Sonic Kayaks: Environmental monitoring and experimental music by citizens.

The Sonic Kayak is a musical instrument used to investigate nature and developed during open hacklab events. The kayaks are rigged with underwater environmental sensors, which allow paddlers to hear real-time water temperature sonifications and underwater sounds, generating live music from the marine world. Sensor data is also logged every second with location, time and date, which allows for fine-scale mapping of water temperatures and underwater noise that was previously unattainable using standard research equipment. The system can be used as a citizen science data collection device, research equipment for professional scientists, or a sound art installation in its own right.

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income.

BACKGROUND: Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched. METHODS: We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status. RESULTS: After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (ORadj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% ORadj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample. CONCLUSION: Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.

Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.

OBJECTIVE: To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. METHODS: We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. RESULTS: We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). CONCLUSIONS: Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.

A validated translation of a survey for measuring incontinence knowledge in Chinese-speaking American immigrants.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is common amongst Chinese immigrants. These women are a rapidly growing population in the USA who require unique assessment tools due to language barriers. Presently, there are no Chinese language surveys to assess knowledge of urinary incontinence. Our goal was to translate and validate a urinary incontinence knowledge survey from English into Chinese. METHODS: The English language Urinary Incontinence Quiz (UIQ) developed and validated by Branch et al. for the Educational Demonstration of Urinary Continence Assessment and Treatment for the Elderly program assesses general knowledge of urinary incontinence as a disease entity. We translated it into Chinese using the forward translation/back translation technique. The Chinese and English versions were then administered to bilingual volunteers in a nonrandomized order during a single encounter. Their responses were analyzed using Cohen's kappa coefficient to establish the validity of the translated knowledge survey. RESULTS: Minimal reconciliation was needed in construction of the Chinese survey. Minor English grammatical corrections were made to the back-translated English survey. One question testing two knowledge concepts was separated into two questions to allow clear testing of both concepts individually. Twenty-one bilingual participants performed the validity testing. Over 50% (8 out of 15) of the questions showed nearly perfect agreement with a kappa coefficient >0.80, 5 out of the 15 questions showed substantial agreement with kappa coefficients between 0.61 and 0.8 and two questions showed moderate agreement with kappa coefficients between 0.4 and 0.6. CONCLUSIONS: We validated a translation of the UIQ for assessment of urinary incontinence knowledge in Chinese-speaking immigrants to the USA.

Underwater Sound Levels at a Wave Energy Device Testing Facility in Falmouth Bay, UK.

Passive acoustic monitoring devices were deployed at FaBTest in Falmouth Bay, UK, a marine renewable energy device testing facility during trials of a wave energy device. The area supports considerable commercial shipping and recreational boating along with diverse marine fauna. Noise monitoring occurred during (1) a baseline period, (2) installation activity, (3) the device in situ with inactive power status, and (4) the device in situ with active power status. This paper discusses the preliminary findings of the sound recording at FabTest during these different activity periods of a wave energy device trial.

Predictors of Non-Attendance to the Postpartum Follow-up Visit.

Objectives This study aimed to measure the incidence and identify predictors of postpartum visit non-attendance, using medical records of women who received prenatal care and went on to deliver live births at Montefiore Hospital in 2013. Methods Pearson's Chi square tests were used to assess the association between maternal demographics, insurance status, and delivery information with non-attendance of a postpartum visit. Logistic regression and modified Poisson regression models were then used to identify statistically significant predictors of postpartum visit non-attendance. Results We found that one-third of all women who attended a prenatal visit at Montefiore Hospital did not return for a postpartum visit. Variables significantly associated with non-attendance include having Medicaid or no insurance (RR 1.4, 95 % CI 1.2-1.6), being Hispanic or Latino (RR 1.2, 95 % CI 1.1-1.3), having a vaginal delivery (RR 1.2, 95 % CI 1.1-1.4), and age <20 years (RR 0.77, 95 % CI 0.64-0.92). Conclusions for Practice We conclude that the risk of postpartum visit non-attendance disproportionately impacts socially and economically vulnerable patients who are: younger, part of a minority ethnic background, and depend on state funded health insurance. Our results highlight the disparity in access to postpartum care and the importance of identifying barriers to attendance as well as developing creative strategies of providing postpartum care outside of the traditional postpartum visit framework.

