and regional diversity. However, most ponds are located in anthropogenically influenced areas, and their biodiversity is constantly threatened by human activities. Thus, knowledge of the effect of pond management on biodiversity is essential for designing effective conservation strategies., Here, we study the main drivers of diversity of three functional groups of primary producers (phytoplankton, filamentous green algae and submerged macrophytes) in 87 ponds distributed across a large region (c. 90000 km2) in Southern Spain. We hypothesised that spatial effects would increase with increasing propagule size. However, given the regional extent of the study, we anticipated that both spatial and environmental controls would be significant., We determined α -, β - and γ-components of biodiversity for each functional group and pond type (embankment ponds, excavated ponds and artificial ponds) and assessed the influence of environmental and spatial drivers on diversity with generalised additive models ( GAMs). Redundancy analyses ( RDAs) with variation partitioning were used to determine the relative contribution of environmental and spatial predictors of the community assembly. Spatial variables were calculated by applying distance-based Moran's eigenvector maps (db- MEM)., Both α - and β -diversities of phytoplankton and filamentous green algae varied significantly with pond type. Generally, environmental predictors of diversity were more important than spatial variables. Assemblage structure was controlled by water chemistry and eutrophication, with a marked influence of pond type. Spatial variables included broad-scale variation for the three groups of primary producers, which were also strongly influenced by the management regime., Limited management activities, as occurs at embankment ponds, promoted the local richness of phytoplankton and contributed importantly to the regional diversity of macrophytes. Moreover, the relative contribution of environmental and spatial variables was similar between embankment ponds and natural ecosystems, that is, dispersal limitation increasing with propagule size. Excavated and artificial ponds also contributed importantly to regional diversity by enhancing phytoplankton and filamentous green algal β-diversity. However, spatial patterns in the latter pond type did not meet our expectations, most likely due to the intensive disturbance from pond management hampering the development of macrophytes. [ABSTRACT FROM AUTHOR]

This essay attempts to examine Danielewski's experimental novel from the standpoint of postmodernity, architecture, and information theory in order to demonstrate how it exemplifies the new modes of spatio-temporal ordering which characterize late capitalist society in the digital age. Both the figure of the house and the form of the text suggest the futility of spatially and temporally fixed identities in contemporary society. The fictional house contains a corridor that constantly expands, defying any attempts to accurately record its interior. Typographical innovations are used to merge the tempo of the narrative with the readers' sense of space and time. Furthermore, the online forum where readers discuss the text serves as an extension of the narrative into digital space and also exemplifies the spatio-temporal dimension the novel evokes. Situated within this context we can understand the novel as a meditation upon the ontological uncertainty produced by the ubiquity of digital technologies, as we are no longer able to clearly demarcate the boundaries between online and offline, fact and fiction, real and fantasy. [ABSTRACT FROM AUTHOR]

Background: A randomized, controlled trial, intended to include 460 patients, is currently studying peroperative goal-directed hemodynamic treatment (GDHT) of aged hip-fracture patients. Interim efficacy analysis performed on the first 100 patients was statistically uncertain; thus, the trial is continuing in accordance with the trial protocol. This raised the present investigation's main question: Is it reasonable to continue to fund the trial to decrease uncertainty? To answer this question, a previously developed probabilistic cost-effectiveness model was used. That model depicts (1) a choice between routine fluid treatment and GDHT, given uncertainty of current evidence and (2) the monetary value of further data collection to decrease uncertainty. This monetary value, that is, the expected value of perfect information (EVPI), could be used to compare future research costs. Thus, the primary aim of the present investigation was to analyze EVPI of an ongoing trial with interim efficacy observed. Methods: A previously developed probabilistic decision analytic cost-effectiveness model was employed to compare the routine fluid treatment to GDHT. Results from the interim analysis, published trials, the meta-analysis, and the registry data were used as model inputs. EVPI was predicted using (1) combined uncertainty of model inputs; (2) threshold value of society's willingness to pay for one, quality-adjusted life-year; and (3) estimated number of future patients exposed to choice between GDHT and routine fluid treatment during the expected lifetime of GDHT. Results: If a decision to use GDHT were based on cost-effectiveness, then the decision would have a substantial degree of uncertainty. Assuming a 5-year lifetime of GDHT in clinical practice, the number of patients who would be subject to future decisions was 30,400. EVPI per patient would be €204 at a €20,000 threshold value of society's willingness to pay for one quality-adjusted life-year. Given a future population of 30,400 individuals, total EVPI would be €6.19 million. Conclusions: If future trial costs are below EVPI, further data collection is potentially cost-effective. When applying a cost-effectiveness model, statements such as 'further research is needed' are replaced with 'further research is costeffective and 'further funding of a trial is justified'. Trial registration: ClinicalTrials.gov NCT01141894 [ABSTRACT FROM AUTHOR]

