Discrepancies in Gleason score between needle core biopsy and radical prostatectomy specimens with correlation between clinical and pathological staging.

BACKGROUND: The studies have shown that GS given after assessment of the entire prostate gland on the radical prostatectomy specimen may differ from GS given after examination of a small sample from needle core biopsy. We conducted this study to assess discrepancies in the Gleason score between NCB and RP specimens and to find out the correlation between the clinical stage and pathological stage. METHODS: The study included 174 patients with carcinoma prostate which underwent robotic-assisted radical prostatectomy (RARP). Pre-operative Gleason score was determined on 12-core biopsy samples under trans-rectal ultrasound (TRUS) guidance. The Gleason score obtained from the radical prostatectomy specimen was compared with that of the NCB Gleason score to find out differences. RESULTS: The preoperative Gleason score (GS) ranges from 6 to 9 with a mean GS of 6.97 ± 1.02. The post-operative GS ranges between 6 and 10 with mean and GS of 7.5 ± 1.10. On the pre-operative assessment of biopsy specimens, 70 (43.2%) patients had a GS of 6, while 44 patients had a GS of 7 (27.1%) and 48 (29.8%) patients had a GS of more than 7. On the postoperative assessment of specimens, 31 (19.1%) patients had post-operative GS of 6, while 66 (41%) patients had GS of 7 and 74 (41.1%) patients had GS of more than 7. When pre-operative GS and post-operative GS were compared, no changes were observed in the GS of 79 patients, whereas 83 patients showed the difference in GS, with 75 patients showing up-gradation and eight patients marked as down-graded. CONCLUSION: concordance between biopsy and the pathology results directly affects the prognosis of the patient. The results of our study demonstrated the rate of discordance between Gleason scores obtained from transrectal prostate biopsy and RP surgical specimens. This rate brings into question the accuracy of the chosen treatment.

Dandelion (Taraxacum officinale): A Promising Source of Nutritional and Therapeutic Compounds.

BACKGROUND: Taraxacum officinale, commonly referred to as dandelion, is a selfgrowing plant/ weed in various parts of India and the rest of the world (particularly the northern hemisphere). The plant's chemical composition, including sesquiterpene lactones, saponins, flavonoids, phenols, and many other compounds, contributes positively to the human body, promoting overall health. AIM: This review aims to shed light on the therapeutic potential of dandelion by summarizing its nutritional benefits, phytochemical constituents, and effectiveness in addressing health conditions like diabetes, inflammation, and cancer. It also provides insights into the applications of this plant beyond the food industry to gain researchers' attention to unravel the unexplored aspects of this therapeutic plant. It will further help in laying specific considerations, which are required to be taken into account before the development of functional foods incorporated with dandelion. Scope and approach: Being rich in essential vitamins, minerals, and other phytoconstituents, dandelion is a natural remedy for various ailments. Whether consumed raw or cooked, the plant's inclusion in the diet poses potential therapeutic effects on conditions such as diabetes, inflammation, liver disease, and tumors. It also aids in immune system modulation and fights infections by targeting microbes at their root. Researchers have developed various value-added food products by incorporating different parts of dandelion. CONCLUSION: This review highlights the therapeutic potential of dandelion, emphasizing its effectiveness against various health conditions. Insights into dosage, toxicity, and diverse applications further underscore its role as a versatile and promising natural remedy.

An overview on the types, applications and health implications of fat replacers.

Driven by the demand of consumers for low-fat foods, the field of fat replacers has made a tremendous breakthrough over the past decade. A fat replacer is a substance that replaces whole or part of the fat in food while asserting the same physiological properties. Based on the source, fat replacers can be carbohydrate, protein or lipid-based. They serve two major purposes in food viz. reducing the calorie content and amount of fat used in the preparation of food products as well as impart fat-like properties. Fat replacers exhibit its functionalities by providing texture, acting as stabilizers, emulsifiers, gelling and thickening agents. It is crucial to select the proper kind of fat replacer because fat functionality varies considerably depending on the meal type and the formulation. Evidence suggests that reducing fat intake can help in controlling body weight and the risk of diseases like type-2 diabetes, hypertension and cardiovascular disease. Consumers should not be misled into believing that fat and calorie-reduced foods may be consumed indefinitely. Fat replacers are most beneficial when they aid in calorie control and promote the consumption of meals that provide essential nutrients. This review aims to provide a deep insight into the fact that fat replacers can be utilized in various food commodities in order to meet the dietary guidelines for reducing fat intake with a healthy lifestyle and prudent dietary approach.

