Global potential for harvesting drinking water from air using solar energy.

Access to safely managed drinking water (SMDW) remains a global challenge, and affects 2.2 billion people1,2. Solar-driven atmospheric water harvesting (AWH) devices with continuous cycling may accelerate progress by enabling decentralized extraction of water from air3-6, but low specific yields (SY) and low daytime relative humidity (RH) have raised questions about their performance (in litres of water output per day)7-11. However, to our knowledge, no analysis has mapped the global potential of AWH12 despite favourable conditions in tropical regions, where two-thirds of people without SMDW live2. Here we show that AWH could provide SMDW for a billion people. Our assessment-using Google Earth Engine13-introduces a hypothetical 1-metre-square device with a SY profile of 0.2 to 2.5 litres per kilowatt-hour (0.1 to 1.25 litres per kilowatt-hour for a 2-metre-square device) at 30% to 90% RH, respectively. Such a device could meet a target average daily drinking water requirement of 5 litres per day per person14. We plot the impact potential of existing devices and new sorbent classes, which suggests that these targets could be met with continued technological development, and well within thermodynamic limits. Indeed, these performance targets have been achieved experimentally in demonstrations of sorbent materials15-17. Our tools can inform design trade-offs for atmospheric water harvesting devices that maximize global impact, alongside ongoing efforts to meet Sustainable Development Goals (SDGs) with existing technologies.

Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes.

BACKGROUND: Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels. METHODS: We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure-response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH. FINDINGS: We estimate that 1·4 (95% CI 1·3-1·5) million deaths and 74 (68-80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65-0·72), 0·14 (0·13-0·17) for acute respiratory infections, and 0·10 (0·09-0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH. INTERPRETATION: WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns. FUNDING: WHO and Foreign, Commonwealth & Development Office.

Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis.

BACKGROUND: Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs). METHODS: In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164. FINDINGS: 19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]). INTERPRETATION: WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG. FUNDING: WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences.

Modelling COVID-19 vaccination status and adherence to public health and social measures, Eastern Mediterranean Region and Algeria.

Objective: To study the link between coronavirus disease 2019 (COVID-19) vaccination status and adherence to public health and social measures in Members of the Eastern Mediterranean Region and Algeria. Methods: We analysed two rounds of a large, cross-country, repeated cross-sectional mobile phone survey in June-July 2021 and October-November 2021. The rounds included 14 287 and 14 131 respondents, respectively, from 23 countries and territories. Questions covered knowledge, attitudes and practices around COVID-19, and demographic, employment, health and vaccination status. We used logit modelling to analyse the link between self-reported vaccination status and individuals' practice of mask wearing, physical distancing and handwashing. We used propensity score matching as a robustness check. Findings: Overall, vaccinated respondents (8766 respondents in round 2) were significantly more likely to adhere to preventive measures than those who were unvaccinated (5297 respondents in round 2). Odds ratios were 1.5 (95% confidence interval, CI: 1.3-1.8) for mask wearing; 1.5 (95% CI: 1.3-1.7) for physical distancing; and 1.2 (95% CI: 1.0-1.4) for handwashing. Similar results were found on analysing subsamples of low- and middle-income countries. However, in high-income countries, where vaccination coverage is high, there was no significant link between vaccination and preventive practices. The association between vaccination status and adherence to public health advice was sustained over time, even though self-reported vaccination coverage tripled over 5 months (19.4% to 62.3%; weighted percentages). Conclusion: Individuals vaccinated against COVID-19 maintained their adherence to preventive health measures. Nevertheless, reinforcement of public health messages is important for the public's continued compliance with preventive measures.

Access to Household Water Quality Information Leads to Safer Water: A Cluster Randomized Controlled Trial in india.

Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by Escherichia coli counts. We randomly assigned 589 participating households to one of three arms: (1) a messaging-only arm receiving messaging on safe water management ( n = 237); (2) a standard testing arm receiving the same messaging plus laboratory E. coli testing results specific to that household's drinking water ( n = 173); and (3) a test kit arm receiving messaging plus low-cost E. coli tests that could be used at the household's discretion ( n = 179). Self-reported water treatment increased significantly in both the standard testing arm and the test kit arm between baseline and follow-up one month later. Mean log10 E. coli counts per 100 mL in household stored drinking water increased in the messaging-only arm from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality.

How Much Will It Cost To Monitor Microbial Drinking Water Quality in Sub-Saharan Africa?

