Prevention is better than cure, but...: Preventive medication as a risk to ordinariness?

Preventive health remains at the forefront of public health concerns; recent initiatives, such as the NHS health check, may lead to recommendations for medication in response to the identification of 'at risk' individuals. Little is known about lay views of preventive medication. This paper uses the case of aspirin as a prophylactic against heart disease to explore views among people invited to screening for a trial investigating the efficacy of such an approach. Qualitative interviews (N=46) and focus groups (N=5, participants 31) revealed dilemmas about preventive medication in the form of clashes between norms: first, in general terms, assumptions about the benefit of prevention were complicated by dislike of medication; second, the individual duty to engage in prevention was complicated by the need not to be over involved with one's own health; third, the potential appeal of this alternative approach to health promotion was complicated by unease about the implications of encouraging irresponsible behaviour among others. Though respondents made different decisions about using the drug, they reported very similar ways of trying to resolve these conflicts, drawing upon concepts of necessity and legitimisation and the special ordinariness of the particular dru

Global effects of soil and climate on leaf photosynthetic traits and rates

ABSTRACT Aim The influence of soil properties on photosynthetic traits in higher plants is poorly quantified in comparison with that of climate. We address this situation by quantifying the unique and joint contributions to global leaf-trait variation from soils and climate. Location Terrestrial ecosystems world-wide. Methods Using a trait dataset comprising 1509 species from 288 sites, with climate and soil data derived from global datasets, we quantified the effects of 20 soil and 26 climate variables on light-saturated photosynthetic rate (Aarea), stomatal conductance (gs), leaf nitrogen and phosphorus (Narea and Parea) and specific leaf area (SLA) using mixed regression models and multivariate analyses. Results Soil variables were stronger predictors of leaf traits than climatic variables, except for SLA. On average, Narea, Parea and Aarea increased and SLA decreased with increasing soil pH and with increasing site aridity. gs declined and Parea increased with soil available P (Pavail). Narea was unrelated to total soil N. Joint effects of soil and climate dominated over their unique effects on Narea and Parea, while unique effects of soils dominated for Aarea and gs. Path analysis indicated that variation in Aarea reflected the combined independent influences of Narea and gs, the former promoted by high pH and aridity and the latter by low Pavail. Main conclusions Three environmental variables were key for explaining variation in leaf traits: soil pH and Pavail, and the climatic moisture index (the ratio of precipitation to potential evapotranspiration). Although the reliability of global soil datasets lags behind that of climate datasets, our results nonetheless provide compelling evidence that both can be jointly used in broad-scale analyses, and that effects uniquely attributable to soil properties are important determinants of leaf photosynthetic traits and rates. A significant future challenge is to better disentangle the covarying physiological, ecological and evolutionary mechanisms that underpin trait-environment relationships

Is Australia weird? A cross-continental comparison of biological, geological and climatological features

Australia’s distinctive biogeography means that it is sometimes considered an ecologically unique continent with biological and abiotic features that are not comparable to those observed in the rest of the world. This leaves some researchers unclear as to whether findings from Australia apply to systems elsewhere (or vice-versa), which has consequences for the development of ecological theory and the application of ecological management principles. We analyzed 594,612 observations spanning 85 variables describing global climate, soil, geochemistry, plants, animals, and ecosystem function to test if Australia is broadly different to the other continents and compare how different each continent is from the global mean. We found significant differences between Australian and global means for none of 15 climate variables, only seven of 25 geochemistry variables, three of 16 soil variables, five of 12 plant trait variables, four of 11 animal variables, and one of five ecosystem function variables. Seven of these differences remained significant when we adjusted for multiple hypothesis testing: high soil pH, high soil concentrations of sodium and strontium, a high proportion of nitrogen-fixing plants, low plant leaf nitrogen concentration, low annual production rate to birth in mammals, and low marine productivity. Our analyses reveal numerous similarities between Australia and Africa and highlight dissimilarities between continents in the northern vs. southern hemispheres Australia ranked the most distinctive continent for 26 variables, more often than Europe (15 variables), Africa (13 variables), Asia (12 variables each), South America (11 variables) or North America (8 variables). Australia was distinctive in a range of soil conditions and plant traits, and a few bird and mammal traits, tending to sit at a more extreme end of variation for some variables related to resource availability. However, combined analyses revealed that, overall, Australia is not significantly more different to the global mean than Africa, South America, or Europe. In conclusion, while Australia does have some unique and distinctive features, this is also true for each of the other continents, and the data do not support the idea that Australia is an overall outlier in its biotic or abiotic characteristics

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Allocation, stress tolerance and carbon transport in plants: How does phloem physiology affect plant ecology?

Despite the crucial role of carbon transport in whole plant physiology and its impact on plant-environment interactions and ecosystem function, relatively little research has tried to examine how phloem physiology impacts plant ecology. In this review, we highlight several areas of active research where inquiry into phloem physiology has increased our understanding of whole plant function and ecological processes. We consider how xylem-phloem interactions impact plant drought tolerance and reproduction, how phloem transport influences carbon allocation in trees and carbon cycling in ecosystems, and how phloem function mediates plant relations with insects, pests, microbes and symbiotes. We argue that in spite of challenges that exist in studying phloem physiology, it is critical that we consider the role of this dynamic vascular system when examining the relationship between plants and their biotic and abiotic environment

wcornwell/leaf13C v0.0.2

testing zenod

Data and code from: Flammability across the gymnosperm phylogeny: the importance of litter particle size

<p>Data and code from: </p> <p>Flammability across the gymnosperm phylogeny: the importance of litter particle size</p> <p>by William K. Cornwell, Alba Elvira, Lute van Kempen, Richard S.P. van Logtestijn, Andre Aptroot, and J. Hans C. Cornelissen</p> <p>This data and code should be able to generate the figures as published in the paper.   In theory, reproducing the figures on your computer should take only 3 lines of R code.  See the github repository for more details.  </p

traitecoevo/taxonlookup v1.1.2

fixing a few tpl error