Strengthening pro-poor targeting of investments by African utilities in urban water and sanitation - the role of the International Development Association of the World Bank: Case studies from Ghana, Burkina Faso and Tanzania

This report for WaterAid presents findings from research into the impact of selected IDA-funded projects on water supply and sanitation services in urban areas of sub-Saharan Africa, with particular emphasis on the impact on poor areas and households

Voices from the Source: Struggles with Local Water Security in Ethiopia

This report explores local water security in two different sites in Ethiopia, Shinile and Konso. This issue cannot be reduced to a single diagnostic such as measures of water use or presence of an improved source. The pressures of water security on livelihoods and household-level responses are discussed and local and national government responses are examined

Linking action at different levels through innovation platforms

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Accidental injury, risk-taking behaviour and the social circumstances in which young people (aged 12-24) live: a systematic review

In industrialised countries such as England and Wales, unintended injury (which ranges from sprains in sport to hospitalisation and death due to drugs or transport crashes) is the leading cause of death in children aged 0 to 14 years, and a major cause of death in young adults aged 15 to 24. It is also a major cause of ill health and disability in these age groups. There is a large body of research on young people and their perceived propensity to take risks. Common sense suggests that an increased willingness to place oneself at risk will result an increased likelihood of physical injury. However, given that pathways to injury are complex and not always well understood, the UK Department of Health commissioned a large systematic review to examine this multifaceted issue. Drug use • The review found that the use of drugs is associated with an increased risk of accidental death among young people and that 12–24 year olds are less at risk than those immediately older. However, risk of death increases with length of drug use, so there is value in targeting interventions at this age group. • Many more young men than women die from drug overdoses, because more men take drugs, but those women who do use drugs are at higher risk. Certain other groups of young people are more at risk than others. These include young people in deprived areas and men who have recently been released from prison. • There was a clear disjunction of views between young people who used drugs and those who did not. The young people who did not take drugs regarded them as risky and stated that media images about possible negative consequences dissuaded them from trying them, while those who did tended not to believe ‘official’ messages about possible harms and did not perceive taking drugs as being dangerous. Cannabis in particular was singled out as possibly being good for you, with some young people believing it to be cheaper than alcohol. The recent reclassification of cannabis and the subsequent debate may have helped to reinforce this view. • The burden of the more serious injuries – as demonstrated by the mortality statistics – is carried by young people in the lower socio-economic groups. • In road injuries, drugs are found in the bloodstream of more young fatal accident victims than older age groups; however, it is difficult to assess whether drugs actually contributed to the accident. • Driving on cannabis was thought to be more acceptable than drink-driving and not thought to be dangerous. Alcohol use • Almost everyone admitted to hospital for alcohol poisoning is aged between 11 and 17. After a sharp peak among 14 and 15 year olds, hospital admissions for injuries with alcohol involvement decline slowly between the ages of 16 and 30. • Correlational studies have shown that alcohol puts the drinker at an increased risk of injury, that young people are more likely to have injuries than older people, and that young men are more at risk than young women. In the one study that examined ethnicity, minority ethnic status did not increase alcohol-related injuries, and may in fact have had a protective association. • Views studies found that young people say that they do not commonly mix alcohol and other drugs. Most young people reported that drinking places them at greater risk of injury, though some did not. The younger teenagers – 14 and 15 year olds – felt most in danger of injury when drinking. Young people felt that they learned to manage their drinking through experience and that unsupervised, outdoor drinking was the most dangerous and was more common among younger teenagers (with injuries being considered less common in licensed venues). Peers encourage both drinking and drunken pranks, but also protect one another when they have become more vulnerable as a result of drink. Young people felt that drinking reduces their perceptions of danger and some stated that injury as a result was inevitable. Most young people were cautious about getting very drunk, though being sick as a result of drinking is common and not regarded as serious. Bad experiences – whether to self or someone else – might change behaviour in the short- but not long-term. • One study which examined attempts to reduce alcohol-related injuries found some evidence that motivational interviews in A&E departments are more effective than information handouts. Drink-driving • Drink-driving was generally considered dangerous and not socially acceptable, whereas driving on cannabis was more acceptable and not thought to be dangerous. Some young people stated that a lack of public transport (or alternatives, such as taxis) made it more likely that they would drink and drive. • Interventions based on models of behaviour change to reduce drink-driving are ineffective or have a negative effect. Combining different approaches has more effect than using a single approach. Education or skills training has either negative or no effects on driver behaviour and subsequent accidents, possibly because these approaches lead to over-confidence or early licensing. • Legislation and enforcement on reducing drink-driving has been found to be effective

Power dynamics and representation in innovation platforms

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Innovation Platforms to Enhance Participation in Rainwater Management: Lessons from The Nile Basin Development Challenge with a Particular Focus on Political Economy and Equity Issues

This paper draws lessons from two years of work with ‘innovation platforms’ that were established by the Nile Basin Development Challenge (NBDC) program in an attempt to strengthen landscape-level rainwater management in Ethiopia. The NDBC’s work included the use of an innovation fund to support pilot interventions. This paper particularly reviews questions of political economy and equity in platform activities and examines decision-making processes, the roles and level of influence of different platform members, the nature of platform-community relations and the extent to which different groups are benefiting. The information presented in this working paper was gathered from a mixture of sources: interviews conducted with platform members; observation of meetings and activities by NBDC staff; official minutes of platform meetings and other associated events (e.g., training sessions) and informal discussions between NBDC staff and platform members

Impact of innovation platforms

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Recognition and management of agitation in acute mental health services: A qualitative evaluation of staff perceptions

© 2020, The Author(s). Background: Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. Methods: This study used a descriptive qualitative methodology. Semi-structured focus group interviews were conducted with 20 nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. Results: Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care. Conclusion: The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework

A thrombospondin in the anthozoan Nematostella vectensis is associated with the nervous system and upregulated during regeneration

Thrombospondins are multimeric extracellular matrix glycoproteins that play important roles in development, synaptogenesis and wound healing in mammals. We previously identified four putative thrombospondins in the genome of the starlet sea anemone Nematostella vectensis. This study presents the first analysis of these thrombospondins, with the goals of understanding fundamental roles of thrombospondins in the Eumetazoa. Reverse transcriptase PCR showed that each of the N. vectensis thrombospondins (Nv85341, Nv22035, Nv168100 and Nv30790) is transcribed. Three of the four thrombospondins include an RGD or KGD motif in their thrombospondin type 3 repeats at sites equivalent to mammalian thrombospondins, suggesting ancient roles as RGD integrin ligands. Phylogenetic analysis based on the C-terminal regions demonstrated a high level of sequence diversity between N. vectensis thrombospondins. A full-length cDNA sequence was obtained for Nv168100 (NvTSP168100), which has an unusual domain organization. Immunohistochemistry with an antibody to NvTSP168100 revealed labeling of neuron-like cells in the mesoglea of the retractor muscles and the pharynx. In situ hybridization and quantitative PCR showed that NvTSP168100 is upregulated during regeneration. Immunohistochemistry of the area of regeneration identified strong immunostaining of the glycocalyx, the carbohydrate-rich matrix coating the epidermis, and electron microscopy identified changes in glycocalyx organization during regeneration. Thus, N. vectensis thrombospondins share structural features with thrombospondins from mammals and may have roles in the nervous system and in matrix reorganization during regeneration