Anticholinergic medication use for female overactive bladder in the ambulatory setting in the United States.

INTRODUCTION AND HYPOTHESIS: Our objective was to estimate the prevalence and sociodemographic factors associated with anticholinergic medication use by adult women for overactive bladder (OAB) in the United States. METHODS: We conducted a cross-sectional study using the 2009 National Ambulatory Medical Care Survey database (NAMCS). We included women aged 18 years and older and identified visits for which anticholinergic medications for OAB were in active use. We evaluated the prevalence of medications used and estimated the use of short-acting versus long-acting drugs. We also assessed variables associated with anticholinergic use, (age, race/ethnicity, insurance, geographic location) using survey weights in the analysis to estimate national data. RESULTS: In 2009, adult women made 516.8 million outpatient office visits. Of these, 8.1 million (1.6 %) were associated with an OAB anticholinergic medication (annual rate 68 per 1,000 women). Women who used anticholinergics were predominantly insured by Medicare (61.0 %) and were older than those not using anticholinergic medications (70.0 ± 1.1 vs. 53.0 ± 0.5, p < 0.001). No racial or ethnic differences were evident between the two groups. Tolterodine (33.8 %) and oxybutynin (33.1 %) were the most commonly reported medications, followed by solifenacin (19.5 %), darifenacin (9.3 %), and trospium (4.4 %). Long-acting anticholinergics were used more often than short-acting medications (53.8 % vs. 46.3 %, respectively, p < 0.001). CONCLUSIONS: Annually, more than 8 million outpatient visits occur in which adult women in the United States are using an OAB anticholinergic medication. Despite the abundance of newer-generation medications, tolterodine and oxybutynin remain the most commonly prescribed anticholinergic drugs for OAB. Solifenacin is the most popular newer-generation anticholinergic drug.

Quality of life and broader experiences of those with acoustic neuroma: a mixed methods approach.

Background Acoustic neuromas (ANs) are consistently associated with decreased quality of life (QOL) related to the physical and psychosocial impacts of symptoms experienced from the tumour and its treatment. This study explored patient-reported experiences of ANs in New Zealand, with a focus on the impact on QOL and the provision of information, support and services. Methods A mixed methods approach was taken, conducting an online community survey that included the Penn Acoustic Neuroma Quality of Life Scale (N = 52). Those who indicated interest were offered semi-structured interviews after the survey (N = 17), which were analysed using content analysis. Results A negative impact on QOL was found, highlighting five key themes in the experiences of people: (1) ongoing physical, social and psychological impacts; (2) information and support from the medical system; (3) autonomy and decision-making; (4) the importance of peer support; and (5) remaining positive - life goes on. Conclusions Our findings indicate areas for improvement that may benefit people's healthcare experience and QOL. Both quantitative and qualitative results identified gaps associated with person-centred care and the need for information, education, emotional support and access to services. Recommendations include a need for more information (verbal and written) during all stages of diagnosis and treatment, shared decision-making and increased access to allied health, including psychological services and support groups.

The use of Enhanced Vegetation Index for assessing access to different types of green space in epidemiological studies.

BACKGROUND: Exposure to green space can protect against poor health through a variety of mechanisms. However, there is heterogeneity in methodological approaches to exposure assessments which makes creating effective policy recommendations challenging. OBJECTIVE: Critically evaluate the use of a satellite-derived exposure metric, the Enhanced Vegetation Index (EVI), for assessing access to different types of green space in epidemiological studies. METHODS: We used Landsat 5-8 (30 m resolution) to calculate average EVI for a 300 m radius surrounding 1.4 million households in Wales, UK for 2018. We calculated two additional measures using topographic vector data to represent access to green spaces within 300 m of household locations. The two topographic vector-based measures were total green space area stratified by type and average private garden size. We used linear regression models to test whether EVI could discriminate between publicly accessible and private green space and Pearson correlation to test associations between EVI and green space types. RESULTS: Mean EVI for a 300 m radius surrounding households in Wales was 0.28 (IQR = 0.12). Total green space area and average private garden size were significantly positively associated with corresponding EVI measures (ß = < 0.0001, 95% CI: 0.0000, 0.0000; ß = 0.0001, 95% CI: 0.0001, 0.0001 respectively). In urban areas, as average garden size increases by 1 m2, EVI increases by 0.0002. Therefore, in urban areas, to see a 0.1 unit increase in EVI index score, garden size would need to increase by 500 m2. The very small ß values represent no 'measurable real-world' associations. When stratified by type, we observed no strong associations between greenspace and EVI. IMPACT: It is a widely implemented assumption in epidiological studies that an increase in EVI is equivalent to an increase in greenness and/or green space. We used linear regression models to test associations between EVI and potential sources of green reflectance at a neighbourhood level using satellite imagery from 2018. We compared EVI measures with a 'gold standard' vector-based dataset that defines publicly accessible and private green spaces. We found that EVI should be interpreted with care as a greater EVI score does not necessarily mean greater access to publicly available green spaces in the hyperlocal environment.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries.

