Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes.

Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)-perceptions regarding a group's ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming

Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India.

INTRODUCTION: Government efforts to address massive shortfalls in rural water and sanitation in India have centred on construction of community water sources and toilets for selected households. However, deficiencies with water quality and quantity at the household level and community coverage and actual use of toilets have led Gram Vikas, a local non-governmental organization in Odisha, India, to develop an approach that provides household-level piped water connections contingent on full community-level toilet coverage. METHODS: This matched cohort study was designed to assess the effectiveness of a combined piped water and sanitation intervention. Households with children <5 years in 45 randomly selected intervention villages and 45 matched control villages will be followed over 17 months. The primary outcome is prevalence of diarrhoeal diseases; secondary health outcomes include soil-transmitted helminth infection, nutritional status, seroconversion to enteric pathogens, urogenital infections and environmental enteric dysfunction. In addition, intervention effects on sanitation and water coverage, access and use, environmental fecal contamination, women's empowerment, as well as collective efficacy, and intervention cost and cost-effectiveness will be assessed. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the ethics boards of the London School of Hygiene and Tropical Medicine, UK and KIIT University, Bhubaneswar, India. Findings will be disseminated via peer-reviewed literature and presentation to stakeholders, government officials, implementers and researchers. TRIAL REGISTRATION NUMBER: NCT02441699

Maintaining behaviour change: innovations in demand-side sanitation and hygiene interventions

This paper explores innovations in demand-side sanitation and hygiene intervention design and implementation. These innovations build on approaches employed by Community-Led Total Sanitation and Hygiene (CLTSH) programming to sustain improved WASH behaviours. Through an iterative process, our team conducted formative activities in Amhara, Ethiopia to: 1) generate information regarding stakeholders’ experiences with the government’s Health Extension Package (HEP) and previous CLTSH programming, and 2) explore options for intervention design and delivery. Our results suggest in some cases, community members were willing to engage in demand-side sanitation and hygiene programming after having negative experiences with ineffectual CLTSH triggering. Health Extension Workers (HEWs) indicated that high demand is placed on them to deliver the 16-component HEP. We conclude that what is needed are demand-side approaches that: 1) engage more community-level change agents, 2) include plans and resources to provide community actors with supportive supervision and on-the-job-training, and 3) focus on behavioural maintenance

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis.

BACKGROUND: Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry. METHODS AND FINDINGS: We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review's end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review's inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high. CONCLUSIONS: This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions

Bifurcation study of a neural field competition model with an application to perceptual switching in motion integration.

Perceptual multistability is a phenomenon in which alternate interpretations of a fixed stimulus are perceived intermittently. Although correlates between activity in specific cortical areas and perception have been found, the complex patterns of activity and the underlying mechanisms that gate multistable perception are little understood. Here, we present a neural field competition model in which competing states are represented in a continuous feature space. Bifurcation analysis is used to describe the different types of complex spatio-temporal dynamics produced by the model in terms of several parameters and for different inputs. The dynamics of the model was then compared to human perception investigated psychophysically during long presentations of an ambiguous, multistable motion pattern known as the barberpole illusion. In order to do this, the model is operated in a parameter range where known physiological response properties are reproduced whilst also working close to bifurcation. The model accounts for characteristic behaviour from the psychophysical experiments in terms of the type of switching observed and changes in the rate of switching with respect to contrast. In this way, the modelling study sheds light on the underlying mechanisms that drive perceptual switching in different contrast regimes. The general approach presented is applicable to a broad range of perceptual competition problems in which spatial interactions play a role

Contrast Adaptation Contributes to Contrast-Invariance of Orientation Tuning of Primate V1 Cells

BACKGROUND: Studies in rodents and carnivores have shown that orientation tuning width of single neurons does not change when stimulus contrast is modified. However, in these studies, stimuli were presented for a relatively long duration (e. g., 4 seconds), making it possible that contrast adaptation contributed to contrast-invariance of orientation tuning. Our first purpose was to determine, in marmoset area V1, whether orientation tuning is still contrast-invariant with the stimulation duration is comparable to that of a visual fixation. METHODOLOGY/PRINCIPAL FINDINGS: We performed extracellular recordings and examined orientation tuning of single-units using static sine-wave gratings that were flashed for 200 msec. Sixteen orientations and three contrast levels, representing low, medium and high values in the range of effective contrasts for each neuron, were randomly intermixed. Contrast adaptation being a slow phenomenon, cells did not have enough time to adapt to each contrast individually. With this stimulation protocol, we found that the tuning width obtained at intermediate contrast was reduced to 89% (median), and that at low contrast to 76%, of that obtained at high contrast. Therefore, when probed with briefly flashed stimuli, orientation tuning is not contrast-invariant in marmoset V1. Our second purpose was to determine whether contrast adaptation contributes to contrast-invariance of orientation tuning. Stationary gratings were presented, as previously, for 200 msec with randomly varying orientations, but the contrast was kept constant within stimulation blocks lasting >20 sec, allowing for adaptation to the single contrast in use. In these conditions, tuning widths obtained at low contrast were still significantly less than at high contrast (median 85%). However, tuning widths obtained with medium and high contrast stimuli no longer differed significantly. CONCLUSIONS/SIGNIFICANCE: Orientation tuning does not appear to be contrast-invariant when briefly flashed stimuli vary in both contrast and orientation, but contrast adaptation partially restores contrast-invariance of orientation tuning

Context Modulation of Facial Emotion Perception Differed by Individual Difference

Background: Certain facial configurations are believed to be associated with distinct affective meanings (i.e. basic facial expressions), and such associations are common across cultures (i.e. universality of facial expressions). However, recently, many studies suggest that various types of contextual information, rather than facial configuration itself, are important factor for facial emotion perception. Methodology/Principal Findings: To examine systematically how contextual information influences individuals ’ facial emotion perception, the present study estimated direct observers ’ perceptual thresholds for detecting negative facial expressions via a forced-choice psychophysical procedure using faces embedded in various emotional contexts. We additionally measured the individual differences in affective information-processing tendency (BIS/BAS) as a possible factor that may determine the extent to which contextual information on facial emotion perception is used. It was found that contextual information influenced observers ’ perceptual thresholds for facial emotion. Importantly, individuals ’ affectiveinformation tendencies modulated the extent to which they incorporated context information into their facial emotion perceptions. Conclusions/Significance: The findings of this study suggest that facial emotion perception not only depends on facial configuration, but the context in which the face appears as well. This contextual influence appeared differently wit