Lessons from an initiative to address gender bias

How a letter addressing the lack of women invited to speak at a conference in brain stimulation encouraged researchers to take action

Development of Single-station Early Warning Lightning Alarm System

Lightning is one of the spectacular natural phenomena which happen on the earth. More than 2000 people are killed worldwide by lightning each year. The lightning monitoring system is important as the early warning alarm system. In this paper,lightning warning alarm system which can monitor and observe the lightning activity has been discussed. The system able to trigger the warning alarm whenever a lightning strikes at a particular area in 10 km radius from UMP Pekan, Pahang, Malaysia. The LabVIEW software was used as a data logger to measure, analyze and calculate the lightning distance. The accuracy of the system has been compared and validated by the Pekan Lightning Detection System (PLDS)

Palliative radiotherapy after oesophageal cancer stenting (ROCS): a multicentre, open-label, phase 3 randomised controlled trial

Background: patients with advanced oesophageal cancer have a median survival of 3-6 months, and most require intervention for dysphagia. Self-expanding metal stent (SEMS) insertion is the most typical form of palliation in these patients, but dysphagia deterioration and re-intervention are common. This study examined the efficacy of adjuvant external beam radiotherapy (EBRT) compared with usual care alone in preventing dysphagia deterioration and reducing service use after SEMS insertion.Methods: this was a multicentre, open-label, phase 3 randomised controlled trial based at cancer centres and acute care hospitals in England, Scotland, and Wales. Patients (aged ≥16 years) with incurable oesophageal carcinoma receiving stent insertion for primary management of dysphagia were randomly assigned (1:1) to receive usual care alone or EBRT (20 Gy in five fractions or 30 Gy in ten fractions) plus usual care after stent insertion. Usual care was implemented according to need as identified by the local multidisciplinary team (MDT). Randomisation was via the method of minimisation stratified by treating centre, stage at diagnosis (I-III vs IV), histology (squamous or non-squamous), and MDT intent to give chemotherapy (yes vs no). The primary outcome was difference in proportions of participants with dysphagia deterioration (&gt;11 point decrease on patient-reported European Organisation for Research and Treatment of Cancer quality of life questionnaire-oesophagogastric module [QLQ-OG25], or a dysphagia-related event consistent with such a deterioration) or death by 12 weeks in a modified intention-to-treat (ITT) population, which excluded patients who did not have a stent inserted and those without a baseline QLQ-OG25 assessment. Secondary outcomes included survival, quality of life (QoL), morbidities (including time to first bleeding event or hospital admission for bleeding event and first dysphagia-related stent complications or re-intervention), and cost-effectiveness. Safety analysis was undertaken in the modified ITT population. The study is registered with the International Standard Randomised Controlled Trial registry, ISRCTN12376468, and ClinicalTrials.gov, NCT01915693, and is completed.Findings: 220 patients were randomly assigned between Dec 16, 2013, and Aug 24, 2018, from 23 UK centres. The modified ITT population (n=199) comprised 102 patients in the usual care group and 97 patients in the EBRT group. Radiotherapy did not reduce dysphagia deterioration, which was reported in 36 (49%) of 74 patients receiving usual care versus 34 (45%) of 75 receiving EBRT (adjusted odds ratio 0·82 [95% CI 0·40-1·68], p=0·59) in those with complete data for the primary endpoint. No significant difference was observed in overall survival: median overall survival was 19·7 weeks (95% CI 14·4-27·7) with usual care and 18·9 weeks (14·7-25·6) with EBRT (adjusted hazard ratio 1·06 [95% CI 0·78-1·45], p=0·70; n=199). Median time to first bleeding event or hospital admission for a bleeding event was 49·0 weeks (95% CI 33·3-not reached) with EBRT versus 65·9 weeks (52·7-not reached) with usual care (adjusted subhazard ratio 0·52 [95% CI 0·28-0·97], p=0·038; n=199). No time versus treatment interaction was observed for prespecified QoL outcomes. We found no evidence of differences between trial group in time to first stent complication or re-intervention event. The most common (grade 3-4) adverse event was fatigue, reported in 19 (19%) of 102 patients receiving usual care alone and 22 (23%) of 97 receiving EBRT. On cost-utility analysis, EBRT was more expensive and less efficacious than usual care.Interpretation: patients with advanced oesophageal cancer having SEMS insertion for the primary management of their dysphagia did not gain additional benefit from concurrent palliative radiotherapy and it should not be routinely offered. For a minority of patients clinically considered to be at high risk of tumour bleeding, concurrent palliative radiotherapy might reduce bleeding risk and the need for associated interventions.Funding: National Institute for Health Research Health Technology Assessment Programme.</p

Severe low back or lower limb pain is associated with recurrent falls among older Australians

Background: Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Objectives: Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls-related injuries. Methods: Community-dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self-reported, cross-sectional questionnaire data regarding number of falls and falls-related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately. Results: Of 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls-related injury in the last 12 months compared to females with mild pain. Conclusion: Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls-related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls-risk evaluation. Significance: Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls-related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls-risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms

A clinical and neurophysiological investigation of acquired synaesthetic pain in amputees

