Dietary glucosinolates derived isothiocyanates: chemical properties, metabolism and their potential in prevention of Alzheimer's disease.

Alzheimer's disease (AD) is the most prevalent form of dementia affecting millions of people worldwide. It is a progressive, irreversible, and incurable neurodegenerative disorder that disrupts the synaptic communication between millions of neurons, resulting in neuronal death and functional loss due to the abnormal accumulation of two naturally occurring proteins, amyloid ß (Aß) and tau. According to the 2018 World Alzheimer's Report, there is no single case of an Alzheimer's survivor; even 1 in 3 people die from Alzheimer's disease, and it is a growing epidemic across the globe fruits and vegetables rich in glucosinolates (GLCs), the precursors of isothiocyanates (ITCs), have long been known for their pharmacological properties and recently attracted increased interest for the possible prevention and treatment of neurodegenerative diseases. Epidemiological evidence from systematic research findings and clinical trials suggests that nutritional and functional dietary isothiocyanates interfere with the molecular cascades of Alzheimer's disease pathogenesis and prevent neurons from functional loss. The aim of this review is to explore the role of glucosinolates derived isothiocyanates in various molecular mechanisms involved in the progression of Alzheimer's disease and their potential in the prevention and treatment of Alzheimer's disease. It also covers the chemical diversity of isothiocyanates and their detailed mechanisms of action as reported by various in vitro and in vivo studies. Further clinical studies are necessary to evaluate their pharmacokinetic parameters and effectiveness in humans.

MRI-Based Effective Ensemble Frameworks for Predicting Human Brain Tumor.

The diagnosis of brain tumors at an early stage is an exigent task for radiologists. Untreated patients rarely survive more than six months. It is a potential cause of mortality that can occur very quickly. Because of this, the early and effective diagnosis of brain tumors requires the use of an automated method. This study aims at the early detection of brain tumors using brain magnetic resonance imaging (MRI) data and efficient learning paradigms. In visual feature extraction, convolutional neural networks (CNN) have achieved significant breakthroughs. The study involves features extraction by deep convolutional layers for the efficient classification of brain tumor victims from the normal group. The deep convolutional neural network was implemented to extract features that represent the image more comprehensively for model training. Using deep convolutional features helps to increase the precision of tumor and non-tumor patient classifications. In this paper, we experimented with five machine learnings (ML) to heighten the understanding and enhance the scope and significance of brain tumor classification. Further, we proposed an ensemble of three high-performing individual ML models, namely Extreme Gradient Boosting, Ada-Boost, and Random Forest (XG-Ada-RF), to derive binary class classification output for detecting brain tumors in images. The proposed voting classifier, along with convoluted features, produced results that showed the highest accuracy of 95.9% for tumor and 94.9% for normal. Compared to individual methods, the proposed ensemble approach demonstrated improved accuracy and outperformed the individual methods.

Acute Lymphoblastic Leukemia in an Adult After Renal Transplantation.

Solid organ transplant patients are at an increased risk of developing various types of malignancies including hematological ones. The mechanisms behind these malignant changes are multifactorial. These include immunosuppressive agents, pre-transplantation cancer recurrence in the recipient, and de novo cancer development. Acute lymphoblastic leukemia is a rare malignancy in renal transplant recipients. Here, we describe the case of an adult male patient who underwent renal transplantation for end-stage renal disease due to diabetes and hypertension. He developed high hyper-diploid acute lymphoblastic leukemia four months after transplantation. This case is unique due to the presence of the high hyper-diploid cytogenetics of the B-cell acute lymphoblastic leukemia (B-ALL) occurrence in an adult renal transplant recipient.

Impact of Lung Metastasis versus Metastasis of Bone, Brain, or Liver on Overall Survival and Thyroid Cancer-Specific Survival of Thyroid Cancer Patients: A Population-Based Study.

