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  • Pret A Manger unveils £13 salads as office lunch battle heats up

    Pret A Manger unveils £13 salads as office lunch battle heats up

    Pret A Manger has launched a new range of “premium” salads costing up to £12.95, which the company says have been “priced competitively”.

    The four new “Super Plates” – including options like chipotle chicken and miso salmon – are said to be “nearly 60%” larger than the chain’s existing salads and are filled with “premium ingredients” including “hand massaged” kale.

    Defending the higher price point, a Pret spokesperson told the BBC the new range was launched to meet growing demand for “larger, nutrient-rich lunch options”.

    Pret’s new offering comes after the chain faced backlash last year for making changes to its popular subscription model.

    Like many companies that cater to office workers and commuters, Pret took a hit during the Covid pandemic when the majority of Britons were ordered to work from home if they could.

    Many employees who have spent the last few years working from home are now being encouraged, or mandated by their employers, to return to the office – a move which has seen the lunchtime market become fiercely competitive again.

    The most expensive of Pret’s new range of salads is the miso salmon with a price tag of £12.95. The company said the range had been launched in order to “reflect a shift in customer habits”.

    The use of more premium ingredients “reflects the growing trend of workers treating themselves to a more filling lunch the days they are in the office”, a spokesperson for Pret said.

    Pret was criticised by customers last year when it changed its subscription offer of up to five coffees a day for a monthly fee of £30 to up to five half-price coffees a day for £5 a month.

    It also ended its 20% discount on food, saying it had “never really got comfortable” with the dual pricing system across its food products as it announced it was scrapping the offer.

    Among Pret’s biggest competitors is the bakery chain Greggs. The bakery was ranked as the most popular dining brand in the UK in 2025 and the second strongest brand of 2024, according to data platform Statista.

    Other competitors include the likes of Atis, Farmer J and Salad Project which already focus their menus on “premium” salads and lunches aimed at inner-city workers.

    The new Pret salads are available in over 250 shops in large cities such as London, Birmingham, Edinburgh and Manchester.

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  • An Indian fighter jet crashes and both pilots are killed

    An Indian fighter jet crashes and both pilots are killed

    NEW DELHI — An Indian air force jet crashed in the western state of Rajasthan on Wednesday, killing both pilots, officials said.

    The Indian air force said in a statement on X that the trainer aircraft was on a routine training mission. Both pilots sustained fatal injuries, and an inquiry has been ordered to determine the cause of the accident, the air force said.

    The accident occurred near Churu in Rajasthan state. The air force did not identify the aircraft. A military pilot familiar with the crash said it involved a two-seater Jaguar fighter jet. The pilot spoke on condition of anonymity because he wasn’t authorized to speak to the media.

    Images from the crash site showed debris of the aircraft scattered around an agriculture field.

    Wednesday’s crash is the latest in a string of accidents involving India’s air force. At least three two Jaguars and one Mirage 2000 had crashed this year while on routine training.

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  • State-sponsored terrorism part of India’s policy to destabilise Pakistan: DG ISPR

    State-sponsored terrorism part of India’s policy to destabilise Pakistan: DG ISPR

    India is using state-sponsored terrorism as a policy against Pakistan, especially in Balochistan, said Inter-Services Public Relations (ISPR) Director-General Lieutenant General Ahmed Sharif Chaudhry on Wednesday.

    In an exclusive interview with Al Jazeera TV, the military spokesperson said India’s support for terrorist activities is aimed at destabilising Pakistan’s security, particularly in the volatile region of Balochistan.

    “These nefarious designs of India are a systematic conspiracy to destabilise Pakistan, especially in Balochistan,” he said. He added that India had admitted multiple times to supporting terrorism within Pakistan.

    Lt Gen Chaudhry reiterated that Pakistan views any aggression against its sovereign territory as a direct threat to regional stability. 

    “India’s political leadership has repeatedly admitted to supporting terrorism in Pakistan,” said Gen Chaudhry, naming Ajit Doval, India’s National Security Advisor, as the mastermind behind New Delhi’s network of state-sponsored terrorism. 

    Read: Doval Doctrine: India’s trail of terror

    The military spokesperson also referred to the recent attack in Waziristan, claimed by the proscribed TTP, which martyred 16 Pakistani soldiers and injured over 20 others.

    Pakistan has consistently maintained that India is directly involved in such attacks. “India is supporting and financing terrorist activities in Pakistan,” reiterated Gen Chaudhry while speaking to Al Jazeera TV.

    The term ‘Khawarij’ has been widely used by Pakistan’s military and media recently to refer to armed groups that attack the state and its military forces. 

    These nefarious designs of India are a systematic conspiracy to destabilise Pakistan, especially in Balochistan.

    ISPR DG Lieutenant General Ahmed Sharif Chaudhry

    “The current Fitna al-Khawarij is a continuation of the misguided ideology that has historically led to the killing of Muslims under a false religious narrative,” he said.

    In Islam, only the state has the authority to wage holy war (jihad) or engage in combat, and no individual, organisation, or group has this power, he said. 

    Read More: COAS warns of crippling response to aggression

    “The Khawarij have no relation to Islam, humanity, Pakistan, or Pakistani traditions,” maintained Gen Chaudhry.

    DG ISPR added that the term Fitna al-Hindustan was used in Pakistan to describe terrorists supported by India. “Fitna al-Hindustan is particularly active in destabilising the country, especially in the province of Balochistan,” he said.

    He emphasised that several countries, including the United States and Canada, have acknowledged Indian state-sponsored terrorism on their soil.

    Referring to the country’s nuclear capability, the senior army general maintained that Pakistan was a responsible and declared nuclear power and its nuclear program was completely secure. “Our nuclear capability is invincible and no one can dare to target our nuclear programme,” he added.

    The army spokesperson also spoke about broader geopolitical issues, reaffirming Pakistan’s support for Iran in the face of Israeli aggression. “Pakistan stands firmly with Iran in these challenging times.” 

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  • The Correlation of Interleukin-8 And Vitamin D Levelsin Jordanian Rheu

    The Correlation of Interleukin-8 And Vitamin D Levelsin Jordanian Rheu

    Introduction

    Rheumatoid arthritis (RA) is a chronic autoimmune disease, expressing its inflammatory manifestations within the synovial joints, provoking pain, swelling, and, if untreated, destroying the joints.1,2 Despite significant progress in the cessation of its physiopathology and the designing of tailored therapies, RA remains difficult for patients and healthcare providers to cope with.3,4

    The complicated interrelation of not only different immune mediators but also of numerous signaling pathways ensures that inflammation is self-maintained in RA.5 Of these mediators, IL-8 is the most powerful cytokine that plays the most important role during the inflammatory process in the synovial cavity.6 IL-8 is mainly released upon being activated by macrophages, fibroblasts, and endothelial cells in response to the inflammation trigger, and it acts through the production of neutrophils and their activation at sites of inflammation.7,8

    Patients with RA have been found to have elevated levels of IL-8 in joint synovial fluid and the blood was assessed for the disease and joint damage severity.9 Along with a wide variety of immune mediators that have been found to be involved in RA, IL-8 and vitamin D have come to light as crucial with the prospects of influencing inflammation responses and dysregulated immunity. IL-8, representing the family of cytokines with a proven pro-inflammatory potency, exhibits its effects by mediating the recruitment and activation of neutrophils in the synovial fluid, whereby inflammation is only amplified in RA patients.10,11 Besides its aggressive joint damaging effect, the prolonged inflammatory state plays a role in impairing overall health which makes RA chronic disability.12

    However, vitamin D, which was once known as a bone health and calcium homeostasis regulator, has got the interest of researchers because of its immunomodulatory capacities.10 Besides the classical functions, apart from its anti-inflammatory effects, vitamin D is one of the factors that modulate the activities of various immune cells, including T lymphocytes, macrophages, and dendritic cells.13 The results of a number of epidemiological studies have shown how low levels of vitamin D in the serum correspond with an increased possibility that a person will relapse or progress into rheumatoid arthritis.14 Though the activities of IL-8 and vitamin D in inflammation and immune functioning are quite clear, the exact processes through which they interact in RA are yet to be fully understood. Discovering the interplay between IL-8 and vitamin D concentrations in RA patients might help us to recognize in more depth the complicated immunological interactions that lead to sickness development and progression.

