Bury College

To evaluate how UK guidelines for individual health conditions consider coexisting multiple long term conditions and to propose improvements to guideline development processes so that guidelines appropriately account for and consider coexisting multiple long term conditions. Analysis and recommendations from review of single condition guidelines. Clinical guidelines developed by the National Institute for Health and Care Excellence (NICE), UK, 1 January 2013 to 31 December 2024. 56 clinical guidelines developed by NICE covering a broad range of long term conditions. The extent to which guideline recommendations consider multiple long term conditions and coexisting conditions, distinguishing between concordant conditions (those affecting the same organ system as the index condition) and discordant conditions (those affecting different systems). All but one of the NICE guidelines (n=55, 98%) included some advice on managing the index condition in the presence of coexisting conditions, and 50 (89%) guidelines offered general guidance on tailoring care. Only 11 (20%) guidelines, however, explicitly referred to multiple long term conditions, and none included a dedicated section on multiple long term conditions or how care should be adapted in this context. 19 (34%) guidelines featured sections looking at specific coexisting conditions or coexisting conditions generally. Coverage of coexisting conditions varied widely across categories of conditions, with mental health guidelines dealing with the most coexisting conditions (median 10, interquartile range (IQR) 4.5-14.75) in contrast with guidelines on cancer and eye disease covering the fewest conditions (median 3, 1-4.5; median 3, 2.25-2.75, respectively). Of the 397 possible concordant pairings, 120 (30%) were referenced, whereas of the 3859 possible discordant pairings, 259 (7%) were referenced, indicating greater coverage of same system combinations. Data on the composition of guideline committees showed wide variation in size, disciplinary diversity, inclusion of generalist clinicians (eg, general practitioners, general physicians, or others with no single specialty focus), and public contributors, although lived experience of multiple long term conditions was rarely specified. Despite widespread acknowledgement of coexisting or multiple long term conditions, NICE guidelines are predominantly condition specific and offer limited tailored support for the care of multiple long term conditions. Recommendations rarely considered common condition clusters or the cumulative effect of multiple long term conditions. Structured improvements, such as clearer guidance on adapting care, broader cross condition referencing, and more transparent inclusion of lived experience could enhance the relevance and usability of guidelines for clinicians managing patients with multiple long term conditions.

Abstract Background. Maximal oxygen consumption (VO2max) is the gold standard for assessing cardiorespiratory fitness (CRF), and it is a strong predictor of clinical outcomes, but it is measured during cardiopulmonary exercise testing (CPET), which is expensive and time-consuming. Smartwatches provide a great opportunity to assess CRF at scale. Although smartwatches have been previously validated in young and physically active individuals, their accuracy in sedentary individuals remains undetermined and this limits the use smartwatch VO2max in large clinical or epidemiological studies. This study aims to determine the accuracy of smartwatch VO2max in a large group of individuals with varying underlying CRF. Methods. N=203 adults (160 (79%) female; median (interquartile range; IQR) 55 (32,61) years old) from the CONVALESCENCE case-control study of long COVID, performed a maximal CPET on a semi-recumbent ergometer and wore a consumer-grade smartwatch for three months. Smartwatch-estimated VO2max was compared to reference VO2max measured by CPET and predicted VO2max calculated using standard non-exercise equations. Agreement was assessed using Bland-Altman analysis (Bias [Limits of Agreement; LoA]), error (ΔVO2max), absolute error (|ΔVO2max|), and Pearson’s correlation coefficient (r). Results. CPET-measured VO2max was 22.2 (17.5, 27.3) ml/kg/min. Smartwatch-estimated VO2max correlated moderately with CPET-measured VO2max (r=0.65) and strongly with VO2max predicted using non-exercise equations (r=0.92). Bland-Altman plots showed a large positive bias and wide LoA (14.5 [2.2, 26.8 ml/kg/min]). Inaccuracy of smartwatch-estimated VO2max (ΔVO2max) linearly increased with increasing mismatch between expected and measured CRF (correlation with %pVO2max r=-0.81). The absolute error was larger in those with lower-than-expected CRF (%pVO2max<100%) and in those engaging in light intensity activities, while no differences were observed when comparing participants with or without long COVID or symptoms of fatigue. Multiple linear regression analysis of the absolute error identified the mismatch between expected and measured CRF (%pVO2max) as the main contributor to smartwatch inaccuracy. Conclusions. In non-athletes, smartwatch-derived VO2max correlated with reference values but did not provide additional accuracy to VO2max prediction based on sex, age, weight and height. Inaccuracy significantly increased in those with lower-than-expected CRF. These findings highlight current limitations in the use of smartwatch VO2max for clinical applications and large epidemiological studies. Trial registration number: Z6364106/2021/06/04.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Treatments that influence this dysregulated host response are sparse. The immunopathophysiology of sepsis entails overzealous inflammation causing acute organ dysfunction, as well as a profound and/or persistent anti-inflammatory response that increases susceptibility to secondary infection. The immune response in sepsis is under the influence of various endogenous and exogenous factors, including genetic makeup, age, sex, comorbidities, metabolism, prior microbial exposure and medications. The consequent heterogeneity of the syndrome hampers immunomodulatory treatment strategies that rely on a 'one-size-fits-all' approach. A precision medicine approach is therefore warranted. Balanced application of prognostic- and predictive-enrichment strategies is instrumental to achieve precision medicine. Phenotyping of patients using clinical, physiological, microbiological and/or molecular ('omics') data enablesthe identification of more homogeneous patient subgroups. Several studies suggest that such approaches can be used to tailor adjunctive immunomodulatory therapies in patients with sepsis. As well as repurposing existing drugs to treat sepsis, new drugs aimed at restoring immune homeostasis are under investigation. New clinical trial methodologies, including flexible platform trials, Bayesian statistics and embedding trials in health care systems are increasingly being used to keep pace with rapid developments in the field of sepsis immunobiology and ultimately toimprove clinical outcomes.