Objective. To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation. Background. Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function. Materials and methods. The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded. Results. The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation. Conclusions. In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth. [ABSTRACT FROM AUTHOR]

Cerebrocortical injuries such as stroke are a major source of disability. Maladaptive consequences can result from post-injury local reorganization of cortical circuits. For example, epilepsy is a common sequela of cortical stroke, but the mechanisms responsible for seizures following cortical injuries remain unknown. In addition to local reorganization, long-range, extra-cortical connections might be critical for seizure maintenance. In rats, we found that the thalamus, a structure that is remote from, but connected to, the injured cortex, was required to maintain cortical seizures. Thalamocortical neurons connected to the injured epileptic cortex underwent changes in HCN channel expression and became hyperexcitable. Targeting these neurons with a closed-loop optogenetic strategy revealed that reducing their activity in real-time was sufficient to immediately interrupt electrographic and behavioral seizures. This approach is of therapeutic interest for intractable epilepsy, as it spares cortical function between seizures, in contrast with existing treatments, such as surgical lesioning or drugs. [ABSTRACT FROM AUTHOR]

We compared the INR (International Normalized Ratio) monitoring process using a telemedicine device with the conventional approach in which blood samples were sent to the hospital for analysis. We conducted a randomized controlled trial. We enrolled 40 patients on chronic warfarin therapy from two primary healthcare centres (PHCs). Half were monitored using the telemedicine device and half were monitored conventionally. Each patient received three INR measurements. The total processing time was measured from blood sampling until warfarin dosing was performed in the anticoagulant clinic. The median total processing time was significantly shorter with telemedicine than usual care (34 vs. 260 min, P, 0.001). This was mainly because sample transport was avoided using the point-of-care device and automatic data transmission. Telemedicine reduced the total processing time for INR monitoring and has the potential to improve the management of patients undergoing anticoagulant treatment at PHCs. [ABSTRACT FROM AUTHOR]

1. Flood-pulsed wetlands make vital contributions to local and global biodiversity. However, the patterns and controls of spatial and temporal variation in aquatic biodiversity in flood-pulsed wetlands are not well understood. We analysed the relationship between variation in hydrological regime and the patterns of aquatic biodiversity in a large pristine flood-pulsed wetland, the Okavango Delta, Botswana. 2. Surveys of water chemistry, diatoms and macroinvertebrates were conducted over the seasonal phases of the flood pulse. Hydrological variables of flood frequency and hydroperiod class were collated from 16 years of satellite images. Multivariate regression trees and generalised least squares regression were used to determine the chief controls of community composition and taxon richness. 3. Hydroperiod class, phase of the flood and conductivity explained 32% and 43% of the variation in diatom and invertebrate taxon richness, respectively. There was a negative relationship between hydroperiod class and invertebrate taxon richness on the rising, peak and receding flood, whereas at low flood there was no significant relationship. Multivariate regression tree analysis revealed hydroperiod class, phase of the flood and conductivity as the dominant forces shaping invertebrate and diatom community composition. 4. Seasonal and spatial variation in hydrological conditions are the principal drivers of variation in aquatic biodiversity in flood-pulsed wetlands. In pristine flood-pulsed wetlands, increased productivity caused by the arrival of the flood waters appears to override disturbance and connectivity in shaping taxon richness and community composition. Thus, these data suggest that the maintenance of a rich mosaic of habitats covering a broad range of hydroperiod is the key to preserving aquatic biodiversity and natural ecosystem function in flood-pulsed wetlands. [ABSTRACT FROM AUTHOR]

