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The role of policy styles in policymaking has attracted renewed scholarly interest in recent years. One of the central debates in this literature revolves around the question of how to reconcile archetype national policy styles with considerable differences in modus operandi across policy sectors. A sector-specific feature that is considered a key determinant of the manifestation of archetype national policy styles in the European Union is the degree of Europeanisation of policy sectors. This paper picks up this suggestion by addressing the question of whether and how Europeanisation affects the degree to which features of an archetype national policy style are manifest within a sector. We address this question by exploring sectoral policy styles in agricultural and food-related public health policymaking across three EU Member States: The Netherlands, the United Kingdom (England), and France. Our findings suggest that the degree of Europeanisation of a policy sector does prove an important condition that helps to understand the relationship between national and sectoral policy styles. More specifically, Europeanisation has the strongest effect when sectors face a higher adaptation pressure, i.e., when there is a larger misfit between sectoral regimes and EU-induced institutional demands. We suggest various promising avenues of future research on this relationship. [ABSTRACT FROM AUTHOR]

Background and Objectives Recruitment and retention of research participant serve as a significant challenge in the search for ways to slow or prevent Alzheimer's disease. While barriers to participation are well documented, less is known about motivations for Alzheimer's disease clinical research participation. The purpose of this study was to explore what motivates individuals—who ultimately develop an ongoing connection to research and frequently participate—to engage and stay involved in Alzheimer's disease research. Research Design and Methods Individuals who had participated in multiple Alzheimer's disease-related clinical trials, or their study partners, were interviewed about their decisions to engage and remain in research. Findings Interviews were completed with 33 individuals, 28 research participants, and 5 study partners. All interviews were audio-recorded and transcribed verbatim for analysis. Respondents indicated learning about research opportunities through the media, community events, doctors, and other research participants. While many were initially motivated by a family history or knowing someone with Alzheimer's disease, others had no personal exposure. Individuals in prevention studies were generally proactive and viewed research as a constructive way to address memory concerns. While several individuals acknowledged personal benefits of research participation, most indicated an understanding of the importance of research and being motivated to help others in the future, frequently referencing a sense of social responsibility or moral obligation to help. Positive relationships with personnel at the site encouraged continued involvement. Discussion and Implications These findings suggest that efforts to identify research participants should highlight the value of research and help illuminate how participation may contribute to well-being of future generations. [ABSTRACT FROM AUTHOR]

Components of the renin-angiotensin system (RAS) are expressed in a number of areas in the brain involved in cardiovascular control. However, it has been difficult to link RAS actions in circumscribed brain regions to specific physiological functions. In a study appearing in this issue of the JCI, Sakai and associates use a combination of sophisticated transgenic techniques and stereotaxic microinjection of recombinant viral vectors to demonstrate a pivotal role in the regulation of thirst and salt appetite of angiotensin II generated in the subfornical organ in the brain (see the related article beginning on page 1088). [ABSTRACT FROM AUTHOR]

The mouse has become the most important model organism for the study of human physiology and disease. However, until the recent generation of mice lacking the enzyme gulanolactone oxidase (Gulo), the final enzyme in the ascorbic acid biosynthesis pathway, examination of the role of ascorbic acid in various biochemical processes using this model organism has not been possible. In the mouse, similar to most mammals but unlike humans who carry a mutant copy of this gene, Gulo produces ascorbic acid from glucose. We report here that, although ascorbic acid is essential for survival, its absence does not lead to measurable changes in proline hydroxylation. Vitamin C deficiency had no significant effect on the hydroxylation of proline and collagen production during tumor growth or in angiogenesis associated with tumor or mammary gland growth. This suggests that factors other than ascorbic acid can support proline hydroxylation and collagen synthesis in vivo. Furthermore, the failure of Gulo-/- mice to thrive on a vitamin C-deficient diet therefore suggests that ascorbic acid plays a critical role in survival other than the maintenance of the vasculature. [ABSTRACT FROM AUTHOR]

• London's metropolis-wide food policy activities and actors are described. • The concept of institutions as policy-structuring forces is applied. • Enablers of and constraints on London's food policy are examined. • A heuristic: sub-system, programme and plan, within wider government structures, is proposed. • Re-balancing of national-local powers for food systems transformation is explored. This article explores the spaces for, and boundaries to, London's food policy. Leveraging the concept of institutions as policy-structuring forces, it positions immediate policymaking capacity and potential as delineated by broader historical, social and legislative institutions. Using new data, the findings identify structuring effects including: the strategic force of different policy areas; the Mayor's remit and interests; relationships between the London authority and the boroughs, as well as in relation to the national level; and requirements for integration. Within the metropolitan government space, distinguishing between the food policy sub-system, programme and plan provides a conceptual device to understand how food policy in London extends beyond its limited direct levers and resources – reflecting and responding to the city's longstanding complicated and multi-tiered governance. Food policy is enabled through a sub-system consisting of a set of dedicated food governance structures and mechanisms – a permanent team of staff, plus policy networks, advisors and street-level implementers – which utilise different modes of policy integration to bolster the programme of activities around food. A new cross-cutting food plan – the London Food Strategy – was developed in 2018 to coordinate these different actors and activities. The case study enables critical reflection on the potential for urban food policy to address a range of food systems outcomes. While some harder policy interventions are possible, there remains a multi-level disconnect in policy authority between the local borough, metropolitan and national levels. There are constraints on how far transformation can take place, raising questions about the re-balancing of national-local power sharing which will be required for a more coherent and transformative approach. [ABSTRACT FROM AUTHOR]

