Social learning through participatory integrated catchment risk assessment in the Solomon Islands

In developed countries a social learning approach has been shown to support Integrated Water Resources Management (IWRM) by fostering stakeholders' understanding of system complexity, recognition of mutual dependence, appreciation of others' perspectives, and development of the capacity to work together and to create mutual trust. Much less is known about social learning's potential in less developed small island states, particularly postconflict island states, where integration must navigate prescriptive management, limited resources, widely differing world views, a history of adversarial relationships, and unsuccessful attempts at government-community collaboration. This paper analyzes the transformative aspects of a social learning experience that occurred during research facilitating participatory integrated catchment management in the Pacific. The study elicited community and expert knowledge to create systems understanding to generate and analyze complex scenarios for integrated catchment risk assessment in the Kongulai catchment, Solomon Islands. Separate sequenced and then combined discussions led to facilitated exploration of others' subjective assessment of catchment risks and management options. Issues of transparency, trust, accountability, and mutual responsibility were explored in carefully created discursive spaces, assisted by the immediacy of personal contact and the absence of complex bureaucratic structures. Despite historical difficulties, through the use of bridging individuals, participants were generally able to transcend the constraints of their individual knowledge cultures, expand awareness and appreciation of the complexity of human-environment systems for IWRM, and envisage new opportunities for productively working together in integrated catchment management

Capacity building in Cambodia's rural local governments for the sanitation market

Approximately 72% of Cambodians practice open defecation. The government has implemented strategies and policies to improve access to sanitation and decentralized roles and responsibilities to the local rural district and commune governments so that it can be more effective in supporting rural sanitation marketing (SanMark). Semi-structured informal interviews with local stakeholders were analysed to understand the role of rural local governments (LGs) in SanMark and what capacities they possess – and need. The different roles perceived for LGs to fill include monitoring, regulation, and demand creation, however are not specific as to the details of how these roles can be implemented. The research found that capacity of LGs is very weak and needs to accommodate older personnel with lower levels of education. The capacities identified to support roles given to LGs are often general and unclear, such as “coordination” and “monitoring”, though the key basic capacities in need are effective communication

Beyond the air-conditioned boardroom: Bridging western and Fijian Indigenous knowledge in tourism research

The COVID-19 outbreak and increasing natural disasters have intensified concerns about effective water, sanitation and hygiene (WASH) practices in Fiji’s tourism sector. Whilst Indigenous values and customs are recognised in tourism development, socially inclusive WASH research in the sector has inadequately addressed Indigenous cultural nuances, especially in Pacific communities. Drawing from the Fijian Vanua Research Framework (FVRF), a Pacific research methodology that incorporates Fijian values, relationship protocols, and ways of knowing, this research designed a culturally-sensitive and socially-inclusive methodology to respect traditional Fijian protocols, and examine hotel staff and host communities’ WASH practices. The research identified differential access to, and gaps in, the provision of WASH, and provided guidelines for future change. This paper presents the challenges of, and the lessons learnt from, the application of the methodology to field research. The methodology provided invaluable intellectual detail, resulting in the development of contextually appropriate recommendations and tools, and strengthening long-term working relationships

Using Q method to investigate the influence of inclusive water, sanitation and hygiene (WASH) on tourists’ hotel choice in Fiji

Consequent to the COVID-19 pandemic and the reopening of international borders, tourists are increasingly concerned about sanitation and hygiene practices in tourism destinations. There is an evident need to investigate how the COVID-19 pandemic has transformed tourist choices. This paper investigates the perceptions of hotel staff and tourists on the influence of inclusive water, sanitation, and hygiene (WASH) practices on tourists’ hotel choices in Fiji. This study explores the value of Q-methodology through a case study of Fiji with data collected from 80 hotel staff and 75 tourists. The findings demonstrate that Q-methodology is effective in identifying three tourist types who have a strong interest in WASH impacts and aspects of their safety including concerns about how their visit impacts the local community and environment. Similarly, the Q method was useful in identifying four perspectives of staff understanding on WASH impacts that are significant to tourists’ choice of hotel. The findings suggest a significant potential for hotel operators to enact socially inclusive WASH practices to enhance their appeal in the ‘new normal'

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Mental health nursing education in undergraduate and postgraduate programs: Time for change

Unfortunately, despite nurses encountering people diagnosed with mental illness and experiencing significant mental health challenges, increased awareness is not reflected in the mental health component of undergraduate nursing programs. Since the introduction of comprehensive nursing education, mental health nursing has been severely under-represented in undergraduate programs in most Australian universities. The future of mental health service delivery, quality of care, and patient outcomes depends in no small part on these decisions

Putting WASH in the water cycle: climate change, water resources and the future of water, sanitation and hygiene challenges in Pacific Island Countries

Pacific Island Countries (PICs) lag behind global trends in water, sanitation and hygiene (WaSH) development. We conducted a systematic search of all English language papers (published before February 2015) about WaSH in PICs to evaluate the state of the peer-reviewed literature and explore thematic findings. A total of 121 papers met the criteria for full-text review following an initial search result of more than 6,000 papers. Two reviewers independently assessed the quality and relevance of each article and consolidated their findings according to four emergent themes: public health, environment, emergency response and interventions, and management and governance. Findings indicate a knowledge gap in evidence-guided WaSH management strategies that advocate for human health while concurrently protecting and preserving drinking water resources. Extreme weather events threaten the quantity and quality of limited freshwater resources, and cultural factors that are unique to PICs present challenges to hygiene and sanitation. This review highlights the strengths and weaknesses of the peer-reviewed literature on WaSH in PICs, addresses spatial and temporal publication trends, and suggests areas in need of further research to help PICs meet development goals