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

Embarrassment as a Key Emotion in Young People Talking About Sexual Health

This paper highlights embarrassment as one of the often-ignored emotions of young people when it comes to discussing issues around sexual health. There have been many sexual health studies on knowledge, attitudes and behaviour of young people over the past two decades, but emotional aspects have been largely ignored, despite a growing literature in the sociology of emotion. A qualitative approach was adopted in the form of focus group discussions, which included questions on sex education, sexual health campaigns and formal and informal sources of sexual health information and advice. Focus groups were conducted in secondary schools in and around Edinburgh and Aberdeen as part of a four-year evaluation study of a Scottish Demonstration Project on young people's sexual health: 'Healthy Respect'. We conclude that is it important for policy makers and sexual health promoters to understand young people's notions of embarrassment. Not only are there elements of sex education that (some) young people perceive as embarrassing, they also sense embarrassment in those people providing them with sex education. Young people reported that both professionals (e.g. teachers and doctors) and their parents could be embarrassed about raising the topic of sexual health. Moreover, as one of the goals of sex education is to ensure an open and non-embarrassing attitude towards sex and sexuality, there is still a major gap between the aspirations of health educators and policy makers and the ways that young people experience such education.Sexual Health Services, Adolescence, School, Scotland, Emotion, Qualitative Research, Sex Education, Parents, Focus Groups, Relationships

Peer-led dementia courses as part of post-diagnostic support:A realist evaluation of the Good Life with Dementia course

Background: Dementia diagnosis is a major life event. What happens next can mean the difference between feeling ‘sent away’ and ‘opening the door’ to a future with possibilities and purpose (Kelly and Innes, 2016). Yet studies of support for people newly diagnosed with dementia have repeatedly highlighted gaps in provision and noted that services often fail to meet people’s wholistic needs. The Good Life with Dementia course is an innovative co-produced, peer-tutored course facilitated by an English third sector organisation specialising in dementia empowerment and engagement. This session presents the findings of a realist evaluation of the Good Life with Dementia course as an element of post-diagnostic support. The aim was to test and refine the underlying programme theory to better understand how change may be brought about by this complex intervention, as a first step towards full evaluation. Objectives: To explore the contextual factors and mechanisms at play that may influence outcomes for people with dementia participating in the Good Life with Dementia course. Methods: 1. Observation of two Good Life courses and qualitative interviews (guided by the initial programme theory) with Good Life participants living with dementia, supplemented by group discussions. 2. Focus groups about the transferability of the Good Life model with people with experience of dementia from South Asian communities. Results: Through observations, group discussions and interviews with 22 people with dementia participating on two Good Life courses, we learnt that peer-led courses can create a ‘safe space’ where people with dementia feel able to share experience, gain relevant knowledge and skills, and take on meaningful roles. People with dementia enjoyed the courses, felt ‘seen’ by others, grew in confidence and made social connections. We theorised that this could contribute to both positive reframing and tangible support networks which together could help people to live well with dementia going forwards. However, these outcomes are not guaranteed: they were produced in a context where people with dementia felt safe and seen as people with something valuable to offer. Professional facilitators have a key role in creating this context, as well as organising and sustaining the course. Our focus groups with 67 people from South Asian communities demonstrated the complexity of establishing these ‘safe spaces’ for people with diverse identities who may have differing social expectations and experiences. Cultural and community norms affect how people experience dementia, in both positive and negative ways, and creating a context where people feel ‘safe’ and ‘seen’ needs to account for this. Moreover, focus group members felt that social connection and shared experience goes beyond sharing a specific diagnosis or a specific cultural heritage, and contexts should therefore be culturally adaptive, to embrace a more inclusive, holistic view of people. Conclusions: This study produced a robust programme theory for peer-led dementia courses which will underpin future evaluative research and can also be used by service commissioners and providers looking to replicate the Good Life model in different settings with diverse communities

The improved prognosis of hypoplastic left heart:A Population-Based Register Study of 343 Cases in England and Wales

