Evaluating the Potential of Container-Based Sanitation

In the face of urbanization, alternative approaches are needed to deliver adequate and inclusive sanitation services across the full sanitation service chain. Container-based sanitation (CBS) consists of an end-to-end service—that is, one provided along the whole sanitation service chain—that collects excreta hygienically from toilets designed with sealable, removable containers and strives to ensure that the excreta is safely treated, disposed of, and reused. This report builds on four case studies (SOIL – Haiti, x-runner – Peru, Clean Team – Ghana, Sanergy – Kenya) to assess the role CBS can play in a portfolio of solutions for citywide inclusive sanitation (CWIS) services. The authors conclude that CBS approaches should be part of the CWIS portfolio of solutions, especially for poor urban populations for whom alternative on-site or sewer-based sanitation services might not be appropriate. Customer satisfaction with existing services is high and services provided by existing CBS providers are considered safe but have some areas for improvement. While the proportion of total CBS service costs covered by revenues is still small, CBS services are considered to be priced similarly to the main sanitation alternatives in their service areas. Recommendations include adopting a conducive policy and regulatory environment and exploring ways to ensure that CBS services are sustainably financed. The report also identifies areas for further analysis

Haemodynamic optimisation: are we dynamic enough?

Perioperative haemodynamic optimisation of high-risk surgical patients has long been documented to improve both short-term and long-term outcomes, as well as to reduce the rate of postoperative complications. Based on the evidence, cardiac output monitoring and fluid resuscitation, combined with the use of inotropes, would seem to be the gold standard of care for these difficult surgical cases. However, clinicians do not universally apply these techniques and principles in their everyday practice. By exploring the reasons why this is so, perhaps we could move forward in the standardisation of care and the application of evidence-based practice

The burden of proof: The process of involving young people in research

Patient and public involvement in research includes non‐academics working with researchers, on activities from consultative tasks, to joint working, and on user‐led initiatives. Health and social care funding bodies require involvement in research projects. A current debate focuses on a perceived lack of empirical “proof” to demonstrate the impact of involvement upon the quality of research. It is also argued that the working relationships between researchers and those becoming involved need to be understood more fully. These areas are beginning to be reported upon but there are few studies of young people involved in health research. This study describes the experiences of adult academics and young people, working together on a large‐scale, UK health research programme. Using qualitative interview and focus group methods, the aim was to explore participants’ perceptions about the process and outcomes of their work together. The importance of cyclical, dynamic and flexible approaches is suggested. Enablers include having clear mechanisms for negotiation and facilitation, stakeholders having a vision of “the art of the possible,” and centrally, opportunities for face‐to‐face working. What is needed is a continuing discourse about the challenges and benefits of working with young people, as distinct from younger children and adults, understanding the value of this work, without young people having to somehow “prove” themselves. Involvement relies on complex social processes. This work supports the view that an improved understanding of how key processes are enabled, as well as what involvement achieves, is now needed

Why there is a 'right' kind of trauma in Uganda: part two

Recent calls to increase mental health interventions in post-conflict settings omit crucial evidence on their social impact. Indeed, Western narratives around trauma and PTSD can obscure the needs of its recipients. Research on ex-LRA combatants in Uganda highlights why health interventions should engage critically with the lived realities of those it seeks to assist. Based on a paper in Anthropology Today, this is the second in a two-part series on the anthropology behind ‘trauma’ in war-affected and post-conflict settings

Early-life adversity accelerates cellular ageing and affects adult inflammation: experimental evidence from the European starling

Early-life adversity is associated with accelerated cellular ageing during development and increased inflammation during adulthood. However, human studies can only establish correlation, not causation, and existing experimental animal approaches alter multiple components of early-life adversity simultaneously. We developed a novel hand-rearing paradigm in European starling nestlings (Sturnus vulgaris), in which we separately manipulated nutritional shortfall and begging effort for a period of 10 days. The experimental treatments accelerated erythrocyte telomere attrition and increased DNA damage measured in the juvenile period. For telomere attrition, amount of food and begging effort exerted additive effects. Only the combination of low food amount and high begging effort increased DNA damage. We then measured two markers of inflammation, high-sensitivity C-reactive protein and interleukin-6, when the birds were adults. The experimental treatments affected both inflammatory markers, though the patterns were complex and different for each marker. The effect of the experimental treatments on adult interleukin-6 was partially mediated by increased juvenile DNA damage. Our results show that both nutritional input and begging effort in the nestling period affect cellular ageing and adult inflammation in the starling. However, the pattern of effects is different for different biomarkers measured at different time points