    The primary objective of this study is to investigate the correlation between IL-8 and 25-hydroxyvitamin D levels in patients diagnosed with rheumatoid arthritis. To the best of our knowledge, this is the first study to explore the interplay between these biomarkers in Jordanian RA patients.

    Therefore, this study aims to compare serum levels of IL-8 and vitamin D between RA patients and healthy controls and assess the relationships between these biomarkers and other inflammatory indicators such as RF, anti-CCP antibodies, CRP, ESR, and WBC count. Understanding these associations may help clarify the roles of IL-8 and vitamin D in RA pathogenesis and guide future diagnostic or therapeutic strategies.

    Subjects and Methods

    Design and Study Population

    The current study was carried out between February and April 2024 on 123 participants divided into two groups, 63 patients with RA fulfilling the American Rheumatism Association 1987 revised criteria for the classification of RA and 60 normal healthy age-and sex-matched controls. The study was conducted in a private medical laboratory (Smart Labs, Amman, Jordan). Participants were selected from subjects referred to in the laboratory for routine checkups. This study was conducted in accordance with the principles of the Declaration of Helsinki. Zarqa University approved the study protocol (IRB /ZU/2024/15). The objective of the study was explained, and information sheets and consent forms were distributed to participants before data and blood collection.

    Subjects were divided into two groups based on levels of RF. Subjects with RF >14.0 IU/mL were classified as patients, while subjects with lower than these cut-off values were considered controls. History and clinical examinations were conducted. Age, gender, intake of medication, and supplements were assessed as appropriate.

    Participants were excluded from the study if they had any of the following conditions: other autoimmune diseases, chronic infections, malignancies, liver or kidney disorders, recent Vitamin D supplementation (within the past three months), corticosteroid or immunosuppressive therapy unrelated to RA, or pregnancy. These criteria were applied to ensure that the observed changes in Vitamin D and IL-8 levels were specifically related to RA and not influenced by other confounding conditions.

    Biochemical Investigations

    Ten milliliters of peripheral venous blood was collected from each subject via venipuncture and divided into two parts. The first part was left without an anticoagulant for serum separation, while the second part was collected into sterile EDTA vacutainers for complete blood count and ESR measurements. ESR was recorded in millimeters per hour. CRP, mg/L and RF, IU/mL were analyzed using immunoturbidimetry on a cobas 6000 (Roche) CCP, U/mL was checked using an ELISA assay on a Chorus Trio 2013 system (Italy). Vitamin D (ng/mL) 25-OH vitamin D was evaluated using an enzyme-linked immunosorbent assay in serum samples from patients, on a cobas 6000 (Roche) system.

    Total concentrations of IL-8 in serum samples were measured using a commercial Enzyme-linked Immunosorbent Assay (ELISA) Kit (My BioSource, according to manufacturer’s instructions.

    Statistical Analysis

    Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp). Qualitative data were described using numbers and percentages. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using ranges (minimum and maximum), mean, standard deviation, median, and interquartile range (IQR). The significance of the results obtained was judged at the 5% level.

    Results

    Characteristics of Patients Population

    Sixty-three patients with confirmed RA were enrolled in this study. Sixty individuals served as a control group. The details of age and gender of the individual are presented in Table 1. Patients did not receive any treatment. Most of the patients were females (47 females versus 16 males). In controls, there were 35 males versus 25 females. Mean age of RA patients was 44.42 ± 10.01 while that of controls was 36.6 ± 12.9 years.

    Table 1 Comparison Between the Two Study Groups According to Age and Gender

    Serum Levels of IL-8

    A statistically significant higher levels of IL-8 (P < 0.001) in RA patients compared to healthy controls, 33.0 (176.5 ± 546.9) versus 2.8 (3.1 ± 2.7) was demonstrated (Table 2).

    Table 2 Comparison Between the Two Study Groups According to IL-8 and Vitamin D

    Serum Level of Vit D

    A statistically significant lower levels of Vitamin D (P < 0.001) in RA patients compared to healthy controls, 34.0 (25.0–47.6) versus 48.0 (37.0–55.0) was demonstrated (Table 2).

    In Table 3, all inflammatory markers (RF, CCP, CRP, ESR, and WBC) showed significantly higher levels in the patients’ group compared to normal subjects (p= <0.001 for all parameters).

    Table 3 Comparison Between the Two Study Groups According to Inflammatory Parameters

    Among the patients’ group, Table 4 showed no correlation between IL-8 and vitamin D with p = 0.737. In addition, Table 5 illustrates that there is no correlation between IL-8 and vitamin D with other inflammatory markers (RF, CCP, CRP, ESR, and WBC) with IL-8 (P= 0.061, 0.387, 0.375, 0.661, and 0.281; respectively), and vitamin D (P= 0.114, 0.416, 0.769, 0.663, and 0.777; respectively).

    Table 4 Correlation Between IL-8 and Vitamin D in Patients’ Group (n = 63)

    Table 5 Correlation Between IL-8 and Vitamin D with Different Parameters in Patient Group

    Discussion

    The current study intended to determine the Plasma Rheumatoid Factor (RF), inflammatory markers, and cytokines among the patient and normal control subjects emphasizing Vitamin D and interleukin-8 (IL-8). This study involved 123 participants divided into two groups: 63 patients and 60 normal subjects, out of each group 15 males and 15 females. To give a clearer perspective on the magnitudes and directions of these outcomes, the results of this study were benchmarked against the results of prior research.