Assessing pentafecta outcomes post radical cystectomy: A tertiary care center study.

INTRODUCTION: Bladder cancer is a common and serious disease globally, often requiring radical cystectomy as the preferred treatment. However, this procedure carries substantial risks and complications. To evaluate its success, pentafecta, a five-component measure, was introduced. This study investigates the attainment of pentafecta following radical cystectomy and examines factors that influence its achievement. METHODOLOGY: This retrospective, single-group study was conducted at AIIMS Jodhpur. The study population included 42 patients who underwent radical cystectomy for bladder cancer. Various data, including demographic characteristics, clinical features, surgical techniques, and postoperative outcomes, were collected from medical records. The primary outcome measure was the rate of achieving pentafecta, which comprises five parameters. RESULTS: Out of 42 patients, 26 (61.9%) achieved pentafecta. Age, gender, comorbidities and surgical approach did not significantly affect the attainment of pentafecta. Negative surgical margins were achieved in 95.2% of cases, and adequate lymph node dissection (>16 lymph nodes) was performed in 85.7% of cases. The absence of Clavien-Dindo grade 3-5 complications and recurrence was observed in 80.9% and 90.47% of cases, respectively. Uretero-enteric stricture was absent in 95.2% of cases. CONCLUSION: The study emphasizes the significance of negative surgical margins, thorough lymph node dissection, absence of complications, recurrence, and uretero-enteric strictures in evaluating the success of radical cystectomy as pentafacta outcomes. Patients with higher drain output and wound infections are less likely to achieve pentafacta outcome and indicates poorer outcome. By considering these factors, clinicians can assess patient outcomes and identify areas for improvement.

Correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy.

BACKGROUND: In addition to ensuring cancer control, prevention of incontinence which significantly impact patients' quality of life, is also an important issue in robot-assisted radical prostatectomy (RARP) operations. In this study, we aimed to find the correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy. METHODS: This study included 162 patients treated with RARP with perioperative data and at least 1 year of follow-up. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. The continence recovery rate in our study was assessed at 6th week, 3rd month, 6th month, 9th month, and 12th month, post-surgery. Logistic regression analysis evaluated the association between the predictive factors and urinary continence recovery in the early and late stages. RESULTS: The majority of patients with prostate cancer present in sixth decade of life. The majority of our patients (56.7%) were categorized as high risk using D'Amico classification. The continence rate in our study at 6th week, 3rd month, 6th month, 9th month, and 12th month were 40.1%, 72.2%, 85.2%, 89.5%, and 91.4%, respectively. No improvement in continence status was observed after 1 year in our study. There was significant correlation of age with continence status at 6th week, 3rd month, and 6th month. The young age is associated with early recovery of continence. At 3 and 9 months, the non-diabetics cases achieved significantly higher continence rates than diabetics (p < 0.05) which shows that diabetes causes delay in attainment of continence. CONCLUSION: The young age may be associated with early recovery of continence, but further validation requires large number of cases. We attributed good continence recovery rate to meticulous dissection and preservation of good urethral length.

Genetics, Nutrition, and Health: A New Frontier in Disease Prevention.