The effects of 'nature' on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales.

Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index ß = - 1.84, 95% confidence interval (CI) - 3.63, - 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none ß = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14-70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales.

BACKGROUND: Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities. METHODS: A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation. FINDINGS: After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0-1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80-0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93-0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04-1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles. INTERPRETATION: Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs. FUNDING: National Institute for Health and Care Research Public Health Research programme.

Green-blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data.

Background: Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives: To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design: A retrospective, dynamic longitudinal panel study. Setting: Wales, UK. Participants: An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008-2019). A 5312-strong 'National Survey for Wales (NSW) subgroup' was surveyed on well-being and visits to green and blue spaces. Main outcome measures: Common mental health disorders, general practice records; subjective well-being, Warwick-Edinburgh Mental Well-being Scale. Data sources: Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods: Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions: Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick-Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) -10.15, 95% CI -17.13 to -3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick-Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta -0.06, 95% CI -0.11 to -0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick-Edinburgh Mental Well-being Scale: time outdoorsâ€…× in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation -0.18, 95% CI -0.33 to -0.04) although well-being remained generally lower. Limitations: Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work: Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast.

We investigated whether people who live near or visit green (parks, woodlands) and blue (riversides, beaches) spaces have fewer common mental health disorders (anxiety or depression), and better well-being. We considered whether changes in the amount of green and blue space around the home affected people's mental health. We assessed the availability of local green and blue spaces. Annual exposure and access to local green and blue spaces were extracted from planning and satellite data. We linked these data to anonymised health records of 2,801,483 adults registered with a general practice from 2008 to 2019, and to survey answers about leisure visits to natural environments and well-being. We found: people who lived in greener and bluer areas were less likely to seek help for a common mental health disorder than those in less green or blue areas, with those living in the most deprived areas benefiting the most people who used green and blue spaces for leisure, especially those with the greatest levels of deprivation, had better well-being and were less likely to seek help for common mental health disorders no evidence that changing amounts of green and blue space affected how likely people were to seek help for common mental health disorders; this may be because we found mostly small changes in green and blue space, and we may not have allowed enough time between moving home and recording mental health. We found evidence for relationships between green and blue space and mental health. However, some analyses were restricted due to lack of data on changes in green and blue spaces. An important finding was that people in deprived communities appear to benefit the most. Provision of green and blue spaces could be a strategy to improve the mental health of people living in disadvantaged areas.

A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation.

OBJECTIVE: Significant deficiencies exist in the communication of prognosis for patients requiring prolonged mechanical ventilation after acute illness, in part because of clinician uncertainty about long-term outcomes. We sought to refine a mortality prediction model for patients requiring prolonged ventilation using a multicentered study design. DESIGN: Cohort study. SETTING: Five geographically diverse tertiary care medical centers in the United States (California, Colorado, North Carolina, Pennsylvania, and Washington). PATIENTS: Two hundred sixty adult patients who received at least 21 days of mechanical ventilation after acute illness. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For the probability model, we included age, platelet count, and requirement for vasopressors and/or hemodialysis, each measured on day 21 of mechanical ventilation, in a logistic regression model with 1-yr mortality as the outcome variable. We subsequently modified a simplified prognostic scoring rule (ProVent score) by categorizing the risk variables (age 18-49, 50-64, and ≥65 yrs; platelet count 0-150 and >150; vasopressors; hemodialysis) in another logistic regression model and assigning points to variables according to ß coefficient values. Overall mortality at 1 yr was 48%. The area under the curve of the receiver operator characteristic curve for the primary ProVent probability model was 0.79 (95% confidence interval 0.75-0.81), and the p value for the Hosmer-Lemeshow goodness-of-fit statistic was .89. The area under the curve for the categorical model was 0.77, and the p value for the goodness-of-fit statistic was .34. The area under the curve for the ProVent score was 0.76, and the p value for the Hosmer-Lemeshow goodness-of-fit statistic was .60. For the 50 patients with a ProVent score >2, only one patient was able to be discharged directly home, and 1-yr mortality was 86%. CONCLUSION: The ProVent probability model is a simple and reproducible model that can accurately identify patients requiring prolonged mechanical ventilation who are at high risk of 1-yr mortality.

