Health service approaches to providing care for people who seek treatment for obesity : identifying challenges and ways forward

OBJECTIVE: This paper aims to identify challenges in current health service approaches to providing optimal care for people who seek treatment for obesity. Type of program or service: Health service management of obesity in Australia Methods: Drawing on lived experience, clinical and academic perspectives, and available evidence, we reflect on the current state of the healthcare system to support people seeking treatment for obesity. We suggest actions to enable effective, acceptable and equitable care for this group of people. RESULTS: Identified challenges include the complexity of care required to adequately manage obesity, existing service capability and capacity, and high out-of-pocket patient costs. LESSONS LEARNT: To address these challenges, a comprehensive response is required at all levels of the healthcare system. As a starting point, we propose eight areas of action: partner with people living with obesity; eliminate weight stigma; increase healthcare professional education, guidelines and resources; establish clear referral pathways and working partnerships; scale services to meet demand; ensure flexible and accessible service delivery; implement changes to the Medicare Benefits Schedule to increase service provision and pursue opportunities for subsidised medicines

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the “what” is needed to foster the best start to life for all children, we provide recommendations of “how” we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations

Virological fitness of HIV in patients with resistance to enfuvirtide

Resistance to the HIV fusion inhibitor enfuvirtide is associated with mutations in the first heptad repeat region of gp41, but little is known of their impact on replicative fitness in vivo. We followed seven patients undergoing salvage therapy that included enfuvirtide in order to document the temporal generation of genotypic and phenotypic resistance in parallel with replicative fitness. Resistance to enfuvirtide was not associated with decreased replicative fitness of HIV strains infecting these patients

Self-developing Proprioception-Based Robot Internal Models

Part 6: Intelligent RobotInternational audienceResearch in cognitive science reveals that human central nervous system internally simulates dynamic behavior of the motor system using internal models (forward model and inverse model). Being inspired, the question of how a robot develops its internal models for arm motion control is discussed. Considering that human proprioception plays an important role for the development of internal models, we propose to use autoencoder neural networks to establish robot proprioception, and then based on which the robot develops its internal models. All the models are learned in a developmental manner through robot motor babbling like human infants. To evaluate the proprioception-based internal models, we conduct experiments on our PKU-HR6.0 humanoid robots, and the results illustrate the effectiveness of the proposed approach. Additionally, a framework integrating internal models is further proposed for robot arm motion control (reaching, grasping and placing) and its effectiveness is also demonstrated

Contributions of vision-proprioception interactions to the estimation of time-varying hand and target locations

We investigated the relative importance of vision and proprioception in estimating target and hand locations in a dynamic environment. Subjects performed a position estimation task in which a target moved horizontally on a screen at a constant velocity and then disappeared. They were asked to estimate the position of the invisible target under two conditions: passively observing and manually tracking. The tracking trials included three visual conditions with a cursor representing the hand position: always visible, disappearing simultaneously with target disappearance, and always invisible. The target’s invisible displacement was systematically underestimated during passive observation. In active conditions, tracking with the visible cursor significantly decreased the extent of underestimation. Tracking of the invisible target became much more accurate under this condition and was not affected by cursor disappearance. In a second experiment, subjects were asked to judge the position of their unseen hand instead of the target during tracking movements. Invisible hand displacements were also underestimated when compared with the actual displacement. Continuous or brief presentation of the cursor reduced the extent of underestimation. These results suggest that vision–proprioception interactions are critical for representing exact target–hand spatial relationships, and that such sensorimotor representation of hand kinematics serves a cognitive function in predicting target position. We propose a hypothesis that the central nervous system can utilize information derived from proprioception and/or efference copy for sensorimotor prediction of dynamic target and hand positions, but that effective use of this information for conscious estimation requires that it be presented in a form that corresponds to that used for the estimations

Difference in the perception of the horizon during true and simulated tilt in the absence of semicircular canal cues.

Perception of tilt (somatogravic illusion) in response to sustained linear acceleration is generally attributed to the otolithic system which reflects either a translation of the head or a reorientation of the head with respect to gravity (tilt/translation ambiguity). The main aim of this study was to compare the tilt perception during prolonged static tilt and translation between 8 and 20 degrees of tilt relative to the gravitoinertial forces (i.e., G and GIF, respectively) when the semicircular cues were no more available. An indirect measure of tilt perception was estimated by means of a visual and kinesthetic judgment of the gravitational horizon. The main results contrast with the interpretation regarding the tilt/translation ambiguity as the same orientation relative to the shear forces G for the true tilt or GIF in the centrifuge did not induce the same horizon perception. Visual adjustment and arm pointing in the centrifuge were always above the ones observed in a G environment. Part of the lowering of the judgment in the centrifuge may be related to the mechanical effect of GIF on the effectors as shown by the shift of the egocentric coordinates in the direction of GIF. The role of the extravestibular graviceptors in the judgment of the degree of tilt of one's own body relative to G or GIF was discussed