Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping?

Myofascial trigger points (MTPs) have long been a contentious issue in relation to fibromyalgia, and poorly defined pain complaints in general. Can MTPs be reproducibly identified? Do MTPs have valid objective findings, such as spontaneous electromyographic activity, muscle microdialysis evidence for an inflammatory milieu or visualization with newer ultrasound techniques? Is fibromyalgia a syndrome of multiple MTPs, or is focal muscle tenderness a manifestation of central sensitization? These issues are discussed with relevance to a recent paper reporting that manual palpation of active MTPs elicits the spontaneous pain experienced by fibromyalgia patients

An Algorithmic Bridge Between Hamming and Levenshtein Distances

The edit distance between strings classically assigns unit cost to every character insertion, deletion, and substitution, whereas the Hamming distance only allows substitutions. In many real-life scenarios, insertions and deletions (abbreviated indels) appear frequently but significantly less so than substitutions. To model this, we consider substitutions being cheaper than indels, with cost $1/a$ for a parameter $a\ge 1$. This basic variant, denoted $ED_a$, bridges classical edit distance ($a=1$) with Hamming distance ($a\to\infty$), leading to interesting algorithmic challenges: Does the time complexity of computing $ED_a$ interpolate between that of Hamming distance (linear time) and edit distance (quadratic time)? What about approximating $ED_a$? We first present a simple deterministic exact algorithm for $ED_a$ and further prove that it is near-optimal assuming the Orthogonal Vectors Conjecture. Our main result is a randomized algorithm computing a $(1+\epsilon)$-approximation of $ED_a(X,Y)$, given strings $X,Y$ of total length $n$ and a bound $k\ge ED_a(X,Y)$. For simplicity, let us focus on $k\ge 1$ and a constant $\epsilon > 0$; then, our algorithm takes $\tilde{O}(n/a + ak^3)$ time. Unless $a=\tilde{O}(1)$ and for small enough $k$, this running time is sublinear in $n$. We also consider a very natural version that asks to find a $(k_I, k_S)$-alignment -- an alignment with at most $k_I$ indels and $k_S$ substitutions. In this setting, we give an exact algorithm and, more importantly, an $\tilde{O}(nk_I/k_S + k_S\cdot k_I^3)$-time $(1,1+\epsilon)$-bicriteria approximation algorithm. The latter solution is based on the techniques we develop for $ED_a$ for $a=\Theta(k_S / k_I)$. These bounds are in stark contrast to unit-cost edit distance, where state-of-the-art algorithms are far from achieving $(1+\epsilon)$-approximation in sublinear time, even for a favorable choice of $k$.Comment: The full version of a paper accepted to ITCS 2023; abstract shortened to meet arXiv requirement

Gap Edit Distance via Non-Adaptive Queries: Simple and Optimal

We study the problem of approximating edit distance in sublinear time. This is formalized as a promise problem $(k,k^c)$-Gap Edit Distance, where the input is a pair of strings $X,Y$ and parameters $k,c>1$, and the goal is to return YES if $ED(X,Y)\leq k$ and NO if $ED(X,Y)> k^c$. Recent years have witnessed significant interest in designing sublinear-time algorithms for Gap Edit Distance. We resolve the non-adaptive query complexity of Gap Edit Distance, improving over several previous results. Specifically, we design a non-adaptive algorithm with query complexity $\tilde{O}(\frac{n}{k^{c-0.5}})$, and further prove that this bound is optimal up to polylogarithmic factors. Our algorithm also achieves optimal time complexity $\tilde{O}(\frac{n}{k^{c-0.5}})$ whenever $c\geq 1.5$. For $1<c<1.5$, the running time of our algorithm is $\tilde{O}(\frac{n}{k^{2c-1}})$. For the restricted case of $k^c=\Omega(n)$, this matches a known result [Batu, Erg\"un, Kilian, Magen, Raskhodnikova, Rubinfeld, and Sami, STOC 2003], and in all other (nontrivial) cases, our running time is strictly better than all previous algorithms, including the adaptive ones