Effect of extreme obesity on outcomes in laparoscopic hysterectomy.

STUDY OBJECTIVE: To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity. DESIGN: Retrospective cohort study (Canadian Task Force classification II-3). SETTING: Tertiary-care university-based teaching hospital. PATIENTS: Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011. INTERVENTION: Laparoscopic hysterectomy for benign indications. MEASUREMENTS AND MAIN RESULTS: Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p < .01); longer operative time (p = .03), nonsurgical operating room time (p = .02), and total operating room time (p < .01); greater estimated blood loss (p < .01); and complication severity (p = .01). CONCLUSION: These data suggest that there is a significant association of BMI with surgical outcomes in laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation.

Stories of hope created together: A pilot, school-based workshop for sharing eco-emotions and creating an actively hopeful vision of the future.

The climate and ecological crises challenge all communities across the world, with the greatest impact upon the most vulnerable and the youngest. There are multiple impacts on mental health, including the psychological burdens that arise with increasing awareness of the loss, threat and injustice caused by these crises. Large numbers of young people globally are understandably concerned and distressed about these crises, whilst simultaneously reporting that their concerns are regularly dismissed and ignored, particularly by those in power. This can increase feelings of isolation and distress, particularly if they have no recourse to effect change. This pilot project sought to explore how a schools-based, co-created workshop for school pupils aged 16 to 18 years could use a community-oriented space to explore their eco-emotions, address feelings of isolation and engender a sense of realistic, active hope, using storytelling and images of possible futures. A 3-h workshop for delivery in schools was co-designed with young people, researchers, educators and clinicians, using principles of Youth Participatory Action Research (YPAR). Six school pupils aged 16-18 years consented and four completed the workshop, which involved a range of group-based activities to explore their understanding of the climate and ecological crises, support emotional expression related to these and engage in storytelling about hopeful and realistic futures. A live illustrator in attendance created shared images of the participants' fears and hopes. The workshop was recorded, transcribed and analysed using Thematic Analysis and sentiment analysis. Feedback was sought from participants at 1 and 4 weeks after completion and analysed using content analysis. Results indicated that participants reported a range of painful and positive emotions about the crises. They highly valued having space to express their experience alongside others. Storytelling and creativity appeared to help them articulate their feelings and hopes for the future, and gave them greater motivation and confidence in talking to others about these topics. This innovative pilot study suggests that a school-based youth participatory group could offer a novel way of helping young people to engage more with the climate and ecological crises in a way that supports their wellbeing. It provides strong support for future, larger-scale projects in this area.

The value of blue-space recreation and perceived water quality across Europe: A contingent behaviour study.

This study estimates the value of recreational visits to blue-space sites across 14 EU Member States, representing 78% of the Union's population. Across all countries surveyed, respondents made an average of 47 blue-space visits per person per year. Employing travel cost and contingent behaviour methods, the value of a visit is estimated at €41.32 which adds up to a recreational value of €631bn per year for the total adult population surveyed. Using the Bathing Water Directive's water quality designation, the analysis shows that a one-level improvement in water quality leads to 3.13 more visits (+6.67%), whereas a one-level deterioration leads to 9.77 fewer annual visits (-20.83%). This study provides valuations of benefits of recreation and changes of recreational values due to changes in surface water quality, which can be compared to the implementation and monitoring costs of efforts under the EU's Bathing Water, Water Framework and Marine Strategy Framework Directives.

The role of race and trust in tissue/blood donation for genetic research.

