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Four scientists reflect on how to foster a more sustainable relationship between water and society amid complex and wide-ranging challenges.

This systematic review of randomized controlled trials evaluated the existing evidence on the effect of exogenous dehydroepiandrosterone (DHEA) on cognitive performance in postmenopausal women. The overall fi ndings do not support a therapeutic benefi t of DHEA on cognitive performance, although a statistically signifi cant improvement was seen in fi ve out of six tests of visual-spatial performance in one small study.

This systematic review of observational studies evaluated the existing evidence for association between endogenous DHEA (dehydroepiandrosterone)/DHEAS (dehydroepiandrosterone sulfate) and depression/depressive symptoms in postmenopausal women. The findings were inconsistent and do not clearly support an association between DHEA/DHEAS and depression.

This multi-authored collection of papers examines the complex realities of research on natural resource industries, including the messy entanglements of extraction, materiality, and everyday social life this research entails. Of central importance to the contributors is how scholars confront fieldwork challenges ethically, methodologically, and corporeally. The collection has two key objectives. First, it expands our understanding of extractive industry by bringing together work on resources conventionally understood as extractive (e.g. oil and minerals) alongside resource-intensive industries not typically examined through an extractive lens, for instance fisheries, agricultural monocultures, water, and tourism. As such, it considers the historical and current conditions that facilitate the extraction of resources in parallel, cyclical, and reproducing forms. Second, the collection examines scholarly positionalities, methodologies, and dilemmas that arise when studying nature-intensive industries, including the extractive dimensions associated with social research itself. Together, the pieces argue that research concerning extractive industries entails multiple scholarly positions—positions problematically inflected with colonialism and always shaped by power relations. Contributors to the section draw largely from feminist, postcolonial, anti-racist, and historical materialist insights to frame and problematize the corporeal and representational concerns arising from their scholarship on nature-intensive industries, including personal dilemmas that they have encountered in their work. Overall, the collection is driven by the realization that research, and the analyses it entails, may serve as a tool for emancipatory intervention yet also reproduce inequality. The futures of the people and ecosystems at the center of our studies impel constant reflection so that our work, and that of the next generation of scholars, may offer critical analysis that contributes to transforming—rather than reinforcing—oppressive relations associated with extractive sectors and industries.

Decolonization has become a popular discourse in academia recently and there are many debates on what it could mean within various disciplines as well as more broadly across academia itself. The field of international development has seen sustained gestures towards decolonization for several years in theory and practice, but hegemonic notions of development continue to dominate. Development is a contested set of ideas and practices that are under critique in and outside of academia, yet the reproduction of colonial power structures and Eurocentric logics continues whereby the realities of the global majority are determined by few powerful institutions and a global elite. To decolonize development's material and discursive powers, scholars have argued for decolonizing development education towards one that is ideologically and epistemologically different from dominant narratives of development. I add to these conversations and posit that decolonized ideologies and epistemologies have to be accompanied by decolonized pedagogies and considerations of decolonization of institutions of higher education. I discuss the institutional and critical pedagogical dilemmas and challenges that exist, since epistemological, methodological, and pedagogical decolonizations are influenced by institutional politics of higher education that are simultaneously local and global. The paper engages with the concept of critical hope in the pursuit of social justice to explore possibilities of decolonizing development praxis and offers suggestions on possible pathways forward.

Geographers should engage with development and the Sustainable Development Goals (SDGs) by utilizing not only the theoretical and methodological tools from our various subfields but also through advocacy, expanding the role of public intellectuals and holding institutions and people to account. If we want emancipatory politics and transformations in development, we need to challenge and improve what is done in the name of SDGs, keeping central the issues of social justice and ethical engagement. This is perhaps the most critical thing geographers can undertake going forward in order to dismantle the master’s current house.

The discursive and material tensions between words and ideas within geography have real impacts on the lives of peoples and the places we describe and study, and thus we should not take such tasks lightly. Political geography is limited by relying on existing genealogies and the limits of Anglo-based language. Silences and gaps can be better addressed by engaging with scholarship and ways of being from ‘other’ places as well as enriching genealogies to include postcolonial and feminist scholarship. While we can argue over the tracing of keywords or problematic interpretations in genealogical interventions, we should also at the same time be accountable to what has been and is continued to be overlooked, ignored, erased, or captured.

