The Roots and Branches of the Medical-Legal Partnership Approach to Health: From Collegiality to Civil Rights to Health Equity

This Article traces the roots of the medical-legal partnership (MLP) approach to health as a way of promoting the use of law to remedy societal and institutional pathologies that lead to individual and population illness and to health inequalities. Given current forces at work - the medical care and public health systems\u27 foctis on social determinants of health, the increased use of value-based medical care payment reforms, and the emerging movement to train the next generation of health care and public health professionals in structural competency - the time is ripe to spread the view that law is an important lens through which we should view health promotion, disease prevention, and overall well-being

Neighborhood Race and Nearby Race Affects Neighborhood Changes in Relative Status and Stability: Testing an Ecological Extension of the Neighborhood Projection Thesis

Current work tests an ecological extension of Ellen’s (2000a) neighborhood projection thesis which explains individual-level moving behavior in response to neighborhood racial composition. It posits that residents anticipate future erosions in local services and amenities based on current and expected future racial composition. The ecological extension tested here anticipates declines in relative neighborhood status and neighborhood residential stability where the population is more predominantly African American initially, or becomes more African American over a decade, or is initially surrounded by more predominantly African American neighborhoods. All three of these race effects have generated mixed results in earlier studies. Looking at a decade of change (1990 to 2000) for two mid-Atlantic central cities (Baltimore (MD) and Philadelphia (PA)), results in both cities confirmed that relative status was more likely to decline if adjoining neighborhoods were more predominantly African American initially, or if the neighborhood was becoming more predominantly African American during the period. The impacts of racial composition on stability changes were neither uniform across cities nor uniformly adverse. At least for neighborhood changes in status, results support the proposed extension of Ellen’s model to the neighborhood level, and underscored the spatial externalities arising from nearby populations of color

Thermal resistant environmental barrier coating

A process for preparing a silicon based substrate with a protective coating having improved thermal resistance at temperature up to at least 1500.degree. C., and the resulting article

Public Health Legal Services: A New Vision

In recent years, the medical profession has begun to collaborate more and more with lawyers in order to accomplish important health objectives for patients. That collaboration invites a revisioning of legal services delivery models and of public health constructs, leading to a concept we develop in this article, and call public health legal services. The phrase encompasses those legal services provided by non-government attorneys to low-income persons the outcomes of which when evaluated in the aggregate using traditional public health measures advance the public\u27s health. This conception of public health legal services has emerged most prominently from innovative developments in Los Angeles (the HIV Legal Checkup model), Boston (Medical-Legal Partnership for Children) and New York (LegalHealth). It departs from the commonplace understanding about public health law as concerned with the exercise of the state\u27s public health power. It extends that understanding to include the exercise of individual rights by private lawyers that also advances the public\u27s health. Just as it was once discovered that communities need access to health information, clean water, inoculation, and regulation of hazardous activities and products as part of a comprehensive scheme for promoting and achieving health, so too the emerging vision suggests that community health promotion also requires affordable access to effective legal information and assistance. The idea of public health legal services offers a rich and powerful incentive for public and private agencies to increase free and subsidized legal services. At the same time, the legal services necessary from a public health perspective may not be the ones currently emphasized by providers. The vision of public health legal services in many ways favors prevention over crisis management, and therefore calls upon traditional legal services providers to rethink their customary resource allocation models. The vision may call for painful short-term choices between the new model and the always urgent demand for litigation and crisis-driven work. This Article engages that tension in an effort to understand, if not resolve, its dimensions

Seafloor biodiversity of Canada's three oceans: patterns, hotspots and potential drivers

Aim We examined the relationships between bathymetry, latitude and energy and the diversity of marine benthic invertebrates across wide environmental ranges of Canada's three oceans. Location Canadian Pacific, Arctic and Atlantic Oceans from the intertidal zone to upper bathyal depths, encompassing 13 marine ecoregions. Methods We compiled 35 benthic datasets that encompass 3,337 taxa (70% identified to species and 21% to genus) from 13,172 samples spanning 6,117 sites. Partitioning the analyses by different gear types, ecoregions or sites, we used Hill numbers to examine spatial patterns in α‐diversity. We used resampling and extrapolation to standardized sampling effort and examined the effects of depth, latitude, chemical energy (export particulate organic carbon [POC] flux), thermal energy (bottom temperature) and seasonality of primary production on the benthic biodiversity. Results The Canadian Arctic harboured the highest benthic diversity (e.g. epifauna and common and dominant infauna species), whereas the lowest diversity was found in the Atlantic. The Puget Trough (Pacific), Beaufort Sea, Arctic Archipelago, Hudson Bay, Northern Labrador and Southern Grand Bank (Atlantic) were the “hotspots" of diversity among the ecoregions. The infauna and epifauna both exhibited hump‐shaped diversity–depth relationships, with peak diversity near shelf breaks; latitude (positively) predicted infaunal diversity, albeit weakly. Food supply, as inferred from primary production and depth, was more important than thermal energy in controlling diversity patterns. Limitations with respect to calculating POC flux in coastal (e.g. terrestrial runoff) and ice‐covered regions or biological interactions may explain the negative POC flux–infaunal diversity relationship. Main Conclusions We show previously unreported diversity hotspots in the Canadian Arctic and in other ecoregions. Our analyses reveal potential controlling mechanisms of large‐scale benthic biodiversity patterns in Canada's three oceans, which are inconsistent with the prevailing view of seafloor energy–diversity relationships. These results provide insightful information for conservation that can help to implement further MPA networks

