Royal College of Physicians and Surgeons of Canada

Due to concerns over the halal status of gelatine traditionally derived from porcine and bovine sources, the demand for halal-certified alternatives is growing that ensure authenticity and meet dietary requirements, particularly in the gummy industry. Developing this product not only embrace the cultural and religious requirements but also expands the opportunities for the pharmaceutical applications in delivering nutraceutical ingredients. The present work aimed to investigate the effect of starch, fish gelatine and stingless bee honey (SBH) and to optimise their concentration using Response Surface Methodology (RSM) for a formulation that meets target criteria of balanced springiness, cohesiveness, and minimised hardness suitable for halal-certified gummy products. Response Surface Methodology (RSM) with a Central Composite Design (CCD) was employed to optimise. Gummies were prepared using a cold mixing technique then followed by textural analysis, pH value determination, storage stability testing, and microbiological testing. The study factors used were starch (15-25 g), fish gelatine (35-45 g) and (SBH 20-30 g) with 18 experimental runs. The runs included 4 centre points, and the targeted responses were springiness (0.9–1.2 mm, goal 1.04 mm), cohesiveness (0.9–1.14, goal 0.98), and hardness (31–107.7 g, minimised) to satisfy the market standards for gummy texture. For cohesiveness (significant model, p = 0.0021 with critical interaction factors AC and quadratic terms A and B significant), hardness (significant model, p = 0.0333; fish gelatine significant, p = 0.007), the fitted models were quadratic. In contrast, the springiness model (non-significant, p = 0.2923). The springiness was considered only as observe texture attribute rather than a primary optimisation target. The optimised formulation (15 starch, 37 fish gelatine, and 25 SBH) was validated, the predicted and actual values closely matched, with only slight variations (hardness deviation within acceptable limits, cohesiveness error ~0.25%, and springiness error ~2.2%). Preliminary storage stability testing over 14 days’ period showed the gummies maintained the textural quality. Microbiological evaluation demonstrated no growth of mould and bacterial also maintained the product safety. These findings showed that RSM with CCD can guide the formulation of fish gelatine and SBH-based gummies to achieve desirable cohesiveness and hardness while preserving the safety and texture gummies features.

Diabetes mellitus and periodontal disease are both chronic inflammatory conditions that are intertwined with a bidirectional, well-observed association. More evidence is emerging by which metabolic dysregulation in diabetes exacerbates periodontal tissue homeostasis, and that periodontal inflammation will also worsen systemic glycaemic control. Clarification of the molecular and immunological processes underlying this relationship is needed to offer improved medical and dental management. This review addresses the epidemiological and mechanistic relationships between periodontal disease and diabetes, with a focus on immune dysregulation, action of pro-inflammatory cytokines, development and influence of advanced glycation end-products (AGEs) and their receptors (RAGEs). It also identifies the clinical implications of concurrent patient management. A detailed literature review was performed using the assistance of MEDLINE and PubMed databases to scan for appropriate studies between 1990 and 2025. Experimental and clinical data were both evaluated to identify the manner in which immune dysfunction resulting from hyperglycaemia contributes to periodontal tissue breakdown. Epidemiological data have substantiated enhanced risk and severity of periodontitis in diabetes in a number of populations. Hyperglycaemia impairs the function of neutrophils and macrophages, enabling poor bacterial clearance and increased production of inflammatory cytokines, specifically TNF-α, IL-1β, and IL-6. Concurrently, AGEs develop in diabetic tissues and trigger RAGE on numerous cell types and promote oxidative stress and inflammation through NF-κB and JAK/STAT signaling. These alterations facilitate periodontal deterioration and further jeopardize glycaemic control. A two-way interaction between periodontal disease and diabetes is supported by shared pathogenic processes including dysregulation of the immune system and chronic inflammation.

Introduction:Learners’ experiences of feedback conversations, and their longitudinal impact, are largely invisible to educators. While we know more about what makes for an effective feedback conversation, we are yet to fully understand how learners make sense of these encounters over time. This has implications for understanding the potency of feedback on practice and for how best to support learners, particularly when the experience is challenging. Our research aimed to explore the characteristics of difficult feedback and the temporal aspects of feedback sensemaking.Methods:We collected written narratives from 32 doctors and 49 medical students via an online questionnaire about a time when they received difficult feedback in a clinical setting. Open- ended prompts facilitated participants to describe their experience, the evaluation of it over time, and the learning that arose from it. We undertook reflexive thematic analysis of the data, informed by constructivist sensemaking perspectives.Results:Difficult feedback conversations were characterized by unpredictable and complex interactions between emotions, sensemaking and learning. Despite some feedback perceived as personal, inappropriate, or threatening, feedback information was seldom disregarded. Participants engaged in feedback sharing and reflection, which often extended over years, contributing to identity work and to development of their clinical practice.Discussion:Our findings highlighted the temporal nature of sensemaking of difficult feedback and challenge expectations for learners to respond and commit to progress in the moment. Providing learners with time for reflection on feedback and opportunities to connect with personal and professional networks may facilitate the longitudinal sensemaking processes.