We have recently demonstrated that the inclusion of electrochemical impedance spectroscopy (EIS) into accelerated stress tests (AST) can provide a wealth of information about the modes of degradation occurring within a fuel cell catalyst layer. In those reports we have used half-cell techniques to validate the interpretation of the transmission line model for durability studies. Here, we have performed AST with membrane-electrode assemblies in fuel cell and applied EIS diagnostics to verify the usefulness of this technique in durability testing.

ObjectiveTo review the first two years of the primary human papillomavirus (HPV) cervical screening programme in an HPV vaccinated population.DesignObservational study.SettingAustralia.Participants3 745 318 women with a primary HPV test between 1 December 2017 and 31 December 2019; most women aged <40 years had previously been offered vaccination against HPV16 and HPV18.InterventionsPrimary HPV screening with referral if HPV16 or HPV18 (HPV16/18) positive and triage with liquid based cytology testing (threshold atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion) for women who were positive for high risk HPV types other than 16/18. A 12 month follow-up HPV test was recommended in triaged women with a negative or low grade cytology result, with referral if they tested positive for any high risk HPV type at follow-up.Main outcome measuresProportion of women who had attended for their first HPV screening test, tested positive, and were referred for colposcopy; and short term risk of detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse, CIN grade 3 or worse, or cancer.Results54.6% (n=3 507 281) of an estimated 6 428 677 eligible women aged 25-69 had undergone their first HPV test by the end of 2019. Among those attending for routine screening, positivity for HPV16/18 and for HPV types not 16/18 was, respectively, 2.0% and 6.6% in women aged 25-69 (n=3 045 844) and 2.2% and 13.3% in highly vaccinated cohorts of women aged 25-34 (n=768 362). Colposcopy referral (ages 25-69 years) was 3.5%, increasing to an estimated 6.2% after accounting for women who had not yet had a 12 month repeat test. Cervical cancer was detected in 0.98% (456/46 330) of women positive for HPV16/18 at baseline, including 0.32% (89/28 003) of women with HPV16/18 and negative cytology. Women with HPV types not 16/18 and negative or low grade cytology at both baseline and 12 months were at low risk of serious disease (3.4% CIN grade 3 or worse; 0.02% cancer; n=20 019) but estimated to account for 62.0% of referrals for this screening algorithm.ConclusionsColposcopy referral thresholds need to consider underlying cancer risk; on this basis, women with HPV16/18 in the first round of HPV screening were found to be at higher risk regardless of cytology result, even in a previously well screened population. Women with HPV types not 16/18 and negative or low grade cytology showed a low risk of serious abnormalities but constitute most referrals and could be managed safely with two rounds of repeat HPV testing rather than one. HPV16/18 driven referrals were low in HPV vaccinated cohorts.

ABSTRACTObjectiveTo assess the perspectives of Bangladeshi teachers on the feasibility of delivery and potential for long-term sustainability of puberty and menstruation education in urban and rural schools.MethodWe developed a multi-module puberty and menstrual hygiene management education curriculum that teachers piloted for six months in four urban and rural government and private schools in Bangladesh. We conducted monthly assessments during piloting, discussion for manual revision and four group discussions with 20 participating teachers to understand perceived benefits, barriers, and sustainability of puberty and menstruation education among school children.ResultsTeachers acknowledged the importance of school-based puberty and menstruation education to improve students’ perception and preparedness. They found that the training and instructors’ manual they received were useful tools for effectively communicating with students. Teachers noted school and community pressure to de-emphasize educational content not included on nationally standardized examinations, and insufficient time and pre-service training for teaching sensitive topics served as barriers to implementing the pilot curriculum.ConclusionPressure from school authorities and community may hinder the successful long-term delivery of school-based puberty and menstruation education programs that are external to the national curriculum. Our findings indicate that feasibly and sustainably improving education on these topics in Bangladeshi classrooms should be achieved through 1) revision of the current national curriculum to incorporate more comprehensive puberty and menstruation information including its physiology, management, and social context, 2) adequate training and support for teachers to deliver the content, and 3) incorporation of puberty and menstruation content into students’ national examinations which may better ensure teachers are given the tools and opportunity to prioritize teaching this content.

This study demonstrates that the clinical sensitivity, specificity, and reproducibility of the novel cobas human papillomavirus (HPV) test on the cobas 6800 system for high-risk HPV types fulfills the criteria for use in population-based cervical screening. The criteria were formulated by an international consortium, using the cobas 4800 HPV test as a validated reference assay.

ObjectiveTo evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women.DesignUpdated meta-analysis.Data sourcesMedline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review).Review methodsAccuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women.Results56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman’s home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I2>95%).ConclusionsWhen used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.