Shallow lakes have been affected by a variety of human activities profoundly altering their ecological structure and function. Cladocerans have been used to track change resulting from a variety of drivers at a number of time scales. Aquatic macrophytes are well recognised as reflecting the ecological condition of a lake. Here, we compare the plant macrofossils with the sub-fossil cladoceran assemblages from 20 dated sediment cores. Co-correspondence analysis was used to determine the degree of commonality of change in community composition of the two biological groups through time. This analysis revealed very high levels of agreement in the nature and timing of change at all the sites examined with very high correlation coefficients between the axis 1 scores for macrofossils and cladocerans. Furthermore, at all sites a high proportion of the variance (min 20%, max 54%) in the macrofossil data was explained by the change in the cladoceran assemblage. Sub-fossil macrofossil and cladoceran assemblages, from at least from 1700 AD onwards, were examined in more detail at three sites: Ormesby Great Broad, Felbrigg Lake and Lake Søbygaard. There was very good accord in the main shifts of the cladoceran and macrofossil assemblages at all three sites. This may reflect the long-term shift in the principal focus of primary production from the benthic to the pelagic habitat. We suggest that the combination of their central position in the food-web and the presence of both pelagic and benthic taxa make cladocerans a strong candidate as the single best indicator of (palaeo) ecological condition related to changing trophic status and alteration in food-web structure in shallow lakes. [ABSTRACT FROM AUTHOR]

Transfer functions have proved very useful for quantitative reconstruction of past environments. Inferring values of a single parameter based on changes in a community with multiple controls may result in unreliable inferences. To assess this unreliability cladoceran surface sediment assemblages from 53 lakes in Greenland, which have substantial variations in lake depth and fish abundance, both of which shape cladoceran communities, were analysed in this study. Redundancy analysis (RDA) revealed that maximum lake depth and either fish abundance or fish presence/absence exerted substantial and significant control on the cladoceran assemblage. Partial RDA showed that maximum lake depth and fish abundance uniquely explained 7.9 and 5.1%, respectively, with 5.3% variance being shared. A transfer function to infer lake depth from cladoceran sub-fossils was constructed and performed moderately well [coefficient of determination ( r) = 0.65; root mean square error of prediction (RMSEP) = 0.32 log maximum depth] on the full dataset. When outliers, defined by a bootstrapped prediction error greater than 25% of the total depth gradient, were excluded, the model performed well ( r = 0.74, RMSEP = 0.25 log maximum depth). The improved transfer function was then applied to sedimentary assemblage from a sediment core from Lake Boresø, in North-eastern Greenland, covering 9,000 years. A large increase in lake depth was inferred around 6250 bp. Whilst the climate was wetter at that time, the inferred changes in depth likely reflect the alteration of the food web, which resulted from the arrival of fish in the lake. This highlights the risks of using single-variable inference models for hindcasting change in lake physical and/or food web structure when there are other important co-variables. [ABSTRACT FROM AUTHOR]

Aim: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. People with AF have a significantly increased risk of thromboembolic events, including stroke, and the main treatment is therefore aimed at preventing thromboembolic events via anticoagulation with warfarin or acetylsalicylic acid. However, the development of new anticoagulation treatments has prompted a need to know the current cost of AF-related thromboembolic events, for future cost-effectiveness comparisons with the existing treatments. In this study, we estimated the cost of thromboembolic events and their prevention among Swedish AF patients in 2010. Methods: The relevant costs were identified, quantified, and valued. The complications included were ischaemic and haemorrhagic stroke, gastrointestinal bleeding, and other types of major bleeding caused by AF. Treatments intended to lower the risk of ischaemic stroke were also included. A societal perspective was used, including productivity loss due to morbidity. Patients with a CHADS2 score of 1 or higher were included. Results: Among the 9 340 682 inhabitants of Sweden, there are 118 000 patients with AF and at least one more risk factor for stroke, comprising 1.26% of the population. Of these patients, 43.3% are treated with warfarin, 28.3% use acetylsalicylic acid, and 28.3% are assumed to have no anticoagulation treatment. The cost of AF-related complications and its prevention in Sweden was estimated at €437 million for 2010, corresponding to €3 712 per AF patient per year. The highest cost was caused by stroke, and the second highest by the cost of monitoring the warfarin treatment. As the prevalence of AF is expected to increase in the future, AF-related costs are also expected to rise. Conclusion: Thromboembolic events cause high costs. New, easily-administered treatments that could reduce the risk of stroke have the potential to be cost-effective. [ABSTRACT FROM AUTHOR]

