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Dunn JM, Steel AE, Adams J, Lloyd I, De Groot N, Hausser T, Wardle J. Characteristics of global naturopathic education, regulation, and practice frameworks: results from an international survey. BMC Complement Med Ther 2021; 21:67. [PMID: 33602181 PMCID: PMC7893718 DOI: 10.1186/s12906-021-03217-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined. METHODS This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 - Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate. RESULTS Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous. CONCLUSION Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.
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Affiliation(s)
- J M Dunn
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia. .,World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada.
| | - A E Steel
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - J Adams
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - I Lloyd
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada
| | - N De Groot
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada.,Canadian College of Naturopathic Medicine, 1255 Sheppard Ave East, Toronto, Ontario, Canada
| | - T Hausser
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada
| | - J Wardle
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.,National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia
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Abstract
Joining a brittle veneer to a strong ceramic core with an adhesive offers potential benefits over current fabrication methods for all-ceramic crowns. We tested the hypothesis that such joining can withstand subsurface radial cracking in the veneer, from enhanced flexure in occlusal loading, as well as in the core. Critical conditions to initiate fractures were investigated in model crown-like layer structures consisting of glass veneers epoxy-joined onto alumina or zirconia cores, all bonded to a dentin-like polymer base. The results showed a competition between critical loads for radial crack initiation in the veneers and cores. Core radial cracking was relatively independent of adhesive thickness. Zirconia cores were much less susceptible to fracture than alumina, attributable to a relatively high strength and low modulus. Veneer cracking did depend on adhesive thickness. However, no significant differences in critical loads for veneer cracking were observed for specimens containing alumina or zirconia cores.
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Affiliation(s)
- J.J.-W. Lee
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - J.-Y. Kwon
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - S. Bhowmick
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - I.K. Lloyd
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - E.D. Rekow
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - B.R. Lawn
- Materials Science and Engineering Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8520, Gaithersburg, MD 20899-8520, USA
- School of Nano and Advanced Materials Engineering, Changwon National University, Changwon, Kyung-Nam, Korea
- Department of Materials Science and Engineering, University of Maryland, College Park, MD 20742-2115, USA; and
- New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
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Bolt S, Routledge E, Lloyd I, Chatenoud L, Pope H, Gorman SD, Clark M, Waldmann H. The generation of a humanized, non-mitogenic CD3 monoclonal antibody which retains in vitro immunosuppressive properties. Eur J Immunol 1993; 23:403-11. [PMID: 8436176 DOI: 10.1002/eji.1830230216] [Citation(s) in RCA: 147] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CD3 antibodies are proven immunosuppressants capable of reversing transplant rejection episodes. Their general application has been limited both by their immunogenicity and, in particular, by the "first-dose" cytokine-release syndrome experienced by patients after the initial administration of antibody. We have produced a set of variants of the humanized YTH 12.5 CD3 monoclonal antibody (mAb) (Routledge et al., Eur. J. Immunol. 1991. 21: 2717) bearing different human heavy (H) chain constant regions, with the intention of finding a form of the antibody that is not able to activate T cells. Comparison of the variants having gamma 1, gamma 2, gamma 3 and gamma 4 H chains in a competitive binding assay showed that antibody avidity was not affected by IgG subclass. Using a sensitive indicator of FcR binding activity (the capacity of the CD3 mAb to redirect cytotoxic T cells to kill the monocytic cell line U-937) we demonstrated a functional hierarchy of gamma 1 = gamma 4 > alpha 2 =/> gamma 3 mb >> gamma 2. An aglycosyl version of the gamma 1 CD3 mAb, produced by site-directed mutagenesis (Asn297 to Ala), still had considerable activity in this assay (intermediate to the gamma 1 and alpha 2 CD3 mAb), albeit at a level approximately 10-fold lower than that of the parental gamma 1 form. When we tested their ability to stimulate T cell proliferation in vitro in the presence of 5% human serum, all of the wild-type immunoglobulin isotypes were found to be active, although there were T cell donor-dependent variations in the extent of the responses. The aglycosyl gamma 1 mAb was, however, completely non-mitogenic in all of ten donors tested, unless the assay was performed in IgG-free medium. Despite being non-stimulatory, this mAb was also able to inhibit the mixed lymphocyte reaction responses of both naive and primed T cells. Comparison of the gamma 1 and aglycosyl gamma 1 mAb in an experimental mouse model for CD3 mAb-induced cytokine release indicated that removal of the carbohydrate moiety from the gamma 1 constant region reduced the in vivo tumor necrosis factor-alpha response by a factor of at least 16-fold. These data suggest that the aglycosyl gamma 1 CD3 mAb is a promising candidate for immunosuppressive therapy without "first dose" side effects.