• To tackle the food system cross-sectoral challenges, a coherent approach must be the priority. • Emilia-Romagna is the case study as its food industry is traditionally and economically strong. • We use a Policy Coherence Matrix to assess food policy coherence over 6 policy domains. • The most prolific domains were agricultural and environmental policies. • Agricultural and environmental policies had the lowest coherence score between them. • Regional policies had good coherence, but no specific coherence process is in place. Achieving a coherent set of food-related policies is a challenge for policymakers worldwide, as food matters are addressed at more than one level of governance and across several policy domains. Policies in different domains can sustain each other by sharing the same objectives and actions or they can hinder each other, resulting in different levels of coherence. Focusing on the case study of the region Emilia-Romagna (Italy), the present research aims to answer the following research questions: to what extent is food mentioned in regional policies? Are the food-related objectives of Emilia-Romagna policies coherent with each other? Mixed methods were used in three subsequent research steps. Step 1 consisted of collating an inventory of regional policies where food is present. In Step 2, identified policies were analysed with quantitative content analysis, to examine their objectives, degree of targeting, which food supply chain step they focus on, and which policy instrument type they plan to use. Step 3 aimed to assess the coherence of the identified food-related policies' objectives among each other through expert interviews, analysed with thematic coding. Overall, regional policies reached a good degree of coherence around the common intention of making Emilia-Romagna thrive economically. However, some level of incoherence is present, as a systematic process that lowers incoherence in policymaking is not in place yet. Therefore, implementing the use of a Policy Coherence Matrix as a standardised practice for policy approval is recommended to coordinate food-related policies. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this project was to determine pharmacy cost savings and improvement in adherence based on a combinatorial pharmacogenomic test (CPGx ) in patients who had switched or added a new psychiatric medication after having failed monotherapy for their psychiatric disorder.Research Design and Methods: The prospective project compared 1 year pharmacy claims between a GeneSight CPGx guided cohort and a propensity-matched control group. Patients were project eligible if they augmented or switched to a different antidepressant or antipsychotic medication within the previous 90 days. Following the medication switch or augmentation, pharmacogenomic (PGx) testing was offered to each patient's treating clinician. Pharmacy claims were extracted from the Medco pharmacy claims database for each patient (n = 2168) for 1 year following testing and compared to a 5-to-1 propensity-matched treatment as usual (TAU), standard of care control group (n = 10,880).Main Outcome Measures: Total pharmacy spend per member per year; adherence.Results: Patients who received PGx testing saved $1035.60 in total medication costs (both CNS and non-CNS medications) over 1 year compared to the non-tested standard of care cohort (p = 0.007). PGx testing improved adherence compared to standard of care (ΔPDCCPGx = 0.11 vs ΔPDCTAU = -0.01; p < 0.0001). Pharmacy cost savings averaged $2774.53 for patients who were changed to a CPGx congruent medication regimen, compared to those who were not (p < 0.0001).Conclusions: PGx testing provides significant 'real world' cost savings, while simultaneously improving adherence in a difficult to treat psychiatric population. Limitations of this study include the lack of therapeutic efficacy follow-up data and possible confounding due to matching only on demographic and psychiatric variables. [ABSTRACT FROM AUTHOR]

Studies in humans and animal models indicate a key contribution of angiotensin II to the pathogenesis of glomerular diseases. To examine the role of type 1 angiotensin (AT1) receptors in glomerular inflammation associated with autoimmune disease, we generated MRL-Faslpr/lpr (lpr) mice lacking the major murine type 1 angiotensin receptor (AT1A); lpr mice develop a generalized autoimmune disease with glomerulonephritis that resembles SLE. Surprisingly, AT1A deficiency was not protective against disease but instead substantially accelerated mortality, proteinuria, and kidney pathology. Increased disease severity was not a direct effect of immune cells, since transplantation of AT1A-deficient bone marrow did not affect survival. Moreover, autoimmune injury in extrarenal tissues, including skin, heart, and joints, was unaffected by AT1A deficiency. In murine systems, there is a second type 1 angiotensin receptor isoform, AT1B, and its expression is especially prominent in the renal glomerulus within podocytes. Further, expression of renin was enhanced in kidneys of AT1A-deficient lpr mice, and they showed evidence of exaggerated AT1B receptor activation, including substantially increased podocyte injury and expression of inflammatory mediators. Administration of losartan, which blocks all type 1 angiotensin receptors, reduced markers of kidney disease, including proteinuria, glomerular pathology, and cytokine mRNA expression. Since AT1A-deficient lpr mice had low blood pressure, these findings suggest that activation of type 1 angiotensin receptors in the glomerulus is sufficient to accelerate renal injury and inflammation in the absence of hypertension. [ABSTRACT FROM AUTHOR]

Prostacyclin is one of a number of lipid mediators elaborated from the metabolism of arachidonic acid by the cyclooxygenase (COX) enzymes. This prostanoid is a potent inhibitor of platelet aggregation, and its production by endothelial cells and protective role in the vasculature are well established. In contrast, much less is known regarding the function of this prostanoid in other disease processes. We show here that COX-2-dependent production of prostacyclin plays an important role in the development of fibrotic lung disease, limiting both the development of fibrosis and the consequential alterations in lung mechanics. In stark contrast, loss of prostaglandin E2 synthesis and signaling through the Gs-coupled EP2 and EP4 receptors had no effect on the development of disease. These findings suggest that prostacyclin analogs will protect against bleomycin-induced pulmonary fibrosis in COX-2-/- mice. If such protection is observed, investigation of these agents as a novel therapeutic approach to pulmonary fibrosis in humans may be warranted. [ABSTRACT FROM AUTHOR]