    The present study showed that the female patient group had a higher percentage (74. 6%) than the normal group (41.7%). This has been consistent with another study which indicates that autoimmune diseases such as rheumatoid arthritis are more prevalent in the female population compared to the male population (Kvien et al, 2010; Tobón et al, 2010; Cincinelli et al, 2018) showed that female patients account for some 57% of rheumatoid arthritis cases, which is 1.5 times the number of male patients, and this study agreed with that, too. On hormonal differences, especially estrogen, it has been proposed that they contribute to gender differences in autoimmune disease susceptibility.15–17

    The comparison of the mean vitamin D levels between the patient and the normal group revealed that the patient had lower vitamin D levels than the normal group. As for the patient group the mean Vitamin D level was established to be 41.4 ± 25.2 < w = 46 > 5 ± 12.4. Analyzing the relationship between Vitamin D and autoimmune diseases18 identified low levels of the Vitamin as present in individuals with autoimmune diseases and discussed how Vitamin D plays an important role in immune regulation and that deficiency in it increases vulnerability to autoimmune diseases. These findings of a significant difference re-emphasize that Vitamin D supplementation may be effective in the management of rheumatoid arthritis and other inflammatory diseases as an additional therapy.18

    Vitamin D levels were significantly lower in the RA patient group compared to the controls (p = 0.002). This finding supports previous studies that highlighted the role of Vitamin D deficiency in the pathogenesis and progression of RA. For instance, Rossini et al, 2010; Meena et al, 2018 found that Vitamin D deficiency is common in RA patients and is associated with increased disease activity and severity. Low levels of Vitamin D may contribute to the immunological dysregulation observed in RA, as Vitamin D has immunomodulatory effects that are crucial in maintaining immune homeostasis.19,20

    The levels of IL-8 were significantly higher in the patient group compared to the normal group (MD = 176,95% CI: 121–230; WMD = 0.33,95% CI: 0.21–0.45; p < 0.001). 5 ± 546.9 pg/mL and 3.1 ± 2.7 pg/mL, respectively. Russo et al, 2014 reported that IL-8 exhibits pro-inflammatory properties and has been linked to rheumatoid arthritis due to its contribution to inflammation.8 Research has established that IL-8 has a significant role in inflammation, which is associated with rheumatoid arthritis. Physiologically, a rise in the level of IL-8 indicates that there is increased inflammatory activity in the body of patients with rheumatoid arthritis, as established Gremese et al, 2023 who noted that higher levels of IL-8 were found in patients with active rheumatoid arthritis and are associated with disease activity.9 The levels of IL-8 were significantly higher in the RA patient group compared to the control group (p < 0.001). The levels of IL-8 were significantly higher in the RA patient group compared to the control group (p < 0.001). IL-8 is a pro-inflammatory cytokine that plays a critical role in the inflammatory process associated with RA. Elevated levels of IL-8 in RA patients have been reported in studies,21 indicating its role in promoting the recruitment and activation of neutrophils and other immune cells in the synovial fluid and tissues of RA patients. This study’s findings corroborate these reports, suggesting that IL-8 is a key player in the inflammatory milieu of RA. Both RF and anti-CCP were significantly higher in the patient group or 49 ±13 versus 17±5, p < 0.001, and 32 ±11 versus 8 ± 2, p < 0.001, respectively. This was expected given the persistently elevated inflammatory marker evident in these patients. These findings are also consistent with the data of Nishimura et al, 2007 who observed that high titers of circulating RF and CCP antibodies correlate with rapid disease progression in patients with RA.22 CRP and ESR are proven biomarkers of inhabitants and are pragmatic tools in clinical medicine to assess the level of inflammation and response to various treatments.

    A cross-sectional comparison of the variables showed no positive relationship between IL-8 and vitamin D in the patient group with a correlation coefficient of 0.737. Additionally, it is worth underlining that there was no graded relationship between IL-8 and other markers of inflammation: RF, CCP, CRP, ESR, and WBC with p-values ranging from 0.061 to 0.661. In the same manner, results on Vitamin D were not different from these inflammatory indicators with corresponding p-values of 0.114 to 0.777. Based on these observations, IL-8 and Vitamin D, have a relationship exclusively with the inflammation process and disease states, but they are unlikely to combine in a way that is reflected in the parameters that were measured in this study. The lack of correlation is in line with Cutolo et al, 2011 where the authors noted that Vitamin D deficiency and inflammatory cytokine levels contribute to disease severity in RA but do not interact with each other.23 However, RF and CCP are specific markers for RA, and elevated levels of these markers are associated with more severe disease with an ability to predict disease progression. This study’s results align with previous findings that both RF and CCP are significantly higher in RA patients, underscoring their diagnostic and prognostic value.

    Elevated levels of the systemic inflammation markers CRP and ESR in RA patients, as observed in this study, indicate ongoing inflammation and are commonly used to monitor disease activity and response to treatment.

    An increased WBC count in RA patients reflects the inflammatory response and is a common finding in active RA. This study’s results are in line with the general observation that RA is associated with leukocytosis due to chronic inflammation. The results of the present study are in almost complete concordance with the earlier findings pointing towards the generally accepted understanding of the disease causation and the following clinical progression of RA and other autoimmune disorders. Several elements have supported the findings such as, the patient group predominantly consisting of females, lower levels of Vitamin D, higher levels of IL-8, and higher significant inflammatory markers have all been documented in the previous literature. Nonetheless, the observed relationship between IL 8 and RA did not show any significant association with Vitamin D or other inflammatory biomolecules; this points to the conclusion that both factors have independent roles to play in the progress of the disease.

    The present study has several limitations. Firstly, the number of patient samples is small, which may affect the generalizability of the findings. Secondly, the patients were taking various medications, which could potentially influence the results. Lastly, the use of anti-inflammatory medications among the participants may have affected the inflammatory markers, thereby impacting the study’s outcomes.

    Conclusion

    In this study, we found that people with rheumatoid arthritis had higher levels of IL-8 and lower levels of vitamin D compared to healthy individuals. However, these two markers did not show a clear link to each other or to other signs of inflammation. This suggests that IL-8 and vitamin D may affect the disease in different ways. Our findings highlight the importance of checking vitamin D levels in RA patients and suggest that IL-8 could be a useful marker for tracking inflammation. More research is needed to better understand how these factors contribute to the disease.

    Data Sharing Statement

    Derived data supporting the findings of this study are available from the corresponding author on request.

    Ethics Approval Statement

    This study was conducted in accordance with the principles of the Declaration of Helsinki. The study was examined and given approval by the Zarqa University’s Ethics Committee for Scientific Research (ECSR), with approval number IRB/ZU//2024/15.

    Consent to Participate and Publication

    Informed consent was taken from all participants.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    This research was supported by Zarqa university. (Grant No: 74/33/1/1).

    Disclosure

    The authors declare that they have no competing interests.

    References

    1. McInnes IB, O’Dell JR. State-of-the-art: rheumatoid arthritis [published correction appears in ann rheum dis. 2011 feb; 70(2):399]. Ann Rheum Dis. 2010;69(11):1898–1906. doi:10.1136/ard.2010.134684

    2. Soleimani Sasani M, Moradi Y. Role of recombinant proteins for treating rheumatoid arthritis. Avicenna J Med Biotechnol. 2024;16(3):137–145. doi:10.18502/ajmb.v16i3.15739

    3. Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370(9602):1861–1874. doi:10.1016/S0140-6736(07)60784-3

    4. Inchingolo F, Inchingolo AM, Fatone MC, et al. Management of rheumatoid arthritis in primary care: a scoping review. Int J Environ Res Public Health. 2024;21(6):662. doi:10.3390/ijerph21060662

    5. Demoruelle MK, Deane KD, Holers VM. When and where does inflammation begin in rheumatoid arthritis? Curr Opin Rheumatol. 2014;26(1):64–71. doi:10.1097/BOR.0000000000000017

    6. Villa P, Triulzi S, Cavalieri B, et al. The interleukin-8 (IL-8/CXCL8) receptor inhibitor reparixin improves neurological deficits and reduces long-term inflammation in permanent and transient cerebral ischemia in rats. Mol Med. 2007;13(3–4):125–133.

    7. Qazi BS, Tang K, Qazi A. Recent advances in underlying pathologies provide insight into interleukin-8 expression-mediated inflammation and angiogenesis. Int J Inflam. 2011;2011:908468. doi:10.4061/2011/908468

    8. Russo RC, Garcia CC, Teixeira MM, Amaral FA. The CXCL8/IL-8 chemokine family and its receptors in inflammatory diseases. Expert Rev Clin Immunol. 2014;10(5):593–619. doi:10.1586/1744666X.2014.894886

    9. Gremese E, Tolusso B, Bruno D, Perniola S, Ferraccioli G, Alivernini S. The forgotten key players in rheumatoid arthritis: IL-8 and IL-17 – unmet needs and therapeutic perspectives. Front Med. 2023;10:956127. doi:10.3389/fmed.2023.956127

    10. Azizieh F, Alyahya KO, Raghupathy R. Association between levels of vitamin D and inflammatory markers in healthy women. J Inflamm Res. 2016;9:51–57. doi:10.2147/JIR.S103298

    11. Ishikawa LLW, Colavite PM, Fraga-Silva TFDC, et al. Vitamin D deficiency and rheumatoid arthritis. Clin Rev Allerg Immunol. 2017;52:373–388. doi:10.1007/s12016-016-8577-0

    12. Jahid M, Khan KU, Ahmed RS. Overview of rheumatoid arthritis and scientific understanding of the disease. Mediterr J Rheumatol. 2023;34(3):284–291. doi:10.31138/mjr.20230801.oo

    13. Cubillos S, Krieg N, Norgauer J, et al. Effect of vitamin D on peripheral blood mononuclear cells from patients with psoriasis vulgaris and psoriatic arthritis. PLoS One. 2016;11(4):e0153094. doi:10.1371/journal.pone.0153094

    14. Huseynova A, Hajiyev A, Efendiyev A, Kerimova I. Proinflammatory cytokines in Rheumatoid arthritis: relationship with vitamin D deficiency. ISJ Theoret ApplSci. 2018;11(67):348–352. doi:10.15863/TAS.2018.11.67.62

    15. Kvien TK, Uhlig T, Ødegård S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann N Y Acad Sci. 2006;1069:212–222. doi:10.1196/annals.1351.019

    16. Tobón GJ, Youinou P, Saraux A. The environment, geo-epidemiology, and autoimmune disease: rheumatoid arthritis. J Autoimmun. 2010;35(1):10–14. doi:10.1016/j.jaut.2009.12.009

    17. Cincinelli G, Generali E, Dudam R, Ravindran V, Selmi C. Why women or why not men? Sex and autoimmune diseases. Indian J Rheumatol. 2018;13(1):44–50. doi:10.4103/injr.injr_1_18

    18. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–281. doi:10.1056/NEJMra070553

    19. Rossini M, Maddali Bongi S, La Montagna G, et al. Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability. Arthritis Res Ther. 2010;12(6):R216. doi:10.1186/ar3195

    20. Meena N, Singh Chawla SP, Garg R, Batta A, Kaur S. Assessment of vitamin D in rheumatoid arthritis and its correlation with disease activity. J Nat Sci Biol Med. 2018;9(1):54–58. doi:10.4103/jnsbm.JNSBM_128_17

    21. O’Brien MB, McLoughlin RM, Roche C, Nelson CD, Meade KG. Effect of IL-8 haplotype on temporal profile in circulating concentrations of interleukin 8 and 25(OH) vitamin D in Holstein-Friesian calves. Vet Immunol Immunopathol. 2021;238:110287. PMID: 34214911. doi:10.1016/j.vetimm.110287

    22. Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Internal Med. 2007;146(11):797–808. doi:10.7326/0003-4819-146-11-200706050-00008

    23. Cutolo M, Plebani M, Shoenfeld Y, Adorini L, Tincani A. Vitamin D endocrine system and the immune response in rheumatic diseases. Vitam Horm. 2011;86:327–351. doi:10.1016/B978-0-12-386960-9.00014-9

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  • ‘Heartbreaking’ — Hira Tareen laments crumbling community, family structures after Humaira Asghar Ali’s death – Culture

    ‘Heartbreaking’ — Hira Tareen laments crumbling community, family structures after Humaira Asghar Ali’s death – Culture

    Model and actor Hira Tareen is opening up about crumbling community and family structures in light of the deaths of actor and model Humaira Asghar Ali and veteran actor Ayesha Khan, who both passed away alone in their homes and were found days later, something that Tareen found “beyond disturbing.”

    Ali’s body was found in an apartment in Karachi’s Defence Housing Authority on Tuesday, police confirmed. South DIG Syed Asad Raza told Images that Ali’s body was recovered from a flat in Ittehad Commercial in Phase-VI. In a statement, the Gizri police identified the body as that of the 32-year-old actor and said she had died around two weeks prior to the discovery.

    In June, Khan was found dead in her apartment in Karachi’s Gulshan-i-Iqbal area. The deceased’s remains indicated that she may have died a few days before she was found, and police discovered she lived by herself.

    In a note posted to her Instagram story, Tareen addressed Ali’s passing and said she met her at a few fashion weeks when she was modelling, adding, “People can be really cruel in the fashion industry at times.”

    “But what we’re witnessing these days is something heartbreaking, something we don’t talk about enough. The way community and family structures are crumbling right in front of us. Hearing about people found dead days later, alone in their homes, is beyond disturbing.”

    Tareen continued that this was a sign of how disconnected people were and that everyone assumed someone would be okay in real life if they appeared alright on social media. “We forget most people only show their best side here.

    “We don’t talk to each other. We turn to acquaintances who tell us what we wanna hear or AI who is programmed to tell us we are always right,” she wrote.

    The Ishq Murshid actor said people constantly consume content that tells them they’re better off alone and everyone else is toxic. She clarified that she was not implying that this happened in Khan and Ali’s cases, but was a reminder of where things were heading.

    “Prayers for those we lost. May they rest in peace.”

    After Ali’s passing, many celebrities took to social media to urge people to check on their friends. Model Saheefa Jabbar Khattak highlighted the complexities of showbiz life. “The industry often looks glamorous from the outside, but navigating it can be deeply challenging. I won’t claim to have known her well… but please have respect for the departed. Be gentle, be sensitive, and be mindful of what you say in the comment section.”

    Actor Hina Altaf reflected, “She lived alone. She passed away alone. And days went by before anyone even noticed. This isn’t just a loss, it’s a wake-up call. Check in on your friends, and also people who never ask.”

    Mawra Hocane asked friends and acquaintances to reach out to her without any judgment. “If you’re in trouble or caught in spiralling thoughts, if I have known you briefly or extensively, if you’re a friend or an acquaintance, if you’re from my fraternity and you feel I will understand your pressures, please reach out!” Hocane wrote.

