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Clinical practice guidelines for the care of people experiencing chronic primary pain: protocol for a systematic review with interpretation against an established chronic pain care priority framework
Get PDFStrength and Limitations of This Study:
• The clinical practice guideline (CPG) search strategy will be comprehensive, encompassing nine scholarly databases, the Epistemonikos database and guidelines clearinghouses, without restriction on language of publication or life course stage.
• We will extract recommendations and key contextual information from included CPGs, including guiding principles, practice guidance statements and GRADE Evidence-to-Decision (EtD) considerations (or equivalent).
• We will interpret the certainty of recommendations through the parameters of recommendation strength and guideline quality, content-analyse contextual information and map this information against a pain care priority framework that reflects the values and preferences of people living with chronic pain.
• We will harness the expertise and insights of an interdisciplinary Advisory Group, including lived experience partners, to interpret the findings.
Although we will search across databases and clearinghouses, our searches are limited to databases that can be searched in English and to the period 2015–2025 to align with the chronic primary pain classification for the eleventh International Classification of Diseases (ICD-11), which may exclude earlier CPGs and any CPGs that are indexed with non-English terms only.Introduction: Most clinical practice guidelines (CPGs) for assessing and managing people’s chronic pain focus on specific pain conditions, body sites or life course stages. This creates complexity for clinicians making care choices in the absence of a diagnosis and/or where a person experiences more than one pain condition. Specific to this context is the ICD-11 classification of chronic primary pain where an experience of pain cannot be better accounted for by another condition. CPGs for chronic primary pain, agnostic to condition or body part, may support clinicians towards best pain care since many of the principles of person-centred chronic pain care are transdiagnostic. The two aims of this systematic review are to (1) identify and appraise CPGs for chronic primary pain, relevant across the life course and (2) map the CPG content against a pain care priority framework to evaluate the extent to which the CPG content aligns with the priorities of people with lived chronic pain experience.
Methods and analysis: We will systematically search nine scholarly databases, the Epistemonikos database and international and national guidelines clearinghouses. CPGs published within 2015–2025, in any language, that offer recommendations about assessment and/or management of chronic primary pain for people of any age, excluding hospitalised inpatients or institutionalised populations, will be included. Pairs of reviewers will independently screen citations for eligibility and appraise CPG quality and implementation potential using the Appraisal of Guidelines for Research and Evaluation (AGREE)-II and the AGREE-Recommendations Excellence tools, respectively. Data extraction will include the citation and scope characteristics of each CPG, methods used to develop recommendations, verbatim recommendations, guiding principles or practice information and narrative excerpts related to the GRADE Evidence-to-Decision (EtD) considerations (or equivalent). We will use the PROGRESS-PLUS framework as a checklist to identify whether determinants of health equity were considered by guideline developers. CPG recommendations will be organised according to common topics and categorised in a matrix according to strength and direction. Qualitative content analysis will be used to synthesise excerpts relating to GRADE EtD considerations (or equivalent), and we will map extracted data against an established chronic pain care priority framework to determine the extent to which the CPGs align with values and preferences of people with lived experience. Interpretation will be informed by an interdisciplinary Advisory Group, including lived experience partners.
Ethics and dissemination: Ethical approval is not required for this systematic review. Results will be disseminated through publication in an open-access peer-reviewed journal, through professional societies, and integrated into education curricula and public-facing resources. Reporting will be consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
PROSPERO registration number CRD420251000482.This research was funded by the Australian Government Medical Research Future Fund (MRFF) (APP2016567) with co-funding from the Government of Western Australia, Department of Health (WA Health) and Curtin University. The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and well-being of Australians. Further information on the MRFF is available at www.health.gov.au/mrff. The contents of this published material are solely the responsibility of the individual authors and do not reflect the views of the Government of Australia or the Government of Western Australia. AMB, RW, N-RK and HS are supported, in part, by MRFF funding. NS, LR, JLB and AS are supported, in part, by funding from Curtin University
Overseas general practitioners (GPs) and opioid prescriptions in England
Get PDFJEL classification: I1; C01; C55; C8.Supplementary materials are available online at: https://www.sciencedirect.com/science/article/pii/S0168851025001186?via%3Dihub#sec0011 .The substantial recent rise in opioid prescription rates, along with increasing evidence of misuse and associated morbidity and mortality, raises serious concerns about the appropri- ateness of these drugs for pain management. This study investigates prescription behaviour differences across opioid drug categories between UK-trained and overseas-trained GPs. Us- ing panel data covering all English practices from 2018 to 2021, we find a strong association between practices with more overseas GPs and opioid prescription patterns. Regional dif- ferences emerge, with GPs from North America prescribing more opioids and those from Africa and Asia prescribing less, relative to the UK-trained counterparts. Heterogeneous cultural norms, different training environments, and varying epidemiological patterns might explain these different prescribing behaviours. Comprehensive cross-country assessments of GP competencies could identify areas for targeted training, helping to align the practices of foreign-trained GPs with UK standards while supporting the attraction of global talent.icodemo receives funding from the National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust
Investigating socioeconomic deprivation and antibiotic prescribing among older medicare patients using an instrumental variable approach
Get PDFSupplementary material is available online at: https://doi.org/10.1017/ash.2025.185 .Background:
Socioeconomic deprivation has been associated with antibiotic overprescription in the US; however, prior studies could not quantify a causal relationship due to endogeneity. This study examines how socioeconomic deprivation is related to the rate of antibiotic days supplied to older Medicare Part D beneficiaries, utilizing an Instrumental Variable (IV) approach.