Microbial water quality monitoring is crucial for managing water resources and protecting public health. However, institutional testing activities in sub-Saharan Africa are currently limited. Because the economics of water quality testing are poorly understood, the extent to which cost may be a barrier to monitoring in different settings is unclear. This study used cost data from 18 African monitoring institutions (piped water suppliers and health surveillance agencies in six countries) and estimates of water supply type coverage from 15 countries to assess the annual financial requirements for microbial water testing at both national and regional levels, using World Health Organization recommendations for sampling frequency. We found that a microbial water quality test costs 21.0 ± 11.3 USD, on average, including consumables, equipment, labor, and logistics, which is higher than previously calculated. Our annual cost estimates for microbial monitoring of piped supplies and improved point sources ranged between 8 000 USD for Equatorial Guinea and 1.9 million USD for Ethiopia, depending primarily on the population served but also on the distribution of piped water system sizes. A comparison with current national water and sanitation budgets showed that the cost of implementing prescribed testing levels represents a relatively modest proportion of existing budgets (<2%). At the regional level, we estimated that monitoring the microbial quality of all improved water sources in sub-Saharan Africa would cost 16.0 million USD per year, which is minimal in comparison to the projected annual capital costs of achieving Sustainable Development Goal 6.1 of safe water for all (14.8 billion USD).

Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator "use of an improved source," which does not account for water quality measurements. Our objectives were to determine whether water from "improved" sources is less likely to contain fecal contamination than "unimproved" sources and to assess the extent to which contamination varies by source type and setting. METHODS AND FINDINGS: Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for "improved" sources than "unimproved" sources (odds ratio [OR] = 0.15 [0.10-0.21], I2 = 80.3% [72.9-85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52-3.71]; p<0.001) and rural areas (OR = 2.37 [1.47-3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption. CONCLUSION: Access to an "improved source" provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.

Global assessment of exposure to faecal contamination through drinking water based on a systematic review.

OBJECTIVES: To estimate exposure to faecal contamination through drinking water as indicated by levels of Escherichia coli (E. coli) or thermotolerant coliform (TTC) in water sources. METHODS: We estimated coverage of different types of drinking water source based on household surveys and censuses using multilevel modelling. Coverage data were combined with water quality studies that assessed E. coli or TTC including those identified by a systematic review (n = 345). Predictive models for the presence and level of contamination of drinking water sources were developed using random effects logistic regression and selected covariates. We assessed sensitivity of estimated exposure to study quality, indicator bacteria and separately considered nationally randomised surveys. RESULTS: We estimate that 1.8 billion people globally use a source of drinking water which suffers from faecal contamination, of these 1.1 billion drink water that is of at least 'moderate' risk (>10 E. coli or TTC per 100 ml). Data from nationally randomised studies suggest that 10% of improved sources may be 'high' risk, containing at least 100 E. coli or TTC per 100 ml. Drinking water is found to be more often contaminated in rural areas (41%, CI: 31%-51%) than in urban areas (12%, CI: 8-18%), and contamination is most prevalent in Africa (53%, CI: 42%-63%) and South-East Asia (35%, CI: 24%-45%). Estimates were not sensitive to the exclusion of low quality studies or restriction to studies reporting E. coli. CONCLUSIONS: Microbial contamination is widespread and affects all water source types, including piped supplies. Global burden of disease estimates may have substantially understated the disease burden associated with inadequate water services.

Synthesis and application of resorufin ß-D-glucuronide, a low-cost chromogenic substrate for detecting Escherichia coli in drinking water.

The development of low-cost tests for Escherichia coli is hampered by the expense and limited choice of enzyme substrates. Most chromogenic substrates are required in costly amounts, while fluorogenic substrates require an additional apparatus (e.g., an ultraviolet lamp) to be detected. Herein, we propose an alternative chromogenic substrate, resorufin ß-d-glucuronide (REG), which is exceptionally sensitive and may be employed in very small amounts. We show that REG can be produced similarly to other simple glucuronides and should therefore be no more expensive. The compound is used by both healthy and injured E. coli, resulting in a pronounced color change from orange to a bright pink. Because the released dye (resorufin) has a high extinction coefficient, substantially lower amounts are needed than for commercially available substrates. The potential of this substrate is demonstrated by a presence/absence test requiring just 0.1 mg of REG/100 mL of water sample, one hundredth of the quantity needed for common chromogenic substrates, with an estimated bulk cost of ≤0.1 U.S. cents/test. REG shows promise as a chromogenic substrate for E. coli detection and should be considered in the development of new water tests, especially for low-income settings.