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  • Small Steps, Giant Leaps: Episode 157: Fighting Wildland Fires with Drones

    Small Steps, Giant Leaps: Episode 157: Fighting Wildland Fires with Drones

    Andres Almeida (Host): As wildland fires grow more intense and unpredictable, NASA is helping first responders gain the upper hand. We’re exploring ACERO, the Advanced Capabilities for Emergency Response Operations Project. It’s something that will better protect communities, potentially saving lives. This is Small Steps, Giant Leaps. 

    [Intro music] 

    Welcome to Small Steps, Giant Leaps, your podcast from NASA’s Academy of Program/Project & Engineering Leadership, or APPEL. Each episode dives into the lessons learned and experiences from NASA’s technical workforce. 

    Today we’re talking about ACERO and the team developing an airspace management system to enable drones and other aircraft to safely monitor and suppress wildland fires 24 hours a day. The system will increase aerial response capabilities for responders during low-visibility conditions in a way that is not currently possible. This will better protect our communities. Here to tell us about it is Patrick Hill, chief of Unmanned Aircraft Systems training at NASA’s Langley Research Center in Hampton, Virginia. 

    Host: Hey, Patrick, thanks for being here. 

    Patrick Hill: Yeah, thanks for having me. 

    Host: Can you talk a bit about ACERO, what it is and what is your role with the project? 

    Hill: Okay, yeah, so I’m a systems engineer and the chief of UAS training at NASA Langley Research Center. Before the flight demonstration, I was involved in payload testing and flight training. We were verifying the functionality all the individual parts that will go into the larger systems that we were testing during the flight demonstration. I was the acting pilot in command for the SuperVolo UAS. The SuperVolo is a hybrid electric, gas, electric, uncrewed aircraft system which takes off vertically and transitions to forward flight. These things combined allow the vehicle to quickly be deployed in some austere environments, while enabling it to stay in the air for much longer than other aircraft. 

    I would also like to mention that it wasn’t just me working on the project. We had dozens of individuals, from software developers to hardware integrators to systems engineers, airspace and ground crews, who all came together, put a lot of hours to accomplish the goals of the project. 

    Host: Yeah, that’s how it often is. It’s such an integrated process, right? 

    Hill: Yeah, it’s not just me out there. I know I’m a pilot, but, and we have high egos, but it’s a, it was not definitely just not me out there. 

    Host: So, can you tell us some advantages of using drones in wildland fire scenarios? 

    Hill: Sure. Let me start by laying out how things are currently done today. So UAS, or drones, are currently used for aerial ignition, where they would drop small pods, which ignite on the ground and start control burns. This manages the larger burns. In some scenarios, you’ll also have aerial ignition from crude aircraft. In the more severe wildfires, you’ll have crude aircraft coming in and dropping in tons of water or fire retardant. All of these aircraft are usually guided by an air boss who acts as a type of local airspace manager. 

    An important note is that during most of the burns today, when crewed aircraft are flying, the drones are not and then when the drones are flying, the crewed aircraft are not. Now, I’m not saying that we’re trying to completely replace all the crewed aircraft. That’s not what we’re trying to do here. What the drones are great at is dull, dirty, and dangerous jobs. We don’t really relate to wildfires as dull, but there are times where we can orbit our aircraft above a mountain for hours so ground crews could have a constant radio communication with each other. 

    UAS are also utilized to monitor critical information like local weather or the progression of the fire in real time. In the future, we plan on utilizing our systems in a second shift capability, or at night when the crewed aircraft are grounded. Low-flying aircraft around mountains at night don’t really jive together, and that’s a place where the UAS would really strive. 

    Host: What types of sensors and technologies are equipped to aid in wildland fire management? 

    Hill: So, for the ACERO flight demonstration, the aircraft I was operating was equipped with the Doodle Labs radio, which acted as a key node in a mesh network of ground radios operated out of these PAM cases we were testing. We also utilize our multirotor aircraft to monitor local weather in real time, equipping an aircraft with a radiosonde, which is the same payload that you would see on a weather balloon (while other crews were flying UAS, utilizing cameras to monitor the progression of the burn).

    Host: I’d love to talk about the PAMS that you have. Can you talk about the Portable Airspace Management System? 

    Hill: Sure. So, the Portable Airspace Management Systems, or PAMS cases, because we love our acronyms here at NASA, is essentially a situational awareness gold mine for UAS and wildfire crews. 

    It allows crews to preserve a block of airspace to operate in during the flight demonstration, when given the green light from our airspace approver, who in this case, was performed by individuals from CAL FIRE the UAS crews were able to see all active flights. Crews were also notified of an aircraft if it was going non-conforming or straight outside of its pre-approved flight area. The case has also received ADS-B [Automatic Dependent Surveillance-Broadcast] in, which allows crews to monitor the local manned traffic in the area. 

    Host: So, you mentioned CAL FIRE. What has been the response to ACERO from emergency officials? 

    Hill: So, I don’t claim to be an emergency official myself, but from the individuals that we worked with during the ACERO flight demonstration, they all seemed extremely pleased with the products that we were able to produce. 

    I believe the PAMS case and the possibility of the future integration with the wildfire crews, both on the ground and in the air, was particularly seen as a useful technology that will generate forward momentum and integration of UAS in the wildfire and wildfire fighting airspace. 

    Host: So, looking ahead, what advancements Do you foresee in drone technology that could further aid in wildfire management. 

    Hill: Yeah, so first we need to be able to assist with controlling the airspace that you’re flying in, which is why we’re testing these PAMS cases. 

    As technology develops and we get more confidence in our systems, we would see a sharing of the airspace with the crewed side, having small UAS delivering equipment to crews in the field, while larger manned aircraft are able to come in and drop their water on location scouted by a UAS, which is flying at a high altitude, which may also be providing key nodes to radios and all crews on the ground. 

    And then going back to the second shift capabilities, [it] will allow crews to be constantly monitored and evolving fire or even react to it when it may not be possible to do otherwise.

    Host: Do you find yourselves sharing knowledge across teams? Is that a core component of what you all do? 

    Hill: Yeah, so sharing the knowledge that we receive is part of NASA mission, right? So, everything that we’re doing should be passed forward to the public, which include includes the firefighter crews and their teams that are, you know, currently in these environments, working and fighting these fires. 

    Host: I do like learning from you the term Air Boss. I hadn’t heard that before, so that’s a term that’s wildfire management, correct? 

    Hill: Yeah, that’s correct. So, the Air Boss kind of acts as a flying ATC tower, right? And he gives out all the instructions to the aircraft coming in and out of what would actually be a TFR, or flight restricted area. And that would allow the, you know, continuation of all the aircraft going in and out at the low distances that these aircraft need to be at.

    Host: With UAS, with these drones, you’re looking to complement, especially at night, right, when it’s less safe to fly, when it’s less safe for a pilot to fly. 

    Hill: Yeah, so, as it is today, for the most part, we ground all manned aircraft at night because, you know, there’s no lights on the mountains, and we don’t want these aircraft get flying into a dangerous area. Now, we do have aircraft that have terrain following and things like that, but the UAS are, in a lack of a better term, much more replaceable than a manned aircraft.

    Host: Can you share any lessons learned from ACERO so far? 

    Hill: far? Well, California has some of the best burritos I’ve ever eaten! But seriously, we have learned a lot of great takeaways from our flight demonstration. In particular, we learned a lot about the complex integration of flying multiple UAS in a confined airspace, and what it takes to really do that safely. 

