Knowledge integration in One Health policy formulation, implementation and evaluation

The One Health concept covers the interrelationship between human, animal and environmental health and requires multistakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Yet, the implementation of the One Health approach appears hampered by shortcomings in the global framework for health governance. Knowledge integration approaches, at all stages of policy development, could help to address these shortcomings. The identification of key objectives, the resolving of trade-offs and the creation of a common vision and a common direction can be supported by multicriteria analyses. Evidence-based decision-making and transformation of observations into narratives detailing how situations emerge and might unfold in the future can be achieved by systems thinking. Finally, transdisciplinary approaches can be used both to improve the effectiveness of existing systems and to develop novel networks for collective action. To strengthen One Health governance, we propose that knowledge integration becomes a key feature of all stages in the development of related policies. We suggest several ways in which such integration could be promoted

Novel Procedures for Evaluating Autism Online in a Culturally Diverse Population of Children: Protocol for a Mixed Methods Pathway Development Study

Background: Current autism assessment procedures are costly and resource-intensive. The COVID-19 pandemic accelerated the adoption of telemedicine, highlighting the benefits of innovative diagnostic tools. Telemedicine-based pathways could enhance accessibility and equity in autism diagnostics. Objective: The Children with Autism Technology Enabled Assessment (CHATA) project aims to develop and pilot an open-source autism diagnostic pathway for children up to 5 years old, delivered through telemedicine. The pathway is designed to be culturally and linguistically adaptable, increasing its applicability to diverse populations and integrating with existing National Health Service digital systems.Methods: Initial pathway development was informed by systematic evidence reviews, coproduction, and mixed methods usability. CHATA comprises 2 key elements: online self-completed standardized autism questionnaires and a structured online interview and observation by a trained clinician. Out of 60 families near the top of the local waiting list will be invited to participate in the pilot evaluation, assessed using both the CHATA and usual assessment pathways. Sensitivity and specificity will be calculated by comparing the diagnosis of autism through CHATA with usual care. Quantitative usability assessment will be gathered from all families using the System Usability Scale (where a mean above 68 indicates above-average usability). A subset of CHATA assessments will be reviewed for interrater reliability (measured by the Cohen κ for categorical data [diagnosis present or absent], with values indicating the level of agreement; eg, <0 indicating no agreement, 0.61-0.80 indicating substantial agreement). Qualitative data on acceptability, feasibility, and usability will be gathered from semistructured interviews with a subset of families and health care providers. We will recruit 60 families for the main pilot study (including the usability testing) and 10-15 participants for the qualitative substudy. Data will estimate CHATA’s diagnostic accuracy, validity, reliability, usability, and acceptability. Patient and public involvement will be integral throughout. The study will take place in a socio-economically deprived, ethnically diverse inner-London Borough within a community-based child health National health service responsible for the Autism assessment of children and young people up to the age of 13 years.Results: Ethics approval was received in June 2023 (Research Ethics Committee reference 22/LO/0751; IRAS project ID 320499). Data collection commenced in April 2023 and completed in October 2024. Project end date is March 2025. As of November 2024, we had enrolled 57 participants to the pilot study and 12 to the qualitative substudy.Conclusions: The CHATA project aims to establish a novel, culturally sensitive, equitable, and accurate online autism assessment pathway. By addressing geographical and linguistic barriers, this pathway seeks to reduce service costs, shorten waiting times, and promote equity in autism diagnosis. The procedures developed are expected to be generalized to other populations nationwide.International Registered Report Identifier (IRRID): DERR1-10.2196/5574

Incorporating one health into medical education

One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers

Novel regulation of Ras proteins by direct tyrosine phosphorylation and dephosphorylation

Somatic mutations in the RAS genes are frequent in human tumors, especially in pancreatic, colorectal, and non-small-cell lung cancers. Such mutations generally decrease the ability of Ras to hydrolyze GTP, maintaining the protein in a constitutively active GTP-bound form that drives uncontrolled cell proliferation. Efforts to develop drugs that target Ras oncoproteins have been unsuccessful. Recent emerging data suggest that Ras regulation is more complex than the scientific community has believed for decades. In this review, we summarize advances in the "textbook" view of Ras activation. We also discuss a novel type of Ras regulation that involves direct phosphorylation and dephosphorylation of Ras tyrosine residues. The discovery that pharmacological inhibition of the tyrosine phosphoprotein phosphatase SHP2 maintains mutant Ras in an inactive state suggests that SHP2 could be a novel drug target for the treatment of Ras-driven human cancers

Descriptive Epidemiology of Cases of Acute Myocardial Infarction in Tobago: " Epidemiología Descriptiva de Casos de Infarto Agudo del Miocardio en Tobago"

Objectives: The goal of this study is to identify co-morbidities associated with acute myocardial infarction in Tobago. Methods: This was a longitudinal retrospective study of myocardial infarction at the Tobago Regional Hospital in two selected periods: January 2007 to April 2007 and January 2008 to April 2008. Data were retrieved from the patients’ medical records. These included co-morbid conditions eg hypertension, diabetes mellitus, dyslipidaemia, ESRD, whether history of smoking or cocaine use and if any prior care. In the former period, 11 cases were confirmed as having myocardial infarction and 27 cases in the latter period. Results: In 2007 and 2008, all cases had dyslipidaemia (LDL > 100 mg/dL) and were hypertensive. There were 36.4% of cases in 2007 that had diabetes mellitus, compared to 33.3% cases in 2008 and 9.1% had chronic kidney disease in 2007, compared to 25.9% in 2008. Conclusion: The most common co-morbidities associated with acute myocardial infarction in Tobago are dyslipidaemia, hypertension and diabetes mellitus, with ESRD, smoking and cocaine use less so. Many of these patients had never received prior care. RESUMEN Objetivos: El objeto de este estudio fue identificar las comorbilidades asociadas con el infarto agudo del miocardio en Tobago. Metódos: Se realizó un estudio retrospectivo longitudinal del infarto del miocardio en el Hospital Regional de Tobago, en dos períodos: enero de 2007 a abril de 2007, y enero de 2008 a abril de 2008. Los datos fueron obtenidos a partir de las historias clínicas de los pacientes. Estos datos incluyeron condiciones co-mórbidas, por ejemplo, hipertensión, diabetes mellitus, dislipidemia, ERFT, historia de hábito de fumar o uso de cocaína, y cualquier atención previa del caso, si la hubiese. En el primero de estos períodos, se confirmó que 11 casos tenían infarto del miocardio, en tanto en el último caso se confirmaron 27 casos. Resultados: En 2007 y 2008, todos los casos padecían de dislipidemia (LDL > 100 mg/dL) y eran hipertensos. El 36.4% de los casos en 2007 sufría de diabetes mellitus, en comparación con el 33.3% de los casos en 2008. El 9.1% tenía la enfermedad renal crónica en 2007, en comparación con el 25.9% en 2008. Conclusión: Las comorbilidades más comunes asociadas con el infarto agudo del miocardio en Tobago son la dislipidemia, la hipertensión y la diabetes mellitus, y en menor grado la ERET, el hábito de fumar, y el consumo de cocaína. Muchos de estos pacientes no habían recibido nunca atención con anterioridad