A cross-sectional ecological study of spatial scale and geographic inequality in access to drinking-water and sanitation.

INTRODUCTION: Measuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation. METHODS: Spatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. Four variants of the dissimilarity index were used to estimate geographic inequality in access to both services using large and small area units in each country through a cross-sectional, ecological study. RESULTS: Inequality was greatest for piped water in South Africa in 2001 (based on 53 areas (N) with a median population (MP) of 657,015; D = 0.5599) and lowest for access to an improved water source in Uganda in 2008 (N = 56; MP = 419,399; D = 0.2801). For sanitation, inequality was greatest for those lacking any facility in Kenya in 2009 (N = 158; MP = 216,992; D = 0.6981), and lowest for access to an improved facility in Uganda in 2002 (N = 56; MP = 341,954; D = 0.3403). Although dissimilarity index values were greater for smaller areal units, when study countries were ranked in terms of inequality, these ranks remained unaffected by the choice of large or small areal units. International comparability was limited due to definitional and temporal differences between censuses. CONCLUSIONS: This five-country study suggests that patterns of inequality for broad regional units do often reflect inequality in service access at a more local scale. This implies household surveys designed to estimate province-level service coverage can provide valuable insights into geographic inequality at lower levels. In comparison with household surveys, censuses facilitate inequality assessment at different spatial scales, but pose challenges in harmonising water and sanitation typologies across countries.

Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression.

Exposure to fecally contaminated drinking water contributes to the global disease burden, especially in sub-Saharan Africa (SSA). We used cross-sectional data and elimination regression analysis to examine factors influencing E. coli contamination in household drinking water samples from 4,499 rural households in nine countries in SSA (Malawi, Mozambique, and Zambia in Southern Africa; Ghana, Mali, and Niger in Western Africa; and Kenya, Rwanda, and Tanzania in Eastern Africa). The proportion of household water samples containing E. coli was 71%, ranging from 45% (Malawi) to 89% (Tanzania). Pooled and multi-country predictive logistic regression models showed that using an unimproved-type water source, the absence of a community water committee, and domestic animal ownership were significantly associated with household drinking water contamination. Household water treatment and storage practices, sanitation and hygiene practices, and payment for drinking water were not significantly associated with E. coli contamination in any model. The season was a significant predictor of E. coli in the pooled model; samples collected in the rainy season were 2.3 [2.0, 2.7] times as likely to be contaminated with E. coli. Practitioners and policymakers should prioritize implementing piped on-plot water services, establishing effective local water source management structures, and incorporating animal husbandry practices into water, sanitation, and hygiene interventions.

Insights from a modelling analysis of COVID-19 vaccination in the Eastern Mediterranean Region.

Background: Understanding the main determinants of COVID-19 vaccine uptake is critical to increasing vaccine coverage. This is particularly important for COVID-19 vaccine uptake, which has been affected by both demand and supply issues. Aim: To understand the links between vaccine uptake and demand and supply issues in the WHO Eastern Mediterranean and UNICEF Middle East and North Africa regions. Methods: We collected data through 2 rounds of a repeated cross-sectional phone survey from 11 000 individuals across 16 low- and middle-income countries. We used logit modelling to distil the main characteristics of the 4 vaccination categories (vaccinated, unvaccinated but willing, unvaccinated and undecided, and unvaccinated and unwilling) while also considering vaccine availability. We conducted sub-regional analysis to account for differences in level of development between the low- and middle-income countries. Results: Despite the increase in vaccination coverage from 60.9% at the end of 2021 to 78.3% by August 2022, about 9% were not willing and were not vaccinated during the two rounds of interviews. Our modelling analysis revealed that positive beliefs about safety, effectiveness and side effects of the COVID-19 vaccines were associated with increased odds of being vaccinated or willingness to be vaccinated. Those who did not believe in the safety of the vaccines were less likely to be vaccinated than those who believed in the safety of the vaccines (OR: 0.56; 95% CI: 0.46-0.67). By contrast, negative beliefs about the COVID-19 vaccines increased the probability of being unwilling to be vaccinated. Conclusion: The results from this research offer useful insights into tackling the supply and demand related barriers to COVID-19 vaccination uptake and provides lessons for future health threats.

Water safety and inequality in access to drinking-water between rich and poor households.

