It alone possesses legislative supremacy and thereby ultimate power over all other political bodies in the UK and the overseas territories. Parliament is bicameral but has three parts, consisting of the sovereign (Crown-in-Parliament), the House of Lords, and the House of Commons (the primary chamber). Both houses of Parliament meet in separate chambers at the Palace of Westminster in the City of Westminster, one of the inner boroughs of the capital city, London.The House of Lords includes two different types of members: the Lords Spiritual, consisting of the most senior bishops of the Church of England; and the Lords Temporal, consisting mainly of life peers, appointed by the sovereign, and of 92 hereditary peers, sitting either by virtue of holding a royal office, or by being elected by their fellow hereditary peers. Prior to the opening of the Supreme Court in October 2009, the House of Lords also performed a judicial role through the Law Lords.The House of Commons is an elected chamber with elections to 650 single-member constituencies held at least every five years under the first-past-the-post system. By constitutional convention, all government ministers, including prime minister, are members of the House of Commons or, less commonly, the House of Lords and are thereby accountable to the respective branches of the legislature. Most cabinet ministers are from the Commons, whilst junior ministers can be from either house.With the global expansion of the British Empire, the UK Parliament has shaped the political systems of many countries as ex-colonies and so it has been called the "Mother of Parliaments".[note 3]In theory, the UK's supreme legislative power is officially vested in the Crown-in-Parliament. However, the Crown normally acts on the advice of the prime minister, and the powers of the House of Lords are limited to only delaying legislation; thus power is de facto vested in the House of Commons.
Artificial intelligence (AI) has potential to revolutionize radiology, yet current solutions and guidelines are predominantly focused on adult populations, often overlooking the specific requirements of children. This is important because children differ significantly from adults in terms of physiology, developmental stages, and clinical needs, necessitating tailored approaches for the safe and effective integration of AI tools. This multi-society position statement systematically addresses four critical pillars of AI adoption: (1) regulation and purchasing, (2) implementation and integration, (3) interpretation and post-market surveillance, and (4) education. We propose pediatric-specific safety ratings, inclusion of datasets from diverse pediatric populations, quantifiable transparency metrics, and explainability of models to mitigate biases and ensure AI systems are appropriate for use in children. Risk assessment, dataset diversity, transparency, and cybersecurity are important steps in regulation and purchasing. For successful implementation, a phased strategy is recommended, involving early pilot testing, stakeholder engagement, and comprehensive post-market surveillance with continuous monitoring of defined performance benchmarks. Clear protocols for managing discrepancies and adverse incident reporting are essential to maintain trust and safety. Moreover, we emphasize the need for foundational AI literacy courses for all healthcare professionals which include pediatric safety considerations, alongside specialized training for those directly involved in pediatric imaging. Public and patient engagement is crucial to foster understanding and acceptance of AI in pediatric radiology. Ultimately, we advocate for a child-centered framework for AI integration, ensuring that the distinct needs of children are prioritized and that their safety, accuracy, and overall well-being are safeguarded.
Aplastic anaemia (AA) is a rare bone marrow failure disorder with a notably higher incidence in Asian populations, including India. Due to limited access to bone marrow transplantation (BMT) in resource-limited settings, immunosuppressive therapy (IST) remains the mainstay of treatment. However, the optimal combination of available IST regimens in low-resource environments remains uncertain. Therefore, we performed a meta-analysis to evaluate the effectiveness and safety of various immunosuppressive strategies—particularly equine antithymocyte globulin (eATG) combined with cyclosporine A (CSA), with or without eltrombopag (EPAG), as well as CSA and anabolic steroids-based monotherapies, for the treatment of AA in Indian patients. Fifty-nine studies (49 single-arm, 10 multi-arm) from PubMed, Google Scholar, and Indian Society of Haematology Blood Transfusion (ISHBT) conference proceedings from December 2024 to December 2024 were included. The primary outcomes comprised overall response rates (ORRs) at 3, 6, and 12 months. Secondary outcomes included 5-year overall survival (OS), event-free survival (EFS), and treatment-related adverse events (TRAEs). Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed with I² statistics. Meta-regression was used to explore sources of variability, and sensitivity analyses assessed the robustness of the pooled outcomes. Response rates (RR) varied significantly across treatment modalities and time points. In single-arm analysis, monotherapy with CSA or anabolic steroids showed limited efficacy, with pooled ORRs at 3 months of 26.9
ObjectivesTo initiate less invasive surfactant administration (LISA) in authors' unit using a quality improvement (QI) approach and increase LISA rates by 50% over 10 mo period.MethodsThe authors adopted a QI methodology to address this issue. The proportion of surfactant administration done by the LISA method was the primary outcome indicator. Focused group discussions were conducted with doctors and nurses during the initial phase to identify the root causes. Meetings were conducted where team members were given descriptions of the insertion method, complications and precautions to be taken. All the members were trained to use LISA on mannequins in a simulation lab. They were also trained regarding the fixation of continuous positive airway pressure (CPAP), monitoring of complications and correction steps. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. A standard operating policy was developed, and all babies requiring surfactant were administered surfactant with the LISA technique.ResultsOver the 10 mo, the proportion of neonates who received surfactant via the LISA method increased from 0 to 90%. Complications such as desaturation (74%), surfactant reflux (32.1%), bradycardia (25%), and unilateral administration of surfactant (26.7%), which were initially observed, gradually decreased to 7.4%, 3.7%, 7.4%, and 7.4%, respectively.ConclusionsUtilising QI tools, the authors achieved an increase in the rate of surfactant administration by the LISA method by more than 50%.
