Review: Evaluating existing policies to address overweight and obesity in the Anglophone Caribbean: A narrative review of Barbados, Grenada, St. Lucia, and Trinidad & Tobago.

Overweight and obesity continues to be a burden to the health and well-being of Caribbean residents. The rise of childhood obesity and non-communicable diseases within the Caribbean is a major public health challenge for policymakers, educators and health professionals. These alarming rates of obesity also pose a threat to the sustainability of existing health systems particularly in small island developing states like the Caribbean. Therefore, it is crucial to evaluate existing policies and create policy solutions to address these problems and reduce the potential impact later on. This systematic review explored existing policies among countries within the Anglophone Caribbean to identify trends within the region. The literature search focused on the following themes: (i) national policies (ii) school nutrition policies and programs (iii) physical activity among youth, and (iv) food import bill and food security. An analysis was conducted on literature from national, regional and international institutions including but not limited to the World Health Organization, Ministries of Health and the Healthy Caribbean Coalition. Countries throughout the region has acknowledged the challenges with overweight and obesity in the region. Collectively decisions have been made to address food insecurity and promote healthy lifestyle behaviours through policy changes. There's still a need for Caribbean countries to work together to create effective policy solutions in collaboration with community service organizations and other stakeholders. As small island developing states grappling with the same issues, pooling resources to create effective regional policies can help to address this public health crisis.

Case Report Detailing an Inferior Myocardial Infarction, Third-Degree Heart Block, and Cardiogenic Shock.

An infarction in the right coronary artery affects the inferior wall of the heart and can also cause impedance to the cardiac conduction system. The right coronary artery perfuses the sinoatrial and atrioventricular nodes, and a loss of blood flow contributes to a breakdown in the communication system within the heart, causing associated bradycardias, heart blocks, and arrhythmias. This case report details the prehospital and emergency care of a middle-aged man who experienced an inferior myocardial infarction, concomitant third-degree heart block, and subsequent cardiogenic shock, with successful revascularization. This case is informative for emergency clinicians to review symptoms of acute coronary syndrome, rapid lifesaving diagnostics and intervention, and the unique treatment and monitoring considerations associated with right ventricular involvement and third-degree heart block.

Phase transitions in fluctuations and their role in two-step nucleation.

We consider the thermodynamic behavior of local fluctuations occurring in a stable or metastable bulk phase. For a system with three or more phases, we present a simple analysis based on classical nucleation theory that predicts thermodynamic conditions at which small fluctuations resemble the phase having the lowest surface tension with the surrounding bulk phase, even if this phase does not have a lower chemical potential. We also identify the conditions at which a fluctuation may convert to a different phase as its size increases, referred to here as a "fluctuation phase transition" (FPT). We demonstrate these phenomena in simulations of a two dimensional lattice model by evaluating the free energy surface that describes the thermodynamic properties of a fluctuation as a function of its size and phase composition. We show that a FPT can occur in the fluctuations of either a stable or metastable bulk phase and that the transition is first-order. We also find that the FPT is bracketed by well-defined spinodals, which place limits on the size of fluctuations of distinct phases. Furthermore, when the FPT occurs in a metastable bulk phase, we show that the superposition of the FPT on the nucleation process results in two-step nucleation (TSN). We identify distinct regimes of TSN based on the nucleation pathway in the free energy surface and correlate these regimes to the phase diagram of the bulk system. Our results clarify the origin of TSN and elucidate a wide variety of phenomena associated with TSN, including the Ostwald step rule.