Some lessons learned from engaging in WaSH participatory action research in Melanesian informal settlements

In Melanesian countries there has been a large flux of people from rural to urban and peri-urban areas, resulting an in increased number living in informal settlements. These settlements often lack connections to mains water and sewerage lines and formal solid waste collection. Our project used a participatory action research (PAR) approach to work in partnership with informal settlement communities and enabling actors to achieve the self-determined WaSH conditions which participants felt would improve the well-being of those living in informal settlements. Because the PAR approach encourages reflection and adaptation, we learned lessons that were incorporated into the design of ongoing and future processes, and this paper presents five such lessons which we judge to be of practical use for WaSH enabling actors

Caspase-8 association with the focal adhesion complex promotes tumor cell migration and metastasis

Caspase-8 is a proapoptotic protease that suppresses neuroblastoma metastasis by inducing programmed cell death. Paradoxically, caspase-8 can also promote cell migration among nonapoptotic cells; here, we show that caspase-8 can promote metastasis when apoptosis is compromised. Migration is enhanced by caspase-8 recruitment to the cellular migration machinery following integrin ligation. Caspase-8 catalytic activity is not required for caspase-8-enhanced cell migration; rather, caspase-8 interacts with a multiprotein complex that can include focal adhesion kinase and calpain 2 (CPN2), enhancing cleavage of focal adhesion substrates and cell migration. Caspase-8 association with CPN2/calpastatin disrupts calpastatin-mediated inhibition of CPN2. In vivo, knockdown of either caspase-8 or CPN2 disrupts metastasis among apoptosis-resistant tumors. This unexpected molecular collaboration provides an explanation for the continued or elevated expression of caspase-8 observed in many tumors

Generating EQ-5D-3L health utility scores from the Edinburgh Postnatal Depression Scale: a perinatal mapping study

Background: Perinatal depression (PND) describes depression experienced by parents during pregnancy or in the first year after a baby is born. The EQ-5D instrument (a generic measure of health status) is not often collected in perinatal research, however disease-specific measures, such as the Edinburgh Postnatal Depression Scale (EPDS) are widely used. Mapping can be used to estimate generic health utility index values from disease-specific measures like the EPDS. Objective: To develop a mapping algorithm to estimate EQ-5D utility index values from the EPDS. Methods: Patient-level data from the BaBY PaNDA study (English observational cohort study) provided 1068 observations with paired EPDS and EQ-5D (3-level version; EQ-5D-3L) responses. We compared the performance of six alternative regression model types, each with four specifications of covariates (EPDS score and age: base, squared, and cubed). Model performance (ability to predict utility values) was assessed by ranking mean error, mean absolute error, and root mean square error. Algorithm performance in 3 external datasets was also evaluated. Results: There was moderate correlation between EPDS score and utility values (coefficient: – 0.42). The best performing model type was a two-part model, followed by ordinary least squared. Inclusion of squared and cubed covariates improved model performance. Based on graphs of observed and predicted utility values, the algorithm performed better when utility was above 0.6. Conclusions: This direct mapping algorithm allows the estimation of health utility values from EPDS scores. The algorithm has good external validity but is likely to perform better in samples with higher health status

Modelling the long-term carbon cycle, atmospheric CO2, and Earth surface temperature from late Neoproterozoic to present day

