Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO's current and future strategy.

As the 'WHO Traditional Medicine Strategy: 2014-2023' is entering its final phase, reflection is warranted on progress and the focus for a new strategy. We used WHO documentation to analyse progress across the objectives of the current strategy, adding the role of traditional, complementary and integrative healthcare (TCIH) to address specific diseases as a dimension absent in the current strategy. Our analysis concludes on five areas. First, TCIH research is increasing but is not commensurate with TCIH use. TCIH research needs prioritisation and increased funding in national research policies and programmes. Second, WHO guidance for training and practice provides useful minimum standards but regulation of TCIH practitioners also need to reflect the different nature of formal and informal practices. Third, there has been progress in the regulation of herbal medicines but TCIH products of other origin still need addressing. A risk-based regulatory approach for the full-range of TCIH products seems appropriate and WHO should provide guidance in this regard. Fourth, the potential of TCIH to help address specific diseases is often overlooked. The development of disease strategies would benefit from considering the evidence and inclusion of TCIH practices, as appropriate. Fifth, inclusion of TCIH in national health policies differs between countries, with some integrating TCIH practices and others seeking to restrict them. We encourage a positive framework in all countries that enshrines the role of TCIH in the achievement of universal health coverage. Finally, we encourage seeking the input of stakeholders in the development of the new WHO Traditional Medicine Strategy

Non-thermal emission processes in massive binaries

In this paper, I present a general discussion of several astrophysical processes likely to play a role in the production of non-thermal emission in massive stars, with emphasis on massive binaries. Even though the discussion will start in the radio domain where the non-thermal emission was first detected, the census of physical processes involved in the non-thermal emission from massive stars shows that many spectral domains are concerned, from the radio to the very high energies. First, the theoretical aspects of the non-thermal emission from early-type stars will be addressed. The main topics that will be discussed are respectively the physics of individual stellar winds and their interaction in binary systems, the acceleration of relativistic electrons, the magnetic field of massive stars, and finally the non-thermal emission processes relevant to the case of massive stars. Second, this general qualitative discussion will be followed by a more quantitative one, devoted to the most probable scenario where non-thermal radio emitters are massive binaries. I will show how several stellar, wind and orbital parameters can be combined in order to make some semi-quantitative predictions on the high-energy counterpart to the non-thermal emission detected in the radio domain. These theoretical considerations will be followed by a census of results obtained so far, and related to this topic... (see paper for full abstract)Comment: 47 pages, 5 postscript figures, accepted for publication in Astronomy and Astrophysics Review. Astronomy and Astrophysics Review, in pres

Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial

Background: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). Objectives: This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. Methods: The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life–5 Dimensions–5 Level visual analogue scale at 12 weeks. Results: MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). Conclusions: Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408)

The Effect of Particulate Air Pollution on Emergency Admissions for Myocardial Infarction: A Multicity Case-Crossover Analysis

Recently, attention has focused on whether particulate air pollution is a specific trigger of myocardial infarction (MI). The results of several studies of single locations assessing the effects of ambient particular matter on the risk of MI have been disparate. We used a multicity case-crossover study to examine risk of emergency hospitalization associated with fine particulate matter (PM) with aerodynamic diameter < 10 μm (PM(10)) for > 300,000 MIs during 1985–1999 among elderly residents of 21 U.S. cities. We used time-stratified controls matched on day of the week or on temperature to detect possible residual confounding by weather. Overall, we found a 0.65% [95% confidence interval (CI), 0.3–1.0%] increased risk of hospitalization for MI per 10 μg/m(3) increase in ambient PM(10) concentration. Matching on apparent temperature yielded a 0.64% increase in risk (95% CI, 0.1–1.2%). We found that the effect size for PM(10) doubled for subjects with a previous admission for chronic obstructive pulmonary disease or a secondary diagnosis of pneumonia, although these differences did not achieve statistical significance. There was a weaker indication of a larger effect on males but no evidence of effect modification by age or the other diagnoses. We also found that the shape of the exposure–response relationship between MI hospitalizations and PM(10) is almost linear, but with a steeper slope at levels of PM(10) < 50 μg/m(3). We conclude that increased concentrations of ambient PM(10) are associated with increased risk of MI among the elderly

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Not AvailableMicrobes excreted in the semen of infected or carrier bulls can be disseminated to susceptible animals through artificial insemination. The polymerase chain reaction (PCR) has been employed successfully to detect infectious agents in tissues and body fluids. PCR inhibitors present in the semen pose serious problems in detection of microorganisms by inhibiting the amplification of the target DNA template. These inhibitors need to be removed completely during DNA extraction to amplify the target sequences in semen by PCR. DNA was extracted using seven different protocols from semen of buffalo bulls, and the quantity and quality was evaluated spectrophotometrically. Chelex-100 and Qiagen modified methods for extraction of DNA from semen were found to be superior qualitatively as compared to the other methods. In the Qiagen modified protocol, the semen was treated with two extra buffers containing EDTA to chelate the metals. Additional treatment of semen with proteinase K was included to completely degrade cellular proteins. DNA extracted by the phenol-chloroform and CTAB methods yielded high value of residual RNA and other contaminants. The chelex-100 method has the potential advantage of requiring a smaller volume of semen to extract good quality of DNA.Not Availabl

Large negative magnetoresistance induced by interplay between smooth disorder and antidots in AlGaN/GaN HEMT structures

Large low temperature negative magnetoresistance (NMR) experimentally observed in AlGaN/GaN high electron mobility transistors (HEMT) structures grown by metalorganic chemical vapour deposition on sapphire substrate has been reported. A linear B-1 ln B dependence of magnetoresistance observed in our samples indicates the presence of random antidot array together with smooth disorder. It is proposed that the antidots are linked with high bandgap AlN rich regions formed due to possible Al-Ga segregation at the interface during growth and the smooth random disorder is due to interface roughness. The antidot density is estimated to be of similar to 7 to 8 x 10(10) cm(-2) in our samples. The magnitude ofNMRis also correlated with the extent of interface roughness indicated by x-ray reflectivity. It is also proposed that the formation of antidots is related with the lattice mismatch between substrate and epitaxial heterostructures. The NMR in AlGaN/GaN HEMT structures grown on SiC substrates having relatively lower lattice mismatch has been shown to have a usual B-2 and ln T dependences indicating only electron-electron interaction and absence of antidot-like scatterers