The field of nutrition research has traditionally focused on the effects of macronutrients and micronutrients on the body. However, it has become evident that individuals have unique genetic makeups that influence their response to food. Nutritional genomics, which includes nutrigenetics and nutrigenomics, explores the interaction between an individual's genetic makeup, diet, and health outcomes. Nutrigenetics studies the impact of genetic variation on an individual's response to dietary nutrients, while nutrigenomics investigates how dietary components affect gene regulation and expression. These disciplines seek to understand the impact of diet on the genome, transcriptome, proteome, and metabolome. It provides insights into the mechanisms underlying the effect of diet on gene expression. Nutrients can cause the modification of genetic expression through epigenetic changes, such as DNA methylation and histone modifications. The aim of nutrigenomics is to create personalized diets based on the unique metabolic profile of an individual, gut microbiome, and genetic makeup to prevent diseases and promote health. Nutrigenomics has the potential to revolutionize the field of nutrition by combining the practicality of personalized nutrition with knowledge of genetic factors underlying health and disease. Thus, nutrigenomics offers a promising approach to improving health outcomes (in terms of disease prevention) through personalized nutrition strategies based on an individual's genetic and metabolic characteristics.

Genetic differences among individuals affect the metabolism, gene regulation, and sensitivity of disease in response to diet therefore traditional nutrition research expands to integrate the influence of genetics on the dietary response of an individual.Nutritional genomics which includes the reciprocal and complementary field of nutrigenetics and nutrigenomics, studies the interactions between gene and dietary components.Nutrigenetics studies the genetic effect on the metabolism of nutrients while Nutrigenomics explores the impact of nutrients on genetic expression thus shaping personalized dietary requirements.A personalized dietary approach based on comprehensive genomic profiling (genomics, proteomics, metabolomics, transcriptomics) can help to promote health and prevent illness.

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy.

Associations, unions and other organised groups representing health workers play a significant role in the development, adoption and implementation of health policy. These representative health worker organisations (RHWOs) are a key interface between employers, governments and their members (both actual and claimed), with varying degrees of influence and authority within and across countries. Existing research in global health often assumes-rather than investigates-the roles played by RHWOs in policy processes and lacks analytical specificity regarding the definitional characteristics of RHWOs. In this article, we seek to expand and complicate conceptualisations of RHWOs as key actors in global health by unpacking the heterogeneity of RHWOs and their roles in policy processes and by situating RHWOs in context. First, we define RHWOs, present a typology of RHWO dimensions and discuss perceived legitimacy of RHWOs as policy actors. Next, we unpack the roles of RHWOs in policy processes and distinguish RHWO roles in regulation from those of regulatory agencies. The final sections situate RHWOs in political and labour relations contexts, and in sociohistorical contexts, with attention to institutional frameworks, professional hierarchies and intersectional factors such as race, gender, sexuality, class, caste and religion. We conclude by outlining research gaps in the study of RHWOs and policy, and by encouraging global health researchers and practitioners to incorporate an expanded focus on these actors. Taking this approach will generate a wider range of strategies to better engage these organisations in policy processes and will ensure stronger health workforce policies globally.

Nutritional management and interventions in complications of pregnancy: A systematic review.

Background: Pregnancy, also known as the "gestation period" which lasts for 37-40 weeks, has been marked as the period of "physiological stress" in a woman's life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.

Effect of Liposomal Encapsulation and Ultrasonication on Debittering of Protein Hydrolysate and Plastein from Salmon Frame.

The impacts of liposomal encapsulation on the bitterness of salmon frame protein hydrolysate (SFPH) and salmon frame protein plastein (SFPP) with the aid of ultrasound (20% amplitude, 750 W) for different time intervals (30, 60 and 120 s) were investigated. Liposomes loaded with 1% protein hydrolysate (L-PH1) and 1% plastein (L-PT1) showed the highest encapsulation efficiency and the least bitterness (p < 0.05). Ultrasonication for longer times reduced encapsulation efficiency (EE) and increased bitterness of both L-PH1 and L-PT1 along with a reduction in particle size. When comparing between L-PH1 and L-PT1, the latter showed less bitterness due to the lower bitterness in nature and higher entrapment of plastein in the liposomes. In vitro release studies also showed the delayed release of peptides from L-PT1 in comparison to the control plastein hydrolysate. Therefore, encapsulation of liposomes with 1% plastein could be an efficient delivery system for improving the sensory characteristics by lowering the bitterness of protein hydrolysates.

