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It has been argued that widespread extinctions of top predators have changed terrestrial ecosystem structures through mesopredator release, where increased abundances of medium-sized predators have detrimental effects on prey communities. This top-down concept has received much attention within conservation biology, but few studies have demonstrated the phenomenon. The concept has been criticized since alternative explanations involving bottom-up impacts from bioclimatic effects on ecosystem productivity and from anthropogenic habitat change are rarely considered. We analyse the response of a mesopredator (the red fox) to declines in top predators (wolf and Eurasian lynx) and agricultural expansion over 90 years in Sweden, taking bioclimatic effects into account. We show a top-down mesopredator release effect, but ecosystem productivity determined its strength. The impacts of agricultural activity were mediated by their effects on top predator populations. Thus, both top-down and bottom-up processes need to be understood for effective preservation of biodiversity in anthropogenically transformed ecosystems.

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Background: Robot-assisted laparoscopic prostatectomy is increasingly used compared to a standard laparoscopic technique but it remains uncertain whether potential benefits offset higher costs.Objective: To determine cost-effectiveness of robotic prostatectomy.Design, Setting, Participants: Care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. Data Sources:We used data from a meta-analysis, other published literature, and costs from United Kingdom (UK) National Health Service (NHS) and commercial sources.Outcome Measurements and Statistical Analysis: Care received by men for ten years following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Results and Limitations: Over ten years robotic prostatectomy was on average [95% confidence interval] £1412 (€1595) [£1304 (€1473) to £1516 (€1713)] more costly than laparoscopic prostatectomybut more effective with mean (95% confidence interval) gain in quality adjusted life years (QALY) of 0.08 (0.01 to 0.15). The incremental cost-effectiveness ratio (ICER) was £18,329 (€20,708) with an 80% probability that robotic prostatectomy was cost-effective at a threshold of £30,000 (€33,894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Conclusions:Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin provided more than 150 cases are performed each year.Considerable uncertainty persists in the absence of directly comparative randomised data.