The purpose of this study was to estimate the cost-effectiveness of using individual-donor nucleic acid testing (ID-NAT) in addition to serologic tests compared with the sole use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among blood donors in Sweden. The two strategies analyzed were serologic tests and ID-NAT plus serologic tests. A health-economic model was used to estimate the lifetime costs and effects. The effects were measured as infections avoided and quality-adjusted life-years (QALYs) gained. A societal perspective was used. The largest number of viral transmissions occurred with serologic testing only. However, the risks for viral transmissions were very low with both strategies. The total cost was mainly influenced by the cost of the test carried out. The cost of using ID-NAT plus serologic tests compared to serologic tests alone was estimated at Swedish Krona (SEK) 101 million (USD 12.7 million) per avoided viral transmission. The cost per QALY gained was SEK 22 million (USD 2.7 million). Using ID-NAT for testing against HBV, HCV, and HIV among blood donors leads to cost-effectiveness ratios that are far beyond what is usually considered cost-effective. The main reason for this is that with current methods, the risks for virus transmission are very low in Sweden. [ABSTRACT FROM AUTHOR]

1. Seasonal relationships between macrophyte and phytoplankton populations may alter considerably as lakes undergo eutrophication. Understanding of these changes may be key to the interpretation of ecological processes operating over longer (decadal-centennial) timescales. 2. We explore the seasonal dynamics of macrophytes (measured twice in June and August) and phytoplankton (measured monthly May–September) populations in 39 shallow lakes (29 in the U.K. and 10 in Denmark) covering broad gradients for nutrients and plant abundance. 3. Three site groups were identified based on macrophyte seasonality; 16 lakes where macrophyte abundance was perennially low and the water generally turbid (‘turbid lakes’); 7 where macrophyte abundance was high in June but low in August (‘crashing’ lakes); and 12 where macrophyte abundance was high in both June and August (‘stable’ lakes). The seasonal behaviour of the crashing and turbid lakes was extremely similar with a consistent increase in nutrient concentrations and chlorophyll- a over May–September. By contrast in the stable lakes, seasonal changes were dampened with chlorophyll- a consistently low (<10–15 μg L−1) over the entire summer. The crashing lakes were dominated by one or a combination of Potamogeton pusillus, Potamogeton pectinatus and Zannichellia palustris, whereas Ceratophyllum demersum and Chara spp. were more abundant in the stable lakes. 4. A long-term loss of macrophyte species diversity has occurred in many shallow lakes affected by eutrophication. One common pathway is from a species-rich plant community with charophytes to a species-poor community dominated by P. pusillus, P. pectinatus and Z. palustris. Such compositional changes may often be accompanied by a substantial reduction in the seasonal duration of plant dominance and a greater tendency for incursions by phytoplankton. We hypothesise a slow-enacting (10–100 s years) feedback loop in nutrient-enriched shallow lakes whereby increases in algal abundance are associated with losses of macrophyte species and hence different plant seasonal strategies. In turn such changes may favour increased phytoplankton production thus placing further pressure on remaining macrophytes. This study blurs the distinction between so-called turbid phytoplankton-dominated and clear plant-dominated shallow lakes and suggests that plant loss from them may be a gradual process. [ABSTRACT FROM AUTHOR]