Neurosyphilis is a well-recognized mimicker and may present with diverse movement disorders resembling neurodegenerative or autoimmune syndromes. This systematic review aims to elucidate the comprehensive clinical, laboratory, imaging, and outcome spectrum of movement disorders in neurosyphilis. This systematic review followed PRISMA guidelines with a protocol registered in PROSPERO (CRD420251135620). PubMed, Embase, Scopus, and Google Scholar were searched. Eligible studies included case reports, case series, and observational cohorts with confirmed or probable neurosyphilis and clinically diagnosed movement disorders. Data on demographics, clinical features, cerebrospinal fluid, neuroimaging, treatment, and outcomes were extracted. We analyzed a total of 48 individual cases reported across 44 publications and two retrospective cohorts (n = 223, with 61 movement disorder patients). The mean age was 47 years (range 10–83), with 76.3
BACKGROUND:Although cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD), the efficacy and safety of β blockers in reducing cardiac events and mortality is uncertain. This study was designed to assess whether the cardioselective β blocker, bisoprolol, improves cardiorespiratory outcomes when added to usual COPD care. METHODS:This double-blind, randomised, controlled, phase 3 trial was done across 22 hospital and research institute sites selected by research experience and resources to conduct the study in Australia, India, New Zealand, and Sri Lanka. Participants aged 40-85 years with COPD, post-bronchodilator FEV1 30-70% predicted, and at least one COPD exacerbation in the previous 2 years were randomly assigned to receive bisoprolol (1·25-5 mg) or matched placebo, orally, once daily, for 2 years, with both groups continuing to receive usual COPD care. Randomisation was with a concealed, computer-generated sequence, stratified by site, smoking status, and previous diagnosis of cardiovascular disease requiring treatment. Participants, site personnel, and investigators remained masked to study treatment throughout the trial. The primary outcome was a composite of cardiac and respiratory effects, starting with the most important outcome (death), then cardiac or respiratory hospital admissions, exacerbations, quality-of-life measures, and FEV1. Analysis was by intention-to-treat (ITT) in all randomly assigned patients, using a country-stratified win ratio. Adverse events were analysed from the ITT population using all available data. Missing data were not used to determine wins, but regarded as a tie on that level of the hierarchy. The trial was prospectively registered on ClinicalTrials.gov (NCT03917914), Clinical Trial Registry - India (CTRI/2020/08/027322), and the Sri Lanka Clinical Trials Registry (SLCTR/2021/033). The study is complete. FINDINGS:Of 360 participants screened for eligibility between June 30, 2020, and March 20, 2023, 280 were randomly assigned to bisoprolol (n=143) or placebo (n=137), with 249 completing 2 years of follow-up. 233 patients (83%) were male and 47 (17%) were female; mean age was 68 years (SD 8). Mean post-bronchodilator FEV1 was 45% (SD 11) predicted at baseline. According to the hierarchy of outcomes, bisoprolol was associated with better cardiorespiratory health for 3041 (45%) of 6763 comparisons and placebo for 3240 (48%), with 482 (7%) showing no difference, giving a win ratio of 0·95 (95% CI 0·72 to 1·25, p=0·72) and a net benefit of -2% (95% CI -15 to 10) with bisoprolol. No significant differences were seen between bisoprolol and placebo in all-cause mortality, cardiorespiratory hospitalisations, major adverse cardiac events, or moderate or severe COPD exacerbations. Additionally, no significant differences were seen in FEV1, COPD symptoms, or quality of life, or adverse events. The most common adverse events were COPD exacerbations, occuring in 83 (58%) participants in the bisoprolol group and 87 (64%) in the placebo group. 15 (10%) participants in the bisoprolol group and 11 (8%) in the placebo group died. None of these deaths were attributed to the treatment. INTERPRETATION:In patients with moderately severe COPD, treatment with bisoprolol made no difference to overall cardiorespiratory health, all-cause mortality, or serious cardiorespiratory events. FUNDING:National Health and Medical Research Council of Australia and the Health Research Council of New Zealand.