IntroductionClinical learning environments (CLE) are complex and have not been thoroughly explored from the perspective of advancing conceptual understanding of their unique dynamics. An opportunity to advance this understanding rests in examining specific situations, such as what happens when a student/trainee has been involved in a serious patient safety event.MethodsShaped by concepts of negotiated orders and discourses, we conducted a qualitative, interpretive study in a large urban university and affiliated health science centre in Canada using document analysis and semi‐structured interviews. Documents and interview transcripts were analysed using concepts and tools from Adele Clarke's situational analysis.ResultsBetween March 2022 and April 2023, we conducted 17 interviews with staff physicians (n = 6), medical residents (n = 2), safety leaders and/or university administrators (n = 9). Analysis revealed counter‐vailing forces that must be constantly interpreted, negotiated and re‐negotiated by participants attempting to deliver on the aspirations of the CLE. Furthermore, analysis revealed potentially competing discourses about the nature of learning in the CLE, animating long‐standing tensions about the role of the CLE in developing clinical expertise and professional identity.DiscussionOur study reveals counter‐vailing forces, interacting policies and potential disagreements about the learning imperatives and priorities of the CLE. These counter‐vailing pressures shape learning about patient safety. More than learning content or process, invested groups must also learn to negotiate risks and responsibilities distributed across multiple social arenas. These distributions are changing. Understanding these dynamics is essential for educators and researchers seeking to positively influence the CLE. Future CLE research should account for the various pressures acting on health service organizations and the possible implications for educational mandates in these spaces.

ObjectivesThe rapid integration of artificial intelligence (AI) in healthcare requires robust legal safeguards to ensure safety, privacy and non-discrimination, crucial for maintaining trust. Yet, unaddressed differences in disciplinary perspectives and priorities risk impeding effective reform. This study uncovers convergences and divergences in disciplinary comprehension, prioritisation and proposed solutions to legal issues with health-AI, providing law and policymaking guidance.MethodsEmploying a scoping review methodology, we searched MEDLINE (Ovid), EMBASE (Ovid), HeinOnline Law Journal Library, Index to Foreign Legal Periodicals (HeinOnline), Index to Legal Periodicals and Books (EBSCOhost), Web of Science (Core Collection), Scopus and IEEE Xplore, identifying legal issue discussions published, in English or French, from January 2012 to July 2021. Of 18 168 screened studies, 432 were included for data extraction and analysis. We mapped the legal concerns and solutions discussed by authors in medicine, law, nursing, pharmacy, other healthcare professions, public health, computer science and engineering, revealing where they agree and disagree in their understanding, prioritisation and response to legal concerns.ResultsCritical disciplinary differences were evident in both the frequency and nature of discussions of legal issues and potential solutions. Notably, innovators in computer science and engineering exhibited minimal engagement with legal issues. Authors in law and medicine frequently contributed but prioritised different legal issues and proposed different solutions.Discussion and conclusionDiffering perspectives regarding law reform priorities and solutions jeopardise the progress of health AI development. We need inclusive, interdisciplinary dialogues concerning the risks and trade-offs associated with various solutions to ensure optimal law and policy reform.

<p>Background: Funding for educational innovations is increasingly scarce in academic medicine. While there is some funding for medical education research, this is often for discovery or application work, and there are few avenues for those with a heavy innovation focus to fund early work.</p> <p>Objective of the innovation: The objective was to develop an intrapreneurial unit focused on medical education projects and scholarship.</p> <p>Development process and implementation: The GridlockED and TriagED games are educational or serious games that seek to teach health care learners about emergency medicine processes. Both games were cocreated with learners and brought to market in the past 3 years. All of the proceeds from the sales of these games have been accrued over time to create a new innovation fund. This fund seeks to support trainees and early career educators in their medical education projects.</p> <p>Outcomes: Sales for GridlockED began in March 2018 and the TriagED began in November 2019. In the first year, sales for GridlockED yielded a total of $9,534. After 18 months of sales, the fund has accrued a total of $14,530. The fund has helped finance the development of new games. Additionally, the fund awarded two internal $500 Kickstarter grants to assist with evaluating and improving two local education projects. The GridlockED and TriagED games have also spurred multiple academic opportunities for junior educators interested in this domain: five workshops, eight conference abstracts, two peer-reviewed papers, and two research protocols are being developed.</p> <p>Conclusions: The GridlockED and TriagED games represent a new academically oriented, intrapreneurial approach to medical education work.</p>