While water and sanitation are now recognized as a human right by the United Nations, monitoring inequality in safe water access poses challenges. This study uses survey data to calculate household socio-economic-status (SES) indices in seven countries where national drinking-water quality surveys are available. These are used to assess inequalities in access as indicated by type of improved water source, use of safe water, and a combination of these. In Bangladesh, arsenic exposure through drinking-water is not significantly related to SES (p = 0.06) among households using tubewells, whereas in Peru, chlorine residual in piped systems varies significantly with SES (p < 0.0001). In Ethiopia, Nicaragua, and Nigeria, many poor households access nonpiped improved sources, which may provide unsafe water, resulting in greater inequality of access to "safe" water compared to "improved" water sources. Concentration indices increased from 0.08 to 0.15, 0.10 to 0.14, and 0.24 to 0.26, respectively, in these countries. There was minimal difference in Jordan and Tajikistan. Although the results are likely to be underestimates as they exclude individual-level inequalities, they show that use of a binary "improved"/"unimproved" categorization masks substantial inequalities. Future international monitoring programmes should take account of inequality in access and safety.

Accuracy of the H2S test: a systematic review of the influence of bacterial density and sample volume.

The presence/absence hydrogen sulphide test (P/A H2S) is widely used as a low-cost alternative faecal indicator test in remote and resource-poor settings. The aim of the paper is to assess how bacterial density and sample volume affect its accuracy. Based on a systematic search, we identified studies that tested water samples (n = 2,034) using both the P/A H2S test and recognised tests for thermotolerant coliforms (TTC) or Escherichia coli. We calculated P/A H2S test specificity and sensitivity against a range of TTC and E. coli densities. For two studies, we compared this with sensitivity and specificity estimates for simulated 100 and 20 ml presence/absence tests. For most of the 19 included studies, as the threshold used to define contamination increased from 1 to 100 cfu/100 ml, P/A H2S test sensitivity increased but specificity decreased. Similarly, the simulation indicated that increasing test volumes from 20 to 100 ml increased sensitivity but reduced specificity. There was potential for bias, for example from lack of blinding during test interpretation, in most of the studies reviewed. In assessing the P/A H2S test as an alternative to standard methods, careful consideration of likely indicator bacteria levels and sample volume is required.

COVID-19 Vaccination Personas in Yemen: Insights from Three Rounds of a Cross-Sectional Survey.

We used three rounds of a repeated cross-sectional survey on COVID-19 vaccination conducted throughout the entire territory of Yemen to: (i) describe the demographic and socio-economic characteristics associated with willingness to be vaccinated; (ii) analyse the link between beliefs associated with COVID-19 vaccines and willingness to be vaccinated; and (iii) analyse the potential platforms that could be used to target vaccine hesitancy and improve vaccine coverage in Yemen. Over two-thirds of respondents were either unwilling or unsure about vaccination across the three rounds. We found that gender, age, and educational attainment were significant correlates of vaccination status. Respondents with better knowledge about the virus and with greater confidence in the capacity of the authorities (and their own) to deal with the virus were more likely to be willing to be vaccinated. Consistent with the health belief model, practising one (or more) COVID-19 preventative measures was associated with a higher willingness to get a COVID-19 vaccination. Respondents with more positive views towards COVID-19 vaccines were also more likely to be willing to be vaccinated. By contrast, respondents who believed that vaccines are associated with significant side effects were more likely to refuse vaccination. Finally, those who relied on community leaders/healthcare workers as a trusted channel for obtaining COVID-19-related information were more likely to be willing to be vaccinated. Strengthening the information about the COVID-19 vaccination (safety, effectiveness, side effects) and communicating it through community leaders/healthcare workers could help increase the COVID-19 vaccine coverage in Yemen.

Benefits of Mentoring in Oncology Education for Mentors and Mentees: Pre-Post Interventional Study of the British Oncology Network for Undergraduate Societies' National Oncology Mentorship Scheme.