    A major takeaway that I received was that the communication line from the aircraft to the ground systems to everybody else is vital for all crews. It’s not just vital for our crew flying the aircraft, but for the other crews that are in the area need to know what’s going on with us as well. 

    Host: Patrick, one more question for you. What was your giant leap? 

    Hill: Yeah. So, my giant leap started way back when I was in college. My intent was to go to school and become an airline pilot. The way my major worked, I was able to take some classes studying UAS, and I was immediately sucked. In my second year of school, I took my giant leap, stepping away from my original major to study UAS, and I’ve never looked back. That decision has taken me places that I’d never have gone otherwise, like working for NASA. 

    Host: Do you think when you like your own, like pilot’s license just for recreation? 

    Hill: Yeah, so I actually have 70 hours in a crude aircraft, which is a stone’s throw away. I should probably have my license already, to be honest.  

    [Laughter] 

    But just the way things have worked, and I’ve got I’ve gained those hours in very short bursts many times. So, I reached the point to take my test several times and then gone back to restudy. But yes, I think one day in my future, I will be flying myself. 

    Host: There have to be many pilots there at Langley, correct? Like, recreational? 

    Hill: Yeah, yeah. So I think most of the people I work with have their own license or in some like, shape or form. We have a lot of glider pilots here, actually, which is, you know, that’s not something you see every day or run into, so, quite unique for the people that we have. But their skills are some of the best I’ve ever seen. 

    Host: That’s pretty great. Do you have any closing words for anybody who wants to pursue a career at NASA and something you’d follow in your footsteps, perhaps? 

    Hill: Follow your heart, but do what you’re good at? I loved UAS, and fortunately, I had an engineering mindset, which has taken me far in this in this world. So, if you’re, you know, planning on following my footsteps, go to school, get your degree, I bet you relied on mentors too, yeah, oh, yeah, so I wouldn’t have gotten where I am today without the help of, you know, former classmates, teachers, professors, my old bosses, my current bosses. Everybody has, you know, put a little bit of effort into the person I am today, which, you know, working for NASA is pretty fantastic. 

    Host: Well, thanks, Patrick, thanks for your time today. 

    Hill: Yeah, thanks. I really appreciate it. And also, as of this recording date, yesterday was Father’s Day. So, shout out to all the dads out there, especially my dad and my two brothers who recently had kids. Just want to put that out there. 

    Host: Excellent. Happy Father’s Day to all.

    Host: That’s it for this episode of Small Steps, Giant Leaps. For more on Patrick Hill and the topics we discussed today, visit appel.nasa.gov. That’s A-P-P-E-L dot NASA dot gov. And while you’re there, check out our other podcasts like Houston, We Have a Podcast, Curious Universe, and Universo curioso de la NASA. Thanks for listening. 

    [Outro music] 

    Outro: Three. Two. One. This is an official NASA podcast. 

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  • Not Just Pills — Cardiologists Must Talk Spirituality

    Not Just Pills — Cardiologists Must Talk Spirituality

    Spirituality is becoming an area of growing interest in cardiovascular medicine as evidence mounts linking it to improved physiological outcomes and treatment adherence. Emerging research suggests that qualities such as purpose in life, gratitude, and hope — even when not tied to religious practice — may positively influence cardiovascular health.

    At the 45th Congress of the Cardiology Society of the State of São Paulo, experts explored how this subjective dimension may contribute to fewer hospitalizations, better blood pressure control, and improved clinical outcomes in patients with heart disease.

    Opening the discussion, cardiologist and hypertension specialist Fernando Nobre, MD, PhD, emphasized the important distinction between spirituality and religiosity. While often used interchangeably, the two are not synonymous. Religiosity refers to structured beliefs, practices, and rituals associated with faith and community life. In contrast, spirituality encompasses moral, emotional, and mental values that shape an individual’s behavior and decision-making. These can be assessed using scientific frameworks.

    “Religiosity is about how connected someone is to their religion — attendance at services, observance of rituals. That can be part of spirituality, but spirituality goes further. It cuts across and transcends a person’s life, shaping their choices and way of living,” said Nobre, who is also a professor at the University of São Paulo, São Paulo, Brazil.

    Patients with a stronger sense of spiritual engagement tend to have lower blood pressure and are less likely to develop hypertension. Studies suggest these effects may be linked to lower peripheral vascular resistance, improved cardiac output, and better adherence to prescribed treatment — particularly among women.

    One recent example is the Brazilian Feel study, led by cardiologist Maria Emília Figueiredo Teixeira, MD, PhD, at the Brazilian Federal University of Goiás, Goiânia, Brazil. Cited by Nobre, the study was published in 2024 and followed 100 individuals with hypertension over 12 weeks. The intervention group received short, non-religious videos and messages promoting spiritual reflection — delivered via WhatsApp — and were encouraged to write about gratitude, forgiveness, life purpose, and optimism.

    The group receiving the intervention showed a more significant drop in blood pressure and notable improvement in endothelial function, measured through flow-mediated dilation.

    “If spirituality appears to influence both key components of blood pressure, that alone is reason enough for us to understand it better,” said Nobre.

    Heart Failure: Fewer Hospitalizations, Better Quality of Life

    In patients with heart failure, spirituality may influence not only psychological resilience but also the underlying pathophysiology of the disease. Studies have found that individuals with greater spiritual engagement show reduced sympathetic nervous system activity, lower levels of stress hormones, and decreased inflammatory cytokines. Clinically, these changes are associated with fewer symptoms, fewer hospitalizations, and an improved quality of life.

    At the session, cardio-oncologist Rafael Nunes, MD, PhD, of the Oswaldo Cruz German Hospital, São Paulo, highlighted a 2022 review published in JACC: Heart Failure. The review analyzed 47 studies examining spirituality in heart failure patients. Despite differences in methodology, the evidence consistently linked higher spirituality levels with lower rates of anxiety and depression, improved adherence to treatment, fewer hospital admissions, and, in some cases, reduced mortality.

    A follow-up review published in 2023 reinforced these findings and added an important distinction: Participation in religious organizations alone was not sufficient to deliver clinical benefit. “It’s the spiritual experience — the meaning a person assigns to their life, beliefs, and motivations — that is associated with positive outcomes,” explained Nunes.

    Another study underscored this point. Titled Is Belonging to a Religious Organization Enough?, the study separately assessed the effects of religiosity and spirituality. The results showed that spirituality was linked to lower levels of anger, anxiety, and emotional exhaustion. In contrast, religiosity alone — without deeper personal engagement — did not significantly impact emotional well-being.

    Coronary Artery Disease: Stress and Acute Cardiac Events

    While coronary artery disease can remain stable for years, its progression into acute myocardial infarction — one of the leading global causes of death — can be sudden and unpredictable. Although plaque accumulation is gradual, rupture events are often triggered by acute neuro-immuno-hormonal and inflammatory responses.

    Roberto Veiga Giraldez, MD, PhD, director of the Acute Coronary Care Unit at the Heart Institute, Hospital das Clínicas, University of São Paulo, cited research linking acute myocardial infarction to external stressors such as natural disasters or high-stakes sporting events. During these situations, sympathetic nervous system activation and systemic inflammation intensify, raising the risk of acute coronary syndromes.

    One study cited by Giraldez was conducted in South Korea, where cities vulnerable to earthquakes experienced a significant spike in acute coronary syndrome cases immediately following seismic events. Incidence peaked shortly after the quakes and gradually declined over time.

    Another analysis focused on the 2006 FIFA World Cup. In several German cities, rates of myocardial infarction rose during high-stakes national team matches — especially during tense or decisive games. The highest incidence occurred in the early minutes of play, when fan anxiety was likely at its peak.

    “These data illustrate how acute stress can influence outcomes in patients with coronary artery disease,” said Giraldez. “Spirituality can help mitigate this impact. Resignation and faith — whatever form they take — can help individuals face stressful situations with greater composure.”

    How Should Clinicians Address Spirituality?

    According to Nunes, spirituality should be systematically integrated into clinical practice — always with sensitivity to the patient’s values, preferences, and boundaries. “We should approach spirituality with the same seriousness we apply to mental health and lifestyle habits. Understanding what matters to the patient and why they seek care can shape the therapeutic journey,” he said.

    He advocated for incorporating spiritual assessment into palliative care and broader multidisciplinary strategies, particularly in advanced stages of heart failure. “Nutritionists, nurses, psychologists — everyone can play a role in listening,” he added.

    Nobre emphasized that addressing spirituality doesn’t have to be complex — just intentional. “During the medical history, when we ask about lifestyle, why not also ask how the illness is affecting them emotionally? Or whether they believe in something greater? For some, spirituality may be irrelevant, and that’s fine. But if it matters to the patient, it can become a powerful ally — especially in supporting treatment adherence.”

    “We’re not necessarily talking about religion,” he continued. “A person might be Catholic, Evangelical, Umbandist, or have no religion at all. The point is: Does it matter to them? When we make that connection, care moves beyond the physical body. It becomes whole-person care — addressing mind, emotions, and values. And that’s when medicine reaches its fullest potential,” Nobre concluded.

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  • The Strad – Consone Quartet: it’s not every day that a period string quartet plays music by a living composer

    The Strad – Consone Quartet: it’s not every day that a period string quartet plays music by a living composer

    Discover more Featured Stories like this in The Strad Playing Hub 

    It’s not every day that a period string quartet gets to play music written by a living composer. We spend so much of our lives working with historical equipment, poring over old scores and performing editions, listening to early recordings and trying to figure out what a composer was really after. What inspired them. What sound-world they imagined. To have the composer in the room with you, to be able to ask questions and to explore the music together, is both a novelty and a privilege for us.  

    We were thrilled when Oliver Leith agreed to write us a piece in our 10th anniversary year. The brief was… well, brief – something chaconne-inspired. This was in honour of our late friend, Philip Yeeles, who was a fan of chaconnes and of the Consone Quartet.

    The chaconne theme is subtle, but palpable. Oliver describes the piece as ’seven endings — or different perspectives of the same end; close ups, swooping, rolling oil landscapes and glimpses.’ Of the Chaconne he says “the image started as a look at the idea of the chaconne, a ‘form’ that, over centuries has been pulled through bushes of different shapes, to become a feeling more than a codified thing… There are familiar chaconne tropes, repetitions, descending drooping laments, but those things are more about a feeling than they are form.’ The writing is atmospheric and colourful, somehow perfectly suited to the visceral timbre and blend of our gut strings.  

    The writing is atmospheric and colourful, somehow perfectly suited to the visceral timbre and blend of our gut strings

    This commission is just one part of our anniversary celebrations. Over the last three years we have been associate ensemble at Paxton House in the Scottish borders, and 2025 marks our final year. We have curated programmes each summer, featuring one of Schumann’s three quartets each time. With Schumann as our common denominator, we have explored his relationships with his contemporaries and also the way in which he was inspired by (and in turn provided inspiration) for other composers throughout history. It has been a treat to plan programmes with such a long scope, creating a narrative that spins through the three years of our residency. We have also enjoyed getting to know the Paxton audience better and seeing familiar faces each year in the same magical setting. 

    Collaboration is a big part of what we do and so we have invited lots of our musical colleagues to come and join us in Paxton: we have explored string sextets (including a new commission by Gavin Bryars) with violist Francesca Gilbert and cellist Alexander Rolton and we have delved into the lieder world with song arrangements alongside mezzo-soprano Helen Charlston. This year we team up with Philip Higham for Schubert’s Quintet in C major and Katherine Spencer for the Brahms Clarinet Quintet.  

    NEW (18)

    Aside from our Paxton collaborations, we are currently touring a programme with keyboard player Kristian Bezuidenhout. The partnership has taken us to Germany and Austria, and in the autumn we will travel to the USA and Canada. Later this year, we will be joined yet again by Francesca Gilbert and Alexander Rolton for Brahms’ B flat major sextet and Schoenberg’s iconic Verklärte Nacht. The piece is, unusually, programmatic; the writing complex, lush and highly chromatic – great fun on gut strings!  

    We have been recording more than ever this year: the second volume in our Mendelssohn CD cycle with Linn Records will be out later in the autumn and we will record the third and final disc of the set in January 2026. We are excited to record a lieder programme with fellow BBC New Generation Artist, Helen Charlston, on BIS records later in the year. Bill Thorp, a great friend of Consone, has lovingly arranged songs for us by both Clara and Robert Schumann, as well as Fanny and Felix Mendelssohn, and they work so well for string quartet.

    The Consone Quartet performs as associate ensemble at Music at Paxton on 19 and 20 July 2025. Find out more here.

    Best of Technique

    In The Best of Technique you’ll discover the top playing tips of the world’s leading string players and teachers. It’s packed full of exercises for students, plus examples from the standard repertoire to show you how to integrate the technique into your playing.

    Masterclass

    In the second volume of The Strad’s Masterclass series, soloists including James Ehnes, Jennifer Koh, Philippe Graffin, Daniel Hope and Arabella Steinbacher give their thoughts on some of the greatest works in the string repertoire. Each has annotated the sheet music with their own bowings, fingerings and comments.

    Calendars

    The Canada Council of the Arts’ Musical Instrument Bank is 40 years old in 2025. This year’s calendar celebrates some its treasures, including four instruments by Antonio Stradivari and priceless works by Montagnana, Gagliano, Pressenda and David Tecchler.

     

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  • Sepsis and the impact of antibiotic resistance

    Sepsis and the impact of antibiotic resistance

    Sepsis remains a critical health challenge globally, with 48.9 million cases annually, contributing to significant morbidity and mortality. Despite being a preventable, treatable disease – due in part to advancements in therapeutics – sepsis claims the lives of 11 million individuals each year (20% of all global deaths), making it a leading cause of mortality worldwide.

    Nearly half (20 million) of all cases occur in children under five years of age. The highest incidence rates are seen in low- and middle-income countries (LMICs). Sepsis drives hospital mortality and incident disability; patients who survive hospitalisation develop an increased risk for negative health outcomes, including new morbidity, deterioration, hospital readmission and death. The World Health Organization (WHO) Global Antimicrobial Surveillance System report underscores the serious global impact of antimicrobial resistance (AMR), which exacerbates the substantial burden that sepsis poses on patients, the health community and health systems.