Improving pregnancy outcomes in low- and middle-income countries

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone

Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries

The Global Network’s Antenatal Corticosteroids Trial (ACT), was a multi-country, cluster-randomized trial to improve appropriate use of antenatal corticosteroids (ACS) in low-resource settings in low-middle income countries (LMIC). ACT substantially increased ACS use in the intervention clusters, but the intervention failed to show benefit in the targeted < 5th percentile birth weight infants and was associated with increased neonatal mortality and stillbirth in the overall population. In this issue are six papers which are secondary analyses related to ACT that explore potential reasons for the increase in adverse outcomes overall, as well as site differences in outcomes. The African sites appeared to have increased neonatal mortality in the intervention clusters while the Guatemalan site had a significant reduction in neonatal mortality, perhaps related to a combination of ACS and improving obstetric care in the intervention clusters. Maternal and neonatal infections were increased in the intervention clusters across all sites and increased infections are a possible partial explanation for the increase in neonatal mortality and stillbirth in the intervention clusters, especially in the African sites. The analyses presented here provide guidance for future ACS trials in LMIC. These include having accurate gestational age dating of study subjects and having care givers who can diagnose conditions leading to preterm birth and predict which women likely will deliver in the next 7 days. All study subjects should be followed through delivery and the neonatal period, regardless of when they deliver. Clearly defined measures of maternal and neonatal infection should be utilized. Trials in low income country facilities including clinics and those without newborn intensive care seem to be of the highest priority.Fil: McClure, Elizabeth M.. RTI International; Estados UnidosFil: Goldenberg, Robert L.. Columbia University; Estados UnidosFil: Jobe, Alan H.. Cincinnati Children’s Hospital; Estados UnidosFil: Miodovnik, Menachem. Eunice Kennedy Shriver National Institute of Child and Human Development; Estados UnidosFil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child and Human Development; Estados UnidosFil: Buekens, Pierre. University of Tulane; Estados UnidosFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Translating research evidence into practice: a report from the 2nd International Conference on Maternal and Newborn Health from KLE University - Belagavi, India

The Jawaharlal Nehru Medical College (JNMC) Women’s and Children’s Health Research Unit (WCHRU) of the Karnataka Lingayat Education (KLE) Academy of Higher Education and Research Deemed-to-be-University and its collaborators convened the ‘2nd International Conference on Maternal and Newborn Health -Translating Research Evidence to Practice’ to address the common theme of improving maternal and newborn health in low- and middle- income countries (LMIC). This supplement, including 16 manuscripts, reflects much of the research presented at the conference, including analyses of the state of knowledge, as well as completed, ongoing and planned research in these areas conducted by the WCHRU in India together with many collaborators across high-income and LMIC. The first paper reviews maternal, fetal and neonatal mortality in low-income countries, considers their causes, as well as evidence for potential interventions to reduce mortality. A second paper addresses near miss maternal mortality. Several manuscripts address the research conducted by WCHRU and their colleagues in a multi-center research network. One study examines rates of miscarriage and medically terminated pregnancy in India and the risk factors for these occurrences. Another paper addresses stillbirth and its risk factors, both in India as well as in other LMIC. Haemorrhage and preeclampsia/eclampsia, important causes of maternal mortality, stillbirth and neonatal morbidity in LMIC, are addressed in a series of papers summarizing trials of interventions to reduce improve outcomes associated with these conditions. Poor maternal and infant nutritional status, which contribute to adverse outcomes, are addressed through papers which describe a number of important studies that the WCHRU and their colleagues have conducted to attempt to improve nutritional status. Another paper describes a study to investigate causes of stillbirth and deaths among preterm births, which will utilize new techniques to investigate the infectious causes of these deaths. Finally, the supplement addresses the process for dissemination of research results to inform public policy. Together these manuscripts represent a body of research to inform interventions to reduce maternal, fetal and newborn mortality and illustrates what a dedicated research group together with institutional support can accomplish

Commentary: reducing the world's stillbirths

One of the major success stories of modern obstetrics in high-income countries in the last 5 decades is the reduction of stillbirths from rates as high as 50 per 1000 births to about 5 per 1000 births today. Fetal mortality associated with obstructed labour, asphyxia, hypertension, diabetes, Rh disease, placental abruption, post-term pregnancies and infections such as syphilis all have declined. Much of this success has occurred in term births in the intrapartum period so that most stillbirths in high-income countries now occur in the antepartum period and are pre-term. Current stillbirth rates in many low- and middle-income countries, and especially in those areas within the countries with poorly functioning health systems, approximate those seen in high-income countries 50 years ago. A major difference between the stillbirths occurring in high-income countries and those occurring elsewhere is the preponderance of late pre-term, term and intrapartum stillbirths in low-resource countries. Those stillbirths should be relatively easy to prevent by known risk assessment methods and prompt delivery, often by Cesarean section. This commentary addresses an extensive six-paper review of stillbirths with an emphasis on low- and middle-income countries. Among the conclusions are that while a number of interventions have been shown to be effective in reducing stillbirths, unless there is a functioning health system in which these interventions can be implemented, the potential for a sustainable and substantial reduction in stillbirth rates will not be reached