BACKGROUND: Public willingness to donate tissue samples is critical to genetic research. Prior work has linked minority status and mistrust with less willingness to provide specimens. Some have suggested recruitment of prior research participants to address these barriers. We present data from a genetic epidemiology study with a request for blood and/or saliva specimens to (1) measure willingness to donate tissue/blood samples, (2) identify demographic, trust, and other factors associated with willingness to donate samples, and (3) measure willingness to participate in future genetic research. METHODS: We surveyed participants in the North Carolina Colorectal Cancer Study, which included biologic sample collection from consenting participants. Participants were later asked about sample provision; trust in researchers, and future research participation. RESULTS: African Americans were less likely to give a blood sample, when compared with whites (21% vs. 13%, P < 0.05). After controlling for "trust," this difference was no longer statistically significant (17% vs. 13%, P = 0.27). Those who had given samples were more likely to express willingness to participate in future research. CONCLUSION: Despite prior participation in a genetic epidemiology study, factors associated with provision of tissue samples reflected many previously identified demographic factors (race and trust). Interventions to improve and demonstrate the trustworthiness of the research team and recruitment of subjects with a record of sample donation might enhance future study participation.

Asking the right questions: views on genetic variation research among black and white research participants.

BACKGROUND: Genetic variation research (GVR) may raise concerns about misuse of information and discrimination. Seemingly contradictory positive views about GVR have also been reported. OBJECTIVE: To dissect this inconsistency, our objectives were to: (1) explore open-ended views of GVR and (2) quantify views of and willingness to participate in GVR by race. DESIGN: Cross-sectional study. PARTICIPANTS: 801 African-American and white prior participants in a case-control genetic epidemiology study of colon cancer risks (NCCCS). MEASURES: Qualitative measures evaluated responses to questions about good and bad things about GVR. Quantitative measures evaluated positive and negative perceptions, perceptions of discrimination, and likelihood of future participation by race. RESULTS: Open-ended queries about GVR resulted in few "negative" responses. In closed-ended questions, however, African Americans were more likely to feel that such research would: result in higher insurance (41% vs. 30%, p = 0.008), not benefit minorities (29% vs. 14%, p=<0.001), reinforce racism (32% vs. 20%, p = 0.002), and use minorities as guinea pigs (27% vs. 6%, p < 0.001). Overall, after adjustment for potential confounding factors, African-American race remained inversely associated with feeling "very positive" about GVR (46% vs. 57%, p = 0.035). In contrast, African Americans were as likely as whites to express willingness to participate in future GVR studies (46%). CONCLUSIONS: Open-ended questions about GVR were unlikely to spontaneously generate "negative" responses. In contrast, when presented specific examples of potentially negative implications, more respondents agreed, and minorities were more likely to express concerns. This suggests that while participants appear generally positive about GVR, their inability to articulate views regarding these complex concepts may require that researchers engage lay audiences, ensure accurate understanding, and provide them with language to express concerns.

Assessing local health department performance in diabetes prevention and control--North Carolina, 2005.

INTRODUCTION: To improve the public health system's ability to prevent and control chronic diseases, we must first understand current practice and develop appropriate strategies for measuring performance. The objectives of this study were to measure capacity and performance of local health departments in diabetes prevention and control and to investigate characteristics associated with performance. METHODS: In 2005, we conducted a cross-sectional mailed survey of all 85 North Carolina local health departments to assess capacity and performance in diabetes prevention and control based on the 10 Essential Public Health Services and adapted from the Local Public Health System Performance Assessment Instrument. We linked survey responses to county-level data, including data from a national survey of local health departments. RESULTS: Local health departments reported a median of 0.05 full-time equivalent employees in diabetes prevention and 0.1 in control. Performance varied across the 10 Essential Services; activities most commonly reported included providing information to the public and to policy makers (76%), providing diabetes education (58%), and screening (74%). The mean score on a 10-point performance index was 3.5. Characteristics associated with performance were population size, health department size and accreditation status, and diabetes-specific external funding. Performance was not better in localities where the prevalence of diabetes was high or availability of primary care was low. CONCLUSION: Most North Carolina local health departments had limited capacity to conduct diabetes prevention or control programs in their communities. Diabetes is a major cause of illness and death, yet it is neglected in public health practice. These findings suggest opportunities to enhance local public health practice, particularly through targeted funding and technical assistance.