Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome.

Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question 'what works in water, sanitation, hygiene (WASH)?' remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a primary outcome; however, WASH trials mostly use reported diarrhoea. While diarrhoea is a significant source of morbidity, it is subjected to significant misclassification error with respect to enteric infection due to the existence of non-infectious diarrhoea and asymptomatic infection. We show how this may lead to bias of estimated effects of interventions from WASH trials towards no effect. The problem is further compounded by other biases in the measurement process. Alongside testing for infection of the gut, an examination of the causal assumptions underlying WASH interventions present several other reliable alternative and complementary measurements and outcomes. Contemporary guidance on the evaluation of complex interventions requires researchers to take a broad view of the causal effects of an intervention across a system. Reported diarrhoea can fail to even be a reliable measure of changes to gastrointestinal health and so should not be used as a primary outcome if we are to progress our knowledge of what works in WASH.

Loss of alpha3beta1 integrin function results in an altered differentiation program in the mouse submandibular gland.

Mammalian submandibular gland (SMG) development leads to the establishment of highly organized secretory acinar and nonsecretory ductal epithelial cells. The ability of maturing salivary epithelial cells to attain their differentiated state has been shown to depend, in part, on interactions between extracellular matrix (ECM) proteins and their integrin receptors. In a search for key regulators of salivary cell lineage, we have studied alpha3beta1 integrin, a receptor for the basement membrane protein laminin, by characterizing embryonic day 18 (E18) SMGs isolated from mice carrying a targeted mutation in the alpha3 integrin gene. Transmission electron microscopy studies showed that the mutant SMGs exhibited an aberrant differentiation phenotype with defects in the apical-basal polarity axis and in the basement membrane. Based on immunohistochemistry and Western blot analyses, the alpha3beta1-deficient SMGs had altered expression and/or localization of several ECM and adhesive molecules, including laminin beta1, fibronectin, alpha5 integrin, and E-cadherin. These changes correlated with alterations in the activation state of Ras-extracellular signal-regulated kinase (ERK), as well as the expression and/or localization of Cdc42 and RhoA, two Rho GTPases that regulate the organization of the actin cytoskeleton. We conclude that alpha3beta1 is required for normal salivary cell differentiation and that its absence affects multiple components of adhesive complexes and their associated signalling pathways.

Level of aspiration and performance of chronic psychiatric patients on a simple motor task.

The level of aspiration and performance was examined for 25 male psychiatric inpatients whose mean age was 57.4 yr. and mean length of hospitalization was 23.6 yr. For a simple motor task involving flipping a plastic chip over a goal line, each patient expressed the ward and his personal pretask levels of aspiration, performed the task, and expressed his personal posttask aspiration. The expressions of both the ward and pretask levels of aspiration were less than the mean score of a nonhospitalized referent group. Both performance and posttask levels of aspiration were greater than the pretask level. More patients predicted they would perform worse than the other patients on the ward than predicted they would perform better. The patients appropriately shifted their levels of aspiration either up after success or down after failure. The results were discussed according to expectations from classical theory as well as findings with schizophrenics. Implications for further research were discussed.

Hepatitis B: an occupational hazard for health care personnel.

Hepatitis B infection historically has constituted a serious occupational hazard for susceptible health care personnel. The Occupational Safety and Health Act requires employers, including health care provides, to take all feasible measures necessary to eliminate substantial and recognized occupational hazards. With respect to hepatitis B, such measures might include not only traditional hygienic, identification, sterilization, and post-exposure procedures, but also use of the hepatitis B viral vaccine to immunize at-risk personnel. Because this vaccine is highly efficacious, relatively safe, and cost-effective, its use for health care workers significantly at risk of exposure to the hepatitis B virus might well be required by this federal statute.

The Trail Making Test and Canter Background Interference Procedure in screening for organicity in chronic schizophrenia: a preliminary report.

For 10 male organic chronic schizophrenics scores on the Trail Making Test and Canter Background Interference Procedure were compared. These patients had severe hyponatremia, a condition that results in brain damage. The hit rate for correctly classifying the oranicity was 100% on the basis of sequence binding on Trial Making B and 50% on Canter's procedure. The findings suggested that the Trial Making Test may prove useful in discriminating organic from nonorganic schizophrenics. Implications for research were discussed.

A-B status and sex stereotyping among psychotherapists and patients. Toward a model for maximizing therapeutic potential.

Previous studies indicate that mental health professionals, when evaluating the mental health of males and females, sex role stereotype to the disparagement of females. Some feminists have further assumed that male therapists in particular discourage self-actualization of females, and have argued that female patients should be seen by female therapists only. This study examined the major hypothesis that among both male and female therapists and among both male and female patients, there may be identifiable kinds of therapists and patients who sex role stereotype more than others. A total of 240 subjects (male and female) were recruited from three populations: professional psychotherapists, medical and nursing students, and psychiatric patients. Each subject was administered an A-B therapist scale and a sex role stereotyping questionnaire. Analysis of variance of this 3 x 2 x 3 factorial study revealed: a) patient groups stereotyped significantly more than professional therapist groups (p less than .01), with student groups stereotyping intermediately; b) within each major group, male subjects stereotyped significantly more than their female counterparts (p less than .01); and c) within each male group and within each female group, A status subjects stereotyped significantly more than B status subjects (p less than .01), with AB status subjects stereotyping intermediately. Previous research has indicated that A status psychotherapists are more effective in treating schizophrenic disorders, while B status therapists are more effective in treating neurotic disorders. Since our results reveal a strong relationship between A-B status and degree of stereotyping, our discussion explores the possibility of differentially matching psychotherapists and patients in order to maximize therapeutic potential. Matching could be done according to complementary differences between psychotherapist and patient (in terms of A-B status and sex role stereotyping) or according to similarities between psychotherapist and patient, depending on whether reconstructive or supportive therapy is the objective. Sex of patient and therapist as well as diagnosis of the patient are other variables considered in the model for maximizing the therapeutic potential.

Sex cues in estimating and performing a simple motor task.

The present study examined direct behavioral effects of sex cues in a modified level of aspiration experiment for 60 male and 60 female undergraduates. Each S was provided a constant referent score (25), identified as the average score, average score for men, or average score for women. E's sex was controlled and its effects examined. Male Ss estimated and performed significantly higher than female Ss. All Ss provided the average score for the men estimated and performed lower than Ss provided the average score for women. Effect of E's sex was nonsignificant. Results were discussed in terms of behavioral effects of sex-role stereotypes and the implications of such effects for future research.