Spirulina- An Edible Cyanobacterium with Potential Therapeutic Health Benefits and Toxicological Consequences.

Spirulina is a blue-green algae which is cultivated not only for its maximum protein content but also due to the presence of other essential nutrients such as carbohydrates and vitamins (A, C and E). It is also a storehouse of minerals including iron, calcium, chromium, copper, magnesium, manganese, phosphorus, potassium, sodium and zinc. Simultaneously, γ- linolenic acid (an essential fatty acid), as well as pigments such as chlorophyll A and phycobiliproteins (C-phycocyanin, allophycocyanin and ß-carotene), is also a major component of its rich nutritional profile. Spirulina is known to have various promising effects on the prevention of cancer, oxidative stress, obesity, diabetes, cardiovascular diseases and anemia. Moreover, it also plays a positive role in treating muscular cramps. The safety recommended dosage of Spirulina is approximately 3-10 g/d for adults and it's biological value (BV) is 75 with a net protein utilization (NPU) of 62. Spirulina does not have pericardium due to which it does not hinder the absorption of iron by chelation with phytates or oxalates. On the contrasting note, it may have some adverse effects due to the toxins (microcystins, ß-methylamino-L-alanine (BMAA)) produced by Spirulina which might contribute to acute poisoning, cancer, liver damage as well as gastrointestinal disturbances. Its long-term consumption may also lead to the pathogenesis of Alzheimer's disease and Parkinson's disease. The current review focuses on the various aspects of spirulina including its cultivation, nutritional composition, extraction techniques, health benefits, adverse effects, industrial scope and market value which could be beneficial for its utilization in the development of value-added products and supplementary foods due to its high content of protein and bioavailability of nutrients.

• Spirulina is a nutrient-dense cyanobacterium which is composed of protein, carbohydrates, vitamins, minerals, essential fatty acids, antioxidants and pigments including chlorophyll A and Phycocyanin.• To avoid the contamination of Spirulina species by other algae, the specific pH maintenance of the media around 9-11 (alkaline) is mandatory.• Positive effects were noticed on the yield and productivity of Spirulina after its biomass was grown in polybags and greenhouse.• Its beneficial effects have been identified in particular reference to obesity, diabetes, hypertension, cardiovascular diseases, anemia, cancer, oxidative stress, arthritis, immunity as well as muscular cramps.• The toxins such as microcystins and hepatotoxins, produced by Spirulina, are accountable to cause acute poisoning, liver damage, gastrointestinal disturbances and cancer.• The safe recommended dosage of Spirulina for adults accounts to approximately 3-10 g/d, with 30 g/d being the maximum limit for consumption.

Modulation of the autonomic nervous system by one session of spinal low-level laser therapy in patients with chronic colonic motility dysfunction.

Patients with a defecation disorder may not evoke a normal defecation reflex, or the reflex may be excessive, as a dysfunction of the spinal autonomic nervous system. Treatment with various forms of lumbar and sacral neuromodulation have shown symptom improvement, but potential changes in autonomic functioning are rarely studied. Here we evaluate the effects on autonomic function of a single session of low-level laser therapy (LLLT) on the lumbar and sacral spine in 41 patients with chronic gastrointestinal motor dysfunction. The LLLT protocol used red LED light at a wavelength of 660 nm for 10 min and infrared LED light at a wavelength of 840 nm for 10 min, followed by infrared laser light at a wavelength of 825 nm for 10 min. Effects on the autonomic nervous system were assessed by measuring heart rate variability (HRV) changes. Respiratory Sinus Arrhythmia (RSA) and Root Mean Square of Successive Differences (RMSSD) were used to quantify parasympathetic reactivity; the Baevsky's Stress Index (SI) reflected sympathetic activity while the ratios SI/RSA and SI/RMSSD were used to show shifts in autonomic dominance. The results indicate that lumbar and sacral neuromodulation using light arrays reduced, whereas stimulation by the laser probes significantly increased parasympathetic activity. The light arrays increased whereas the laser probes significantly decreased sympathetic activity (SI). The entire protocol shifted the autonomic balance toward parasympathetic activity. The comparison of actual vs. sham neuromodulation proved that the change in HRV parameters was due to actual light stimulation and not due to the arrays and probe touching the skin. In conclusion, a single session of LLLT markedly affects autonomic nervous system activity reflected in changes in HRV which is only possible by generating activity in the spinal autonomic nerves. These results warrant a study into the effects of LLLT on restoring autonomic dysfunction in chronic refractory colonic motility disorders.