We investigate the impact of lung metastasis versus metastasis of bone, brain, or liver on overall survival (OS) and thyroid cancer-specific survival (TCSS) in patients with thyroid cancer (TC). Therefore, de-identified SEER 18 registry data of primary TC patients diagnosed between 2010 and 2016 were analyzed. The primary outcome was the prognosis of TC patients with lung metastasis compared with other sites. The secondary outcomes included the prognosis comparison between patients with and without surgery and between single and multiple metastasis sites. Isolated lung metastasis was associated with worse OS and TCSS than bone metastasis (both p < 0.05) and was associated with worse OS than liver metastasis (p = 0.0467). Surgery performed either for the primary or distant site was associated with better OS and TCSS in patients with metastasis of lung or bone (p < 0.05). Isolated lung metastasis was related to better OS and TCSS than lung−liver, lung−brain, and lung−other multiple metastases. The multivariable analysis revealed that age < 55 years, surgery to the primary site, and to the distant site(s) were associated with better outcomes, while T4 and Tx were associated with worse outcomes. Nevertheless, it revealed that the other race (i.e., any race other than white, black, or unknown) and male gender were associated with better TCSS only (p < 0.05). Isolated lung metastasis is associated with a worse prognosis in TC patients compared with bone or liver metastasis. Surgery performed either for the primary or distant site(s) is associated with better survival outcomes in TC patients with metastasis of lung or bone.

Role of Uric Acid Levels in the Development of Gestational Diabetes Mellitus: A Review.

Gestational diabetes mellitus (GDM) is a common disorder affecting pregnancy. Besides conventional risk factors, several novel risk factors have been linked to causing GDM. Increased serum uric acid levels, also termed hyperuricemia, are regarded as one of the significant risk factors for increased insulin resistance and GDM, causing detrimental impacts on both mother and child. The likelihood of developing GDM is at its peak during the first three months of pregnancy in patients with hyperuricemia. Still, its pathophysiology needs to be evaluated in detail. This review is aimed at assessing the function of hyperuricemia in the development of GDM.

A Systematic Review of the Link Between Autism Spectrum Disorder and Acetaminophen: A Mystery to Resolve.

The purpose of this study is to review the published papers investigating maternal acetaminophen (AP) use during pregnancy and its effect on the offspring's neurodevelopment, particularly autism spectrum disorders (ASD). Acetaminophen is an over-the-counter analgesic and antipyretic considered safe in pregnancy. Recent studies have found an association between acetaminophen and immune system alterations like asthma and adverse neurodevelopmental outcomes. We used online databases (PubMed/Medline/PubMed Central, Science Direct, and Google Scholar) to search the studies relevant to our topic. We screened the papers by titles, abstracts, and then full-text availability. The screened articles were checked for eligibility using relevant quality assessment tools for each study design, extracting and analyzing the data. We finalized 30 studies after the screening; 14 were ineligible. Our final selection included 16 high-quality papers - 13 prospective cohort studies, two review articles, and one meta-analysis. We found a wide range of neurodevelopmental outcomes in our data collection. So, we included autism spectrum disorders, intelligent quotient (IQ), attention-deficit/hyperactivity disorder (ADHD), isolated language, attention and executive function, communication, behavior, and psychomotor development. All studies showed an association between acetaminophen use and listed neurodevelopmental outcomes. Long-term use, increased dose, and frequency were associated with a stronger association. We extracted collective evidence from 16 studies suggesting acetaminophen's role in developing adverse neurodevelopmental outcomes. It is urgent to do more research on this association before pregnant women can be cautioned about the precise use of acetaminophen.

Adverse Obstetric Outcomes in Pregnant Women Using Natalizumab for the Treatment of Multiple Sclerosis: A Systematic Review.

Multiple sclerosis is a common disease in women of childbearing age, characterized by demyelination of the central nervous system. Among the different treatment options available, disease-modifying therapies (DMTs) are the most efficacious, and natalizumab (NAT) is an injectable DMT best for relapsing-remitting multiple sclerosis. However, it comes under pregnancy category C drug classification. This systematic review aims to analyze the adverse outcomes of using NAT during pregnancy. PubMed/Medline, PubMed Central (PMC), ScienceDirect, and Google Scholar were the databases used to search for articles. Appropriate keywords and Medical Subject Headings (MeSH) strategy were used to identify relevant articles. Articles were then screened using inclusion/exclusion criteria followed by the title and abstract screening. The Joanna Briggs Institute (JBI) quality appraisal tools were used for quality check, and nine articles were finalized for review. NAT suspension during pregnancy is shown to have a high risk of disease relapse. Despite the risk of mild hematological abnormalities in the newborn and the risk of spontaneous abortions at the same rate as that of the general population, NAT use can be considered safe in pregnancy. These adverse outcomes can be minimized by strict monitoring of patients. Studies of better quality with larger sample sizes are needed for further investigation.