The African electric vehicle market is gaining momentum, with indigenous automotive manufacturers like Nigeria's Innoson Vehicle Manufacturing (IVM), Ghana's Kantanka, and Uganda's Kiira Motors driving innovation and resilience despite challenges. This study highlights the role of entrepreneurship, local systems, and government policies in shaping the industry's growth. While obstacles such as infrastructure gaps, high costs, and limited support persist, these firms hold potential for both local and global impact. Drawing particularly from the case of IVM, the findings underscore the need for aligned policies, education, and industrial strategies to foster sustainable growth and global competitiveness, emphasizing the importance of indigenous enterprise development and sustainable marketing.

Africa's rapid urbanization presents both opportunities and challenges. By 2040, the continent will host 12 megacities and numerous secondary cities poised to be drivers of regional development. Rwanda, through its innovative National Urbanization Pol

The objective of this review is to identify immunological pathways and markers of severity of illness associated with clinical outcomes that may represent potential therapeutic targets in the management of secondary hemophagocytic lymphohistiocytosis. A broad range of immunomodulatory therapies is used to manage hemophagocytic lymphohistiocytosis, however, the supporting evidence for these therapies is scarce. Identifying patients likely to experience more severe disease or die is currently extremely difficult, if not impossible. The identification of implicated cytokines in secondary disease can provide further support for the identification of high-risk patients and the development of targeted therapies. Studies reporting immune biomarker and cytokine measurement in adult patients (age ≥18 years) with secondary hemophagocytic lymphohistiocytosis will be considered for inclusion. The proposed review will be conducted in line with the JBI methodology for scoping reviews. MEDLINE (Ovid) and Embase (Ovid) will be searched, without date limitations. Data will be extracted using a data extraction tool developed by the reviewers. Relevant sources will be retrieved, and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information. Open Science Framework https://osf.io/9524e.

This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery.

Solid waste management is a critical global challenge, with approximately 11.2 billion tons of waste collected annually, contributing to 5% of global greenhouse gas emissions (UNEP, 2024). This paper offers a comparative analysis of waste management practices in the United States, Canada, and China, focusing on waste composition, factors driving increased waste, and waste diversion patterns. The study underscores the strengths and weaknesses of each country’s management approach, providing insights for policymakers and stakeholders to enhance global waste management strategies.