Menstrual Health and Hygiene Management and WASH in Urban Slums: Gaps in the Evidence and Recommendations

The rapid urbanization and development of megacities across many low- and middle-income countries creates new challenges in global health; this is particularly true for women and girls who are disproportionately affected by poor urban planning, inadequate sanitation infrastructure, and limited access to water. Urban slums serve to reinforce many gendered inequalities, as reflected in poor sexual and reproductive health outcomes and various other health and wellbeing indicators. Women and adolescent girls in urban slums are particularly vulnerable in relation to their experiences of menstruation, given the limited access they may have to safe, private spaces with water for changing, washing, bathing, and laundering reusable pads, menstrual cloths and pads, and insufficient access to culturally acceptable, adequate disposal mechanisms for used menstrual materials. On-going taboos and stigma around menstruation likely augment these challenges in urban slum contexts; however, there exists limited literature on the intersection of menstrual hygiene management with water and sanitation systems in urban slums in low- and middle-income countries. Through a review of literature, this article seeks to highlight critical interlinkages between urbanization, sanitation, and menstruation, and identify important gaps in the existing menstruation-related evidence base that have implications for the health and wellbeing of adolescent girls and women

Anterior insula stimulation suppresses appetitive behavior while inducing forebrain activation in alcohol-preferring rats

The anterior insular cortex plays a key role in the representation of interoceptive effects of drug and natural rewards and their integration with attention, executive function, and emotions, making it a potential target region for intervention to control appetitive behaviors. Here, we investigated the effects of chemogenetic stimulation or inhibition of the anterior insula on alcohol and sucrose consumption. Excitatory or inhibitory designer receptors (DREADDs) were expressed in the anterior insula of alcohol-preferring rats by means of adenovirus-mediated gene transfer. Rats had access to either alcohol or sucrose solution during intermittent sessions. To characterize the brain network recruited by chemogenetic insula stimulation we measured brain-wide activation patterns using pharmacological magnetic resonance imaging (phMRI) and c-Fos immunohistochemistry. Anterior insula stimulation by the excitatory Gq-DREADDs significantly attenuated both alcohol and sucrose consumption, whereas the inhibitory Gi-DREADDs had no effects. In contrast, anterior insula stimulation failed to alter locomotor activity or deprivation-induced water drinking. phMRI and c-Fos immunohistochemistry revealed downstream activation of the posterior insula and medial prefrontal cortex, as well as of the mediodorsal thalamus and amygdala. Our results show the critical role of the anterior insula in regulating reward-directed behavior and delineate an insula-centered functional network associated with the effects of insula stimulation. From a translational perspective, our data demonstrate the therapeutic potential of circuit-based interventions and suggest that potentiation of insula excitability with neuromodulatory methods, such as repetitive transcranial magnetic stimulation (rTMS), could be useful in the treatment of alcohol use disorders.Peer reviewe

Can holography reproduce the QCD Wilson line?

Recently a remarkable agreement was found between lattice simulations of long Wilson lines and behavior of the Nambu Goto string in flat space-time. However, the latter fails to fit the short distance behavior since it admits a tachyonic mode for a string shorter than a critical length. In this paper we examine the question of whether a classical holographic Wilson line can reproduce the lattice results for Wilson lines of any length. We determine the condition on the the gravitational background to admit a Coulombic potential at short distances. We analyze the system using three different renormalization schemes. We perform an explicit best fit comparison of the lattice results with the holographic models based on near extremal D3 and D4 branes, non-critical near extremal AdS6 model and the Klebanov Strassler model. We find that all the holographic models examined admit after renormalization a constant term in the potential. We argue that the curves of the lattice simulation also have such a constant term and we discuss its physical interpretation

Patient-reported outcomes in patients with hematological relapse or progressive disease:a longitudinal observational study

Abstract Background Patients with hematological cancer who experience relapse or progressive disease often face yet another line of treatment and continued mortality risk that could increase their physical and emotional trauma and worsen their health-related quality of life. Healthcare professionals who use patient-reported outcomes to identify who will have specific sensitivities in particular health-related quality of life domains may be able to individualize and target treatment and supportive care, both features of precision medicine. Here, in a cohort of patients with relapsed or progressive hematological cancer, we sought to identify health-related quality of life domains in which they experienced deterioration after relapse treatment and to investigate health-related quality of life patterns. Method Patients were recruited in connection with a precision medicine study at the Department of Hematology, Aalborg University Hospital. They completed the European Organization for Research and Treatment of Cancer questionnaire and the Hospital Anxiety and Depression Scale at baseline and at 3, 6, 9, and 12 months after the relapse diagnosis or progressive cancer. Modes of completion were electronically or on paper. Clinically relevant changes from baseline to 12 months were interpreted according to Cocks’ guidelines. We quantified the number of patients with moderate or severe symptoms and functional problems and the number who experienced improvements or deterioration from baseline to 12 months. Results A total of 104 patients were included, of whom 90 (87%) completed baseline questionnaires and 50 (56%) completed the 12-month assessments. The three symptoms that patients most often reported as deteriorating were fatigue (18%), insomnia (18%), and diarrhea (18%). The three functions that patients most often reported as deteriorating were role (16%) and emotional (16%) and cognitive (16%) functioning. Conclusion In this study, patient-reported outcome data were useful for identifying negatively affected health-related quality of life domains in patients with relapsed or progressive hematological cancer. We identified patients experiencing deterioration in health-related quality of life during treatment and characterized a potential role for patient-reported outcomes in precision medicine to target treatment and supportive care in this patient group

Development of a Precision Medicine Workflow in Hematological Cancers, Aalborg University Hospital, Denmark

Within recent years, many precision cancer medicine initiatives have been developed. Most of these have focused on solid cancers, while the potential of precision medicine for patients with hematological malignancies, especially in the relapse situation, are less elucidated. Here, we present a demographic unbiased and observational prospective study at Aalborg University Hospital Denmark, referral site for 10% of the Danish population. We developed a hematological precision medicine workflow based on sequencing analysis of whole exome tumor DNA and RNA. All steps involved are outlined in detail, illustrating how the developed workflow can provide relevant molecular information to multidisciplinary teams. A group of 174 hematological patients with progressive disease or relapse was included in a non-interventional and population-based study, of which 92 patient samples were sequenced. Based on analysis of small nucleotide variants, copy number variants, and fusion transcripts, we found variants with potential and strong clinical relevance in 62% and 9.5% of the patients, respectively. The most frequently mutated genes in individual disease entities were in concordance with previous studies. We did not find tumor mutational burden or micro satellite instability to be informative in our hematologic patient cohort