1. Quantitative palaeolimnology has traditionally sought to quantify species-environment relationships to use alterations in biological assemblages to reflect past environmental change. Transfer functions have used regression techniques, such as weighted averaging, to define taxon optima and tolerance for a single chemical or biological variable. 2. Cladoceran assemblages and their sub-fossil remains in shallow lakes are shaped by a combination of interacting factors. Partial constrained ordination of sub-fossil cladoceran assemblages from 39 shallow lakes (29 in Norfolk, U.K. and 10 in Denmark) indicated that both zooplanktivorous fish (ZF) density and submerged macrophyte abundance significantly influenced community composition. These dual structuring forces precluded the use of a transfer function as one of the key assumptions of this approach was not met, namely that environmental variables apart from the variable being modelled have negligible influence on species distribution or that there is a linear relationship between the two. Separate transfer functions for ZF and macrophyte abundance were developed but had poor performance diagnostics with low bootstrapped r2, high root mean square error of prediction (RMSEP) and large bias. 3. To obviate the problem of multiple structuring forces a multivariate regression tree (MRT) was employed, which allows for more than one explanatory variable within a model. The MRT analysis defined six groups with discrete ranges of ZF and macrophyte densities. The technique identified critical values or ‘break points’ in ZF and macrophyte abundances which result in significant alterations in the sub-fossil cladoceran assemblage. In addition, the MRT groups had different summer mean values for chlorophyll-a, Secchi depth, total phosphorus and nitrate-nitrogen. 4. The predictive abilities of the model were assessed by comparing the observed versus predicted MRT group membership. In general group membership was reliably predicted, suggesting sub-fossil cladoceran assemblages reliably reflect ZF and macrophyte density in shallow lakes. For a relatively small number of sites there were differences between the observed and predicted MRT group membership. These failures of prediction may result, at least in part, from the disparity of the time period represented by the environmental data and the surface sediment cladoceran assemblage. [ABSTRACT FROM AUTHOR]

1. Palaeolimnology and contemporary ecology are complementary disciplines but are rarely combined. By reviewing the literature and using a case study, we show how linking the timescales of these approaches affords a powerful means of understanding ecological change in shallow lakes. 2. Recently, palaeolimnology has largely been pre-occupied with developing transfer functions which use surface sediment-lake environment datasets to reconstruct a single environmental variable. Such models ignore complex controls over biological structure and can be prone to considerable error in prediction. Furthermore, by reducing species assemblage data to a series of numbers, transfer functions neglect valuable ecological information on species’ seasonality, habitat structure and food web interactions. These elements can be readily extracted from palaeolimnological data with the interpretive assistance of contemporary experiments and surveys. For example, for one shallow lake, we show how it is possible to infer long-term seasonality change from plant macrofossil and fossil diatom data with the assistance of seasonal datasets on macrophyte and algal dynamics. 3. On the other hand, theories on shallow lake functioning have generally been developed from short-term (<1–15 years) studies as opposed to palaeo-data that cover the actual timescales (decades–centuries) of shallow lake response to stressors such as eutrophication and climate change. Palaeolimnological techniques can track long-term dynamics in lakes whilst smoothing out short-term variability and thus provide a unique and important means of not only developing ecological theories, but of testing them. 4. By combining contemporary ecology and palaeolimnology, it should be possible to gain a fuller understanding of changing ecological patterns and processes in shallow lakes on multiple timescales. [ABSTRACT FROM AUTHOR]

1. Eutrophication has a profound effect on the biological structure and function of shallow lakes, altering the composition and abundance of submerged macrophyte and fish assemblages. Relatively little is known, however, about decadal to centennial-scale change in these important aspects of shallow lake ecology. 2. Established palaeolimnological inference models are limited to reconstructing a single variable. As macrophyte and zooplanktivorous fish abundance exert dual and interacting controls on cladoceran assemblages a single variable inference model may contain significant error. To obviate this problem, we applied a new cladoceran-based multivariate regression tree (MRT) model to cladoceran subfossil assemblages from dated cores from a small shallow lake (Felbrigg Lake, U.K.) to assess long-term change in fish and submerged macrophyte abundance. Plant macrofossil, chironomid and mollusc subfossil assemblages were also analysed to track changes in biological structure and function and to evaluate the inferences of the MRT model. 3. Over the 200+ year period covered by the sediment cores, there was good agreement in the timing and nature of ecological change reflected by the plant macrofossil, mollusc, chironomid and cladoceran data. The sediment sequence was divided into three dated zones: c. 1797–1890, c. 1890–1954 and c. 1954–present. Prior to 1890 plant-associated mollusc, cladoceran and chironomid assemblages indicated a species-rich macrophyte community; a scenario confirmed by the plant macrofossil data. From c. 1890 to 1954 macrophyte-associated species of all three invertebrate groups remained abundant but the proportion of pelagic cladocerans rose. Post-1954 mollusc and chironomid assemblages changed to sediment associated detrital feeders and the proportion of pelagic cladoceran taxa increased further. 4. The cladoceran-based MRT model indicated a long period of stability, c. 1790–1927, characterised by abundant submerged macrophytes and zooplanktivorous fish. From c. 1927 to 1980, the MRT model inferred a decline in zooplanktivorous fish density (ZF) but relative stability in August macrophyte abundance. From 1980 to 2000, an increase in zooplanktivorous fish was inferred tallying well with available data on the fish population (since the 1970s), which indicated extirpation of perch in the 1970s and a subsequent increase in the rudd population. The model inferred little change in August macrophyte abundance until post- c. 1980 at which point it indicated a decline. The surface sediment assemblage was placed in MRT group A, where submerged plants are absent or very rare in late summer in good agreement with current conditions at the site. 5. The MRT model, applied here for the first time, appears to have successfully tracked changes in macrophyte abundance and ZF over the last 200 years at Felbrigg Lake. The inferences agreed with historical observations on the fish community and the supporting palaeolimnological data. Given that multiple structuring forces shape most biological communities, the application of a model capable of allowing for this represents a significant advance in palaeolimnology. [ABSTRACT FROM AUTHOR]

Summary: During pauses in exploration, ensembles of place cells in the rat hippocampus re-express firing sequences corresponding to recent spatial experience. Such “replay” co-occurs with ripple events: short-lasting (∼50–120 ms), high-frequency (∼200 Hz) oscillations that are associated with increased hippocampal-cortical communication. In previous studies, rats exploring small environments showed replay anchored to the rat''s current location and compressed in time into a single ripple event. Here, we show, using a neural decoding approach, that firing sequences corresponding to long runs through a large environment are replayed with high fidelity and that such replay can begin at remote locations on the track. Extended replay proceeds at a characteristic virtual speed of ∼8 m/s and remains coherent across trains of ripple events. These results suggest that extended replay is composed of chains of shorter subsequences, which may reflect a strategy for the storage and flexible expression of memories of prolonged experience. [Copyright &y& Elsevier]

Background: Atrial Fibrillation is the most common cardiac arrhythmia. It increases the risk of thromboembolic events and many atrial fibrillation patients suffer quality of life impairment due to disturbed heart rhythm. Pulmonary vein isolation using radiofrequency catheter ablation treatment is aimed at maintaining sinus rhythm ultimately improving quality of life. Randomized clinical trial have shown that catheter ablation is more effective than antiarrhythmic drugs for the treatment of atrial fibrillation, but its impact on quality of life and cost-effectiveness has not been widely studied. Aims: To assess the cost-effectiveness of radiofrequency ablation (RFA) vs. antiarrhythmic drug (AAD) treatment, among symptomatic atrial fibrillation patients not previously responding to AAD. Methods: A decision-analytic Markov model was developed to assess costs and health outcomes in terms of quality adjusted life years (QALYs) of RFA and AAD over a lifetime time horizon. We conducted a literature search and used data from several sources as input variables of the model. One-year rates of atrial fibrillation with RFA and AAD, respectively, were available from published randomized clinical trials. Other data sources were published papers and register data. Results: The RFA treatment strategy was associated with reduced costs and an incremental gain in QALYs compared to the AAD treatment strategy. The results were sensitive to whether long-term quality of life improvement is maintained for the RFA treatment strategy and the risk of stroke in the different atrial fibrillation health states. Conclusion: This study shows that the short-term improvement in atrial fibrillation associated with RFA is likely to lead to long-term quality of life improvement and lower costs indicating that RFA is cost-effective compared to AAD. [ABSTRACT FROM AUTHOR]