Pain typically describes an experience resulting from injury to one’s own body. In the current thesis, we investigate a newly identified pain phenomenon where the experience of pain is triggered by the observation or imagination of injury to another: ‘synaesthetic pain’. The earliest accounts of synaesthetic pain, an intriguing phenomenon of which little is known, were serendipitously identified in a sample of amputees who experience pain in their absent limb(s). The broad aim of this thesis was to provide the first systematic clinical and neurophysiological investigations of acquired synaesthetic pain experienced following amputation. Four main studies are reported. The first is an investigation of the incidence and characteristics of synaesthetic pain in a sample of amputees. Participants completed a brief questionnaire on phantom limb pain experiences, including whether their phantom limb pain was triggered by observing or imagining pain in another. Of the total sample of 74 amputees, around 16 % responded positively to this question, indicating that synaesthetic pain is experienced in a relatively large number of amputees. In the second study, electroencephalography (EEG) was used to investigate neurophysiological responses to pain observation in amputees who experience synaesthetic pain. Participants also completed selected behavioural measures in order to explore aspects of interpersonal differences (e.g., empathy), and their relationship to synaesthetic pain. We found that amputees who experience synaesthetic pain exhibit a unique neurophysiological response to observed pain, compared to controls, perhaps reflective of changes in inhibitory processing. No differences were observed between amputees who experience synaesthetic pain and controls on selected behavioural measures. The third study used transcranial magnetic stimulation (TMS) to investigate pain observation in amputees who experience synaesthetic pain. Here we found enhanced motorevoked potential response to observed pain in pain synaesthetes, compared to controls, that was not specific to the site of observed injury. No differences were observed between amputees who experience synaesthetic pain and controls on selected behavioural measures. There was, however, a trend towards significance within the pain synaesthete group for reduced response to observed pain and greater scores on a subscale of an empathy measure. The final study was a TMS investigation of motor cortical excitability and inhibition in acquired pain synaesthetes compared to controls. Although differences were observed between groups, we did not observe differences between amputees who experience synaesthetic pain and the amputee control-group who do not experience synaesthetic pain. When combining the two amputee groups, however, increased cortical facilitation was observed compared to healthy controls. This may reflect changes in motor cortex excitability related to neuropathic pain in amputees. This thesis describes the very first attempt at obtaining a clinical description of synaesthetic pain in amputees, and the investigation of its neurophysiological underpinnings. The findings indicate acquired synaesthetic pain in amputees is experienced in a substantial portion of individuals following amputation. Moreover, there appear to be unique neurophysiological responses to pain observation in amputees who experience synaesthetic pain. These findings have significant implications for our understanding of synaesthetic pain, and, more generally, for synaesthesia, social cognition, and pain

A clinical and neurophysiological investigation of acquired synaesthetic pain in amputees

Pain typically describes an experience resulting from injury to one’s own body. In the current thesis, we investigate a newly identified pain phenomenon where the experience of pain is triggered by the observation or imagination of injury to another: ‘synaesthetic pain’. The earliest accounts of synaesthetic pain, an intriguing phenomenon of which little is known, were serendipitously identified in a sample of amputees who experience pain in their absent limb(s). The broad aim of this thesis was to provide the first systematic clinical and neurophysiological investigations of acquired synaesthetic pain experienced following amputation. Four main studies are reported. The first is an investigation of the incidence and characteristics of synaesthetic pain in a sample of amputees. Participants completed a brief questionnaire on phantom limb pain experiences, including whether their phantom limb pain was triggered by observing or imagining pain in another. Of the total sample of 74 amputees, around 16 % responded positively to this question, indicating that synaesthetic pain is experienced in a relatively large number of amputees. In the second study, electroencephalography (EEG) was used to investigate neurophysiological responses to pain observation in amputees who experience synaesthetic pain. Participants also completed selected behavioural measures in order to explore aspects of interpersonal differences (e.g., empathy), and their relationship to synaesthetic pain. We found that amputees who experience synaesthetic pain exhibit a unique neurophysiological response to observed pain, compared to controls, perhaps reflective of changes in inhibitory processing. No differences were observed between amputees who experience synaesthetic pain and controls on selected behavioural measures. The third study used transcranial magnetic stimulation (TMS) to investigate pain observation in amputees who experience synaesthetic pain. Here we found enhanced motorevoked potential response to observed pain in pain synaesthetes, compared to controls, that was not specific to the site of observed injury. No differences were observed between amputees who experience synaesthetic pain and controls on selected behavioural measures. There was, however, a trend towards significance within the pain synaesthete group for reduced response to observed pain and greater scores on a subscale of an empathy measure. The final study was a TMS investigation of motor cortical excitability and inhibition in acquired pain synaesthetes compared to controls. Although differences were observed between groups, we did not observe differences between amputees who experience synaesthetic pain and the amputee control-group who do not experience synaesthetic pain. When combining the two amputee groups, however, increased cortical facilitation was observed compared to healthy controls. This may reflect changes in motor cortex excitability related to neuropathic pain in amputees. This thesis describes the very first attempt at obtaining a clinical description of synaesthetic pain in amputees, and the investigation of its neurophysiological underpinnings. The findings indicate acquired synaesthetic pain in amputees is experienced in a substantial portion of individuals following amputation. Moreover, there appear to be unique neurophysiological responses to pain observation in amputees who experience synaesthetic pain. These findings have significant implications for our understanding of synaesthetic pain, and, more generally, for synaesthesia, social cognition, and pain

Differential cortical processing of location and pitch changes in dichotic pitch

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Combined cerebral and peripheral treatments for pain : a commentary on Hazime et al.

In this issue you find a paper by Hazime et al., entitled, “Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double-blind, factorial clinical trial” (Hazime et al., 2017). The authors present an efficacy trial of transcranial direct current stimulation (tDCS) combined with peripheral electrical stimulation (PES) over four treatment weeks in a sample of 92 patients with chronic low back pain