Background: Hypoplastic Left Heart Syndrome (HLHS) is a severe congenital heart defect (CHD) characterised by the underdevelopment of the left side of the heart with varying levels of hypoplasia of the left atrium, mitral valve, left ventricle, aortic valve and aortic arch. In the UK, age 12 survival for cases born between 1991 and 1993 was 21%. UK survival estimates corresponding to cases born between 2000 and 2015 were improved at 56%, but survival was examined up to age five only. Contemporary long-term survival estimates play a crucial role in counselling parents following diagnosis. The aim of this study was to report survival estimates up to age 15 for children born with HLHS or hypoplastic left ventricle with additional CHD in England and Wales between 1998 and 2012. Methods: Cases of HLHS notified to four congenital anomaly registers in England and Wales during 1998–2012, matched to Office for National Statistics mortality information, were included. Kaplan-Meier survival estimates to age 15 were reported. Cox regression models were fitted to examine risk factors for mortality. Results: There were 244 cases of HLHS and 99 cases of hypoplastic left ventricle co-occurring with other CHD, with traced survival status. Kaplan-Meier survival estimates for HLHS were 84.4% at age 1 week, 76.2% at 1 month, 63.5% at age 1 year, 58.6% at age 5 years, 54.6% at age 10 years, and 32.6% to age 15 years. The Kaplan-Meier survival estimates for cases of hypoplastic left ventricle co-occurring with additional CHD were 90.9% at age 1 week, 84.9% at 1 month, 73.7% at age 1 year, 67.7% to age 5 years, 59.2% to age 10 years, and 40.3% to age 15 years. Preterm birth (p = 0.007), low birth weight (p = 0.005), and female sex (p = 0.01) were associated with mortality. Conclusions: We have shown that prognosis associated with HLHS in the twenty first century exceeds that of many previous population-based studies, likely due to improvements in intensive care technologies and advances in surgical techniques over the last few decades

Metatranscriptomics reveals metabolic adaptation and induction of virulence factors by Haemophilus parasuis during lung infection

Haemophilus parasuis is a common inhabitant of the upper respiratory tract of pigs, and the causative agent of Glässer's disease. This disease is characterized by polyserositis and arthritis, produced by the severe inflammation caused by the systemic spread of the bacterium. After an initial colonization of the upper respiratory tract, H. parasuis enters the lung during the early stages of pig infection. In order to study gene expression at this location, we sequenced the ex vivo and in vivo H. parasuis Nagasaki transcriptome in the lung using a metatranscriptomic approach. Comparison of gene expression under these conditions with that found in conventional plate culture showed generally reduced expression of genes associated with anabolic and catabolic pathways, coupled with up-regulation of membrane-related genes involved in carbon acquisition, iron binding and pathogenesis. Some of the up-regulated membrane genes, including ABC transporters, virulence-associated autotransporters (vtaAs) and several hypothetical proteins, were only present in virulent H. parasuis strains, highlighting their significance as markers of disease potential. Finally, the analysis also revealed the presence of numerous antisense transcripts with possible roles in gene regulation. In summary, this data sheds some light on the scarcely studied in vivo transcriptome of H. parasuis, revealing nutritional virulence as an adaptive strategy for host survival, besides induction of classical virulence factors

Thermo-mechanical, morphological and water absorption properties of thermoplastic starch/cellulose composite foams reinforced with PLA

Expanded polystyrene foams are lightweight and cheap, but they have excellent strength and insulation properties. However, their inability to biodegrade in traditional landfill situations makes their disposal problematic. Starch, a polysaccharide, has the potential to replace synthetic thermoplastics for some applications but starch-based foams are hydrophilic, which limits their applications. In this work, polylactide (PLA), a sustainably derived and industrially compostable polymer, was added to starch/cellulose composite foams to enhance their water barrier properties. PLA powder at various weight % was mixed with moistened starch and cellulose mixture, and composite foams were prepared by compression moulding at 220 °C. The thermomechanical and viscoelastic properties of the produced foam materials were analysed by thermogravimetric analysis, dynamic mechanical thermal analysis, mechanical testing, and also by the 3-point compressive mechanical quasi-static testing. It was found that the tensile strength of the composite foams increased with an increase in the PLA loading, which increased from 2.50 MPa for 0% PLA to 3.27 MPa for 9.72% PLA loading. The flexural strength also increased from 345.91 kPa for the 0% PLA to 378.53 kPa for the composite foam containing 4.86% PLA; beyond which the flexural strength started decreasing with an increase in PLA loading. Similarly, the stiffness of the starch/cellulose composite also increased with an increase in PLA loading up to 4.86%, and further increase in PLA loading decreased the stiffness. The flexural modulus of the composite foams increased from 522 MPa for 0% PLA loading to 542.85 MPa for the 4.86% PLA loading. The thermal stability of the starch/cellulose composite foams also increased and the water absorbency decreased with the increased PLA loading