Diagnosis of colonic dysmotility associated with autonomic dysfunction in patients with chronic refractory constipation.

We report the first study assessing human colon manometric features and their correlations with changes in autonomic functioning in patients with refractory chronic constipation prior to consideration of surgical intervention. High-resolution colonic manometry (HRCM) with simultaneous heart rate variability (HRV) was performed in 14 patients, and the resulting features were compared to healthy subjects. Patients were categorized into three groups that had normal, weak, or no high amplitude propagating pressure waves (HAPWs) to any intervention. We found mild vagal pathway impairment presented as lower HAPW amplitude in the proximal colon in response to proximal colon balloon distention. Left colon dysmotility was observed in 71% of patients, with features of (1) less left colon HAPWs, (2) lower left colon HAPW amplitudes (69.8 vs 102.3 mmHg), (3) impaired coloanal coordination, (4) left colon hypertonicity in patients with coccyx injury. Patients showed the following autonomic dysfunction: (1) high sympathetic tone at baseline, (2) high sympathetic reactivity to active standing and meal, (3) correlation of low parasympathetic reactivity to the meal with absence of the coloanal reflex, (4) lower parasympathetic and higher sympathetic activity during occurrence of HAPWs. In conclusion, left colon dysmotility and high sympathetic tone and reactivity, more so than vagal pathway impairment, play important roles in refractory chronic constipation and suggests sacral neuromodulation as a possible treatment.

Microalgae as a sustainable source of edible proteins and bioactive peptides - Current trends and future prospects.

The global demand for protein ingredients is continuously increasing owing to the growing population, rising incomes, increased urbanization, and aging population. Conventionally, animal-derived products (dairy, egg, and meat) satisfy the major dietary protein requirements of humans. With the global population set to reach 9.6 billion by 2050, there would be a huge deficit in meeting dietary protein requirements. Therefore, it is necessary to identify sustainable alternative protein sources that could complement high-quality animal proteins. In recent years, microalgae have been advocated as a potential industrial source of edible proteins owing to their wide and excellent ecological adaptation. Microalgae can grow in marginal areas utilizing non-potable wastewaters with high photosynthetic efficiency. Previously microalgae species such as Arthospira, and Chlorella have been used as single-cell proteins (SCP) with limited application in pharmaceutical industries. In recent years, the demand for innovative and sustainable functional ingredients for food applications has renewed the interest worldwide in microalgae proteins. The present review aims to provide a holistic view of various aspects related to the production and processing of edible proteins from microalgae biomass. A critical review of available literature on the nutritional quality, techno-functional properties, applications in food and feed sectors, and biological activities is presented. Further, challenges associated with each stage of processing are discussed. From the literature review, it can be summarized that microalgae proteins are comparable to reference proteins both in terms of amino acid (AA) quality and techno-functional properties. However recalcitrant cell wall poses a challenge in digestibility and effective utilization of the microalgae proteins. Further, poor sensory scores and palatability of microalgae biomass limit its applications in the food and feed sector. Novel applications of microalgae proteins include meat analogues, emulsifying agents, and bioactive peptides. Development of low-cost cultivation strategies, wet biomass-based downstream processing along with the bio-refinery approach of complete biomass volarization would enhance the sustainability quotient for human food applications.