Over geological timescales, CO2 levels are determined by the operation of the long term carbon cycle, and it is generally thought that changes in atmospheric CO2 concentration have controlled variations in Earth's surface temperature over the Phanerozoic Eon. Here we compile independent estimates for global average surface temperature and atmospheric CO2 concentration, and compare these to the predictions of box models of the long term carbon cycle COPSE and GEOCARBSULF. We find a strong relationship between CO2 forcing and temperature from the proxy data, for times where data is available, and we find that current published models reproduce many aspects of CO2 change, but compare poorly to temperature estimates. Models are then modified in line with recent advances in understanding the tectonic controls on carbon cycle source and sink processes, with these changes constrained by modelling 87Sr/86Sr ratios. We estimate CO2 degassing rates from the lengths of subduction zones and rifts, add differential effects of erosion rates on the weathering of silicates and carbonates, and revise the relationship between global average temperature changes and the temperature change in key weathering zones. Under these modifications, models produce combined records of CO2 and temperature change that are reasonably in line with geological and geochemical proxies (e.g. central model predictions are within the proxy windows for >~75% of the time covered by data). However, whilst broad long-term changes are reconstructed, the models still do not adequately predict the timing of glacial periods. We show that the 87Sr/86Sr record is largely influenced by the weathering contributions of different lithologies, and is strongly controlled by erosion rates, rather than being a good indicator of overall silicate chemical weathering rates. We also confirm that a combination of increasing erosion rates and decreasing degassing rates over the Neogene can cause the observed cooling and Sr isotope changes without requiring an overall increase in silicate weathering rates. On the question of a source or sink dominated carbon cycle, we find that neither alone can adequately reconstruct the combination of CO2, temperature and strontium isotope dynamics over Phanerozoic time, necessitating a combination of changes to sources and sinks. Further progress in this field relies on >108 year dynamic spatial reconstructions of ancient tectonics, paleogeography and hydrology. Whilst this is a significant challenge, the latest reconstruction techniques, proxy records and modelling advances make this an achievable target

Chondrosarcoma presenting as dyspnea in a 19-year-old man: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acute pulmonary embolism has varied presentations ranging from asymptomatic, incidentally discovered emboli to massive embolism, causing immediate death. Tumor embolism is a rare but unique complication of malignancies. This uncommon catastrophe of a malignant tumor in a young patient, culminating as a pulmonary embolism, is being reported for the first time.</p> <p>Case presentation</p> <p>A 19-year-old Asian man presented to the emergency service at our hospital with acute onset dyspnea. His clinical examination led to the suspicion of an acute pulmonary embolism with a lower lumbosacral radiculopathy. A magnetic resonance imaging scan of the pelvis demonstrated a chondrosarcoma arising from the right iliac wing, eroding into the common iliac vein and creeping up the inferior vena cava to lodge in the pulmonary artery, thus producing a saddle embolus.</p> <p>Conclusion</p> <p>The importance of exploring for malignancies in the event of an idiopathic pulmonary embolism is highlighted. Early detection of such malignancies can substantially affect the outcome in young patients.</p

Achieving Development Outcomes by Building Practical Authority in WASH Participatory Collectives in Melanesia

The strength of the ‘enabling environment’ for development is often considered to be one of the key elements in whether development initiatives fail or succeed. Attempts to strengthen the enabling environment have resulted in a series of checklists and frameworks that imagine it largely to be fixed, static, and separated from ‘beneficiaries’. In the Water, Sanitation, and Hygiene (WASH) sector, there is a preoccupation with fostering an optimal enabling environment that will result naturally in ‘ideal’ and formalised user participation, which will in turn lead to universal access to water and sanitation. In this paper, we challenge this simplistic and linear view of an enabling environment that is perpetuated by checklists and frameworks. We conducted a three-and-a-half-year transdisciplinary participatory action research (PAR) project which sought to foster WASH solutions in impoverished informal settlements in Fiji, Solomon Islands and Vanuatu. In a critical reflection on this project, we analyse the ways in which we both perpetuated problematic checklists and worked collaboratively with our participants to reimagine the enabling environment. We show how individuals challenged the expert-beneficiary dichotomy as they built ‘practical authority’ from their peers through taking action. Our study demonstrates that conceptualising the enabling environment as a dynamic ecology of actors, relationships and processes that includes the users of WASH as active participants was essential to supporting progress towards universal WASH access. We argue that working within the politics of development rather than seeking to render problems as technical was crucial to fostering WASH improvements that were determined by residents themselves and supported by stakeholders. Such an inclusive approach is essential to fully leveraging the co-productive possibilities of participation. If development practitioners and scholars are to achieve development outcomes in an equitable and participatory manner, they must shift their conceptualisation of the enabling environment as being a checklist of things ‘out there’ to one where they work to find their place within an ecology of participatory collectives

