--Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India.

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

Gastrointestinal Uses of Botulinum Toxin.

Botulinum toxin (BT), one of the most powerful inhibitors that prevents the release of acetylcholine from nerve endings, represents an alternative therapeutic approach for "spastic" disorders of the gastrointestinal tract such as achalasia, gastroparesis, sphincter of Oddi dysfunction, chronic anal fissures, and pelvic floor dyssynergia.BT has proven to be safe and this allows it to be a valid alternative in patients at high risk of invasive procedures but long-term efficacy in many disorders has not been observed, primarily due to its relatively short duration of action. Administration of BT has a low rate of adverse reactions and complications. However, not all patients respond to BT therapy, and large randomized controlled trials are lacking for many conditions commonly treated with BT.The local injection of BT in some conditions becomes a useful tool to decide to switch to more invasive therapies. Since 1980, the toxin has rapidly transformed from lethal poison to a safe therapeutic agent, with a significant impact on the quality of life.

Ending the epidemic of HIV/AIDS by 2030: Will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries?

The third Sustainable Development Goal (SDG-3) has a target to end the epidemic of HIV/AIDS by 2030 (Project 2030). This will be achieved when the number of new HIV infections and 'AIDS-related deaths' decline by 90% between 2010 and 2030. So far, the rate of drop in AIDS-related deaths is on track, whereas the rate of drop in new HIV infections is off track to achieve Project 2030. Even if Project 2030 was achieved, HIV would be an endemic health problem. Hence, HIV prevention and control programmes cannot close down for the foreseeable future. This rather demands a paradigm shift from a fully vertical to an integrated health systems response that provides services according to disease burden towards universal health coverage. This will ensure the sustainability of HIV services in the post-2030 era. These all entail unrelenting political commitment, and increased and sustainable funding from both national and global sources.

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping.

People who sleep rough/experience unsheltered homelessness face barriers accessing mainstream healthcare and psychosocial services. The barriers to service access exacerbate poor health, which in turn create additional challenges for rough sleepers to access health and psychosocial services, including stable housing. The study presents descriptive statistics to identify housing outcomes of people working with a Multidisciplinary Model that comprises integrated healthcare and psychosocial support, and qualitative data with clients and service providers to investigate how the Model is experienced and delivered in practice. Fieldwork was conducted between December 2016 and March 2018 with the Multidisciplinary Team operating in Cairns, in the far north of Australia. Qualitative data are drawn from in-depth interviews with 26 rough sleepers and 33 health and psychosocial service providers from the Multidisciplinary Team and the wider service system. Descriptive statistics show that 67% of clients who were sleeping rough were supported to immediately access stable housing, and at the end of the program, all clients remained housed. The qualitative findings illustrated how integrated healthcare and psychosocial outreach enabled people sleeping rough to overcome barriers they experienced accessing mainstream healthcare and other services. With the benefit of healthcare, people felt sufficiently well to engage with the psychosocial service providers to have their housing and other psychosocial needs addressed. This article demonstrates how individual responsibility for and control over healthcare is not only a matter of the individual, but also a matter requiring systems change and the active provision of resources to cater for the constraints and opportunities present in people's immediate environments.

Leaf venation pattern to recognize austral South American medicinal species of "cow's hoof" (Bauhinia L., Fabaceae)

ABSTRACT The leaves extracts of some species of Bauhinia L. s.l. are consumed to treat diabetes, inflammation, pains and several disorders in traditional medicine in austral South America. Despite its wide use and commercialization, sale is not controlled, and botanical quality of samples is not always adequate because of plant misidentification and adulteration. Here, we characterized leaf vein pattern in nineteen taxa to contribute to the recognition and commercial quality control of plant material commercially available. The vein characters intercostal tertiary and quinternary vein fabric, areole development and shape, free ending veinlet branching and marginal ultimate venation allowed to distinguish the main medicinal species in the region.

Effect of Electroacupuncture at the Beginning and Ending Points of Bicipital Muscle on the Superficial Electromyography of the Spastic Limb in Hemiplegia / 上海针灸杂志

Objective To observe the effect of electroacupuncture at the beginning and ending points of bicipital muscle on the superficial electromyography (sEMG) of the spastic limb in hemiplegia.Method Forty patients with spastic hemiplegia after cerebral stroke were divided by the random number table into a group of electroacupuncture at the beginning and ending points (group A) and a group of electroacupuncture at antagonistic muscles (group B). The former selected Ashi points at the beginning and ending points of bicipital muscle, while the latter selected points at the antagonistic muscles [Tianjing (TE10), Qinglingyuan (TE11), etc.], to receive perpendicular puncturing. The needles were retained for 30 min, and the sEMG of bicipital muscles in resting state was detected after the removal of the needles. The spastic bicipital muscle was examined by sEMG prior to the acupuncture treatment, and respectively after 2-week and 4-week acupuncture treatment, and the detected parameters included root mean square (RMS) and integrated electromyography (IEMG).ResultThe EMG and IEMG declined gradually in the two groups after the acupuncture treatment; the intra-group comparisons of the RMS and IEMG values at three time points, e.g. prior to acupuncture treatment, after 2-week acupuncture treatment and after 4-weekacupuncture treatment, showed that the values changed significantly compared to those at the previous time point (P0.05). The RMS and IEMG values presented same changing tendencies after 4-week acupuncture treatment in the two groups.ConclusionAcupuncture at the beginning and ending points and at the points on antagonistic muscles both can decrease the resting-state muscle tension in hemiplegia patients; sEMG is of certain significance in evaluating the treatment of hemiplegia.

Human skin as revealed by optical and electron microscopy / 全日本鍼灸学会雑誌

[Objective]The skin is the biggest organ in the body. The human epidermis functions as a defence against various antigens in addition to physical and bio-chemical protection. The dermis consists of dense connective tissue which contains the circulatory system and sensory nerve endings. In this paper, regional differences in the structures of human skin are described.<BR>[Materials and Methods]The skin of different regions in the human body was examined by optical and electron microscopy and by utilizing various morphological techniques. <BR>[Results and Discussion]Epidermis:The cornified layer in the finger pulp and heel, which receives strong mechanical stimuli, is considerably thicker than other regions. The germinal layer consisting of spinous and basal layers becomes thinner with aging. Langerhans cells that produce antigens are scattered in the germinal layer. Furthermore, Merkel cells situated at the basal layer are found in the finger pulp, bottom of the foot and the hair disks of limbs. These cells are involved in the sense of touch or pressure. Dermis:The dermis is divided into the papillary and reticular layers, which consist of loose and dense connective tissue, respectively. In the papillary layer, fibrocytes and mast cells are distributed. Large-sized dermal papillae are found the in finger pulp and bottom of the foot, but there are also a few small papillae in other regions. In large papillae, loops of blood capillaries and Meissner's tactile corpuscles were observed. In addition, large-sized lymphatic capillaries are present in the papillary layer.A dense network of free endings, which are situated beneath the epidermis and are responsible for thermal nociception, are abundant in the face, palm, forearm and sacrum. Corpuscles of Vater-Pacini situated in the deep dermis or subcutaneous tissue are found in the finger pulp, and bottom of the foot. <BR>[Conclusion]In conclusion, it is likely that acupuncture and moxibustion may directly or indirectly stimulate Langerhans cells, Merkel cells, fibrocytes, mast cells or various nerve endings.