Background: Community First Responders (CFR) are volunteers who respond to appropriate medical emergencies while an ambulance is en route. The emergencies that CFRs attend are situations where stress is inherent, yet little is known of which stressors and demands are present and which are considered to be the greatest attributer to stress experienced. Objective: This survey aims to gain further understanding of the demands and stressors experienced by CFRs. Design: An online survey using a modified NASA-TLX scoring system was distributed to CFRs throughout Scotland (n=535). CFRs were asked to gauge the demands and stressors experienced during a ‘typical’ and their ‘most stressful’ callout, what would be the biggest cause of stress if present and the most stressful time-period during callouts. Results: 88 CFRs started the survey with 40 continuing to completion. Frustration that the CFR could not help the patient more was considered to be the biggest stressor for both a typical and most the stressful callout. Emotional demand was the most present demand in a typical callout and mental demand in the most stressful callout. If present, loneliness and isolation was deemed to be the biggest cause of stress for CFRs. Prior to arrival at scene was the most stressful time. Conclusions: This insight provides a valuable appraisal for the Scottish Ambulance Service of the CFR scheme and the concerns and demands experienced by its volunteers. The results also act as a cross-sectional study for research investigating stress alleviation through human-computer interaction in the pre-hospital care domain.

The Anaerobic Digestion Pasteurization Latrine (ADPL) is a self-contained and energy neutral on-site sanitation system using anaerobic digestion of fecal sludge to generate biogas and then uses the biogas to pasteurize the digester effluent at 65–75°C to produce a safe effluent that can be reused locally as a fertilizer. Two ADPL systems were installed on residential plots with 17 and 35 residents in a peri-urban area outside of Eldoret, Kenya. Each system comprised three toilets built above a floating dome digester and one heat pasteurization system to sanitize the digested effluent. ADPLs are simple systems, with no moving parts and relying on gravity-induced flows. Adoption at the two sites was successful, and residents reported that the systems had little to no odor or flies. ADPLs were monitored for biogas production and temperatures in the pasteurization system. ADPLs serving 17 and 35 residents produced on average 16 and 11 Lbiogas/person/day (maximum of 20 and 15 Lbiogas/p/d), respectively. The temperature in the sterilization system was greater than 65°C on 58% and 87% of sampling days during the most stable period of operation. Treated effluent was analyzed periodically for chemical oxygen demand (COD), biochemical oxygen demand (BOD), total ammonia nitrogen (TAN), pH, and fecal coliform (FC). On average, the effluent at the two locations contained 4,540 and 6,450 mg COD/L (an 85% or 89% reduction of the estimated input), 2,050 and 3,970 mg BOD/L, and 2,420 and 4,760 mg NH3-N, respectively, and greater than 5 log reductions of FC (nondetectable) in the sterilization tank. Results from this field study show that anaerobic digestion of minimally diluted fecal sludge can provide enough energy to pasteurize digester effluent and that the ADPL may be a suitable option for on-site fecal sludge treatment.

Access to basic imaging and laboratory services remains a major challenge in rural, resource-limited settings in sub-Saharan Africa. In 2016, the Academic Model Providing Access to Healthcare programme in western Kenya implemented a mobile diagnostic unit (MDU) outfitted with a generator-powered X-ray machine and basic laboratory tests to address the lack of these services at rural, low-resource, public health facilities. The objective of this paper is to describe the design, implementation, preliminary impact and operational challenges of the MDU in western Kenya. Since implementing the MDU at seven rural health facilities serving a catchment of over half a million people, over 4500 chest radiographs have been performed, with one or more abnormalities detected in approximately 30% of radiographs. We observed favorable feedback and uptake of MDU services by healthcare workers and patients. However, various operational challenges in the design and construction of the MDU and the transmission and reporting of radiographs in remote areas were encountered. Our experience supports the feasibility of deploying an MDU to increase access to basic radiology and laboratory services in rural, resource-limited settings.

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