The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. An individual-patient data meta-analysis of four multicentre randomized trials of EVARversus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

(1) The movement patterns of Canadian (Vancouver) and Australian (Canberra) cabbage butterfly females searching for hosts are described, and the descriptions in...

Arias, A., J. E. Cinner, R. E. Jones, and R. L. Pressey. 2015. Levels and drivers of fishers’ compliance with marine protected areas. Ecology and Society 20(4):19.http://dx.doi.org/10.5751/ES-07999-200419

Illegal exploitation of resources is a cause of environmental degradation worldwide. The effectiveness of conservation initiatives such as marine protected areas relies on users' compliance with regulations. Although compliance can be motivated by social norms (e.g. peer pressure and legitimacy), some enforcement is commonly necessary. Enforcement is expensive, particularly in areas far from land, but costs can be reduced by optimizing enforcement. We present a case study of how enforcement could be optimized at Cocos Island National Park, Costa Rica, an offshore protected area and World Heritage Site. By analysing patrol records we determined the spatial and temporal distribution of illegal fishing and its relationship to patrol effort. Illegal fishing was concentrated on a seamount within the Park and peaked during the third year-quarter, probably as a result of oceanographic conditions. The lunar cycle in conjunction with the time of year significantly influenced the occurrence of incursions. The predictability of illegal fishing in space and time facilitates the optimization of patrol effort. Repeat offenders are common in the Park and we suggest that unenforced regulations and weak governance are partly to blame. We provide recommendations for efficient distribution of patrol effort in space and time, establishing adequate governance and policy, and designing marine protected areas to improve compliance. Our methods and recommendations are applicable to other protected areas and managed natural resources.