How Do You Build a "Culture of Health"? A Critical Analysis of Challenges and Opportunities from Medical Anthropology.

The Robert Wood Johnson Foundation's Culture of Health Action Framework aims to "make health a shared value" and improve population health equity through widespread culture change. The authors draw upon their expertise as anthropologists to identify 3 challenges that they believe must be addressed in order to effectively achieve the health equity and population health improvement goals of the Culture of Health initiative: clarifying and demystifying the concept of "culture," contextualizing "community" within networks of power and inequality, and confronting the crises of trust and solidarity in the contemporary United States. The authors suggest that those who seek to build a "Culture of Health" refine their understanding of how "culture" is experienced, advocate for policies and practices that break down unhealthy consolidations of power, and innovate solutions to building consensus in a divided nation

Tonic inhibition of accumbal spiny neurons by extrasynaptic 4 GABAA receptors modulates the actions of psychostimulants

Within the nucleus accumbens (NAc), synaptic GABAA receptors (GABAARs) mediate phasic inhibition of medium spiny neurons (MSNs) and influence behavioral responses to cocaine. We demonstrate that both dopamine D1- and D2-receptor-expressing MSNs (D-MSNs) additionally harbor extrasynaptic GABAARs incorporating α4, β, and δ subunits that mediate tonic inhibition, thereby influencing neuronal excitability. Both the selective δ-GABAAR agonist THIP and DS2, a selective positive allosteric modulator, greatly increased the tonic current of all MSNs from wild-type (WT), but not from δ−/− or α4−/− mice. Coupling dopamine and tonic inhibition, the acute activation of D1 receptors (by a selective agonist or indirectly by amphetamine) greatly enhanced tonic inhibition in D1-MSNs but not D2-MSNs. In contrast, prolonged D2 receptor activation modestly reduced the tonic conductance of D2-MSNs. Behaviorally, WT and constitutive α4−/− mice did not differ in their expression of cocaine-conditioned place preference (CPP). Importantly, however, mice with the α4 deletion specific to D1-expressing neurons (α4D1−/−) showed increased CPP. Furthermore, THIP administered systemically or directly into the NAc of WT, but not α4−/− or α4D1−/− mice, blocked cocaine enhancement of CPP. In comparison, α4D2−/− mice exhibited normal CPP, but no cocaine enhancement. In conclusion, dopamine modulation of GABAergic tonic inhibition of D1- and D2-MSNs provides an intrinsic mechanism to differentially affect their excitability in response to psychostimulants and thereby influence their ability to potentiate conditioned reward. Therefore, α4βδ GABAARs may represent a viable target for the development of novel therapeutics to better understand and influence addictive behaviors

Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [RCPCH Poster]

Conflicts over the care of children with life-limiting conditions can reach the point where courts have to intervene,but giving evidence causes distress, unwanted media attention and costs. The decision in Charlie Gard’s case in Englandincluded a plea for parties to mediate. No case has arisen in Scotland, where law and practice differ, but there are approximately 16,000 children with complex conditions where care might potentially be disputed. This study seeks to understand reasons for disputes, identify potential solutions (including mediation) and reduce the risk of a case coming before a Scottish court. In-depth interviews (online and face-to-face) with NHS Grampian clinicians and parents were conducted from which qualitative data were obtained on their experiences and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches. This is being funded by the NHS Grampian Endowment Fund. Ten clinicians and five parents were interviewed. Preliminary thematic analysis suggests that clinicians feel multidisciplinary team meetings improve conflict resolution for patients with complex requirements, where specialism boundaries can blur. When disputes arise, the type of intervention varied depending on its scale, urgency and impact on other care teams. A cause of disputes is variation in goals within and between care teams, but micro-discussions and step-bystep approaches from the outset work well and mitigate risk of disputes. The settings, timing and language used in conversations with parents is important. Findings suggest that clinicians may prefer a two-stage process where meetings are held without parents in the first instance. A strong Chair facilitates useful meetings, but parents still find it difficult to know who to address questions to. Families' use of social media/online searches can be problematic and lead to strained relationships, but emphasis on 'good death' and 'doing what's right' were highlighted. When a child is hospitalised, 'handing over' a child who has been looked after at home can be difficult for parents and home care teams. A desire to connect with parents facing similar challenges was expressed. It is clear that conflict exists in Scottish paediatric care. Practice suggests that there are strategies which can be employed to minimise risk of intractable disputes arising which could be used to assess the suitability of mediation and formalised into a toolkit to support families and clinicians

Wolbachia strain wAu efficiently blocks arbovirus transmission in Aedes albopictus

The global incidence of arboviral diseases transmitted by Aedes mosquitoes, including dengue, chikungunya, yellow fever, and Zika, has increased dramatically in recent decades. The release of Aedes aegypti carrying the maternally inherited symbiont Wolbachia as an intervention to control arboviruses is being trialled in several countries. However, these efforts are compromised in many endemic regions due to the co-localization of the secondary vector Aedes albopictus, the Asian tiger mosquito. Ae. albopictus has an expanding global distribution following incursions into a number of new territories. To date, only the wMel and wPip strains of Wolbachia have been reported to be transferred into and characterized in this vector. A Wolbachia strain naturally infecting Drosophila simulans, wAu, was selected for transfer into a Malaysian Ae. albopictus line to create a novel triple-strain infection. The newly generated line showed self-compatibility, moderate fitness cost and complete resistance to Zika and dengue infections

Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [NHS Grampian R&D Poster]