«To be or not to be»: the shakespearean tragedy of mental illness in India / "Ser o no ser": la tragedia shakespeariana de la enfermedad mental en la India

Indian Cinema fondly referred to as Bollywood, has remained the cultural barometer of the country while being a powerful medium of entertainment articulating contemporaneous societal and medical issues. Particularly, the portrayal of mental illnesses remains an interesting yet under-studied domain to-date. Initially projected as synonymous with madness or insanity, psychiatric conditions gradually metamorphosed to more rational screen reflection. This article analyses the portrayal of the mental illness in three Hindi feature films ( Omkara (2006), Haider (2014), Maqbool (2003) by Vishal Bhardwaj) that were based on the screen adaptations of Shakespearean Tragedy namely Othello, Hamlet and Macbeth, respectively. Through this phenomenological deliberation, we discuss how these movies in their own style and expressions have embodied mental illness in a hitherto unexplored way. Using extended case studies, we qualitatively investigated how the spectrum of mental illness was depicted; how these representations operated within cinematic narratives; whether the characters presented as an ideal; and, how the idea of the mental illness was an important construct for rendering structures comprehensible according to commonly held cultural understandings. Overall, we found, mental illness representations were characterized by a multi-dimensional morality; accompanied by gloomy structures with social chaos. Such adaptation of Shakespeare in the Indian context brings to light how mental illnesses is still perceived in India. (AU)

El cine indio, conocido cariñosamente (entrañablemente) como Bollywood, se ha mantenido como el barómetro cultural del país al mismo tiempo que es un poderoso medio de entretenimiento que articula problemas sociales y médicos contemporáneos. En particular, la descripción de las enfermedades mentales sigue siendo un dominio interesante pero poco estudiado hasta la fecha. Proyectadas inicialmente como sinónimo de locura o insania, las condiciones psiquiátricas se metamorfosearon gradualmente en un reflejo más tradicional en la pantalla. Este artículo analiza la representación de la enfermedad mental en tres largometrajes en hindi ( Omkara (2006), Haider (2014), Maqbool (2003) de Vishal Bhardwaj) que se basaron en las adaptaciones cinematográficas de Tragedias Shakespearianas a saber Otelo, Hamlet y Macbeth respectivamente. A través de esta deliberación fenomenológica, discutimos cómo estas películas en su propio estilo y expresiones han encarnado la enfermedad mental de una manera hasta ahora inexplorada. Utilizando estudios de casos ampliados, investigamos cualitativamente cómo se describía el espectro de las enfermedades mentales; cómo operaron estas representaciones dentro de las narrativas cinematográficas; si los personajes se presentan como un ideal; y cómo la idea de la enfermedad mental fue un constructo importante para hacer comprensibles las estructuras de acuerdo con los entendimientos culturales comúnmente sostenidos. En general, encontramos, que las representaciones de enfermedades mentales se caracterizaban por una moralidad multidimensional; acompañadas de estructuras lúgubres en un caos social. Tal adaptación de Shakespeare en el contexto indio pone de manifiesto cómo todavía se perciben las enfermedades mentales en la India. (AU)

Guidance we can trust? The status and quality of prehospital clinical guidance in sub-Saharan Africa: A scoping review.

