Vaccine Confidence and the Importance of an Interdisciplinary Approach.

Parental confidence in vaccines is waning. To sustain and improve childhood vaccine coverage rates, insights from multiple disciplines are needed to understand and address the socio-cultural factors contributing to decreased vaccine confidence and uptake

Reasons to Accept Vaccine Refusers in Primary Care

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal

Achieving an Optimal Childhood Vaccine Policy

Policies to remove parents' ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit

Potential Unintended Consequences Of Recent Shared Decision Making Policy Initiatives

Shared decision making (SDM)-when clinicians and patients make medical decisions together-is moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed

Interplay between electron-phonon and Coulomb interactions in cuprates

Evidence for strong electron-phonon coupling in high-Tc cuprates is reviewed, with emphasis on the electron and phonon spectral functions. Effects due to the interplay between the Coulomb and electron-phonon interactions are studied. For weakly doped cuprates, the phonon self-energy is strongly reduced due to correlation effects, while there is no corresponding strong reduction for the electron self-energy. Polaron formation is studied, focusing on effects of Coulomb interaction and antiferromagnetic correlations. It is argued that experimental indications of polaron formation in undoped cuprates are due to a strong electron-phonon interaction for these systems.Comment: 43 pages and 22 figure

A Multi-Center, Qualitative Assessment of Pediatrician and Maternal Perspectives on Rotavirus Vaccines and the Detection of Porcine circovirus

<p>Abstract</p> <p>Background</p> <p>In 2010, researchers using novel laboratory techniques found that US-licensed rotavirus vaccines contain DNA or DNA fragments from <it>Porcine circovirus </it>(PCV), a virus common among pigs but not believed to cause illness in humans. We sought to understand pediatricians' and mothers' perspectives on this finding.</p> <p>Methods</p> <p>We conducted three iterations of focus groups for pediatricians and non-vaccine hesitant mothers in Seattle, WA, Cincinnati, OH, and Rochester, NY. Focus groups explored perceptions of rotavirus disease, rotavirus vaccination, and attitudes about the detection of PCV material in rotavirus vaccines.</p> <p>Results</p> <p>Pediatricians understood firsthand the success of rotavirus vaccines in preventing severe acute gastroenteritis among infants and young children. They measured this benefit against the theoretical risk of DNA material from PCV in rotavirus vaccines, determining overall that the PCV finding was of no clinical significance. Particularly influential was the realization that the large, randomized clinical trials that found both vaccines to be highly effective and safe were conducted with DNA material from PCV already in the vaccines.</p> <p>Most mothers supported the ideal of full disclosure regarding vaccination risks and benefits. However, with a scientific topic of this complexity, simplified information regarding PCV material in rotavirus vaccines seemed frightening and suspicious, and detailed information was frequently overwhelming. Mothers often remarked that if they did not understand a medical or technical topic regarding their child's health, they relied on their pediatrician's guidance.</p> <p>Many mothers and pediatricians were also concerned that persons who abstain from pork consumption for religious or personal reasons may have unsubstantiated fears of the PCV finding.</p> <p>Conclusions</p> <p>Pediatricians considered the detection of DNA material from PCV in rotavirus vaccines a "non-issue" and reported little hesitation in continuing to recommend the vaccines. Mothers desired transparency, but ultimately trusted their pediatrician's recommendation. Both vaccines are currently approved for their intended use, and no risk of human PCV illness has been reported. Communicating this topic to pediatricians and mothers requires sensitivity to a broad range of technical understanding and personal concerns.</p

Special Issue: Recent advances (2008 – 2015) in the study of ground ice and cryostratigraphy

Cryostratigraphy involves the description, interpretation and correlation of ground-ice 17 structures (cryostructures) and their relationship to the host deposits. Recent advances in the 18 study of ground ice and cryostratigraphy concern permafrost aggradation and degradation, 19 massive-ice formation and evaluation of ground-ice content. Field studies have increased our 20 knowledge of cryostructures and massive ground ice in epigenetic and syngenetic permafrost. 21 Epigenetic permafrost deposits are relatively ice-poor and composed primarily of pore-filled 22 cryostructures, apart from an ice-enriched upper section and intermediate layer. Syngenetic 23 permafrost deposits are commonly identified from cryostructures indicative of an aggrading 24 permafrost table and are characterized by a high ice content, ice-rich cryofacies, and nested 25 wedge ice. Degradation of ice-rich permafrost can be marked by thaw unconformities, 26 truncated buried ice wedges, ice-wedge pseudomorphs, and organic-rich ‘forest beds’. 27 Studies of massive ground ice have focused on wedge ice, thermokarst-cave ice, intrusive ice, 28 and buried ice. Significant advances have been made in methods for differentiating between 29 tabular massive ice bodies of glacier and intrasedimental origin. Recent studies have utilized 30 palynology, isotope geochemistry and hydrochemistry, in addition to sedimentary and 31 cryostratigraphic analyses. The application of remote sensing techniques and laboratory 32 methods such as CT scanning has improved estimations of the ice content of frozen 33 sediments

Characterisation of age and polarity at onset in bipolar disorder

Background Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools. Aims To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics. Method Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts. Results Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO. Conclusions AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses

Eroding permafrost coasts release low amounts of dissolved organic carbon (DOC) from ground ice into the nearshore zone of the Arctic Ocean

Ice-rich permafrost coasts in the Arctic are highly sensitive to climate warming and erode at a pace that exceeds the global average. Permafrost coasts deliver vast amounts of organic carbon into the nearshore zone of the Arctic Ocean. Numbers on flux exist for particulate organic carbon (POC) and total or soil organic carbon (TOC, SOC). However, they do not exist for dissolved organic carbon (DOC), which is known to be highly bioavailable. This study aims to estimate DOC stocks in coastal permafrost as well as the annual flux into the ocean. DOC concentrations in ground ice were analyzed along the ice-rich Yukon coast (YC) in the western Canadian Arctic. The annual DOC flux was estimated using available numbers for coast length, cliff height, annual erosion rate, and volumetric ice content in different stratigraphic horizons. Our results showed that DOC concentrations in ground ice range between 0.3 and 347.0 mg L^-1 with an estimated stock of 13.6 ± 3.0 g m^-3 along the YC. An annual DOC flux of 54.9 ± 0.9 Mg yr^-1 was computed. These DOC fluxes are low compared to POC and SOC fluxes from coastal erosion or POC and DOC fluxes from Arctic rivers. We conclude that DOC fluxes from permafrost coasts play a secondary role in the Arctic carbon budget. However, this DOC is assumed to be highly bioavailable. We hypothesize that DOC from coastal erosion is important for ecosystems in the Arctic nearshore zones, particularly in summer when river discharge is low, and in areas where rivers are absent