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Affiliation(s)
- S Bolt
- Department of Pathology, University of Cambridge, GB
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Abstract
The rat monoclonal antibody (mAb) YTH12.5, specific for the CD3 antigen complex on human T cells has been modified in order to improve its efficacy in human therapy. With the aim of rendering it less immunogenic, it has been humanized using the method of framework grafting. During this process sequence analysis of the YTH12.5 VL gene indicated that it was of the lambda subclass, however, it was markedly dissimilar from previously published rat and mouse V lambda gene sequences and may represent a new V lambda gene family. The humanization of this light chain represents the first successful reshaping of a lambda light chain V region. To improve the effector function of the antibody we have created a monovalent form (1 Fab, 1 Fc) using a novel method involving the introduction of an N-terminally truncated human IgG1 heavy chain gene into cells producing the humanized CD3 mAb. Comparison of the mono- and bivalent humanized mAb in a complement-mediated cell lysis assay revealed that the monovalent antibody mediated lysis of human T cell blasts whereas the bivalent form did not. The availability of a humanized, complement-fixing CD3 mAb may improve opportunities for human therapy, in the management of organ rejection, autoimmunity and the treatment of T cell lymphoma.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/genetics
- Antigen-Antibody Reactions
- Antigens, CD/immunology
- Antigens, Differentiation, T-Lymphocyte/immunology
- Base Sequence
- CD3 Complex
- Cloning, Molecular
- Complement Activation
- Cytotoxicity, Immunologic
- Humans
- Immunoglobulin Variable Region/genetics
- Isoantibodies/chemistry
- Isoantibodies/genetics
- Molecular Sequence Data
- Rats
- Receptors, Antigen, T-Cell/immunology
- Recombinant Fusion Proteins/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes, Cytotoxic/immunology
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Klein M, Lloyd I, Redman C, Bull M, Turnbull AC. A comparison of low-risk pregnant women booked for delivery in two systems of care: shared-care (consultant) and integrated general practice unit. II. Labour and delivery management and neonatal outcome. Br J Obstet Gynaecol 1983; 90:123-8. [PMID: 6824612 DOI: 10.1111/j.1471-0528.1983.tb08895.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A random sample of low-risk pregnant women were equally divided into four groups of 63 nulliparae and multiparae each booked for care in a integrated general practice unit (GPU) and a shared-care (consultant) system. Selection criteria included only women who were admitted because they were in spontaneous labour or thought they were. Nulliparous women booked for shared-care came into hospital at a less advanced state of cervical dilatation than those booked for the GPU and spent longer (11 compared with 8 h) in hospital before delivery; the comparable durations in multiparae were 6 and 4 h. Both the first and second stages of labour were longer in the GPU-booked women but they received less pethidine and fewer had epidural analgesia; they received less electronic fetal monitoring, augmentation and forceps delivery, and fetal distress was diagnosed less often. The 1-min Apgar score was less than or equal to 6 in 17.5% of infants of nulliparae booked for the shared-care system compared with 1.6% of those booked for the GPU. The intubation rate of infants of nulliparae was 11% in the shared-care system compared with no intubations in the GPU. These comparisons demonstrate the simplicity and safety of delivery of low-risk women in the GPU as compared with deliveries of similar women in a shared-care (consultant) unit.
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