INTRODUCTION: Prehospital care is integral in addressing sub-Saharan Africa's (SSA) high injury and illness burden. Consequently, robust, high-quality prehospital guidance documents are needed to inform care. These guidance documents include, but are not limited to, clinical practice guidelines (CPGs), protocols and algorithms that are contextually appropriate for SSA. However, SSA prehospital guidance mostly originates from the 'Global North,' with limited guidance for Africa by Africans. To strengthen prehospital clinical practice in SSA, we described and appraised all prehospital SSA guidance documents informing clinical decision making. METHODS: We conducted a scoping review of prehospital-relevant guidance documents, including CPGs, algorithms, protocols and position statements originating from SSA. We performed a comprehensive literature search in various databases (PUBMED and SCOPUS), guideline clearing houses (Scottish Intercollegiate Guidelines Network, Trip, and Guidelines International Network), journals, various forms of grey literature and contacted experts. Guidance document screening and data extraction was done independently, in duplicate and reviewed by a third author. Guidance quality was then determined using the AGREE II tool and data were analysed using simple descriptive statistics. RESULTS: We included 51 guidance documents from 13 countries across SSA after screening 2320 potential documents. The majority of guidance documents lacked an evidence foundation, made recommendations based on expert input, and were predominantly end-user presentations such as algorithms or protocols. Overall, reporting quality was poor, specifically for critical domains such as rigour of development; however, clarity of presentation was generally strong. Guidance topics were focused around resuscitation and common diseases (both communicable and non-communicable) with major gaps identified across a variety of topics; such as mental health for example. CONCLUSION: The majority of prehospital clinical guidance from SSA provides clinicians with excellent ready to use end-user material. Conversely, most of the guidance documents lack an appropriate evidence foundation and fail to transparently report the guidance development process, highlighting the need to strengthen and build guideline development capacity to promote the transition from eminence-based to evidence-based guidance for prehospital care in SSA. Guideline developers, professional societies and publishers need to be aware of international and local guidance document development and reporting standards in order to produce guidance we can trust.

Examining the role of coaching in health-system transformations

OHTs are being introduced to provide a new way of organizing and delivering care that is more integrated from the perspective of the patients in their local communities, and that achieves measurable improvements in key quadruple-aim metrics of improving care experiences and health outcomes at manageable per capita costs and with positive provider experiences. This change requires significant adjustments to the way in which care is organized and provided, as well as the ways in which organizations and providers across the system interact with one another.

Associations Between Colonic Motor Patterns and Autonomic Nervous System Activity Assessed by High-Resolution Manometry and Concurrent Heart Rate Variability.

Abnormal colonic motility may be associated with dysfunction of the autonomic nervous system (ANS). Our aim was to evaluate if associations between colonic motor patterns and autonomic neural activity could be demonstrated by assessing changes in heart rate variability (HRV) in healthy volunteers. A total of 145 colonic motor patterns were assessed in 11 healthy volunteers by High-Resolution Colonic Manometry (HRCM) using an 84-channel water-perfused catheter. Motor patterns were evoked by balloon distention, a meal and luminal bisacodyl. The electrocardiogram (ECG) and cardiac impedance were assessed during colonic manometry. Respiratory sinus arrhythmia (RSA) and root mean square of successive differences of beat-to-beat intervals (RMSSD) served as measures of parasympathetic reactivity while the Baevsky's Stress Index (SI) and the pre-ejection period (PEP) were used as measures of sympathetic reactivity. Taking all motor patterns into account, our data show that colonic motor patterns are accompanied by increased parasympathetic activity and decreased sympathetic activity that may occur without eliciting a significant change in heart rate. Motor Complexes (more than one motor pattern occurring in close proximity), High-Amplitude Propagating Pressure Waves followed by Simultaneous Pressure Waves (HAPW-SPWs) and HAPWs without SPWs are all associated with an increase in RSA and a decrease in SI. Hence RSA and SI may best reflect autonomic activity in the colon during these motor patterns as compared to RMSSD and PEP. SI and PEP do not measure identical sympathetic reactivity. The SPW, which is a very low amplitude pressure wave, did not significantly change the autonomic measures employed here. In conclusion, colonic motor patterns are associated with activity in the ANS which is reflected in autonomic measures of heart rate variability. These autonomic measures may serve as proxies for autonomic neural dysfunction in patients with colonic dysmotility.

Examining the impacts of educational interventions for families affected by opioid use

Opioid addiction has emerged as a pressing publichealth challenge in recent years. From January 2016 to March 2018 more than 8,000 opioid-related deaths were recorded.(1) In 2018, the number of apparent opioidrelated deaths continues to rise, with more than 1,000 deaths in the first three months of the year.