The Value of Magnetic Resonance Imaging and Endorectal Ultrasound for the Accurate Preoperative T-staging of Rectal Cancer.

Magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) are essential imaging modalities to assess the depth of tumour invasion (T-staging) in rectal cancer preoperative staging. Accurate T-staging is critical for rectal cancer prognosis and has substantial importance in the determination of appropriate treatment strategies for rectal tumours. There seems to be a knowledge gap in the published literature regarding the most appropriate imaging modality for the preoperative staging of rectal cancer. The purpose of this study was to determine the most appropriate imaging technique for the preoperative T-staging of rectal cancer by comparing the MRI and ERUS staging. In this study, we performed a literature review of studies published in the last 10 years and compared the accuracy, sensitivity, and specificity of ERUS and MRI for the preoperative T-staging of rectal cancer with the aim of identifying the most appropriate imaging modality. The studies reviewed were selected by a rigorous literature search of academic databases. Three electronic databases (PubMed, CINAHL, and Scopus) were searched, and articles were identified. Further rescreening of the articles for those that met the inclusion criteria and searching of the citations of the articles produced eleven journal articles used in this research. Endorectal ultrasound produces accurate results for the T-staging of early rectal cancer, particularly T1 and T2, and has the ability to show the layers of the bowels more clearly in early-stage rectal cancer. However, MRI shows more accurate results for the staging of locally advanced tumours such as advanced T3 and T4 and is particularly important when estimating tumour invasion into the mesorectum, which is very important for the prognostication and survival of patients with rectal cancer. MRI has low accuracy for differentiating early T3 tumours from T1 or T2 with desmoplastic reactions, and therefore, is more likely to overstage these tumours.

Treatment Modalities for Dementia in Down's Syndrome: A Literature Review.

Down's syndrome (DS) is the most well-known chromosomal abnormality characterized by an extra chromosome 21 and multiple systemic issues. The higher production of amyloid precursor protein (APP), the precursor peptide of beta-amyloid, predisposes persons with DS to early Alzheimer's disease (AD). The prevalence of dementia has increased as a function of the extended life expectancy of persons with DS. Because we know little about the treatment of dementia in persons with DS, this review focuses on the pathophysiology and management strategies to improve the overall quality of life.

An Outlook on the Etiopathogenesis of Pulmonary Hypertension in HIV.

Although overall survival rates of patients infected with human immunodeficiency virus (HIV) have been significantly improved by antiretroviral therapy (ART), chronic comorbidities associated with HIV result in a worsening quality of life. Pulmonary arterial hypertension (PAH) is the most prevalent comorbidity associated with HIV infection. Despite low viremia and a non-replicative state maintained by ART, few people develop PAH. Previous data from animal models and human pulmonary microvascular endothelial cells (HPMVECs) suggests a constellation of events occurring during the propagation of HIV-associated PAH (HIV-PAH). However, these studies have not successfully isolated HIV virions, HIV-DNA, protein 24 antigen (p24), or HIV-RNA from the pulmonary endothelial cells (ECs). It provides an insight into an ongoing inflammatory process that could be attributed to viral proteins. Several studies have demonstrated the role of viral proteins on vascular remodeling. A composite of chronic inflammatory changes mediated by cytokines and growth factors along with several inciting risk factors such as Hepatitis C virus (HCV) co-infection, genetic factors, male predominance, illegal drug usage, and duration of HIV infection have led to molecular changes that result in an initial phase of apoptosis followed by the formation of apoptotic resistant hyperproliferative ECs with altered phenotype. This study aims to identify the risk factors and mechanisms behind HIV-PAH pathobiology at the host-pathogen interface at the intracellular level.

Factors Showing the Growing Relation Between Vitamin D, Metabolic Syndrome, and Obesity in the Adult Population: A Systematic Review.

