Menstrual management in communal sanitation facilities: recommendations to eThekwini municipality

A growing body of research has shown that menstrual hygiene products (MHPs) are critical to gender equity, and South Africa has committed to providing free sanitary napkins to all indigent women. To address interim water and sanitation needs of its citizens living in informal settlements, South Africa’s eThekwini Water and Sanitation Unit (EWS) constructed community ablution blocks (CABs) that consist of gender-separated toilets, showers, and washbasins. The interactions between women, unfamiliar sanitation systems, and MHPs are likely to impact women and the sanitation systems they utilize. A larger case study led by PATH is evaluating these interactions, within which this sub-study aims to characterize the relationship between CABs and menstrual hygiene management in Durban’s informal settlements. Based on analysis of information gathered through interviews, photo documentation, and observations, we provide recommendations to EWS that we believe will improve women’s experiences at CABs and reduce negative impacts on the sanitation systems

Designing a school water treatment and interactive education program in Kenya to enable future scale-up

Many small-scale public health efforts including those to improve water, sanitation and hygiene (WASH) have not expanded beyond their initial scope. To improve the likelihood of scaling, the goal of this project led by the Program for Appropriate Technology in Health (PATH) was to design a small-scale innovative WASH project in three schools (the pilot) that was embedded within a larger-scale, multi-year program (AIDs Population and Health Integrated Assistance plus [APHIAplus]) focused on capacity-building to achieve integrated health delivery in Kenya. The innovative elements of the pilot included use of onsite electrochlorination and an interactive WASH curriculum that resulted in improved water quality and WASH knowledge at the schools. By aligning the pilot with the results framework of APHIAplus and utilizing a pre-existing partnership with schools, the integrated approach provided structure for implementation and an efficient use of resources. The pilot will be expanded to include 23 schools in 2013-2014

Establishing Age-calibrated Normative PROMIS Scores for Hand and Upper Extremity Clinic

The purpose of our study is to investigate differences in normative PROMIS upper extremity function (PROMIS-UE), physical function (PROMIS-PF), and pain interference (PROMIS-PI) scores across age cohorts in individuals without upper extremity disability. Methods: Individuals without upper extremity disability were prospectively enrolled. Subjects were administered PROMIS-UE, PROMIS-PF, and PROMIS-PI forms. Retrospective PROMIS data for eligible subjects were also utilized. The enrolled cohort was divided into age groups: 20-39, 40-59, and 60-79 years old. ANOVA, ceiling and floor effect analysis, and kurtosis and skewness statistics were performed to assess PROMIS scores trends with age. Results: This study included 346 individuals. In the 20-39 age group, mean PROMIS scores were 56.2 ± 6.1, 59.8 ± 6.9, and 43.1 ± 6.7 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. In the 40-59 age group, mean PROMIS computer adaptive test scores were 53.3 ± 7.5, 55.3 ± 7.6, and 46.6 ± 7.8 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. In the 60-79 age group, mean PROMIS scores were 48.4 ± 7.6, 48.5 ± 5.6, and 48.7 ± 6.9 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. Differences in mean PROMIS scores were significant across all PROMIS domains and age cohorts (P \u3c 0.001). Conclusion: Younger individuals without hand or upper extremity disability show higher normative PROMIS-UE and PROMIS-PF scores and lower PROMIS-PI scores, indicating greater function and less pain than older counterparts. A universal reference PROMIS score of 50 appears suboptimal for clinical assessment and decision-making in the hand and upper extremity clinic. This study included 346 individuals. In the 20-39 age group, mean PROMIS scores were 56.2 ± 6.1, 59.8 ± 6.9, and 43.1 ± 6.7 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. In the 40-59 age group, mean PROMIS computer adaptive test scores were 53.3 ± 7.5, 55.3 ± 7.6, and 46.6 ± 7.8 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. In the 60-79 age group, mean PROMIS scores were 48.4 ± 7.6, 48.5 ± 5.6, and 48.7 ± 6.9 for PROMIS-UE, PROMIS-PF, and PROMIS-PI, respectively. Differences in mean PROMIS scores were significant across all PROMIS domains and age cohorts (P \u3c 0.001)

Loss of LGR4/GPR48 causes severe neonatal salt-wasting due to disrupted WNT signaling altering adrenal zonation.

Disorders of isolated mineralocorticoid deficiency causing potentially life-threatening salt-wasting crisis early in life have been associated with gene variants of aldosterone biosynthesis or resistance, but in some patients no such variants are found. WNT/β-catenin signaling is crucial for differentiation and maintenance of the aldosterone producing adrenal zona glomerulosa (zG). We describe a highly consanguineous family with multiple perinatal deaths or infants presenting at birth with failure to thrive, severe salt-wasting crises associated with isolated hypoaldosteronism, nail anomalies, short stature, and deafness. Whole exome sequencing revealed a homozygous splice variant in the R-SPONDIN receptor LGR4 gene (c.618-1G>C) regulating WNT signaling. The resulting transcripts affected protein function and stability, and resulted in loss of Wnt/β-catenin signaling in vitro. The impact of LGR4 inactivation was analyzed by adrenal cortex specific ablation of Lgr4, using Lgr4Flox/Flox mated with Sf1:Cre mice. Inactivation of Lgr4 within the adrenal cortex in the mouse model caused decreased WNT signaling, aberrant zonation with deficient zG and reduced aldosterone production. Thus, human LGR4 mutations establish a direct link between LGR4 inactivation and decreased canonical WNT signaling with abnormal zG differentiation and endocrine function. Therefore, variants in WNT signaling and its regulators should systematically be considered in familial hyperreninemic hypoaldosteronism

A Case Study of Convectively Sourced Water Vapor Observed in the Overworld Stratosphere over the United States

On 27 August 2013, during the Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys field mission, NASA's ER2 research aircraft encountered a region of enhanced water vapor, extending over a depth of approximately 2 km and a minimum areal extent of 20,000 km(exp 2) in the stratosphere (375 K to 415 K potential temperature), south of the Great Lakes (42N, 90W). Water vapor mixing ratios in this plume, measured by the Harvard Water Vapor instrument, constitute the highest values recorded in situ at these potential temperatures and latitudes. An analysis of geostationary satellite imagery in combination with trajectory calculations links this water vapor enhancement to its source, a deep tropopausepenetrating convective storm system that developed over Minnesota 20 h prior to the aircraft plume encounter. High resolution, groundbased radar data reveal that this system was composed of multiple individual storms, each with convective turrets that extended to a maximum of ~4 km above the tropopause level for several hours. In situ water vapor data show that this storm system irreversibly delivered between 6.6 kt and 13.5 kt of water to the stratosphere. This constitutes a 2025% increase in water vapor abundance in a column extending from 115 hP to 70 hPa over the plume area. Both in situ and satellite climatologies show a high frequency of localized water vapor enhancements over the central U.S. in summer, suggesting that deep convection can contribute to the stratospheric water budget over this region and season