    Globally, 4.95 million and 1.27 million deaths are, respectively, associated or attributed to AMR. Projections estimate ten million deaths by 2050 with cost of care compounding the burden: a UK report calculated a $100trn global economic impact, particularly due to AMR. These factors focus our lens on modern sepsis management strategies like rapid early diagnosis and intervention, for better health outcomes, and benefit to the medical community, health systems and governments.

    Impetus for early recognition and treatment
    Given its frequency, high morbidity and mortality, timely sepsis management at the point of care (POC) is a globally recognised public health priority – the urgent need underscored by the World Health Assembly resolution (2017) towards improving the prevention, diagnosis, rehabilitation from, and management of, sepsis. Regional disparities exacerbate the burden; sepsis is common in high-income countries (HICs) – 1.7 million and 48,000 deaths annually, for the US and the UK, respectively. LMICs face a heavier burden due to limited access to healthcare services, few qualified healthcare providers (HCPs), and inadequate diagnostics and lab services. Mitigating the burden, particularly in low-resource settings, requires the adoption of easy-to-use low-cost diagnostic instruments, alongside provider education, to enhance sepsis management. Clinical decisioning support tools, including biomarker diagnostics like C-reactive protein (CRP) and procalcitonin (PCT), widely used in HICs, are also potentially efficacious in LMIC populations to avert antibiotic overuse and improve patient outcomes.

    Challenges in point-of-care management
    Significant challenges persist in managing sepsis in POC settings across diverse healthcare systems and resource settings. Late presentation and delayed or missed diagnosis, which occur in HICs and are more pronounced in LMICs, result in negative health outcomes. Clinical symptoms of sepsis often present like other conditions. There is no single definitive diagnostic test, which can lead to variable triage and recognition. Furthermore, diversity in patient populations from varying health conditions and immune responses, and the prevalence of healthcare-associated infections (HAIs) are major factors in treatment failure and rapid progression to sepsis and septic shock.

    Collaborative international initiatives, like the Surviving Sepsis Campaign (2021) and National Institute for Health and Care Excellence (NICE) updates to the NG51 guideline (2024) have focused on evidence-based guidelines and practices to address high sepsis mortality rates stemming from persistent delays in recognition, diagnosis and treatment. Given that 918,000 patients are hospitalised each year in the UK with ‘suspicion of sepsis’, and that 80-87% of sepsis hospitalisations in the US present from the healthcare community setting, there are opportunities for early identification and response from patient-provider encounters in the time frame before sepsis hospitalisation. Recognising sepsis early in the disease continuum, when clinical symptoms first manifest – rapid heart rate, fever, abnormal white blood cell count in response to infection – is essential to timely therapy to halt the cascade to multi-organ dysfunction and failure. This narrow window of opportunity also presents challenges. Treatment delays dramatically worsen outcomes; one analysis shows patients admitted to intensive care units (ICUs) with severe sepsis have a 39.8% risk of death, each hour of delay in antibiotic administration contributes up to a 9% increase in mortality.

    Read the article in full here.


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  • NGOs urge European Commission to halt deregulation Omnibus in chemicals sector

    NGOs urge European Commission to halt deregulation Omnibus in chemicals sector

    Press release

    NGOs urge European Commission to halt deregulation Omnibus in chemicals sector

    09 July 2025

    Today, ClientEarth and nine health and environmental organisations have sent an open letter to the European Commission, calling on the institution to abandon the proposed deregulatory Omnibus affecting chemicals legislation. This proposal  – which covers CLP (Classification, Labelling and Packaging) and cosmetics rules – risks rolling back key protections that safeguard public health, consumers and ecosystems.

    Chemical regulation is foundational to our standards of living and environmental protection. In the letter, ClientEarth and other signatories outline how the proposal undermines legal certainty, fails to meet EU transparency and consultation requirements, and is likely in breach of the EU Charter of Fundamental Rights.

    The letter also highlights instances of maladministration in the Commission’s process, including the absence of a proper public consultation and a lack of evidence to justify the rollback of key safety provisions. ClientEarth warns the proposal is legally vulnerable and risks being overturned in court.

    ClientEarth legal expert Julian Schenten said: “The EU institutions exist to protect people and planet, not to bend to industry pressure. The Commission must resist pressure from industry to weaken health and safety rules for the sake of preserving business as usual.”

    Schenten added “The Commission’s proposal lacks a solid evidence base, sidesteps public consultation, and ignores its own Better Regulation Guidelines. That’s not simplification – that’s maladministration. By advancing a legally unsound proposal, the Commission risks triggering legal challenges that will increase uncertainty for industry and exacerbate problems rather than solve them”

    On the planned rollback of CLP measures, Schenten warned previously: “The Commission is planning to scrap rules on packaging and advertising of hazardous mixtures. Cutting paperwork does not make toxic products any safer. The CLP Regulation exists to ensure a high level of protection – not to ease administrative burdens at the expense of public safety.”

    Silvia Pastorelli, EU petrochemicals campaigner at the Center for International Environmental Law (CIEL) added: “Regulatory safeguards aren’t barriers. They are vital investments in public wellbeing, ecosystems, and a just and necessary transition away from a fossil-based economy. Cutting so-called ‘red tape’ cannot come at the cost of public safety.”

    The Commission must commit to full transparency and include civil society and independent experts in the decision-making process. ClientEarth’s letter urges the Commission to drop the omnibus deregulatory package, and refrain from eliminating safeguards in CLP, cosmetics and fertilisers.

    ENDS

    Notes to editors:
    • The letter was signed by ChemSec – the International Chemical Secretariat, Child Rights International Network (CRIN), Center for International Environmental Law (CIEL), Corporate Europe Observatory (CEO), ECOS (Environmental Coalition on Standards), European Environmental Bureau (EEB)
       Federation SEPANSO Aquitaine, Générations Futures, Health and Environment Alliance (HEAL).
    • Since the beginning of this year, the European Commission has been pushing for simplification across many different environment and climate files to boost the competitive edge of Europe. ClientEarth has condemned the downgrading of sustainability standards, as it happened with the Omnibus I package, and has sounded the alarm over the lack of transparency in these processes. In March, we denounced the limited stakeholder engagement in the Strategic Dialogue on the Chemicals Industry Package. With very few representatives of civil society, the high-level dialogue favoured industry’s interests. ClientEarth warned that more deregulation is unacceptable and stressed the need to maintain REACH’s core objectives.
    • This simplification is not just a step backwards for the environment, but also for people’s health and safety. Consumer groups have expressed concerns about the new simplification, as its rules could greatly increase consumer exposure to dangerous chemicals and increase health risks.
    • This call comes as the European watchdog upheld her finding of maladministration against the Commission over systemic delays in authorisation decisions for hazardous chemicals. Teresa Anjinho criticised the Commission’s failure to act on her recommendations or present a credible plan to remedy the situation. These delays pose a serious threat to public health and the environment, reinforcing the need for stronger chemical regulation in the EU.

    About ClientEarth

    ClientEarth is a non-profit organisation that uses the law to create systemic change that protects the Earth for – and with – its inhabitants. We are tackling climate change, protecting nature and stopping pollution, with partners and citizens around the globe. We hold industry and governments to account, and defend everyone’s right to a healthy world. From our offices in Europe, Asia and the USA we shape, implement and enforce the law, to build a future for our planet in which people and nature can thrive together.

     


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