Several theories suggest an inverse association between increasing adiposity, particularly abdominal fat, and low vitamin D levels. As a result, several routes are likely to impact how vitamin D, obesity, and metabolic syndrome (MetS) interact. This systematic study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A comprehensive PubMed, PubMed Central, Google Scholar, and ScienceDirect database search was conducted for published papers over the previous five years. Studies were identified using the following criteria 1) participants, interventions, and outcomes (PIO) components, 2) free full text, 3) studies published in English, and 4) human studies, including systematic and narrative reviews and cross-sectional, observational studies, were among the inclusion and exclusion criteria. In total, 151 articles were returned, and 16 duplicates were rejected. After verifying the titles and abstracts of these records using the review's PIO components and eligibility criteria, 17 received a 70% or above score. On review of the literature, the release of adiponectin from fatty tissues was inversely correlated with body weight and BMI suggesting a link between vitamin D deficiency and insulin resistance.

COVID-19 Crisis: How Can Plant Biotechnology Help?

The emergence of the COVID-19 pandemic has led to significant public health crisis all over the world. The rapid spreading nature and high mortality rate of COVID-19 places a huge pressure on scientists to develop effective diagnostics and therapeutics to control the pandemic. Some scientists working on plant biotechnology together with commercial enterprises for the emergency manufacturing of diagnostics and therapeutics have aimed to fulfill the rapid demand for SARS-CoV-2 protein antigen and antibody through a rapid, scalable technology known as transient/stable expression in plants. Plant biotechnology using transient/stable expression offers a rapid solution to address this crisis through the production of low-cost diagnostics, antiviral drugs, immunotherapy, and vaccines. Transient/stable expression technology for manufacturing plant-based biopharmaceuticals is already established at commercial scale. Here, current opinions regarding how plant biotechnology can help fight against COVID-19 through the production of low-cost diagnostics and therapeutics are discussed.

Biologia futura: medicinal plants-derived bioactive peptides in functional perspective-a review.

Bioactive peptides (BPs) are 3-20 amino acid residues, with a molecular weight lower than 6 kDa; originated from the breakdown of proteins by endogenous and exogenous peptidases. While intact in protein these peptides do not exert any biological activity, but as they release from their parent protein, they exert various pharmacological activities such as antidiabetic, antihypertensive, anticancerous, anti-inflammatory, antimicrobial, antioxidant, and immunomodulatory. Such peptides exist in all living organism like plants, animals, marine organism and also present in food products derived from them. BPs obtained from dairy food products, cereals, vegetables have been gaining much more importance now-a-days, but little work has been done on bioactive peptides obtained from medicinal plants. Some of the medicinal plants such as Tinospora cordifolia Sterculia foetida, Benincasa hispida, Parkia speciosa, Linum usitatissimum, Salvia hispanica and Ziziphus jujube have been explored for bioactive peptides. Current review is aimed to provide a complete information of medicinal plants derived BPs along with the surge of new materials, new plants which will provide more solutions for handling some of the major human health problems of twenty-first century. This review will also be helpful to researchers in providing valuable information about the extraction, separation, characterization of BPs, their known peptide sequences and various pharmacological activities exerted by medicinal plants-derived bioactive peptides.

Managing plastic waste disposal by assessing consumers' recycling behavior: the case of a densely populated developing country.

The rapid increase in urbanization has given rise to the need of proper waste management. Within municipal waste, the plastic waste is a growing concern which is causing severe harm to our ecosystem. If ignored, this problem will have harmful effects on both human and wildlife. Therefore, this study aims to find out the factors that influence the recycling behavior patterns of consumers regarding plastic waste. The variables from the theory of planned behavior were adopted to study the behavior of consumers toward recycling plastic waste. The data was collected from 243 residents of Karachi-metropolitan city of Pakistan. The partial least square-structural equation modelling was applied to analyze the data. The findings of the current study reveal that different consumers' attributes and attitudes trigger different types of recycling behavior when it comes to waste disposal. Pressure from family and friends and perceived behavioral control trigger the behavior of reselling the waste plastic products while consumer's awareness of consequences and personal attitude toward proper waste disposal leads to reuse or donating that product to someone who can use that plastic product. The understanding of these consumer attributes may help to shape the behavioral outcomes in order to manage waste disposal. This study will be beneficial for business managers looking to improve reverse logistics as well as government/municipal policy makers and academics/researchers who are interested in a solution-oriented study.

Eye Donation Awareness and Conversion Rate in Hospital Cornea Retrieval Programme in a Tertiary Hospital of Central India.