<p><strong>Introduction</strong></p> <p>The Nominal Group Technique (NGT) is a consensus group method used to synthesize expert opinions. Given the global shift to virtual meetings, the extent to which researchers leveraged virtual platforms is unclear. This scoping review explores the use of the vNGT in healthcare research during the COVID-19 pandemic.</p> <p><strong>Methods</strong></p> <p>Following the Arksey and O’Malley’s framework, eight cross-disciplinary databases were searched (January 2020-July 2022). Research articles that reported all four vNGT stages (idea generation, round robin sharing, clarification, voting) were included. Media Synchronicity Theory informed analysis. Corresponding authors were surveyed for additional information.</p> <p><strong>Results</strong></p> <p>Of 2,589 citations, 32 references were included. Articles covered healthcare (27/32) and healthcare education (4/32). Platforms used most were Zoom, MS Teams and GoTo but was not reported in 44% of studies. Only 22% commented on the benefits/challenges of moving the NGT virtually. Among authors who responded to our survey (16/32), 80% felt that the vNGT was comparable or superior.</p> <p><strong>Conclusions</strong></p> <p>The vNGT provides several advantages such as the inclusion of geographically dispersed participants, scheduling flexibility and cost savings. It is a promising alternative to the traditional in-person meeting, but researchers should carefully describe modifications, potential limitations, and impact on results.</p>

We report the genome sequence of the bldA39 (J1700) mutant Streptomyces coelicolor, a historically important strain that is deficient in sporulation and antimicrobial production. The S. coelicolor J1700 strain was used extensively from the 1980s onwards to underpin important discoveries in development and antibiotic production in Streptomyces. The bldA gene encodes a leucyl transfer RNA (tRNA), required for the translation of the rare TTA codon found in ~2% of genes in Streptomyces. The whole genome of S. coelicolor J1700 was obtained via Illumina sequencing and mapped to the of S. coelicolor M145 reference genome. Analysis of the genome sequence compared to S. coelicolor M145 identified the known bldA39 mutation (T>C) and revealed more than 300 further mutations, likely associated with the S. coelicolor J1501 genetic background the strain was created in, including the nature of the hisA1 and uraA1 alleles used extensively in genetic mapping experiments and several mutations in natural product biosynthetic gene clusters. This work highlights the importance of whole genome sequencing of historically important strains.

IntroductionDisparities of power between high-income (HICs) and low- and middle-income countries (LMICs) have long characterised the structures of global health, including knowledge production and training. Historical case study analysis is an often-overlooked tool to improve our understanding of how to mitigate inequalities.MethodsDrawing from the contemporary experience of collaborators from Canada and Ethiopia, we chose to examine the historical relationship between Ethiopian Emperor Haile Selassie and Canadian Jesuit Lucien Matte as a case study for international collaborations based on the model of an ‘invited guest’. We used critical historical context and qualitative content analysis methodologies to assess written correspondence between them from the 1940s to the 1970s and drew from postcolonial theory to situate this case study in a broader context.ResultsThe respectful and responsive relationship that developed between Emperor Haile Selassie and Lucien Matte reveals important characteristics needed for meaningful collaborations in global health education. Matte came to Ethiopia fully cognizant of the imperial context of his work and prepared to take on the position of invited guest. As a result, many of both Matte and Haile Selassie’s goals were achieved. At the same time, however, this case study also revealed how problematic constructions of authoritative power can arise even when productive partnerships among individuals occur. Matte and Haile Selassie’s collaboration reinscribed belief in the superiority of western theories of intellectual and social development. In addition, their prescriptive vision for education in Ethiopia repeatedly dismissed competing local positions.ConclusionAs international partnerships in global health education continue to exist and form, historical case studies offer valuable insights to guide such work. Among the most crucial arenas of knowledge is the need to understand powerful dynamics that have and continue to shape HIC-LMIC interaction. The historical case study of Matte and Haile Selassie reveals how problematic power differentials can be reinforced or mitigated.