BACKGROUND: Formal education of oncology is lacking in many undergraduate medical curricula. Mentoring schemes can expose participants to specific areas of medicine and may address the shortfalls in oncology education. Few mentoring schemes have been designed within the United Kingdom, especially within oncology. There is a need to understand reasons for mentor and mentee participation in such schemes and to identify ways to minimize barriers to engagement. OBJECTIVE: This study identifies motivations for participation in an oncology mentoring scheme and its benefits and limitations to both the mentee and the mentor. METHODS: The British Oncology Network for Undergraduate Societies launched a National Oncology Mentorship Scheme (NOMS) on September 1, 2021. Mentees (medical student or foundation doctor) were paired with mentors (specialty registrar or consultant), for 6 months of mentoring. In total, 86 mentors and 112 mentees were recruited to the scheme. The mentees and mentors were asked to meet at least 3 times during this period and suggestions were provided on the content of mentoring. Mentees and mentors were invited to complete a prescheme questionnaire, exploring motivations for involvement in the scheme, current experiences within oncology, and knowledge and interests in the field. At the end of the scheme, mentors and mentees were asked to complete a postscheme questionnaire exploring experiences and benefits or limitations of participation. Paired analysis was performed using the Wilcoxon signed-rank test. For free text data, content analysis was applied to summarize the main themes in the data. RESULTS: Of the 66 (59%) mentees who completed the prescheme questionnaire, 41 (62%) were clinical, 21 (32%) preclinical medical students, and the remainder were junior doctors. For mentees, networking was the primary reason for joining the scheme (n=25, 38%). Mentees ranked experience of oncology at medical school at 3 on 10 (IQR 2-5). In this, 46 (53%) mentors completed the prescheme questionnaire, 35 (76%) were registrar level, and the remainder were consultant level (n=11). The most common reason for mentor participation was to increase awareness and interest in the field (n=29, 63%). Of those who completed the prescheme questionnaire, 23 (35%) mentees and 25 (54%) mentors completed the postscheme questionnaire. Knowledge in all areas of oncology assessed significantly increased during the scheme (P<.001). Most mentees (n=21, 91%) and mentors (n=18, 72%) felt they had benefited from the scheme. Mentees cited gaining insights into oncology as most beneficial; and mentors, opportunities to develop professionally. Whilst mentees did not report any barriers to participating in the scheme, mentors stated lack of time as the greatest barrier to mentoring. CONCLUSIONS: British Oncology Network for Undergraduate Societies' NOMS is expanding and is beneficial for mentees through increasing knowledge, providing exposure, and career advice in oncology. Mentors benefit from improving their mentoring skills and personal satisfaction.

COVID-19 Vaccination Personas in Syria: Evidence from a Cross-Sectional Survey.

Achieving a high level of COVID-19 vaccination coverage in a conflict-affected setting is challenging. The objective of this paper is to shed further light on the main determinants of vaccination coverage using a large, cross-sectional sample (October-November 2022) of over 17,000 adults in Syria. We find evidence that certain demographic and socioeconomic characteristics describe a core set of vaccination personas. Men, older respondents, and those who are more educated and trust information received from healthcare authorities are more likely to be vaccinated. Healthcare workers in this sample are highly vaccinated. Furthermore, respondents with more positive views towards COVID-19 vaccines are also more likely to be willing to be vaccinated. By contrast, respondents who believe that vaccines are associated with significant side effects are also more likely to refuse vaccination. In addition, younger respondents and women, as well as those with a lower level of education, are more likely to refuse to be vaccinated. Respondents with a neutral attitude towards vaccines are also more likely to be undecided, whereas respondents who are refusing to get vaccinated are more likely to trust the information received from private doctors, private clinics, as well as social media and, more broadly, the internet.

Whole genome sequencing provides comprehensive genetic testing in childhood B-cell acute lymphoblastic leukaemia.

Childhood B-cell acute lymphoblastic leukaemia (B-ALL) is characterised by recurrent genetic abnormalities that drive risk-directed treatment strategies. Using current techniques, accurate detection of such aberrations can be challenging, due to the rapidly expanding list of key genetic abnormalities. Whole genome sequencing (WGS) has the potential to improve genetic testing, but requires comprehensive validation. We performed WGS on 210 childhood B-ALL samples annotated with clinical and genetic data. We devised a molecular classification system to subtype these patients based on identification of key genetic changes in tumour-normal and tumour-only analyses. This approach detected 294 subtype-defining genetic abnormalities in 96% (202/210) patients. Novel genetic variants, including fusions involving genes in the MAP kinase pathway, were identified. WGS results were concordant with standard-of-care methods and whole transcriptome sequencing (WTS). We expanded the catalogue of genetic profiles that reliably classify PAX5alt and ETV6::RUNX1-like subtypes. Our novel bioinformatic pipeline improved detection of DUX4 rearrangements (DUX4-r): a good-risk B-ALL subtype with high survival rates. Overall, we have validated that WGS provides a standalone, reliable genetic test to detect all subtype-defining genetic abnormalities in B-ALL, accurately classifying patients for the risk-directed treatment stratification, while simultaneously performing as a research tool to identify novel disease biomarkers.

