bmj;387/nov12_10/q2481/FAF1faJulia and Malcolm Donaldsondonaldson20241111.f1Malcolm Donaldson was a distinguished paediatric endocrinologist with a string of research publications to his name—but he was also happy to play second fiddle (almost literally) to his wife Julia, the celebrated author of much loved children’s books, including The Gruffalo and Room on the Broom.Malcolm, a talented musician and performer, accompanied his wife as she toured festivals, schools, and libraries in the UK and around the world. Together they performed the stories, with Malcolm acting characters ranging from an accident prone dragon to a comic cattle thief. His star role, in the words of Julia’s literary agent, was “a particularly suave fox” in The Gruffalo.Malcolm met Julia Shields when they were students at the University of Bristol and they married in 1972. Donaldson went on to work in Brighton, London, and Lyon, France, before moving back to Bristol to be a senior registrar in paediatrics. Six...

At one of my first meetings as an elected council member of the Royal College of Surgeons of England, we approved a report called Access All Ages. It encouraged less ageist thinking and bias among healthcare staff that might lead to them denying older people surgery.1 But sometimes an operation isn’t the best option. Among patients who have surgery, 14% express regret and 15% experience complications, which are at least four times as likely if they’re frail or physically inactive.2 The Centre for Perioperative Care has published information on the importance of exercise before surgery,3 but that alone may not be enough.We need shared decision making,4 including asking patients what matters to them. The public should be primed to ask about BRAN—the benefits, risks, and alternatives to surgery and the likely result from doing nothing.4 A slew of data supports this approach, especially from the POPS initiative (Perioperative Care of...

bmj;387/nov13_11/q2490/FAF1faDavide Bonaldo/SOPA/Sipa/AlamyThe devastating power and impact of the flash floods that swept through eastern Spain from 29 October is captured in this image from the city of Valencia. More than 200 people are known to have been killed—and around 100 are still missing—in floods caused by rivers and normally dry canals bursting their banks after torrential rain across the region.Medical sites have been severely hit, with several towns setting up temporary clinics in sports centres for essential services. A local GP told Medscape Network that because many roads were closed it was difficult for people to reach these makeshift facilities.In an effort to combat this the Valencia region’s health ministry has established a register of volunteer health professionals available to help in affected areas. It has also launched a public health campaign warning of the spread of infectious diseases made possible by damage to the sanitation infrastructure, including leptospirosis, tetanus,...

A unique population of ventral tegmental area (VTA) neurons co-transmits glutamate and GABA. However, the circuit inputs to VTA VGluT2+VGaT+ neurons are unknown, limiting our understanding of their functional capabilities. By coupling monosynaptic rabies tracing with intersectional genetic targeting in male and female mice, we found that VTA VGluT2+VGaT+ neurons received diverse brainwide inputs. The largest numbers of monosynaptic inputs to VTA VGluT2+VGaT+ neurons were from superior colliculus (SC), lateral hypothalamus (LH), midbrain reticular nucleus, and periaqueductal gray, whereas the densest inputs relative to brain region volume were from the dorsal raphe nucleus, lateral habenula, and VTA. Based on these and prior data, we hypothesized that LH and SC inputs were from glutamatergic neurons. Optical activation of glutamatergic LH neurons activated VTA VGluT2+VGaT+ neurons regardless of stimulation frequency and resulted in flee-like ambulatory behavior. In contrast, optical activation of glutamatergic SC neurons activated VTA VGluT2+VGaT+ neurons for a brief period of time at high frequency and resulted in head rotation and arrested ambulatory behavior (freezing). Stimulation of glutamatergic LH neurons, but not glutamatergic SC neurons, was associated with VTA VGluT2+VGaT+ footshock-induced activity and inhibition of LH glutamatergic neurons disrupted VTA VGluT2+VGaT+ tailshock-induced activity. We interpret these results such that inputs to VTA VGluT2+VGaT+ neurons may integrate diverse signals related to the detection and processing of motivationally salient outcomes.

The prefrontal cortex is critical for decision-making across species, with its activity linked to choosing between options. Drift diffusion models (DDMs) are commonly employed to understand the neural computations underlying this behavior. Studies exploring the specific roles of regions of the rodent prefrontal cortex in controlling the decision process are limited. This study explored the role of the prelimbic cortex (PLC) in decision-making using a two-alternative forced-choice task. Rats first learned to report the location of a lateralized visual stimulus. The brightness of the stimulus indicated its reward value. Then, the rats learned to make choices between pairs of stimuli. Sex differences in learning were observed, with females responding faster and more selectively to high-value stimuli than males. DDM analysis found that males had decreased decision thresholds during initial learning, whereas females maintained a consistently higher drift rate. Pharmacological manipulations revealed that PLC inactivation reduced the decision threshold for all rats, indicating that less information was needed to make a choice in the absence of normal PLC processing. μ-Opioid receptor stimulation of the PLC had the opposite effect, raising the decision threshold and reducing bias in the decision process toward high-value stimuli. These effects were observed without any impact on the rats’ choice preferences. Our findings suggest that PLC has an inhibitory role in the decision process and regulates the amount of evidence that is required to make a choice. That is, PLC activity controls "when," but not "how," to act.

