Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Risk for and consequences of endometriosis: A critical epidemiologic review

Endometriosis affects approximately 10% of women of reproductive age. Characteristics robustly associated with a greater risk for endometriosis include early age at menarche, short menstrual cycle length, and lean body size, whereas greater parity has been associated with a lower risk. Relationships with other potential characteristics including physical activity, dietary factors, and lactation have been less consistent, partially because of the need for rigorous data collection and a longitudinal study design. Critical methodologic complexities include the need for a clear case definition; valid selection of comparison/control groups; and consideration of diagnostic bias and reverse causation when exploring demographic characteristics, medical history, and lifestyle factors. Reviewers and editors must demand a detailed description of rigorous methods to facilitate comparison and replication to advance our understanding of endometriosis

Risk for and consequences of endometriosis: A critical epidemiologic review

Endometriosis affects approximately 10% of women of reproductive age. Characteristics robustly associated with a greater risk for endometriosis include early age at menarche, short menstrual cycle length, and lean body size, whereas greater parity has been associated with a lower risk. Relationships with other potential characteristics including physical activity, dietary factors, and lactation have been less consistent, partially because of the need for rigorous data collection and a longitudinal study design. Critical methodologic complexities include the need for a clear case definition; valid selection of comparison/control groups; and consideration of diagnostic bias and reverse causation when exploring demographic characteristics, medical history, and lifestyle factors. Reviewers and editors must demand a detailed description of rigorous methods to facilitate comparison and replication to advance our understanding of endometriosis

Wheelchair Controlled by Eye Movement Using Raspberry Pi for ALS Patients

The mobility of people who have suffered a degenerative disease or an accident is partially or totally reduced, which limits their locomotive independence. Therefore, this paper presents a proposal that facilitates the mobility of people suffering from moderate levels of amyotrophic lateral sclerosis (ALS). A control system has been adapted to an electric wheelchair to provide it with a certain degree of intelligence. The acquisition of multimedia data is done with a small camera adapted to a glasses frame that the person must use. For eye patterns tracking, a recognition system is performed using the LabVIEW software environment. The control system that regulates the movement of the wheelchair was designed on the Raspberry Pi embedded board as a low-cost proposal. Experimental tests and user surveys validate the correct operation of this device. © 2020, Springer Nature Switzerland AG

Synthesis of Sustainable Biofuel Production Processes: A Generic Methodology for Superstructure Optimization and Data Management

Energy demand and emissions are rising steadily, and are forecast to double by 2050 (IEA 2012). In fact, energy-related carbon dioxide (CO2) emissions have reached historic highs (IEA 2012). Moreover, the reliance on a narrow set of technologies and fossil fuels is a threat to energy security, which raises concerns (IEA 2012). It is therefore clear that current trends in energy supply are unsustainable—economically, environmentally and socially (IEA 2011)

The Keylong Serai rock avalanche, NW Indian Himalaya: geomorphology and palaeoseismic implications

This paper describes the geomorphology of rock avalanche deposits that resulted from a major mountain slope failure at Keylong Serai on the north slope of the Indian High Himalaya, an area of high altitude desert. Cosmogenic 10Be exposure ages of the widespread deposits indicate their formation 7,510 ± 110 years BP. Proxy records for this region of the Himalaya imply a similar dry climatic regime to the present day at this time, suggesting that precipitation was an unlikely trigger for this rock avalanche. An alternative mechanism associated with rock-wall stress relaxation is also unlikely, given the earlier timing of deglaciation in this area. Given the enormous volume of debris generated by this event, the most likely trigger for this mountain collapse and resultant rock avalanche is high ground acceleration during a great earthquake (M > 8). It is proposed that rock avalanches can be used to extend the limited palaeoseismic record and improve information on the recurrence interval of great earthquakes within the Himalaya arc