Evaluating The National Land Cover Database Tree Canopy and Impervious Cover Estimates Across the Conterminous United States: A Comparison with Photo-Interpreted Estimates

The 2001 National Land Cover Database (NLCD) provides 30-m resolution estimates of percentage tree canopy and percentage impervious cover for the conterminous United States. Previous estimates that compared NLCD tree canopy and impervious cover estimates with photo-interpreted cover estimates within selected counties and places revealed that NLCD underestimates tree and impervious cover. Based on these previous results, a wall-to-wall comprehensive national analysis was conducted to determine if and how NLCD derived estimates of tree and impervious cover varies from photo-interpreted values across the conterminous United States. Results of this analysis reveal that NLCD significantly underestimates tree cover in 64 of the 65 zones used to create the NCLD cover maps, with a national average underestimation of 9.7% (standard error (SE) = 1.0%) and a maximum underestimation of 28.4% in mapping zone 3. Impervious cover was also underestimated in 44 zones with an average underestimation of 1.4% (SE = 0.4%) and a maximum underestimation of 5.7% in mapping zone 56. Understanding the degree of underestimation by mapping zone can lead to better estimates of tree and impervious cover and a better understanding of the potential limitations associated with NLCD cover estimates

Addressing WaSH challenges in Pacific Island Countries: A participatory marketing systems mapping approach to empower informal settlement community action

Addressing complex and challenging issues entails access to credible systems information in the form of systems maps or diagrams. The purpose of our paper is to describe a participatory action research (PAR) systems mapping activity that was undertaken by an urban informal settlement community in a small Pacific Island Country. A total of 19 households participated in a systems mapping activity to map a household-level water or sanitation system. The individual household systems maps and related data were then used to construct a de-identified aggregated water, sanitation and hygiene (WaSH) marketing systems map (and accompanying narratives) for the informal settlement. We present the marketing systems map, which delineated a series of marketing exchanges, and report on how the map assisted the community to address a number of expressed needs. We conclude by suggesting that systems mapping is a valuable activity that communities could undertake to generate credible systems information to inform and empower collective planning and actions

Assessing newborn body composition using principal components analysis: differences in the determinants of fat and skeletal size

BACKGROUND: Birth weight is a composite of skeletal size and soft tissue. These components are likely to have different growth patterns. The aim of this paper is to investigate the association between established determinants of birth weight and these separate components. METHODS: Weight, length, crown-rump, knee-heel, head circumference, arm circumference, and skinfold thicknesses were measured at birth in 699 healthy, term, UK babies recruited as part of the Exeter Family Study of Childhood Health. Corresponding measurements were taken on both parents. Principal components analysis with varimax rotation was used to reduce these measurements to two independent components each for mother, father and baby: one highly correlated with measures of fat, the other with skeletal size. RESULTS: Gestational age was significantly related to skeletal size, in both boys and girls (r = 0.41 and 0.52), but not fat. Skeletal size at birth was also associated with parental skeletal size (maternal: r = 0.24 (boys), r = 0.39 (girls) ; paternal: r = 0.16 (boys), r = 0.25 (girls)), and maternal smoking (0.4 SD reduction in boys, 0.6 SD reduction in girls). Fat was associated with parity (first borns smaller by 0.45 SD in boys; 0.31 SD in girls), maternal glucose (r = 0.18 (boys); r = 0.27 (girls)) and maternal fat (r = 0.16 (boys); r = 0.36 (girls)). CONCLUSION: Principal components analysis with varimax rotation provides a useful method for reducing birth weight to two more meaningful components: skeletal size and fat. These components have different associations with known determinants of birth weight, suggesting fat and skeletal size may have different regulatory mechanisms, which would be important to consider when studying the associations of birth weight with later adult disease