A Meta-analytic review of the prevalence of neuropathic pain in the general population of the global south compared to the global north

Background It is suspected that the prevalence of Neuropathic pain (NeP) is higher in the countries normally categorized as belonging to the global South, i.e. developing countries, because of the high prevalence of NeP generating diseases including HIV, diabetes mellitus and cancer. However, few articles have estimated the prevalence of NeP in these limited resource countries. By contrast, the prevalence of NeP worldwide has been evaluated in two systematic reviews to range between 3.3% in Austria to 8.2% in the UK (Smith and Torrance, 2012, Hecke et al., 2014) with an outlier of prevalence at 17% in Canada. Aims The aim of this systematic review was to screen the literature for the prevalence of NeP in the general population of the global South and to compare this prevalence with the prevalence in the global North using a meta-analytic approach. Methods Pubmed; Siencedirect; EMBASE; AMED and PsycINFO databases were searched on July 2016 to capture peer reviewed articles that contain data on NeP prevalence either in adult general populations or among chronic pain patients. Two reviewers applied the inclusion criteria and extracted information from all eligible studies including study period, country, study design, sample size, tools to diagnose NeP, outcome and overall prevalence and judged the outcome for each study by scrutinising the methods and result section. Guidelines for reporting Meta-Analysis of Observational Studies in Epidemiology (MOOSE) (Stroup, 2000) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher, 2009) were followed. Random effects modelling was applied on extracted data to produce the overall prevalence in the two study areas. Effect size and confidence intervals of overall prevalences was calculated by producing Forest plots in the Comprehensive Meta-analysis software. Risk of publication bias and heterogeneity between studies were also estimated. Results Out of the 624 studies identified in the search 14 studies were finally selected (total sample size of 78421 patients, 8137 from developing countries (global south) and 70284 from developed countries (global north). The average quality score of all studies was 6.7 out of a maximum of 8. There was a high level of heterogeneity between the studies (I2>90) possibly because of differences in the target populations, sample sizes, study design and data collection methods. However, there was no publication bias as the Egger’s test value was not significant (p=0.053). The prevalence of NeP worldwide was 4.8 % (95%CI, 4.7%-5.0%). Only four studies were conducted in the global South; 2 in Libya, 1 in Morocco and 1 in Brazil. The prevalence of NeP in the global South was 8.3% (7.7%-9.0%). The overall prevalence in the global North was 4.9% (4.7%-6.0%). Conclusion There were few studies on the prevalence of NeP in the global South suggesting that there is less awareness of the significance of NeP in the developing countries. Differences exist between the studies in each region in the estimate of the prevalence of NeP and this is mainly because of differences in data collection methods. Clinical examination tends to produce more variable estimates than telephone, postal and internet based questionnaires using NeP screening tools such as DN4 and S-LANSS. This meta-analysis tentatively suggests that the prevalence of NeP is significantly higher in the global South compared to global North

ISCEV extended protocol for derivation and analysis of the strong flash rod-isolated ERG a-wave

The International Society for the Clinical Electrophysiology of Vision (ISCEV) standard for full-field electroretinography (ERG) describes a minimum set of tests, but encourages the use of additional protocols for clinical ERG testing. This extended protocol describes recording methods and derivations that will allow analysis of rod-driven components of the dark-adapted (DA) strong flash ERG a-wave, more closely related to rod phototransduction than ISCEV standard DA ERGs. The method involves recording ERGs to a flash strength equivalent to 30 cd s m2 under conditions of dark adaptation and additionally to the same stimulus following light adaptation (LA) and in the presence of a standard photopic background luminance of 30 cd m−2. The isolated rod-driven ERG a-wave is derived by subtracting the LA response from the DA ERG. The method is likely to be of value in the characterization of retinal disorders which affect rod quantal catch, diseases that affect the dynamics of any component of the activation phase of rod phototransduction, or those affecting total numbers of rod photoreceptors

Thermal slip in oblique radiative nano-polymer gel transport with temperature-dependent viscosity : solar collector nanomaterial coating manufacturing simulation

