To The Editor

I write as an anthropologist who has been doing research in Brazil, other parts of South America and the Caribbean for the past three decades. After learning many years ago from colleagues in Brazil and the media about some of the rather unusual and at times spectacular healing done there, referred to by some as paranormal, I started to investigate healers, systems ofhealing and the patients receiving the healing intensively. After observing dozens of healers and interviewing hundred of their patients, I find it difficult to deny that something positive is happening that science in general and medical science in particular--as we know them-are not able to explain at this time. However, I must urge those who are generating possible explanatory hypotheses, often based on limited clinical or experimental data collected in our own society, to be cautious. Hypotheses, ofcourse, are necessary, but science further requires carefully designed experiments to test, or, in Popper's sense, falsifY them. Given what anthropologists have learned about the ways human behavior is differentially shaped and patterned by diverse cultures, I further urge that not only carefully designed protocols necessary to test hypotheses, but that these protocols must include variables to control for cultural diversity

Preventing Parasites: Developing a Deworming Protocol and Screening Animals at the Willow Park Zoo

The primary object of this project was to research AZA and American Association of Zoo Veterinarian guidelines, write up a deworming protocol and schedule for the zoo, and finally begin screening collection animals

Demographic and temporal variations in immunity and condition of polar bears (\u3ci\u3eUrsus maritimus\u3c/i\u3e) from the southern Beaufort Sea

Assessing the health and condition of animals in their natural environment can be problematic. Many physiological metrics, including immunity, are highly influenced by specific context and recent events to which researchers may be unaware. Thus, using a multifaceted physiological approach and a context-specific analysis encompassing multiple time scales can be highly informative. Ecoimmunological tools in particular can provide important indications to the health of animals in the wild.We collected blood and hair samples from free-ranging polar bears (Ursus maritimus) in the southern Beaufort Sea and examined the influence of sex, age, and reproductive status on metrics of immunity, stress, and body condition during 2013–2015.We examined metrics of innate immunity (bactericidal ability and lysis) and stress (hair cortisol, reactive oxygen species, and oxidative barrier), in relation to indices of body condition considered to be short term (urea to creatinine ratio; UC ratio) and long term (storage energy and body mass index). We found the factors of sex, age, and reproductive status of the bear were critical for interpreting different physiological metrics. Additionally, the metrics of body condition were important predictors for stress indicators. Finally,many of these metrics differed between years, illustrating the need to examine populations on a longer time scale. Taken together, this study demonstrates the complex relationship between multiple facets of physiology and how interpretation requires us to examine individuals within a specific context

A Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity

Many patients of all ages have multiple conditions, yet clinicians often lack explicit guidance on how to approach clinical decision-making for such people. Most recommendations from clinical practice guidelines (CPGs) focus on the management of single diseases, and may be harmful or impractical for patients with multimorbidity. A major barrier to the development of guidance for people with multimorbidity stems from the fact that the evidence underlying CPGs derives from studies predominantly focused on the management of a single disease. In this paper, the investigators from the Improving Guidelines for Multimorbid Patients Study Group present consensus-based recommendations for guideline developers to make guidelines more useful for the care of people with multimorbidity. In an iterative process informed by review of key literature and experience, we drafted a list of issues and possible approaches for addressing important coexisting conditions in each step of the guideline development process, with a focus on considering relevant interactions between the conditions, their treatments and their outcomes. The recommended approaches address consideration of coexisting conditions at all major steps in CPG development, from nominating and scoping the topic, commissioning the work group, refining key questions, ranking importance of outcomes, conducting systematic reviews, assessing quality of evidence and applicability, summarizing benefits and harms, to formulating recommendations and grading their strength. The list of issues and recommendations was reviewed and refined iteratively by stakeholders. This framework acknowledges the challenges faced by CPG developers who must make complex judgments in the absence of high-quality or direct evidence. These recommendations require validation through implementation, evaluation and refinement

St. Thomas's Hospital

n/