INTRODUCTION: Corneal blindness accounts for 6-8 million blinds in the world. In India, it is estimated that there are approximately 6.8 million people who have vision less than 6/60 in at least one eye due to corneal diseases. AIM: This study was done to assess the awareness about eye donation amongst attendants of critically ill and deceased patients, their willingness to donate eyes, the efficacy of grief counselling by Eye Donation Counsellors (EDC), its impact on the conversion rate and the reasons for poor donation rate. MATERIALS AND METHODS: This prospective hospital based study was done in 554 participants (guardians of critically ill and deceased subjects) to understand the awareness of eye donation. Factors related to willingness for eye donation that influenced conversion to actual donation were evaluated. Data was analysed with tests for statistical significance: Chi square test; p<0.05 at 95% confidence interval was set as significant. RESULTS: Awareness index particularly in males <40 years, was found to be statistically more. In participants who were partially/fully aware of eye-donation, time taken for motivation remained less than 12 hours, which was statistically significant (Chi square=106. p<0.001). Subject who were aware, willing for donation in comparison to those who were unaware in a ratio of 2:1. Grief counsellors (57.5%) had the most influence among the causes that were facilitators of donation. CONCLUSION: Utilizing the services of eye donation counsellors is a promising way to motivate the guardians of deceased. Increasing the awareness in society, rendering simple assistances to next of kin and speeding the medico legal formalities can go a long way in increasing the conversion rate and hence actual donation.

A rapid method for sensitive profiling of folates from plant leaf by ultra-performance liquid chromatography coupled to tandem quadrupole mass spectrometer.

Previous published methods for the analysis of folates are time consuming because of lengthy sample extraction, clean-up and total running time. This study details the development and validation of a rapid, sensitive and robust method that combines a simple extraction step with ultra-performance liquid chromatography coupled to tandem quadrupole mass spectrometry. Here, we reported application of a tandem quadrupole mass spectrometer to analyze maximum seven vitamers of folate from plant origin. The analytical performance was evaluated by linearity, sensitivity, precision, recovery test and analysis of certified reference materials. The limit of detection and limit of quantification ranged between 0.003 and 0.021µg/100g FW and between 0.011 and 0.041µg/100g FW, respectively; the recovery and precession ranged from 71.27 to 99. 01% and from 1.7 to 7.8% RSD, respectively, depending upon folate vitamers. This newly developed and validated method is rapid (a chromatographic run time of 5min), easy to be performed (no laborious and time consuming clean-up) and can be used to simultaneously analyze seven vitamers of folate from plant sources.

Low-dose CT for the detection and classification of metastatic liver lesions: Results of the 2016 Low Dose CT Grand Challenge.

PURPOSE: Using common datasets, to estimate and compare the diagnostic performance of image-based denoising techniques or iterative reconstruction algorithms for the task of detecting hepatic metastases. METHODS: Datasets from contrast-enhanced CT scans of the liver were provided to participants in an NIH-, AAPM- and Mayo Clinic-sponsored Low Dose CT Grand Challenge. Training data included full-dose and quarter-dose scans of the ACR CT accreditation phantom and 10 patient examinations; both images and projections were provided in the training data. Projection data were supplied in a vendor-neutral standardized format (DICOM-CT-PD). Twenty quarter-dose patient datasets were provided to each participant for testing the performance of their technique. Images were provided to sites intending to perform denoising in the image domain. Fully preprocessed projection data and statistical noise maps were provided to sites intending to perform iterative reconstruction. Upon return of the denoised or iteratively reconstructed quarter-dose images, randomized, blinded evaluation of the cases was performed using a Latin Square study design by 11 senior radiology residents or fellows, who marked the locations of identified hepatic metastases. Markings were scored against reference locations of clinically or pathologically demonstrated metastases to determine a per-lesion normalized score and a per-case normalized score (a faculty abdominal radiologist established the reference location using clinical and pathological information). Scores increased for correct detections; scores decreased for missed or incorrect detections. The winner for the competition was the entry that produced the highest total score (mean of the per-lesion and per-case normalized score). Reader confidence was used to compute a Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit, which was used for breaking ties. RESULTS: 103 participants from 90 sites and 26 countries registered to participate. Training data were shared with 77 sites that completed the data sharing agreements. Subsequently, 41 sites downloaded the 20 test cases, which included only the 25% dose data (CTDIvol = 3.0 ± 1.8 mGy, SSDE = 3.5 ± 1.3 mGy). 22 sites submitted results for evaluation. One site provided binary images and one site provided images with severe artifacts; cases from these sites were excluded from review and the participants removed from the challenge. The mean (range) per-lesion and per-case normalized scores were -24.2% (-75.8%, 3%) and 47% (10%, 70%), respectively. Compared to reader results for commercially reconstructed quarter-dose images with no noise reduction, 11 of the 20 sites showed a numeric improvement in the mean JAFROC figure of merit. Notably two sites performed comparably to the reader results for full-dose commercial images. The study was not designed for these comparisons, so wide confidence intervals surrounded these figures of merit and the results should be used only to motivate future testing. CONCLUSION: Infrastructure and methodology were developed to rapidly estimate observer performance for liver metastasis detection in low-dose CT examinations of the liver after either image-based denoising or iterative reconstruction. The results demonstrated large differences in detection and classification performance between noise reduction methods, although the majority of methods provided some improvement in performance relative to the commercial quarter-dose images with no noise reduction applied.