Conflicts between parents and clinicians over the care of children with life-limiting conditions can reach the point where courts must intervene, causing distress, unwanted media attention and costs. This NHS Grampian case study sought to understand reasons for disputes, identify potential solutions and reduce the risk of a case coming before a Scottish court. In-depth semi-structured interviews with 20 participants (a mix of NHS Grampian clinicians and parents) were conducted from which qualitative data were obtained on their experiences of and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches

The Next-Generation Multimission U.S. Surveillance Radar Network

The U.S. Government operates seven distinct radar networks, providing weather and aircraft surveillance for public weather services, air traffic control, and homeland defense. In this paper, we describe a next-generation multimission phased-array radar (MPAR) concept that could provide enhanced weather and aircraft surveillance services with potentially lower life cycle costs than multiple single-function radar networks. We describe current U.S. national weather and aircraft surveillance radar networks and show that by reducing overlapping airspace coverage, MPAR could reduce the total number of radars required by approximately one-third. A key finding is that weather surveillance requirements dictate the core parameters of a multimission radar—airspace coverage, aperture size, radiated power, and angular resolution. Aircraft surveillance capability can be added to a phased array weather radar at low incremental cost because the agile, electronically steered beam would allow the radar to achieve the much more rapid scan update rates needed for aircraft volume search missions, and additionally to support track modes for individual aircraft targets. We describe an MPAR system design that includes multiple transmit–receive channels and a highly digitized active phased array to generate independently steered beam clusters for weather, aircraft volume search, and aircraft track modes. For each of these modes, we discuss surveillance capability improvements that would be realized relative to today's radars. The Federal Aviation Administration (FAA) has initiated the development of an MPAR “preprototype” that will demonstrate critical subsystem technologies and multimission operational capabilities. Initial subsystem designs have provided a solid basis for estimating MPAR costs for comparison with existing, mechanically scanned operational surveillance radars.United States. Federal Aviation Administration (FA8721-05-C-0002

Genome-wide association studies for feedlot and growth traits in cattle

A genome wide-association study for production traits in cattle was carried out using genotype data from the 10K Affymetrix (Santa Clara, CA) and the 50K Illumina (San Diego, CA) SNP chips. The results for residual feed intake (RFI), BW, and hip height in 3 beef breed types (Bos indicus, Bos taurus, and B. indicus × B. taurus), and for stature in dairy cattle, are presented. The aims were to discover SNP associated with all traits studied, but especially RFI, and further to test the consistency of SNP effects across different cattle populations and breed types. The data were analyzed within data sets and within breed types by using a mixed model and fitting 1 SNP at a time. In each case, the number of significant SNP was more than expected by chance alone. A total of 75 SNP from the reference population with 50K chip data were significant (P < 0.001) for RFI, with a false discovery rate of 68%. These 75 SNP were mapped on 24 different BTA. Of the 75 SNP, the 9 most significant SNP were detected on BTA 3, 5, 7, and 8, with P ≤ 6.0 × 10 . In a population of Angus cattle divergently selected for high and low RFI and 10K chip data, 111 SNP were significantly (P < 0.001) associated with RFI, with a false discovery rate of 7%. Approximately 103 of these SNP were therefore likely to represent true positives. Because of the small number of SNP common to both the 10K and 50K SNP chips, only 27 SNP were significantly (P < 0.05) associated with RFI in the 2 populations. However, other chromosome regions were found that contained SNP significantly associated with RFI in both data sets, although no SNP within the region showed a consistent effect on RFI. The SNP effects were consistent between data sets only when estimated within the same breed type

Unusual features in the nonlinear microwave surface impedance of Y-Ba-Cu-O thin films

Striking features have been found in the nonlinear microwave (8 GHz) surface impedance $Z_s=R_s + jX_s$ of high-quality YBaCuO thin films with comparable low power characteristics [$R_{res}\sim 35--60 \mu\Omega$ and $\lambda_L(15 K)\sim 130--260 nm$]. The surface resistance $R_s$ is found to increase, decrease, or remain independent of the microwave field $H_{rf}$ (up to 60 mT) at different temperatures and for different samples. However, the surface reactance $X_s$ always follows the same functional form. Mechanisms which may be responsible for the observed variations in $R_s$ and $X_s$ are briefly discussed.Comment: 4 pages, 4 figure

A universal equation to predict methane production of forage-fed cattle in Australia

The methods for estimating methane emissions from cattle as used in the Australian national inventory are based on older data that have now been superseded by a large amount of more recent data. Recent data suggested that the current inventory emissions estimates can be improved. To address this issue, a total of 1034 individual animal records of daily methane production (MP) was used to reassess the relationship between MP and each of dry matter intake (DMI) and gross energy intake (GEI). Data were restricted to trials conducted in the past 10 years using open-circuit respiration chambers, with cattle fed forage-based diets (forage >70%). Results from diets considered to inhibit methanogenesis were omitted from the dataset. Records were obtained from dairy cattle fed temperate forages (220 records), beef cattle fed temperate forages (680 records) and beef cattle fed tropical forages (133 records). Relationships were very similar for all three production categories and single relationships for MP on a DMI or GEI basis were proposed for national inventory purposes. These relationships were MP (g/day) = 20.7 (±0.28) × DMI (kg/day) (R2 = 0.92, P < 0.001) and MP (MJ/day) = 0.063 (±0.008) × GEI (MJ/day) (R2 = 0.93, P < 0.001). If the revised MP (g/day) approach is used to calculate Australia’s national inventory, it will reduce estimates of emissions of forage-fed cattle by 24%. Assuming a global warming potential of 25 for methane, this represents a 12.6 Mt CO2-e reduction in calculated annual emissions from Australian cattle