1. Sedimentary remains of aquatic plants, both vegetative (turions, leaves, spines) and reproductive (fruits, seeds, pollen), may provide a record of temporal changes in the submerged vegetation of lakes. An independent assessment of the degree to which these remains reflect past floristic change is, however, rarely possible. 2. By exploiting an extensive series of historical plant records for a small shallow lake we compare plant macrofossil (three cores) and pollen (one core) profiles with the documented sequence of submerged vegetation change since c. 1750 AD. The data set is based on 146 site visits with 658 observations including 42 taxa classified as aquatic, spanning 250 years. 3. Approximately 40% of the historically recorded aquatic taxa were represented by macro-remains. In general macrofossils underestimated past species diversity, with pondweeds (three of eight historically recorded Potamogeton species were found) particularly poorly represented. Nonetheless, several taxa not reported from historical surveys (e.g. Myriophyllum alterniflorum and Characeae) were present in the sediment record. 4. The pollen record revealed taxa which left no macro-remains (e.g. Littorella uniflora), and the macrofossil record provided improved taxonomic resolution for some taxa (e.g. Potamogeton) and a more reliable record of persistence, appearance and loss of others (e.g. Myriophyllum spp. and Nymphaeaceae). 5. Detrended correspondence analysis indicated that changes in the community composition evidenced by the palaeolimnological and historical records were synchronous and of a similar magnitude. Both records pointed to a major change at around 1800, with the historical record suggesting a more abrupt change than the sedimentary data. There was good agreement on a subsequent change c. 1930. 6. The palaeolimnological data did not provide a complete inventory of historically recorded species. Nevertheless, these results suggest that combined macrofossil and pollen records provide a reliable indication of temporal change in the dominant components of the submerged and floating-leaved aquatic vegetation of shallow lakes. As such palaeolimnology may provide a useful tool for establishing community dynamics and successions of plants over decadal to centennial timescales. [ABSTRACT FROM AUTHOR]

The study of protein function in neurons has been hindered by the lack of highly efficient, nontoxic methods of inducing RNA interference in such cells. Here we show that application of synthetic small interfering RNA (siRNA) linked to the vector peptide Penetratinl results in rapid, highly efficient uptake of siRNA by entire populations of cultured primary mammalian hippocampal and sympathetic neurons. This treatment leads to specific knock-down of targeted proteins within hours without the toxicity associated with transfection. In contrast to current methods, our technique permits study of protein function across entire populations with minimal disturbance of complex cellular networks. Using this technique, we found that protein knock-down (evident after 6 hr) precedes any decrease in targeted message (evident after 24 hr), suggesting an early, translational repression by perfectly targeted siRNAs. [ABSTRACT FROM AUTHOR]

One way to compare health care needs and outcomes on common scales is by estimating the strength of preferences or willingness-to-pay (WTP). The aim of this study was to review directly measured preference values and WTP estimates for health states treated by plastic surgery. The included articles had to meet the criteria defined in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). Relevant databases were searched using predetermined strings. Data were extracted in a standardised manner. Included studies were appraised according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for rating the importance of outcomes. In total, 213 abstracts were retrieved. Of these, 179 did not meet the inclusion criteria and were excluded, leaving 34 studies in the review. The risk of bias was considered moderate in four studies and serious in the rest. The overall certainty of evidence for directly measured preference values and WTP estimates for health states treated by plastic surgery is low (Grade ƟƟОО). The lowest preference scores were generally elicited for facial defects/anomalies and the highest for excess skin after massive weight loss. Scientific knowledge about preferences and the resulting health gains might play an essential role in deciding which procedures should be considered for public funding or rather rationed within the system. Better quality studies are required to allow for such applications. [ABSTRACT FROM AUTHOR]

Biomaterial design relies on controlling interactions between materials and their biological environments to modulate the functions of proteins, cells, and tissues. Phage display is a powerful tool that can be used to discover peptide sequences with high affinity for a desired target. When incorporated into biomaterial design, peptides identified via phage display can functionalize material surfaces to control the interaction between a biomaterial and its local microenvironment. A targeting peptide has high specificity for a given target, allowing for homing a specific protein, cell, tissue, or other material to a biomaterial. A functional peptide has an affinity for a given protein, cell, or tissue, but also modulates its target's activity upon binding. Biomaterials can be further enhanced using a combination of targeting and/or functional peptides to create dual-functional peptides for bridging two targets or modulating the behavior of a specific protein or cell. This review will examine current and future applications of phage display for the augmentation of biomaterials. [ABSTRACT FROM AUTHOR]