Inhibition of prostate cancer-meditated osteoblastic bone lesions by the low-calcemic analog 1alpha-hydroxymethyl-16-ene-26,27-bishomo-25-hydroxy vitamin D3.

Prostate cancer metastasizes almost exclusively into the bone whereby it induces primarily an osteoblastic response. Non-calcemic vitamin D analogs have been shown to inhibit proliferation of prostate cancer cells in culture and inhibit their growth as subcutaneous xenografts in mice. However, their effect on prostate cancer cell growth in the bone has not been examined. In the present study, we inoculated the osteoblastic prostate cancer cell line MDA-PCa 2b into the bone of male SCID mice and examined the effect of the low-calcemic hybrid analog 1alpha-hydroxymethyl-16-ene-26,27-bishomo-25-hydroxy vitamin D(3) (JK-1626-2) on their ability to induce bone lesions. We found that 7 weeks after inoculation of MDA-PCa 2b cells, 90% of the mice in the vehicle-treated group had significant bone lesions that were detectable by micro-computed tomography and characterized by thickening of the cortical bone and ossification of the epiphysis. Only 30% of the mice in the analog-treated group (daily injections of 4microg/kg, 5 days/week for up to 7 weeks) had detectable bone lesions. Histological examination of the decalcified tumor-bearing bones has shown that tumor cells completely replaced the bone marrow in the diaphysis, and destroyed the trabecular bone in the metaphysis in 90% of the vehicle-treated mice. In contrast, the metaphysis of 60% of analog-treated mice appeared normal, although tumor cells were still found in the diaphysis of 70% of the bones in the analog-treated group. There was no evidence of hypercalcemia in any of the analog-treated mice. In a co-culture, MDA-PCa 2b cells induced a profound mitogenic response in osteoblasts followed by enhanced differentiation. However, in the presence of the analog the mitogenic response of the osteoblasts to the malignant cells was significantly attenuated. These experiments led to the hypothesis that, in vivo, JK-1626-2 prevented the metastatic bone lesions by inhibiting the mitogenic response of osteoblasts to growth factors produced by MDA-PCa 2b cells.

Auditory processing disorders: training of speech-language therapists and audiologists within the South African context.

This study examined the nature of the undergraduate curricula for Auditory Processing Disorders (APD) for communication pathologists (speech-language therapists and audiologists) within the South African context. An exploratory descriptive survey design was utilised. The respondents (N=9) were the authoritative voices in the area of APD, i.e. academics based at training institutions involved in the training of Speech-Language Therapists and Audiologists in the field of APD. They represented the five institutions providing training in APD at the time of data collection. A specifically designed questionnaire and the course descriptors and/or study guides were used to obtain information on the APD training programmes at each institution. A curriculum analysis framework was utilised to analyse the curricula (Jansen & Reddy, 1998). The study found no standard with regard to lecture and clinical time allocation. The time allocated to the theoretical training in APD across the training institutions varied significantly from 4 hours 30 minutes to 53 hours and that for clinical training varied from 7 to 48 hours. However, the results showed that the curricula offered in APD at all training institutions compared favourably with international trends. Information was not forthcoming on how the South African social and contextual issues were incorporated into training in APD.