Nano-polymeric solar paints and sol-gels have emerged as a major new development in solar cell/collector coatings offering significant improvements in durability, anti-corrosion and thermal efficiency. They also exhibit substantial viscosity variation with temperature which can be exploited in solar collector designs. Modern manufacturing processes for such nano-rheological materials frequently employ stagnation flow dynamics under high temperature which invokes radiative heat transfer. Motivated by elaborating in further detail the nanoscale heat, mass and momentum characteristics, the present article presents a mathematical and computational study of the steady, two-dimensional, non-aligned thermo-fluid boundary layer transport of copper metal-doped water-based nano-polymeric sol gels under radiative heat flux. To simulate real nano-polymer boundary interface dynamics, thermal slip is analysed at the wall. A temperature-dependent viscosity is also considered. The conservation equations for mass, normal and tangential momentum and energy are normalized via appropriate transformations to generate a multi-degree, ordinary differential, non-linear, coupled boundary value problem. Numerical solutions are obtained via the stable, efficient Runge-Kutta-Fehlberg scheme with shooting quadrature in MATLAB symbolic software. Validation of solutions is achieved with a Variational Iterative Method (VIM) utilizing Langrangian multipliers. The impact of key emerging dimensionless parameters i.e. obliqueness parameter, radiation-conduction Rosseland number (Rd), thermal slip parameter (ALPHA), viscosity parameter (m), nanoparticles volume fraction (PHI) on non-dimensional normal and tangential velocity components, temperature, wall shear stress, local heat flux and streamline distributions is visualized graphically. Shear stress and temperature are boosted with increasing radiative effect whereas local heat flux is reduced. Increasing wall thermal slip parameter depletes temperatures

Phenotype and genotype of 197 British patients with McArdle disease: An observational single-centre study

McArdle disease is caused by recessive mutations in PYGM gene. The condition is considered to cause a “pure” muscle phenotype with symptoms including exercise intolerance, inability to perform isometric activities, contracture, and acute rhabdomyolysis leading to acute renal failure. This is a retrospective observational study aiming to describe phenotypic and genotypic features of a large cohort of patients with McArdle disease between 2011 and 2019. Data relating to genotype and phenotype, including frequency of rhabdomyolysis, fixed muscle weakness, gout and comorbidities, inclusive of retinal disease (pattern retinal dystrophy) and thyroid disease, were collected. Data from 197 patients are presented. Seven previously unpublished PYGM mutations are described. Exercise intolerance (100%) and episodic rhabdomyolysis (75.6%) were the most common symptoms. Fixed muscle weakness was present in 82 (41.6%) subjects. Unexpectedly, ptosis was observed in 28 patients (14.2%). Hyperuricaemia was a common finding present in 88 subjects (44.7%), complicated by gout in 25% of cases. Thyroid dysfunction was described in 30 subjects (15.2%), and in 3 cases, papillary thyroid cancer was observed. Pattern retinal dystrophy was detected in 15 out of the 41 subjects that underwent an ophthalmic assessment (36.6%). In addition to fixed muscle weakness, ptosis was a relatively common finding. Surprisingly, dysfunction of thyroid and retinal abnormalities were relatively frequent comorbidities. Further studies are needed to better clarify this association, although our finding may have important implication for patient management

Developing and evaluating a five minute phishing awareness video

Confidence tricksters have always defrauded the unwary. The computer era has merely extended their range and made it possible for them to target anyone in the world who has an email address. Nowadays, they send phishing messages that are specially crafted to deceive. Improving user awareness has the potential to reduce their effectiveness. We have previously developed and empirically-validated phishing awareness programmes. Our programmes are specifically designed to neutralize common phish-related misconceptions and teach people how to detect phishes. Many companies and individuals are already using our programmes, but a persistent niggle has been the amount of time required to complete the awareness programme. This paper reports on how we responded by developing and evaluating a condensed phishing awareness video that delivered phishing awareness more efficiently. Having watched our video, participants in our evaluation were able to detect phishing messages significantly more reliably right after watching the video (compared to before watching the video). This ability was also demonstrated after a retention period of eight weeks after first watching the video

