Noelkofoed1156

Public health responses to the vaccine-refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science-based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally rese avoiding stigmatising or confrontational vaccine-promotion strategies.Effective use of solar-induced chlorophyll fluorescence (SIF) to estimate and monitor gross primary production (GPP) in terrestrial ecosystems requires a comprehensive understanding and quantification of the relationship between SIF and GPP. To date, this understanding is incomplete and somewhat controversial in the literature. Here we derived the GPP/SIF ratio from multiple data sources as a diagnostic metric to explore its global-scale patterns of spatial variation and potential climatic dependence. We found that the growing season GPP/SIF ratio varied substantially across global land surfaces, with the highest ratios consistently found in boreal regions. Spatial variation in GPP/SIF was strongly modulated by climate variables. The most striking pattern was a consistent decrease in GPP/SIF from cold-and-wet climates to hot-and-dry climates. We propose that the reduction in GPP/SIF with decreasing moisture availability may be related to stomatal responses to aridity. Furthermore, we show that GPP/SIF can be empirically modeled from climate variables using a machine learning (random forest) framework, which can improve the modeling of ecosystem production and quantify its uncertainty in global terrestrial biosphere models. Our results point to the need for targeted field and experimental studies to better understand the patterns observed and to improve the modeling of the relationship between SIF and GPP over broad scales.

Emergency colorectal surgery is associated with significant morbidity and mortality. Most general surgeons have a subspecialty, which forms the focus of their elective work, allowing development of specialist skill sets. The aim of this study was to assess the impact of consultant subspecialization on patient outcomes following emergency colorectal resections.

Data were requested for all emergency admissions under a general surgeon between 1 January 2002 and 31 December 2016 within the north of England. These were acquired from individual Trusts following Caldicott approval. Data included demographics, diagnoses and any procedures undertaken. Patients were assigned to cohorts based on the subspecialist interest of the consultant they were under the care of. The primary outcome of interest was 30-day postoperative mortality. Categorical data were compared with the chi-squared test, and continuous data with the t test or ANOVA. A logistic regression model determined factors associated with 30-day in-hospital mortality.

Overall, 7648 emergency colorectal resections were performed with a 30-day postoperative mortality of 13.8%. This was significantly lower if the responsible consultant was a colorectal surgeon compared with other general surgery subspecialties (11.8% vs. 15.2%, P < 0.001). This was significant on univariate analysis (OR 0.75, P<0.001); however, following multivariable adjustment, this was not statistically significant (P=0.380). The colorectal specialists had a higher laparoscopy rate than their colleagues-9.8% versus 6.8% (P<0.001). Stoma rates were also lower (46.9% vs. 51.0%, P=0.001) and anastomosis rates higher (55.9% vs. 49.3%, P<0.001) amongst colorectal surgeons.

These findings add to the growing body of evidence that patient outcomes may be improved by involving subspecialists in colorectal emergencies.

These findings add to the growing body of evidence that patient outcomes may be improved by involving subspecialists in colorectal emergencies.Pancreatic islet transplantation is a reliable approach for treating insulin-deficient diabetes. This established β-cell replacement approach has shown considerable improvements in the last 2 decades. It has helped achieve metabolic homeostasis and safe outcomes for a subset of patients with type 1 diabetes and severe pancreatitis. Nutrition support, until recently, was considered as a secondary factor, merely identified as a means of providing all the necessary nutrients for such patients. However, new literature suggests that several factors, such as the route, timing, quantity, and composition of all the nutrients administered, have key disease-altering properties and are vital during the perioperative management of such patients. This review will highlight the benefits of performing the clinical islet transplantation on a subgroup of patients with type 1 diabetes and pancreatitis and summarize new data that identify the pivotal role of nutrition support as a critical intervention in their management.

Commentators suggest that patients have unrealistic expectations about the pace of research advances and that such expectations interfere with patient decision-making.

The objective of this study was to compare expert expectations about the timing of research milestone attainment with those of patients who follow Parkinson's disease (PD) research.

Patients with PD and experts were asked to provide forecasts about 11 milestones in PD research in an online survey. PD experts were identified from a Michael J. Ginsenoside Rg1 clinical trial Fox Foundation database, highly ranked neurology centers in the United States and Canada, and corresponding authors of articles on PD in top medical journals. Patients with PD were recruited through the Michael J. Fox Foundation. We tested whether patient forecasts differed on average from expert forecasts. We also tested whether differences between patient forecasts and the average expert forecasts were associated with any demographic factors.

A total of 256 patients and 249 PD experts completed the survey.