Basketball is not played much in South Africa, but OM SportsLink successfully introduces the game to students in Mamelodi, a township outside of Pretoria.

Typically, at least two discarded babies are found in the Mamelodi City Dump every week. AIDS Hope seeks to eliminate this horrible reality.

Jabulani, a youth from South Africa affected by HIV, receives help and care from the OM team ministering in his community.

During door-to-door ministry in a small village in South Africa, a woman opens up her house.

Dorothea, from Germany, joins the one-year programme with OM Russia, which includes visiting Siberian villages to help churches and sharing the Gospel with locals.

OM Russia’s Business for Transformation ministry supports eight projects that empower locals through employment, while impacting the kingdom.

An OM worker in Russia finds opportunities to share Christ's love with members of the Romani ethnic group.

During outreach to a Tatar village, the team met a woman at the well and introduced her to Jesus.

OM Philippines sees signs of hope in the midst of tragic loss while extending help to churches wrecked by Typhoon Pablo (Bopha).

Forty new students registered for OM Philippines-Cebu’s Alternative Learning System (ALS) programme in June, and by faith, their financial needs have been met.

Students from OM Philippines-Cebu's Alternative Learning System bring children joy through a Christmas party, following the trauma caused by Bohol earthquake and Typhoon Haiyan.

On 24 December, OM Philippines-Cebu witnessed the overflowing joy of about 135 families during Christmas parties they hosted in two typhoon-affected areas.

From Leyte Island to Northern Cebu to Bohol Island, the Christmas season brought overwhelming joy to many who received provision and care from OM Philippines.

How OM Philippines is making a long-term difference in the aftermath of Typhoon Haiyan.

OM Philippines send staff to assess the earthquake damages in Surigao City and provide needed disaster relief training.

Long-termers in Turkey get an unexpected opportunity to share the gospel while also representing the Turkish Post Office!

Newly married couple temporarily in Turkey uses spare time and unexpected opportunities to reach out to refugees.

God uses an OMer working amongst Kurdish refugees in Turkey to reach a whole family through one contact.

Two OM workers share the gospel while riding on buses in Turkey.

It has been four full years since she left Syria and now Fayima has seen the Light!

With OM Lifehope, Andrea works with a local church and growing church plant, providing her with many opportunities to build relationships with locals.

At Manna House, in the Greater London Area, guests from all over the world come for accommodation and a place to rest.

Two lifelong friends from the US bring a message of hope, friendship and a future to marginalised locals during OM Zambia’s first-ever wheelchair camp.

In Tongwa village husbands and wives don't know how to love each other. A young couple is working to change that.

It started with one ball and grew to become a garden.

“Seeing how these boys lived…put my own life into perspective,” said Anne Davidson, after spending time with youth living on the streets of Lusaka.

Dimas, the headman of a small village along the shores of Lake Tanganyika, shares about the challenges of being a headman and Christian.

A young man with a disability finds help at Mercy House and his grandmother finds a way to serve.

Testimony of a Greek woman.

A Greek woman embarks on a lonely journey to the Transform 2013 conference in Rome, a journey that began when she accepted Christ at 19.

OM Greece's involvement with refugees is always evolving. This summer the team is able to work in more camps and connect with more people.

Work of OM Romania, partnering with the church

Catherine, from the UK, joined an OM team in July to host a dental clinic and outreach for the residents of Pădureni.

OM founder George Verwer speaks at the Romanian Brethren Assembly about living a pure life and standing against the issue of abortion.

Since 2007, the Bus4Life has visited 150 locations, welcomed 10,000 visitors and touched many lives, including one Romanian teen who comes back to God.

Surprises await Bus4Life coordinator Esko when visiting a Romanian village: Meeting orphaned girls saved on a visit 26 years ago, and the former Chief of Police from the Communist era.

A community of believers from across the world come together to establish houses of prayer along what has been called the Isaiah 19 Highway.

Ten years ago, Lydia* arrived on the field as a single woman. Now married and with two kids, her method of ministry has changed entirely.

An OM training conference equips a local pastor with tools to transform his Sunday service for Syrian refugees.

Global crises provide unprecedented opportunities for OM workers to share truth with least-reached people from Syria, Somalia and Sudan.

During a three week outreach in November, OM Italy speaks to the heart of a young man called Antonio.

In January 2013, OM Norway and Norwegian Naval Training Agency agreed on internship programme for deckhands and motormen on board MV Logos Hope.

Slobodan never thought he could be free, but Jesus gave him a new start. Now Slobodan urges Roma in Croatia and Serbia that there is a better way.

With a cultural theme on Latin America, 231 participants from 40 countries have come together for the September GO conference in the Netherlands.

God is moving the Europe Riverboat Project on as a captain is found, a boat contracted, and volunteer crew begin to board.