The CO-produced Psychosocial INtervention delivered by GPs to young people after self-harm (COPING): protocol for a feasibility study

BackgroundSelf-harm in young people is a growing concern and reducing rates a global priority. General practitioners (GPs) can intervene early after self-harm but there are no effective treatments presently available. We developed the GP-led COPING intervention, in partnership with young people with lived experience and GPs, to be delivered to young people 16–25 years across two consultations. This study aims to examine the feasibility and acceptability of conducting a fully powered effectiveness trial of the COPING intervention in NHS general practice.MethodsThis will be a mixed-methods external non-randomised before-after single arm feasibility study in NHS general practices in the West Midlands, England. Patients aged 16–25 years who have self-harmed in the last 12 months will be eligible to receive COPING. Feasibility outcomes will be recruitment rates, intervention delivery, retention rates, and completion of follow-up outcome measures. All participants will receive COPING with a target sample of 31 with final follow-up data collection at six months from baseline. Clinical data such as self-harm repetition will be collected. A nested qualitative study and national survey of GPs will explore COPING acceptability, deliverability, implementation, and likelihood of contamination.DiscussionBrief GP-led interventions for young people after self-harm are needed and address national guideline and policy recommendations. This study of the COPING intervention will assess whether a main trial is feasible

Lineage Regulators Direct BMP and Wnt Pathways to Cell-Specific Programs during Differentiation and Regeneration

SummaryBMP and Wnt signaling pathways control essential cellular responses through activation of the transcription factors SMAD (BMP) and TCF (Wnt). Here, we show that regeneration of hematopoietic lineages following acute injury depends on the activation of each of these signaling pathways to induce expression of key blood genes. Both SMAD1 and TCF7L2 co-occupy sites with master regulators adjacent to hematopoietic genes. In addition, both SMAD1 and TCF7L2 follow the binding of the predominant lineage regulator during differentiation from multipotent hematopoietic progenitor cells to erythroid cells. Furthermore, induction of the myeloid lineage regulator C/EBPα in erythroid cells shifts binding of SMAD1 to sites newly occupied by C/EBPα, whereas expression of the erythroid regulator GATA1 directs SMAD1 loss on nonerythroid targets. We conclude that the regenerative response mediated by BMP and Wnt signaling pathways is coupled with the lineage master regulators to control the gene programs defining cellular identity

Autoantibodies to αS1-Casein Are Induced by Breast-Feeding

BACKGROUND: The generation of antibodies is impaired in newborns due to an immature immune system and reduced exposure to pathogens due to maternally derived antibodies and placental functions. During nursing, the immune system of newborns is challenged with multiple milk-derived proteins. Amongst them, caseins are the main constituent. In particular, human αS1-casein (CSN1S1) was recently shown to possess immunomodulatory properties. We were thus interested to determine if auto-antibodies to CSN1S1 are induced by breast-feeding and may be sustained into adulthood. METHODS: 62 sera of healthy adult individuals who were (n = 37) or were not (n = 25) breast-fed against human CSN1S1 were investigated by a new SD (surface display)-ELISA. For cross-checking, these sera were tested for anti Epstein-Barr virus (EBV) antibodies by a commercial ELISA. RESULTS: IgG-antibodies were predominantly detected in individuals who had been nursed. At a cut-off value of 0.4, the SD-ELISA identified individuals with a history of having been breast-fed with a sensitivity of 80% and a specificity of 92%. Under these conditions, 35 out of 37 sera from healthy donors, who where breast-fed, reacted positively but only 5 sera of the 25 donors who were not breast-fed. The duration of breast-feeding was of no consequence to the antibody reaction as some healthy donors were only short term breast-fed (5 days minimum until 6 weeks maximum), but exhibited significant serum reaction against human CSN1S1 nonetheless. CONCLUSION: We postulate that human CSN1S1 is an autoantigen. The antigenicity is orally determined, caused by breast-feeding, and sustained into adulthood