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An overview of the ‘Limits to Growth’ debate is provided, from Malthus to Planetary Boundaries and the Planetary Health Commission. I argue that a combination of vested interests, inequalities, and cognitive impediments disguise the seriousness of our collective proximity to limits. Cognitive factors include an increasingly urbanized population heavily in denial through declining exposure to nature, incompletely substituted by the rise of simulated, digital and filmed reality. Following prominence in the 1960s and early 1970s, fears of Limits to Growth diminished as the oil price declined and as the Green Revolution expanded agricultural productivity. While public health catastrophes have occurred which can be conceptualised as arising from the exceedance of local boundaries, including that of tolerance (e.g. the 1994 Rwandan genocide), these have mostly been considered temporary aberrations, of limited significance. Another example is the devastating Syrian civil war. However, rather than an outlier, this conflict can be analysed as an example of interacting eco-social causes, related to aspects of limits to growth, including climate change and aquifer depletion. To view the ‘root causes’ of the Syrian tragedy as overwhelmingly or even exclusively social, leaves civilization vulnerable to many additional disasters, including in the Sahel, elsewhere in the Middle East, and perhaps, within decades, globally. An aspect of the Limits to Growth debate that was briefly prominent was ‘peak oil’. Fear of this has fallen with the oil price. But this does not mean that Limits to Growth are fanciful or will apply only in the far future, even if (which seems unlikely) the oil price remains low. The proximity of dangerous climate change is the starkest example of an imminent environmental limit; other examples include declining reserves of phosphorus and rare elements. Crucially, human responses have the capacity to accelerate or delay the consequences of these limits. Greater understanding of these issues is vital for enduring population health, globally. [ABSTRACT FROM AUTHOR]

Given the high incidence of tick bites and tick-borne diseases in the United States, it is important for primary care providers to recognize common ticks and the pathogens they may transmit. If a patient has removed and saved an attached tick, identifying the tick helps guide clinical management and determine whether antibiotic prophylaxis for Lyme disease is appropriate. To investigate providers’ ability to recognize common ticks and the pathogens they may transmit, we asked 76 primary care providers from Lyme disease endemic areas to identify the common name or genus of preserved ticks found in their area. At baseline, 10.5%, 46.1%, and 57.9% of participants correctly identified an adult female blacklegged tick (engorged), dog tick, and lone star tick, respectively. Less than half of participants identified the three pathogens most frequently transmitted by blacklegged ticks. Use of a reference manual with tick photographs and drawings substantially improved identification of ticks and associated pathogens and therefore should be encouraged in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has rapidly become popular, but there is little consensus regarding the risks and benefits of this approach in comparison with a modern posterior approach (PA).Methods: A total of 2147 patients who underwent DAA THA were propensity score matched with patients undergoing PA THA on the basis of age, gender, body mass index, and American Society of Anesthesia classification using data from a state joint replacement registry. Mean age of the matched cohort was 64.8 years, mean body mass index was 29.1 kg/m(2), and 53% were female. Multilevel logistic regression models using generalized estimating equations to control for grouping at the hospital level were used to identify differences in various outcomes.Results: There was no difference in the dislocation rate between patients undergoing DAA (0.84%) and PA (0.79%) THA. Trends indicating a slightly longer length of stay with the PA and a slightly greater risk of fracture, increased blood loss, and hematoma with the DAA are consistent with previous studies.Conclusion: On the basis of short-term outcome and complication data, neither approach has a compelling advantage over each other, including no difference in the dislocation risk. [ABSTRACT FROM AUTHOR]

Lyme disease is the most commonly reported vector-borne illness in the United States. Since the institution of Nationally Notifiable surveillance efforts for Lyme disease in the United States in 1991, there has been a consistent increase in the number of reported cases. Thus, the need for targeted prevention strategies is underscored. The purpose of this study was to investigate knowledge about tick-borne diseases as well as beliefs and practices related to a variety of personal tick-borne disease prevention methods among individuals in southwestern Connecticut, a Lyme disease-endemic area. Between June and September 2014, an anonymous questionnaire was administered to 275 participants through a point-of-contact convenience sample obtained at community events in southwestern Connecticut. The questionnaire assessed individuals’ general knowledge about tick-borne diseases, performance of four selected tick-borne disease prevention methods, and perceived effectiveness and burdensomeness of those four behaviors. Some 80% of participants were female; median age was 55 years (IQR 45–64 years); 30% reported having been treated for a tick-borne illness and 50% reported a family member having been treated for a tick-borne illness. Overall, participants’ knowledge of tick-borne diseases was poor; the average knowledge score was only 57% (SD 22.6%). The reported frequency of performing preventive behaviors was variable. The most commonly reported behavior was performing a tick check (68%); use of tick repellent was the least commonly reported behavior (38%). Those who were more knowledgeable about Lyme disease were more likely to perform tick checks but knowledge score was not significantly associated with any of the other three behaviors studied. Respondents largely believed preventive behaviors to be effective at reducing the risk of tick-borne diseases. Belief that a prevention behavior is effective was highly correlated with performing that behavior but perceived burdensomeness does not appear to influence behavior performance. The reasons for differential uptake of preventive behaviors remains unknown; further study of barriers to performance of personal preventive behaviors is needed to better target public health interventions. [ABSTRACT FROM AUTHOR]

Objective Elevations in brain angiotensin-II cause increased energy expenditure and a lean phenotype. Interestingly, the metabolic effects of increased brain angiotensin-II mimic the actions of leptin, suggesting an interaction between the two systems. Here we demonstrate that angiotensin-type 1a receptors (AT 1a R) in the subfornical organ (SFO), a forebrain structure emerging as an integrative metabolic center, play a key role in the body weight-reducing effects of leptin via brown adipose tissue (BAT) thermogenesis. Methods Cre/LoxP technology coupled with targeted viral delivery to the SFO in a mouse line bearing a conditional allele of the Agtr1a gene was utilized to determine the interaction between leptin and SFO AT 1a R in metabolic regulation. Results Selective deletion of AT 1a R in the SFO attenuated leptin-induced weight loss independent of changes in food intake or locomotor activity. This was associated with diminished leptin-induced increases in core body temperature, blunted upregulation of BAT thermogenic markers, and abolishment of leptin-mediated sympathetic activation to BAT. Conclusions These data identify a novel interaction between angiotensin-II and leptin in the control of BAT thermogenesis and body weight, and highlight a previously unrecognized role for the forebrain SFO in metabolic regulation. [ABSTRACT FROM AUTHOR]