Methods:
Data from the Medicare Part D and the Social Deprivation Index (SDI) repositories were analyzed. To address potential endogeneity and omitted variable bias in the relationship between SDI and antibiotic prescribing, we used the maximum Earned Income Tax Credit as an IV. Bivariate Moran’s I assessed the spatial correlation between SDI and antibiotic prescribing across geographic regions. The IV analysis then examined the relationship between predicted SDI and antibiotic days supplied (ln). Linear regression models estimated associations between SDI and its components, and antibiotic days supplied, adjusting for prescriber, beneficiary, and geographic factors.
Results:
Among 161,164, there was no significant spatial dependence between SDI and antibiotic days supplied (P = 0.0656). In the IV model, a one-unit increase in SDI was associated with a 0.582 (SE = 0.164, P < 0.0005) increase in antibiotic days supplied (ln). Higher unemployment and single-parent family rates were linked to increased antibiotic days supplied, while crowded housing was associated with a reduction.
Conclusion:
This study identified that socioeconomic deprivation may influence antibiotic days supplied to Medicare Part D beneficiaries. Findings highlight the need for targeted public health interventions to address the socioeconomic factors contributing to excess antibiotic use.None reported
Gender Politics in Nigeria: A Socio-Political Analysis of Women’s Perspectives on Feminism, Feminist Politics, and Democracy
Get PDFNigeria’s democracy exhibits gender-based inequalities that suppress women’s voices and disproportionately under-represent them inpolitical leadership. Using feminist political philosophy as its theoretical framework, and mixed methods to gather data, this study interrogated Nigerian feminism, feminist politics, and democracy through the lens of 100 working-class women. Findings reveal the existential struggles of participants whose material deprivation and political powerlessness have increased apathy towards gender politics, elections, and political institutions. Wedged between modernity and patriarchy, they reject Western notions of sexual liberalism and conceptualize democracy as necessary but incapable of ensuring economic progress – the end for which it exists. The arguments in the present article matter because they contribute to feminist/political scholarship in Nigeria.This work has not been funded and the authors report there are no competing interests to declare
User-Centered Artificial Intelligence for Game Design and Development with the GAGeTx framework: Graphical Asset Generation and Transformation
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“Media is absolutely disgusting”: Emotions and affect towards political elites, information sources and conspiracy theories in anti-lockdown protests
Get PDFUsing a unique dataset collected through ethnographic observations and interviews at six anti-lockdown protest sites, this article examines concrete emotions across different stages of the anti-lockdown protests in London, shedding light on the broader affective anti-lockdown protest atmosphere. Our study contributes to a nuanced understanding of protest movements in times of emergency by demonstrating how the distinct feelings of “distrust” and “disillusionment” in reaction to political elites, information and news sources can mobilise and consolidate a social movement during a crisis. We identify these long-run emotions towards official sources as crucial in fuelling short-run emotions of anger and anxiety at the pandemic's outset, mobilising and uniting protesters around alternative sources of information and conspiracy theories. Moreover, our findings show that despite their distrust towards mainstream media, protesters felt trust in alternative media and each other, assisting them to sustain positive affect during the protests. Even in the tense context of the pandemic, positive emotions such as joy were also fostered through the shared feeling of distrust towards political and media elites, common conspiracy theories and activists' togetherness in protest spaces, which created an evolving anti-lockdown atmosphere.The authors would like to acknowledge that this research was made possible through funding from the Political Studies Association's Innovation and Research Fund and the British Academy's COVID-19 Recovery programme: Building Future Pandemic Preparedness and Understanding Citizen Engagement in the USA and UK [CRUSA210009]. Both grants were awarded to all authors.
