Attention to women's and girls' menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative ...research, which we systematically reviewed and synthesised.
We undertook systematic searching to identify qualitative studies of women's and girls' experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya n = 7, Uganda n = 6, and Ethiopia n = 5), 21 from South Asia (including India n = 12 and Nepal n = 5), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women's and girls' lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas.
Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women's and girls' health and well-being.
The review protocol registration is PROSPERO: CRD42018089581.
We give an introduction to several regularization schemes that deal with ultraviolet and infrared singularities appearing in higher-order computations in quantum field theories. Comparing the ...computation of simple quantities in the various schemes, we point out similarities and differences between them.
Background Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve ...prescription, such as implicit and explicit criteria. Objective To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria.sup.#174; (2015, 2019), the Screening Tool of Older Person's Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. Results A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. Conclusions The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.
•An automatic thresholding algorithm was developed in an OBIA framework.•The algorithm was tested in UAV images acquired on different herbaceous row crops.•The main objective was to accurately ...discriminate vegetation vs bare soil.•Classification accuracies about 90% were achieved.•Two cameras were tested on board the UAV: visible, and visible+infrared.
In precision agriculture, detecting the vegetation in herbaceous crops in early season is a first and crucial step prior to addressing further objectives such as counting plants for germination monitoring, or detecting weeds for early season site specific weed management. The ultra-high resolution of UAV images, and the powerful tools provided by the Object Based Image Analysis (OBIA) are the key in achieving this objective. The present research work develops an innovative thresholding OBIA algorithm based on the Otsu’s method, and studies how the results of this algorithm are affected by the different segmentation parameters (scale, shape and compactness). Along with the general description of the procedure, it was specifically applied for vegetation detection in remotely-sensed images captured with two sensors (a conventional visible camera and a multispectral camera) mounted on an Unmanned Aerial Vehicle (UAV) and acquired over fields of three different herbaceous crops (maize, sunflower and wheat). The tests analyzed the performance of the OBIA algorithm for classifying vegetation coverage as affected by different automatically selected thresholds calculated in the images of two vegetation indices: the Excess Green (ExG) and the Normalized Difference Vegetation Index (NDVI). The segmentation scale parameter affected the vegetation index histograms, which led to changes in the automatic estimation of the optimal threshold value for the vegetation indices. The other parameters involved in the segmentation procedure (i.e., shape and compactness) showed minor influence on the classification accuracy. Increasing the object size, the classification error diminished until an optimum was reached. After this optimal value, increasing object size produced bigger errors.
Background
Programs to support parents are the recommended strategy to reduce disruptive child behavior problems. Efforts have been made to demonstrate which program components (i.e., clusters of ...techniques taught) increase program effects, but these methods fail to account for the fact that components rarely operate in isolation. We examine how combinations of components cluster together to form program types and use network meta‐analysis to estimate the relative effects of these program types.
Methods
We updated an existing systematic review of parenting programs for disruptive child behavior and identified 197 randomized trials. We modeled clusters of components in each trial arm and chose the best‐fitting model. We subsequently took 20 draws from the probability distribution of the latent class for each arm, entered each draw into a network meta‐analysis model and combined findings using Rubin’s rules. Combined estimates were bootstrapped to rank the clusters. We estimated main models and separate models for prevention and treatment settings.
Results
A five‐class solution fit the data best: (1) behavior management; (2) behavior management with parental self‐management; (3) behavior management with psychoeducation and relationship enhancement; (4) maximal component loading and (5) no/minimal component loading (i.e. control). In the main model and in treatment settings, all four program types were effective compared to no/minimal components. In prevention settings, only behavior management and behavior management with parental self‐management were effective compared to no/minimal components. Probabilistic ranking showed that overall and in treatment settings, behavior management had the largest chance, and in prevention settings, behavior management with self‐management had the largest chance, of being most effective compared to no/minimal components.
Conclusions
Programs with more focused content seem more likely to yield stronger effects, and different foci may be needed in treatment versus prevention settings. Next steps include identifying individual family differences in optimal program content.
Cancer immune therapy has shown remarkable benefit in the treatment of a range of cancer types, although it may initiate autoimmune-related disorders in some patients. We have attempted to establish ...whether the incidence of irAEs after the use of anti–PD-1 antibodies nivolumab or pembrolizumab in advanced malignancies is associated with anti–PD-1 treatment efficacy.
We studied patients treated with single-agent nivolumab or pembrolizumab for advanced cancer. irAEs (immune-related adverse events) were identified clinically and graded as per the Common Terminology Criteria for Adverse Events version 4.0. Efficacy was evaluated with objective response rate (ORR, immune-Response Evaluation Criteria in Solid Tumours RECIST criteria) progression-free survival (PFS) and overall survival (OS). Tests were performed to determine the association between irAEs and ORR, PFS or OS.
We identified 106 patients. Primary diagnoses were lung cancer (n = 77), melanoma (n = 8), head and neck carcinoma (n = 7), renal carcinoma (n = 5), Hodgkin's lymphoma (n = 3), urothelial carcinoma (n = 3) and gallbladder adenocarcinoma, hepatocellular carcinoma and Merkel cell carcinoma (n = 1 each). IrAEs were observed in 40 patients (37.7%). The most frequent irAEs were hypothyroidism (n = 15), nephritis (n = 5) and hyperthyroidism (n = 4). Objective response was observed in 44 patients (41.5%), and median PFS was 5.5 months (0.5–31 months). Thirty-three of the 40 patients with irAEs had objective response (82.5%) in contrast with 11 of the 66 cases without irAEs (16.6%) (OR 23.5, P < 0.000001). PFS in patients with irAEs was 10 months and 3 months in those without irAEs (HR 2.2, P = 0.016). OS in patients with irAEs was 32 months and 22 in those without irAEs, without statistically significant differences.
In advanced cancer treated with single-agent anti–PD-1 antibodies, patients with irAEs showed a markedly improved efficacy over patients without irAEs (ORR of 82.5% and PFS of 10 months vs ORR of 16.6% and PFS of 3 months). Future studies of anti–PD-1 immune-therapy should address this association to explore the underlying biological mechanisms of efficacy.
•In advanced cancer treated with anti–PD-1 antibodies nivolumab or pembrolizumab, incidence of irAEs was associated with a marked efficacy.•Response rate increased significantly from 16.6% to 82.5% when an irAE was present.•The follow-up showed an increase of PFS from 3 to 10 months when an irAE was present.•The follow-up showed an increase of OS from 22 to 32 months when an irAE was present.
Abstract
Motivated by recent advances in neuroscience, in this work, we explore the emergent behaviour of quantum systems with a dynamical biologically-inspired qubits interaction. We use a minimal ...model of two interacting qubits with an activity-dependent dynamic interplay as in classical dynamic synapses that induces the so-called synaptic depression, that is, synapses that present synaptic fatigue after heavy presynaptic stimulation. Our study shows that in absence of synaptic depression the two-qubits quantum system shows typical Rabi oscillations whose frequency decreases when synaptic depression is introduced, so one can trap excitations for a large period of time. This creates a population imbalance between the qubits even though the Hamiltonian is Hermitian. This imbalance can be sustained in time by introducing a small energy shift between the qubits. In addition, we report that long time entanglement between the two qubits raises naturally in the presence of synaptic depression. Moreover, we propose and analyse a plausible experimental setup of our two-qubits system which demonstrates that these results are robust and can be experimentally obtained in a laboratory.
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