Eliminating irreproducibility in SERS substrates

Irreproducibility in surface-enhanced Raman spectroscopy (SERS) due to variability among substrates is a source of recurrent debate within the field. It is regarded as a major hurdle towards the widespread adoption of SERS as a sensing platform. Most of the literature focused on developing substrates for various applications considers reproducibility of lower importance. Here, we address and analyse the sources of this irreproducibility in order to show how these can be minimised. We apply our findings to a simple substrate demonstrating reproducible SERS measurements with relative standard deviations well below 1% between different batches and days. Identifying the sources of irreproducibility and understanding how to reduce these can aid in the transition of SERS from the lab to real world applications.Isaac Newton Trust Leverhulme Trust Winton Programme for the Physics of Sustainability Trinity College, University of Cambridg

Randomised, multicentre trial of micafungin vs. an institutional standard regimen for salvage treatment of invasive aspergillosis.

Invasive aspergillosis remains associated with significant morbidity and mortality, necessitating new options for salvage therapy. The objective of this study was to evaluate the efficacy and safety of micafungin as salvage monotherapy in patients with invasive aspergillosis. Patients with proven or probable invasive aspergillosis, who were refractory or intolerant to previous systemic antifungal therapy, were randomised 2 : 1 to receive 300 mg day 121 intravenous micafungin monotherapy or an intravenous control monotherapy [lipid amphotericin B (5 mg kg 121 day 121), voriconazole (8 mg kg 121 day 121) or caspofungin (50 mg day 121)] for 3\u201312 weeks. Patients underwent final assessment 12 weeks after treatment start. Seventeen patients with invasive aspergillosis (proven, n = 2; probable, n = 14; not recorded, n = 1) participated in the study (micafungin arm, n = 12; control arm, n = 5). Three patients each in the micafungin (25.0%; 95% CI: 5.5\u201357.2) and control arm (60.0%; 95% CI: 14.7\u201394.7) had successful therapy at end of treatment as assessed by an Independent Data Review Board. Eleven patients died; six due to invasive aspergillosis. No deaths were considered related to study treatment. During this study it became increasingly common to use combination treatment for salvage therapy. Consequently, enrolment was low and the study was discontinued early. No clear trends in efficacy and safety can be concluded

Effect of sieving on ex-situ soil respiration of soils from three land use types

This study aims to investigate the effect of sieving on ex situ soil respiration (CO2 flux) measurements from different land use types. We collected soils (0–10 cm) from arable, grassland and woodland sites, allocated them to either sieved (4-mm mesh, freshly sieved) or intact core treatments and incubated them in gas-tight jars for 40 days at 10 °C. Headspace gas was collected on days 1, 3, 17, 24, 31 and 38 and CO2 analysed. Our results showed that sieving (4 mm) did not significantly influence soil respiration measurements, probably because micro aggregates (< 0.25 mm) remain intact after sieving. However, soils collected from grassland soil released more CO2 compared with those collected from woodland and arable soils, irrespective of sieving treatments. The higher CO2 from grassland soil compared with woodland and arable soils was attributed to the differences in the water holding capacity and the quantity and stoichiometry of the organic matter between the three soils. We conclude that soils sieved prior to ex situ respiration experiments provide realistic respiration measurements. This finding lends support to soil scientists planning a sampling strategy that better represents the inhomogeneity of field conditions by pooling, homogenising and sieving samples, without fear of obtaining unrepresentative CO2 flux measurements caused by the disruption of soil architecture

On the Maximum Crossing Number

Research about crossings is typically about minimization. In this paper, we consider \emph{maximizing} the number of crossings over all possible ways to draw a given graph in the plane. Alpert et al. [Electron. J. Combin., 2009] conjectured that any graph has a \emph{convex} straight-line drawing, e.g., a drawing with vertices in convex position, that maximizes the number of edge crossings. We disprove this conjecture by constructing a planar graph on twelve vertices that allows a non-convex drawing with more crossings than any convex one. Bald et al. [Proc. COCOON, 2016] showed that it is NP-hard to compute the maximum number of crossings of a geometric graph and that the weighted geometric case is NP-hard to approximate. We strengthen these results by showing hardness of approximation even for the unweighted geometric case and prove that the unweighted topological case is NP-hard.Comment: 16 pages, 5 figure