Author Bogdan Ianosev also acknowledges funding from the EU through the Recovery and Resilience Plan for Slovakia under project No. 09I03-03-V04-00707
Log canonical thresholds of high multiplicity reduced plane curves
Get PDFA preprint version of the article is available at arXiv:2311.00963v1 [math.AG], https://arxiv.org/abs/2311.00963 . It has not been certified by peer review.We compute log canonical thresholds of reduced plane curves of degree d at points of multiplicity d−1. As a consequence, we describe all possible values of log canonical threshold that are less than 2/(d−1) for reduced plane curves of degree d. In addition, we compute log canonical thresholds for all reduced plane curves of degree less than 6.The first author was supported by the Simons Investigato rAward HMS, National Science Fund of Bulgaria, National Scientific Program“Excellent Research and People for the Development of European Science”(VIHREN),Project No. KP-06-DV-7 and this is a contribution to Project-ID 286237555–TRR195–by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation). The second author was partially supported by the Engineering and Physical Sciences Research Council (EPSRC) Grant EP/V048619/1“ Kähler-Einsteinmetrics on Fano Manifolds" and EP/V056689/1“ The Calabi Problem for smooth Fano threefolds"
Review article: Towards multi-hazard and multi-risk indicators – a review and recommendations for development and implementation
Get PDFData availability:
This review is based on previously published studies, and the data supporting the findings are derived from those sources. A summary of the data extracted and analysed is provided in the Supplement. Additional information is available from the corresponding author upon reasonable request.Supplement:
The supplement related to this article is available online at https://doi.org/10.5194/nhess-25-4263-2025-supplement .The development of indicators in disaster risk management has only recently started to explicitly include a multi-hazard and multi-risk approach. However, undertaking a natural hazard or risk assessment from a single hazard approach can be considered incomplete where the interactions between, and impacts from, multiple hazards and risks are not considered. Indicators contain observable and measurable characteristics to simplify information to understand the state of a concept or phenomenon, and/or to monitor it over time. To understand how indicators are being used in this context, using a systematic review, we identified 192 publications that mention indicators within either multi-hazard or multi-risk contexts, including hazards, vulnerability, and risk/impact. We found that most studies exploring indicators focused on multi-layer single hazards and risks, where multiple single hazards or risks within a given location were analysed individually and their outcomes presented in an overlaid format. The results also demonstrate a predominance of studies on hazard indicators (88 %) versus risk indicators, with a dominance of hydrometeorological indicators. Only 20 % of the studies integrated hazard, vulnerability and risk/impact. Based on the findings, we propose a set of actionable recommendations to enable the development and uptake of multi-hazard and multi-risk indicators.This research has been supported by the Natural Environment Research Council (NERC) Global Partnerships Seedcorn Fund “EMERGE” project (grant no. NE/W003775/1). CJW, MSGA, MA, YC and CK were supported by the European Union's Horizon Europe “Multi-hazard and risk informed system for enhanced local and regional disaster risk management” (MEDiate) project under grant agreement no. 101074075. MSGA also received support from the Leverhulme Trust through an Early Career Fellowships under grant reference ECF-2023-074. RC, JC, MD, LS, and PJW were supported by the European Union's Horizon 2020 “Multi-hazard and sYstemic framework for enhancing Risk-Informed mAnagement and Decision-making in the E.U.” (MYRIAD-EU) project under grant agreement no. 101003276
Palestine, 1917–48: Assassination and Information Operations
No full textThis chapter examines covert action in Palestine during 1917-48, focusing on assassination and influence operations. It shows that Britain tended to work through partners in covert action rather than doing it alone. When it did act covertly on its own, it failed. Britain did not need to resort to covert assassination. On the sole occasion when policymakers faced the opportunity, they opted for caution. Britain’s “way” of covert action was improvisational; an act of strategic paralysis more than planning. However, Britain’s suppression of the Palestinian revolt from 1936, produced a more deliberate approach to these tactics. The country became a training ground for British officers who championed covert action during the Second World War. Their triumphs perhaps fostered the delusion that covert action could be a silver bullet
Evidence-Based Ranking of Herbal Medicines for Hypertension Management: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
No full textData availability:
All data relevant to the study are included in the article or uploaded as supplementary information.Supplementary materials are available online at: https://www.sciencedirect.com/science/article/pii/S1876382025001258#sec0030 .Introduction:
Hypertension affects over 116 million adults in the United States and >1 billion globally, substantially contributing to cardiovascular morbidity. Herbal therapies have emerged as potential complementary treatments for blood pressure management. To the best of our knowledge, this study is the first systematic review with network meta-analysis (NMA) aimed at ranking the most effective herbal therapies for lowering blood pressure.
Methods:
We systematically searched MEDLINE, Embase, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews (CDSR), selecting randomized controlled trials (RCTs) enrolling hypertensive and prehypertensive adults that compare herbal medicine interventions to placebo, usual care, or against each other. We used the Cochrane RoB 2 tool to assess the risk of bias. We performed frequentist random-effects network meta-analyses and summarized effects as mean differences (MD) with 95 % confidence intervals (CI). We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.
Results:
A total of 47 RCTs involving 3,559 patients met prespecified eligibility criteria. Our NMA indicates that Celery (Apium graveolens) reduces systolic blood pressure (SBP) by (MD -10.9 [95 % CI -17.6 to -4.3], p-value=0.001) with high certainty of evidence. Caucasian whortleberry (MD -16.2 [95 % CI -22.9 to -9.5], p-value<0.0001), Roselle (MD -7.7 [95 % CI -11.9 to -3.5], p-value=0.0003), and Garlic (MD -6.0 [95 % CI -8.8 to -3.2], p-value<0.0001) probably reduce SBP with moderate certainty. No serious adverse events were reported.
Conclusion:
There is moderate to high certainty that Celery and Caucasian whortleberry were the most effective treatments for reducing blood pressure, among included herbal medicines, in hypertensive and pre-hypertensive patients. Additional long-term, large-sample RCTs are warranted to refine dosing, safety, and sustained effects. Clinicians should interpret results cautiously, given heterogeneity and limited direct evidence for some herbs.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Data sources:
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