Integrative genomic analysis of childhood acute lymphoblastic leukaemia lacking a genetic biomarker in the UKALL2003 clinical trial.

Incorporating genetics into risk-stratification for treatment of childhood B-progenitor acute lymphoblastic leukaemia (B-ALL) has contributed significantly to improved survival. In about 30% B-ALL (B-other-ALL) without well-established chromosomal changes, new genetic subtypes have recently emerged, yet their true prognostic relevance largely remains unclear. We integrated next generation sequencing (NGS): whole genome sequencing (WGS) (n = 157) and bespoke targeted NGS (t-NGS) (n = 175) (overlap n = 36), with existing genetic annotation in a representative cohort of 351 B-other-ALL patients from the childhood ALL trail, UKALL2003. PAX5alt was most frequently observed (n = 91), whereas PAX5 P80R mutations (n = 11) defined a distinct PAX5 subtype. DUX4-r subtype (n = 80) was defined by DUX4 rearrangements and/or ERG deletions. These patients had a low relapse rate and excellent survival. ETV6::RUNX1-like subtype (n = 21) was characterised by multiple abnormalities of ETV6 and IKZF1, with no reported relapses or deaths, indicating their excellent prognosis in this trial. An inferior outcome for patients with ABL-class fusions (n = 25) was confirmed. Integration of NGS into genomic profiling of B-other-ALL within a single childhood ALL trial, UKALL2003, has shown the added clinical value of NGS-based approaches, through improved accuracy in detection and classification into the range of risk stratifying genetic subtypes, while validating their prognostic significance.

Monitoring Drinking Water Quality in Nationally Representative Household Surveys in Low- and Middle-Income Countries: Cross-Sectional Analysis of 27 Multiple Indicator Cluster Surveys 2014-2020.

BACKGROUND: The 2030 Sustainable Development Goals (SDGs) set an ambitious new benchmark for safely managed drinking water services (SMDWs), but many countries lack national data on the availability and quality of drinking water. OBJECTIVES: We quantified the availability and microbiological quality of drinking water, monitored SMDWs, and examined risk factors for Escherichia coli (E. coli) contamination in 27 low-and middle-income countries (LMICs). METHODS: A new water quality module for household surveys was implemented in 27 Multiple Indicator Cluster Surveys. Teams used portable equipment to measure E. coli at the point of collection (PoC, n=61,170) and at the point of use (PoU, n=64,900) and asked respondents about the availability and accessibility of drinking water. Households were classified as having SMDW services if they used an improved water source that was free of E. coli contamination at PoC, accessible on premises, and available when needed. Compliance with individual SMDW criteria was also assessed. Modified Poisson regression was used to explore household and community risk factors for E. coli contamination. RESULTS: E. coli was commonly detected at the PoC (range 16-90%) and was more likely at the PoU (range 19-99%). On average, 84% of households used an improved drinking water source, and 31% met all of the SMDW criteria. E. coli contamination was the primary reason SMDW criteria were not met (15 of 27 countries). The prevalence of E. coli in PoC samples was lower among households using improved water sources [risk ratio (RR)=0.74; 95% confidence interval (CI): 0.64, 0.85] but not for households with water accessible on premises (RR=0.99; 95% CI: 0.94, 1.05) or available when needed (RR=0.95; 95% CI: 0.88, 1.02). E. coli contamination of PoU samples was less common for households in the richest vs. poorest wealth quintile (RR=0.70; 95% CI: 0.55, 0.88) and in communities with high (>75%) improved sanitation coverage (RR=0.94; 95% CI: 0.90, 0.97). Livestock ownership (RR=1.08; 95% CI: 1.04, 1.13), rural vs. urban residence (RR=1.10; 95% CI: 1.04, 1.16), and wet vs. dry season sampling (RR=1.07; 95% CI: 1.01, 1.15) were positively associated with contamination at the PoU. DISCUSSION: Cross-sectional water quality data can be collected in household surveys and can be used to assess inequalities in service levels, to track the SDG indicator of SMDWs, and to examine risk factors for contamination. There is an urgent need for better risk management to reduce widespread exposure to fecal contamination through drinking water services in LMICs. https://doi.org/10.1289/EHP8459.