Promoting war trauma may not be a good idea

Policymakers and practitioners should beware of inadequacies in the World Health Organisation’s recent assessment of mental health in conflict settings. While raising the profile of these issues, by universalising mental disorder classifications across cultures a simplified understanding might harm the roll-out of effective therapies, leading to the question: what would increased and scaled-up interventions actually achieve? Based on a paper in Anthropology Today, this is the first in a two-part series on the anthropology behind ‘trauma’ in war-affected and post-conflict settings

Psychological predictors of health anxiety and pain in ambulatory presentations in a hospital emergency department

Abstract Background: Health anxiety in attendees of out-patient medical clinics is well established; however, there has been a lack of research into health anxiety within emergency settings. Aims: This study explored the prevalence of health anxiety in ambulatory presentations in a tertiary emergency department (ED) as well as the factors associated with pain and health anxiety in this setting. Method: A cross-sectional questionnaire design was used to gather data from adult ED ambulatory attendees across a 4-day sampling period to assess psychological and physical health variables. Number of attendances to ED over the previous 12 months was accessed through healthcare records. Results: Of the final sample (n = 106), 77%were white British, 54%were male, and 14%presented with severe health anxiety as measured by the Short Health Anxiety Inventory (≥18). Participants with pre-existing health conditions had significantly higher levels of health anxiety (M = 12.36, SE = 1.59) compared with those without (M = 7.79, SE = 0.66). Stepwise multiple regression analyses identified anxiety sensitivity and pain catastrophizing as significant independent predictors of health anxiety, explaining 51%of the variance in health anxiety. Pain catastrophizing was also a significant independent predictor of pain level, accounting for 20%of the variance. Conclusion: This study provides insight into the prevalence of health anxiety in ED ambulatory presentations and key psychological predictors of health anxiety and pain. This has implications for treatment in an ED setting whereby patients may benefit from referral to medical psychology or mental health services.</p

Placebos Affect Retrospective and Prospective Memory Performance by Increasing Monitoring

Decreasing physical pain, increasing emotional wellbeing, and improving physical health are just some of the ways placebos have affected people's physiological and psychological health (Crum & Langer, 2007; Kirsch & Sapirstein, 1999; Montgomery & Kirsch, 1997). Recently, Clifasefi, Garry, Harper, Sharman, and Sutherland (2007) demonstrated that a memory placebo called R273 could even reduce people's susceptibility to misleading information. Yet how could a substance with no physiologically active properties affect memory performance? That is the overarching question of this thesis. In order to monitor the sources of information about the past, and in order to remember future tasks and actions, people can either use an effortful monitoring process, or they can rely on their usual, automatic and effortless memory processes. Typically, the more monitoring that people use, the better their memory performance (Johnson, Hashtroudi, & Lindsay, 1993; Einstein et al., 2005). In this thesis, over three experiments, I examined how a placebo might affect the way people monitor information, thus improving aspects of retrospective and prospective memory. Experiment 1 examined whether R273 reduces people's susceptibility to the misinformation effect by leading them to switch from their habitual, automatic, and easy source monitoring to more deliberate and effortful source monitoring. To examine this question I used Clifasefi et al.'s (2007) sham drug procedure and then ran subjects through a three-stage misinformation experiment (Loftus, Miller, & Burns, 1978). The results of Experiments 1 suggest that R273 did not affect effortful monitoring during the post event information (PEI), but did affect effortful monitoring during the memory test. Experiment 2 aimed to find further evidence that R273 affects people's monitoring during the memory test. To address this question, all subjects were told that they had received an inactive drug before they took part in the first two stages of the misinformation effect paradigm. Immediately before taking the memory test, however, I falsely told some people that they had actually received R273. The primary finding of Experiment 2 added support to the idea that R273 affects subjects source monitoring during the memory test: Told Drug subjects were less misled than their Told Inactive counterparts. Finally, Experiment 3 further examined whether R273 leads people to use effortful monitoring, but did so using a prospective memory task, whose underlying memory processes align closely with those of source monitoring. The results showed that Told Drug subjects were slower to perform an ongoing and concurrent task, yet had better prospective memory performance than Told Inactive subjects. These results suggested that R273 lead Told Drug subjects' to use more effortful monitoring. In conclusion, the results suggest that the sham cognitive enhancing placebo R273 improves people's ability to resist misleading suggestion, and perform prospective memory tasks because it leads them to use more effortful monitoring

Physical health interventions on adolescent mental health inpatient units : a systematic review and call to action

Aim: Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30‐year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high‐quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. Method: An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer‐reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. Results: Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym‐based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. Conclusions: Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities