The American Journal of Bioethics
Volume 14, Issue 4, 2014
http://www.tandfonline.com/toc/uajb20/current

Fostering IRB Collaboration for Review of International Research
Francis Barchia*, Megan Kasimatis Singletonb & Jon F. Merzc
pages 3-8
DOI: 10.1080/15265161.2014.892168
Abstract
This article presents a review of the literature, summarizes current initiatives, and provides a heuristic for assessing the effectiveness of a range of institutional review board (IRB) collaborative strategies that can reduce the regulatory burden of ethics review while ensuring protection of human subjects, with a particular focus on international research. Broad adoption of IRB collaborative strategies will reduce regulatory burdens posed by overlapping oversight mechanisms and has the potential to enhance human subjects protections.
[See also six Open Peer Commentaries on the theme above]

BMC Health Services Research
(Accessed 3 May 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations
Kathleen Doherty, Shaffiq Essajee, Martina Penazzato, Charles Holmes, Stephen Resch, Andrea Ciaranello BMC Health Services Research 2014, 14:201 (2 May 2014)
Abstract | Provisional PDF
Background
Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow.
Methods
We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0-13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology.
Results
The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates.
Conclusions
The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments.

Research article
Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey
Abdinoor Haji Mohamed, Warren Dalal, Raymond Nyoka, Heather Burke, Jamal Ahmed, Erick Auko, Wilbert Shihaji, Irene Ndege, Robert F Breiman, Rachel B Eidex BMC Health Services Research 2014, 14:200 (2 May 2014)
Abstract | Provisional PDF
Background
Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees.
Methods
During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest.
Results
Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children <5 years old had the highest frequency of all the illnesses surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported among all age groups of those who sought care. Among participants who reported >=1 illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health care services from private health care providers. Fifty-five (18.9%) participants seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23.0%]), the primary reason was cost (44.8%), followed by belief that the person was not sick enough (34.6%).
Conclusion
Health care utilization in Eastleigh is high; however, a large proportion of residents opt to seek care at private clinics or pharmacies, despite the availability of accessible government-provided health care services in this area.

BMC Public Health
(Accessed 3 May 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands
Ines Keygnaert, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman
BMC Public Health 2014, 14:416 (1 May 2014)
Abstract | Provisional PDF

Research article
“I don’t see an added value for myself”: a qualitative study exploring the social cognitive variables associated with influenza vaccination of Belgian, Dutch and German healthcare personnel
Birthe A Lehmann, Robert AC Ruiter, Sabine Wicker, Dick van Dam, Gerjo Kok
BMC Public Health 2014, 14:407 (28 April 2014)
Abstract | Full text | PDF | PubMed

Bulletin of the World Health Organization
Volume 92, Number 5, May 2014, 309-384
http://www.who.int/bulletin/volumes/92/5/en/

Editorial
International Health Regulations (2005): taking stock
Isabelle Nuttall a
a. Department of Global Capacities, Alert and Response, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2014;92:310. doi: http://dx.doi.org/10.2471/BLT.14.138990
Excerpt
In 2007, the coming into force of the revised International Health Regulations (2005)1 [IHR (2005)] – the most powerful, far-reaching instrument of international law ever conceived to protect people’s health – was met with excitement. The purpose behind the IHR (2005) was to prevent and detect international health threats with minimal disruption to travel, trade and the economy. A simple logic lay at the heart of the IHR (2005): in an interconnected, interdependent world, a threat in one country puts all countries at risk.
Today, international public health threats, be they infectious or not, are harder to prevent and detect because of the mass movement of people, goods and animals facilitated by faster, cheaper modes of travel and complex trade systems. In the last couple of years alone, emerging pathogens such as avian influenza viruses A(H7N9) and A(H10N8) and the Middle East respiratory syndrome coronavirus have for the first time been reported to cause human disease. Three out of four new diseases affecting humans emerge at the human–animal interface.
To ensure compliance with IHR (2005), countries were given until June 2012 to develop systems with capacity in several core areas: legislation and policy; coordination and IHR national focal points; preparedness, surveillance and response; risk communication; human resources; laboratory practice; and points of entry. However, the magnitude of the work led more than 100 countries to request a two-year extension for building up capacity in these domains. In June 2014 this extension period will be over and further requests for extension are expected. What does this mean?
…In terms of the IHR, it is time to take stock of the capacities amassed so far and those that still need to be developed. Countries have yet to implement their concrete plans to meet the capacity requirements of the IHR (2005). Some target capacities call for substantial investment, either from national budgets or international cooperation, and hence renewed financial commitments; others could probably be achieved through improved cost–effectiveness and collaboration between different sectors, including the animal and human health sectors. WHO is also striving, through its programme of reform, to serve its Member States better and in a more coordinated manner so that we can all live in a more secure and prosperous world.

Perspectives
Health system cost of delivering routine vaccination in low- and lower-middle income countries: what is needed over the next decade?
Patrick Lydon a, Gian Gandhi b, Jos Vandelaer b & Jean-Marie Okwo-Bele a
a. Immunization, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
b. United Nations Children’s Fund, New York, United States of America.
(Submitted: 12 September 2013 – Revised version received: 23 January 2014 – Accepted: 31 January 2014 – Published online: 07 February 2014.)
Bulletin of the World Health Organization 2014;92:382-384. doi: http://dx.doi.org/10.2471/BLT.13.130146
Excerpt
On the eve of the 40th anniversary of launching of the Expanded Programme on Immunization (EPI) in 1974, during the twenty-seventh World Health Assembly (WHA), fundamental questions about the level of financing needed to sustain achievements and scale up the EPI in low- and lower-middle income countries continue to permeate the discourse on the economics of immunization. The answer to this question is all the more important in light of the fact that at the sixty-fifth WHA in 2012, ministers of health embraced the Global Vaccine Action Plan (GVAP) – a 10-year global strategic plan for immunization.1 But how much – and in what areas – are the investments needed for this decade?
Today, improved transparency in pricing information allows for relatively accurate vaccine cost estimates.2 Unfortunately, trends in the health system costs of delivering vaccination beyond the cost of the vaccines themselves continue to be poorly understood…

Climate and Development
Volume 6, Issue 2, 2014
http://www.tandfonline.com/toc/tcld20/current#.Uzg0pFcWNdc

The post-2015 global agenda: are the political decisions on climate change shifting to a new forum in the United Nations as it comes together with sustainable development and security?
Mukul Sanwala*
pages 93-95 DOI: 10.1080/17565529.2013.868336
Abstract
The way the issue of global environmentalism is now being framed around convergence of living standards within ecological limits may succeed in securing international cooperation in a manner that the focus on percentage reductions in greenhouse gases, that considered symptoms rather than the causes of climate change, was not able to achieve. The unresolved issue is no longer the approach of the USA but whether in writing its own urban future China will shape new rules and a new type of global partnership based on shared responsibility and prosperity.

Cyclones in a changing climate: the case of Bangladesh
Susmita Dasguptaa*, Mainul Huqb, Zahirul Huq Khanc, Manjur Murshed Zahid Ahmedc, Nandan Mukherjeed, Malik Fida Khand & Kiran Pandeye
pages 96-110 DOI: 10.1080/17565529.2013.868335
Abstract
This paper integrates information on climate-change, hydrodynamic models, and geographic overlays to assess the vulnerability of coastal areas in Bangladesh to larger storm surges and sea-level rise (SLR) by 2050. The approach identifies polders, coastal populations, settlements, infrastructure, and economic activity at risk of inundation, and estimates the damage from storm surge inundation versus the cost of several adaptation measures. A 27-centimetre SLR and 10% intensification of wind speed resulting from global warming suggest that the vulnerable zone increases in size by 69% given a +3-metre inundation depth, and by 14% given a +1-metre inundation depth. Estimates indicate investments including strengthening polders, foreshore afforestation, additional multi-purpose cyclone shelters, cyclone-resistant private housing, and further strengthening of the early warning and evacuation system would cost more than $2.4 billion, with an annual recurrent cost of more than $50 million. These estimates can serve as a prototype in climate negotiations of the adaptation costs of extreme weather events.

Disaster Medicine and Public Health Preparedness
Volume 8 – Issue 02 – April 2014 http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

Original Research
The Operating Room During a Severe Earthquake: Lessons From the 2011 Great East Japan Earthquake
Yasuyuki Suzukia1, Ikuo Fukudaa1 c1 and Shigeyuki Nakajia2
a1 Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
a2 Department of Thoracic and Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
Abstract
Objective The Great East Japan Earthquake occurred at 14:46 on March 11, 2011, producing serious and widespread damage. To assess damages in hospital operating departments during and after the earthquake, we surveyed hospitals in this region.
Methods Questionnaires were sent to 415 acute care hospitals in Tohoku and east Kanto areas. The questionnaires elicited the number of perioperative patients when the earthquake hit, obstacles to continuing surgery, structural and nonstructural damage to the operating department, and the effect on routine surgery after the earthquake.
Results Of the 213 hospitals (51%) that completed questionnaires, 474 patients were undergoing operations during the earthquake, and 222 operations were canceled afterward. Risk factors for continuing operations, as reported by 102 hospitals, were tremors and electrical blackouts (odds ratio [OR]: 79.3 and 110.5; P < .01). In 154 hospitals, difficulties in performing operations after the earthquake were reported. Significant obstacles to the management of operations after the earthquake were characterized by infrastructure disorder scores, seismic intensity, disruption of electrical power and air conditioning, and damage to out-of-hospital telecommunications (OR, 0.46; P = .04).
Conclusions Tremors and electrical blackouts were important risk factors for performing operations. Nonstructural damage, especially to out-of-hospital telecommunications, affected the management of the operating rooms. Hospital logistics are very important to achieve appropriate disaster management. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Journal of Community Health
Volume 39, Issue 3, June 2014
http://link.springer.com/journal/10900/39/3/page/1

The Peru Cervical Cancer Screening Study (PERCAPS): The Design and Implementation of a Mother/Daughter Screen, Treat, and Vaccinate Program in the Peruvian Jungle
Carolina E. Abuelo, Kimberly L. Levinson, Jorge Salmeron, Carlos Vallejos Sologuren, Maria Jose Vallejos Fernandez, Jerome L. Belinson
Abstract
Peru struggles to prevent cervical cancer (CC). In the jungle, prevention programs suffer from significant barriers although technology exists to detect CC precursors. This study used community based participatory research (CBPR) methods to overcome barriers. The objective was to evaluate the utility of CBPR techniques in a mother–child screen/treat and vaccinate program for CC prevention in the Peruvian jungle. The CC prevention program used self-sampling for human papillomavirus (HPV) for screening, cryotherapy for treatment and the HPV vaccine Gardasil for vaccination. Community health leaders (HL) from around Iquitos participated in a two half day educational course. The HLs then decided how to implement interventions in their villages or urban sectors. The success of the program was measured by: (1) ability of the HLs to determine an implementation plan, (2) proper use of research forms, (3) participation and retention rates, and (4) participants’ satisfaction. HLs successfully registered 320 women at soup kitchens, schools, and health posts. Screening, treatment, and vaccination were successfully carried out using forms for registration, consent, and results with minimum error. In the screen/treat intervention 100 % of participants gave an HPV sample and 99.7 % reported high satisfaction; 81 % of HPV + women were treated, and 57 % returned for 6-month follow-up. Vaccine intervention: 98 % of girls received the 1st vaccine, 88 % of those received the 2nd, and 65 % the 3rd. CBPR techniques successfully helped implement a screen/treat and vaccinate CC prevention program around Iquitos, Peru. These techniques may be appropriate for large-scale preventive health-care interventions.

The Joys of Caring for Older Adults: Training Practitioners to Empower Older Adults
Beverly P. Lyons,
Tai Dunson-Strane, Fredrick T. Sherman
Abstract
Many older adults lack knowledge concerning the consequences of a sedentary lifestyle, atypical disease symptoms, the adverse effects of multiple medication use, and the hazards of frequent hospitalizations. Medically trained healthcare providers and community health practitioners can provide older adults with this information through health education classes. However, these healthcare professionals must continually update their knowledge as the science of gerontology and geriatrics is always expanding. The advanced certificate in gerontology administration program at LIU-Brooklyn hosted a 3-h train-the-trainer seminar, which was attended by 62 healthcare professionals to raise awareness concerning the realities of aging and to describe a range of behaviors that support health. For approximately 90 min, the keynote speaker presented issues and solutions that addressed the before-mentioned areas of knowledge deficit, followed by a question and answer period. Participants were asked to use an anonymous survey evaluation form featuring both quantitative and qualitative questions to rate the seminar. Close-ended questions were developed on a five-point scale ranging from 5 = strongly agree to 1 = strongly disagree. These items were analyzed to compute frequency and percent. The participants rated the seminar favorably with 98 % stating that they learned the benefits of exercise for older adults; 97 % learned how to avoid the hazards of hospitalization. Evaluations of the seminar suggest that it is feasible to develop educational programs targeting healthcare professionals and community health practitioners.

Well-Being and Perceived Quality of Life in Elderly People Displaced After the Earthquake in L’Aquila, Italy
Anna Rita Giuliani, Antonella Mattei, Flavio Santilli, Giovanna Clori, Maria Scatigna, Leila Fabiani
Open Access
Download PDF (222 KB)
Abstract
On 6 April 2009, the city of L’Aquila was hit by a violent earthquake that destroyed almost all of its medieval centre, and the surviving inhabitants were evacuated and relocated in temporary quarters or undamaged homes. The aim of this study was to investigate the perceived quality of life of the elderly population 3 years after the earthquake in relation to the social and logistic issues of new housing. The study was carried out between October 2011 and March 2012, and involved 571 subjects aged over 65 years living in the municipality of L’Aquila. The interviews took place in the surgeries of general practitioners and the city’s Department of Prevention and Vaccination in the anti-influenza immunisation period. The instrument used was a 36-item questionnaire with closed, multiple choice answers divided into the following sections: demographics, everyday activities, health and perceived health, and the quality of life in the city. The results show that, 3 years after the earthquake, the elderly population living in the new towns and temporary housing of L’Aquila have a worse perception of their quality of life than the others. They feel a certain social isolation and wish to live elsewhere. Governments faced with the problems arising from a natural calamity should take into account all of the elements making up a good quality of life and, before making choices whose impact cannot be changed, consider both their immediate and long-term social consequences.

The Lancet
May 03, 2014 Volume 383 Number 9928 p1521 – 1608
http://www.thelancet.com/journals/lancet/issue/current
Comment
Variola virus archives: a new century, a new approach
Peter B Jahrling, Owale Tomori
Full Text |
Eradication of smallpox was the signature public health achievement of the 20th century—the result of relentless collective action by the global community. Although the disease is long gone, variola virus, which causes smallpox, still exists in two WHO-approved laboratories.1

Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates
Helen E Jenkins PhD a, Arielle W Tolman BA b, Courtney M Yuen PhD b, Jonathan B Parr MD a b c, Salmaan Keshavjee MD a b c, Carlos M Pérez-Vélez MD c d, Prof Marcello Pagano PhD e, Dr Mercedes C Becerra ScD a b c†, Ted Cohen MD a f
Summary
Background
Multidrug-resistant tuberculosis threatens to reverse recent reductions in global tuberculosis incidence. Although children younger than 15 years constitute more than 25% of the worldwide population, the global incidence of multidrug-resistant tuberculosis disease in children has never been quantified. We aimed to estimate the regional and global annual incidence of multidrug-resistant tuberculosis in children.
Methods
We developed two models: one to estimate the setting-specific risk of multidrug-resistant tuberculosis among child cases of tuberculosis, and a second to estimate the setting-specific incidence of tuberculosis disease in children. The model for risk of multidrug-resistant tuberculosis among children with tuberculosis needed a systematic literature review. We multiplied the setting-specific estimates of multidrug-resistant tuberculosis risk and tuberculosis incidence to estimate regional and global incidence of multidrug-resistant tuberculosis disease in children in 2010.
Findings
We identified 3403 papers, of which 97 studies met inclusion criteria for the systematic review of risk of multidrug-resistant tuberculosis. 31 studies reported the risk of multidrug-resistant tuberculosis in both children and treatment-naive adults with tuberculosis and were used for evaluation of the linear association between multidrug-resistant disease risk in these two patient groups. We identified that the setting-specific risk of multidrug-resistant tuberculosis was nearly identical in children and treatment-naive adults with tuberculosis, consistent with the assertion that multidrug-resistant disease in both groups reflects the local risk of transmitted multidrug-resistant tuberculosis. After application of these calculated risks, we estimated that around 999 792 (95% CI 937 877—1 055 414) children developed tuberculosis disease in 2010, of whom 31 948 (25 594—38 663) had multidrug-resistant disease.
Interpretation
Our estimates underscore that many cases of tuberculosis and multidrug-resistant tuberculosis disease are not being detected in children. Future estimates can be refined as more and better tuberculosis data and new diagnostic instruments become available.
Funding
US National Institutes of Health, the Helmut Wolfgang Schumann Fellowship in Preventive Medicine at Harvard Medical School, the Norman E Zinberg Fellowship at Harvard Medical School, and the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at the Brigham and Women’s Hospital.

Viewpoint
Importance of tuberculosis control to address child survival
Stephen M Graham, Charalambos Sismanidis, Heather J Menzies, Ben J Marais, Anne K Detjen, Robert E Black
Tuberculosis commonly affects young children (<5 years) in countries that have high rates of child mortality.1 The global public health focus to control tuberculosis has traditionally aimed to reduce transmission through early case-finding and effective treatment of the most infectious cases. Young children have historically been excluded from this focus, since their contribution to tuberculosis transmission is believed to be small. In the past decade, national tuberculosis programmes in high-burden settings have given increased attention to the challenges of childhood tuberculosis.

Nature
Volume 509 Number 7498 pp7-128 1 May 2014
http://www.nature.com/nature/current_issue.html
Nature | Comment
Sharing
Agriculture: Engage farmers in research
Tom MacMillan & Tim G. Benton
30 April 2014
A new wave of small-scale agricultural innovation will boost yields and protect the planet, contend Tom MacMillan and Tim G. Benton.
Since the 1970s, agricultural research and development (R&D) has invested mainly in a few research institutes equipped with cutting-edge instruments. For example, the Biotechnology and Biological Sciences Research Council, responsible for much of the public research spending in food security in the United Kingdom, invested 27% of its 2010–11 budget in just three institutes. Multinational seed and agrochemical companies invest billions of dollars to develop products in hopes that they will be used by millions of farmers.
This one-size-fits-all approach has had qualified success. In a 2011 analysis3, average global crop yields increased by 56% between 1965 and 1985, and by 20% from 1985 to 2005, underpinned by increasing inputs of non-renewable resources.
But advances are slowing. According to a 2013 study4, yields have plateaued in some of the world’s most important food-producing regions, including east Asia (for rice) and northwest Europe (for wheat). In some countries, yields have declined.
The next wave of innovation must be at smaller scales. What one farmer can do to boost yield or efficiency is not necessarily the same as for a farmer hundreds of kilometres away with different soil, microclimate, topology and methods. How well crops and livestock grow depends on the interaction of genes, management and environment. As weather patterns fluctuate, gains in production will depend ever more on innovating in context. Big knowledge flowing from institute to farm must be complemented by local knowledge.
Enhancing farmers’ own R&D could reap big rewards for minimal extra cost. Farmers everywhere are practical experimentalists who understand the idiosyncrasies of their land5. Modern agronomy evolved out of practices such as rotating crops to rebuild soil nutrients, fertilizing fields with manure, and adding lime to soil to alter pH. Even technologies not invented by farmers — new kit, seeds or chemicals — are adapted by them to fit their circumstances.
Such essential contributions are rarely recognized in official assessments of agricultural R&D. These count farmers as users, rather than makers, of knowledge. When the US Department of Agriculture tots up the US$20 billion that the global private sector invests annually in agricultural R&D, it does not include that done by farmers6. Makers of farm machinery, pesticides, seeds and other ‘inputs’ invest around 3–11% of their revenue in R&D. Globally, if farmers’ innovations were valued at just 0.5% of farming production — worth $4 trillion — that would match formal R&D investment from the private sector.
Some of the best returns can come from helping farmers to assess their own ideas. Until now, such initiatives have been at arm’s length from formal science, and almost exclusively in the developing world. Our involvement in a farmer-focused innovation programme in the United Kingdom has convinced us that such participatory R&D could also boost agricultural innovation in rich countries.
Grass-roots research
Farmer-centred approaches are not new. In villages in Kenya, rice fields in Indonesia and other places out of reach from industrialized agriculture, group learning programmes recognize and support farmers as innovators.
The best known of these is the farmer field school approach, in which groups of farmers meet regularly to learn alongside their neighbours. The UN Food and Agricultural Organization set up the first such school in Indonesia in 1989, aiming to reduce rice farmers’ reliance on pesticides by enabling them to observe, identify and actively manage pests’ natural enemies.
Since then, at least 10 million smallholder farmers have taken part in field schools across Asia, Africa and Latin America. This year, a meta-analysis7 of 71 projects found that farmers’ experiences of these schools vary enormously, with targeted initiatives being more successful than large-scale national programmes. In targeted initiatives, participants gained knowledge, changed practices and consequently netted higher yields and incomes.
Inspired by the approach, a UK programme adapts participatory learning to suit farmers in the industrialized world, who, in many cases, are not short of capital, training or access to knowledge. Piloted in 2012, the Duchy Originals Future Farming Programme is funded by the Prince of Wales’s Charitable Foundation, in turn funded by sales of products through the supermarket chain Waitrose. The work is led by two charities, the Soil Association in Bristol (at which T.M. works, and T.B. serves on the programme steering group) and the Organic Research Centre in Newbury. The aim is to help farmers to sharpen their skills as innovators so that they can be more productive with fewer non-renewable inputs — good for the environment and their bottom line.
Groups of 5–15 farmers tackle a problem put forward by a participant and test solutions over up to a year in as many as four workshops on one of their own farms. A facilitator helps to keep meetings on track, and a relevant researcher — crop or animal scientist, agronomist or ecologist — is on hand to advise on experimental design and point out existing studies to avoid redundant work.
So far, 450 UK farmers have piloted ‘field labs’ for about 20 topics, with results documented publicly online. Their farms range from under a hectare to more than a thousand. Field labs have tested ways to control black grass (a persistent weed that resists herbicides), assessed the economics of keeping hens alive to lay eggs for a second season, and evaluated ways to reduce use of drugs that control liver fluke in sheep.
These field labs do not always provide clear answers because of their small samples and short timescales. Field labs raise scientific standards nonetheless: early evaluation suggests that most farmers who have taken part in field labs are eager to engage with formal research. And some have yielded useful lessons. In one, vegetable growers tested composts that do not include peat (which releases greenhouse gases when mined). In contrast to prevailing views, the farmers deemed these peat-free composts commercially viable. And the agronomists learned how labour savings from easily handled materials can outweigh business benefits of higher germination rates.
Grass-roots R&D projects are cropping up elsewhere in the developed world. A participatory breeding programme sponsored by the European Union (EU) has recruited farmers to develop crops that can be grown more sustainably. Organic and small-scale farmers in Italy and France (and in some developing countries) are testing and selecting varieties of barley, beans, broccoli, maize (corn), tomato and wheat.
Animal scientists in Denmark adapted the farmer field school approach to develop ‘stable schools’. Four groups of around five farms each worked together to assess changes to herds’ housing, hygiene and milking practices and reduced use of antibiotics8. A study funded by the European Commission is evaluating 17 ‘learning and innovation networks’ for sustainable agriculture.
Apps, software and websites that recognize farmers as innovators, not just managers, are also on the rise. In the United States, FarmHack.net is an open-source community in which mainly small-scale farmers share know-how, tools and designs. Recent posts include advice on affordable aerial imaging and guides for repurposing old equipment.
More lessons are coming from the developing world. CABI, an intergovernmental agency, is training community ‘plant doctors’ who help farmers to identify pests and diseases and to enter the information in open-access databases that could be used to control pests or track epidemics.
Research funders are waking up to the advantages of asking farmers what they need to know. In the United Kingdom, the main farming bodies convened a consultation called Feeding the Future that identified topics such as precision agriculture and animal-disease management as practical priorities9. But we believe that field labs could boost farmers’ productivity by supporting low-cost innovations that fly below the radars of large research institutions. When farmers produce knowledge, they are more likely to adopt new practices, and their insights are more likely to be relevant to local conditions.
Testing ground
Field labs attract innovative farmers — early adopters who can spread best practices. The challenge now is to evaluate and popularize the approach. In Europe, at least, the moment may have arrived. Linked to the latest round of reforms to the Common Agricultural Policy and the Horizon 2020 research programme, the EU launched the European Innovation Partnership for agricultural productivity and sustainability. It aims to promote bottom-up approaches by linking farmers, researchers, businesses and other stakeholders into groups charged with finding solutions to shared problems. With billions of euros earmarked for food and farming research over the next six years, the impact of this initiative is potentially enormous.
The European Commission has set out principles for this approach. Whether it flies or fails depends how EU member states rise to the challenge. For this initiative to succeed, governments must opt to spend a proportion of their rural development funds on supporting grass-roots training and learning by actual farmers — beyond the established partnerships with farmers’ suppliers, customers and political representatives. Governments should back brokerage services that help farmers to team up with relevant researchers on their own terms, and enable them to navigate the maze of bureaucracy that will probably stand between them and this invaluable seed investment.
The time has come to decentralize, diversify, and enrich agricultural R&D. Farmers — not scientists, outreach workers or salespeople — are the essential players in any agricultural innovation system. Helping them will put food on the world’s tables.
[See title link above for references]

New England Journal of Medicine
May 1, 2014 Vol. 370 No. 18
http://www.nejm.org/toc/nejm/medical-journal
Perspective
University Engagement in Global Health
Michael H. Merson, M.D.
N Engl J Med 2014; 370:1676-1678May 1, 2014DOI: 10.1056/NEJMp1401124
Students’ passion for reducing health disparities and universities’ efforts to become more global in a competitive marketplace have led to an unprecedented surge of global health as an academic field. But maintaining momentum requires confronting formidable challenges.
Review Article
Global Health
Global Health and the Law
Lawrence O. Gostin, J.D., and Devi Sridhar, Ph.D.
N Engl J Med 2014; 370:1732-1740 May 1, 2014 DOI: 10.1056/NEJMra1314094
Free full text
Excerpt
The past two decades have brought revolutionary changes in global health, driven by popular concern over the acquired immunodeficiency syndrome (AIDS), new strains of influenza, and maternal mortality.1 International development assistance for health — a crucial aspect of health cooperation — increased by a factor of five, from $5.6 billion in 1990 to $28.1 billion in 2012, with the private and voluntary sectors taking on an ever-increasing share of the total.2 Given the rapid globalization that is a defining feature of today’s world, the need for a robust system of global health law has never been greater.
Global health law is not an organized legal system, with a unified treaty-monitoring body, such as the World Trade Organization. However, there is a network of treaties and so-called “soft” law instruments that powerfully affect global health, many of which have arisen under the auspices of the World Health Organization (WHO). Global health law has been defined as the legal norms, processes, and institutions that are designed primarily to attain the highest possible standard of physical and mental health for the world’s population.3
Global health law can affect multiple spheres, ranging from national security, economic prosperity, and sustainable development to human rights and social justice. Each global health problem is shaped by the language of rights, duties, and rules for engagement used in the law…
…Strategy for Global Health Laws
Given the undoubted need for global cooperation, international norms are accepted as important global health tools. The more difficult question is whether to pursue hard or soft routes to address health challenges. This debate plays out in international forums ranging from alcohol control and biomedical research to broader reforms such as the Framework Convention on Global Health.30,43-45 However, there are strengths and weaknesses to both approaches.
Soft agreements are easier to negotiate, with countries more likely to accede to far-reaching norms if there is no formal obligation to comply. Countries can assent to a soft norm without the national constitutional processes entailed in ratifying a treaty. In addition, soft norms can be negotiated more quickly with the use of fewer resources. Resolutions of the WHO Health Assembly represent a major expression of political will and can lead to progressive deepening of norms — enacted into domestic law, referenced by treaty bodies, or incorporated into international law. The WHO, moreover, is building accountability mechanisms into soft agreements, with targets, monitoring, and timelines for compliance.
However, national governments can largely ignore soft instruments, and as a result, civil society often urges treaty development.30 No hard norms have been enacted, for example, relating to food, alcohol, physical activity, injuries, pain medication, or mental health. If the WHO acts principally through voluntary agreements, while other sectors develop hard law, this weakens and sidelines the agency. Civil society often points to the obligatory nature of international trade law and its binding dispute-settlement mechanism, which often trumps WHO norms.46
Even with all the funding and celebrity power that has entered the global health space, key health indicators lag, whereas the health gap between rich and poor has barely abated.47,48 A renewed attention to lawmaking efforts by the WHO and the human right to health are crucial elements of progress. It is only through law that individuals and populations can claim entitlements to health services and that corresponding governmental obligations can be established and enforced. It is through law that norms can be set, fragmented activities coordinated, and good governance ensured, including stewardship, transparency, participation, and accountability. Global health law, despite its limitations, remains vital to achieving global health with justice.
Editorial
Convergence to Common Purpose in Global Health
David J. Hunter, M.B., B.S., Sc.D., M.P.H., and Harvey V. Fineberg, M.D., Ph.D.
N Engl J Med 2014; 370:1753-1755 May 1, 2014 DOI: 10.1056/NEJMe1404077
[see full text in Week in Review above]

Pediatrics
May 2014, VOLUME 133 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml
Article
Effectiveness of Trivalent Flu Vaccine in Healthy Young Children
Christopher C. Blyth, MBBSa,b,c,d, Peter Jacoby, MScc, Paul V. Effler, MD, MPHe, Heath Kelly, MPHf,g, David W. Smith, MBBSd,h, Christine Robinsc, Gabriela A. Willis, MBBSc, Avram Levy, PhDd, Anthony D. Keil, MBBSd, and Peter C. Richmond, MBBSa,b,c
on behalf of the WAIVE Study Team
Author Affiliations
aSchool of Paediatrics and Child Health and
hSchool of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia;
bPrincess Margaret Hospital for Children, Perth, Australia;
cTelethon Institute of Child Health Research, West Perth, Australia;
dPathWest Laboratory Medicine, Nedlands, Australia;
eCommunicable Disease Control Directorate, Department of Health, Perth, Australia;
fVictorian Infectious Diseases Reference Laboratory, Melbourne, Australia; and
gAustralian National University, Australian Capital Territory, Australia
Abstract
BACKGROUND: There are few studies evaluating the effectiveness of trivalent influenza vaccination (TIV) in young children, particularly in children <2 years. The Western Australian Influenza Vaccine Effectiveness Study commenced in 2008 to evaluate a program providing TIV to children aged 6 to 59 months.
METHODS: An observational study enrolling children with influenza-like illness presenting to a tertiary pediatric hospital was conducted (2008–2012). Vaccination status was determined by parental questionnaire and confirmed via the national immunization register and/or vaccine providers. Respiratory virus polymerase chain reaction and culture were performed on nasopharyngeal samples. The test-negative design was used to estimate vaccine effectiveness (VE) by using 2 control groups: all influenza test-negative subjects and other-virus-detected (OVD) subjects. Adjusted odds ratios were estimated from models with season, month of disease onset, age, gender, indigenous status, prematurity, and comorbidities as covariates. Subjects enrolled in 2009 were excluded from VE calculations.
RESULTS: Of 2001 children enrolled, influenza was identified in 389 (20.4%) children. Another respiratory virus was identified in 1134 (59.6%) children. Overall, 295 of 1903 (15.5%) children were fully vaccinated and 161 of 1903 (8.4%) children were partially vaccinated. Vaccine uptake was significantly lower in 2010–2012 after increased febrile adverse events observed in 2010. Using test-negative controls, VE was 64.7% (95% confidence interval [CI]: 33.7%–81.2%). No difference in VE was observed with OVD controls (65.8%; 95% CI: 32.1%–82.8%). The VE for children <2 years was 85.8% (95% CI: 37.9%–96.7%).
CONCLUSIONS: This study reveals the effectiveness of TIV in young children over 4 seasons by using test-negative and OVD controls. TIV was effective in children aged <2 years. Despite demonstrated vaccine effectiveness, uptake of TIV remains suboptimal.

Science
2 May 2014 vol 344, issue 6183, pages 441-548
http://www.sciencemag.org/current.dtl
Policy Forum
Climate Adaptation
Evaluating Flood Resilience Strategies for Coastal Megacities
Jeroen C. J. H. Aerts1,*, W. J. Wouter Botzen1, Kerry Emanuel2, Ning Lin3, Hans de Moel1,
Erwann O. Michel-Kerjan4,*
Author Affiliations
1Institute for Environmental Studies, VU University, 1081HV, Amsterdam, Netherlands.
2Department of Earth, Atmospheric, and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
3Department of Civil and Environmental Engineering, Princeton University, Princeton, NJ 08544, USA.
4Center for Risk Management and Operations and Information Management Department, The Wharton School of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Recent flood disasters in the United States (2005, 2008, 2012); the Philippines (2012, 2013); and Britain (2014) illustrate how vulnerable coastal cities are to storm surge flooding (1). Floods caused the largest portion of insured losses among all catastrophes around the world in 2013 (2). Population density in flood-prone coastal zones and megacities is expected to grow by 25% by 2050; projected climate change and sea level rise may further increase the frequency and/or severity of large-scale floods (3–7).

Social Science & Medicine
Volume 110, Pages 1-96 (June 2014)
http://www.sciencedirect.com/science/journal/02779536/110
A qualitative exploration of access to urban migrant healthcare in Nairobi, Kenya
Original Research Article
Pages 1-9
Christine Arnold, Jason Theede, Anita Gagnon
Abstract
In recent years, Kenya’s capital city Nairobi has experienced an influx of international economic migrants, as well as migrants forced to flee their neighboring countries of origin, or coming from UNHCR-managed refugee camps into the city. Urban migrants regularly face challenges integrating with host communities and consequently face health vulnerabilities. The International Organization for Migration in Kenya was concerned about the potential marginalization of urban migrants from mainstream health programming and a lack of data upon which to base their activities. The purpose of this project was to gain a greater understanding of urban migrants’ barriers to accessing healthcare in Nairobi compared with barriers faced by Kenyans living in the same locations. Guiding our work was a conceptual framework for assessing access to healthcare, which defines availability, geographic accessibility, financial accessibility and acceptability as the four dimensions of access. We identified key informants in collaboration with The National Organisation for Peer Educators, and these individuals assisted in identifying communities within Nairobi where large proportions of migrants reside. Four communities were selected for further study. In each, interviews with government officials and service providers were conducted, and focus group discussions were held with both migrants and Kenyans. Verbatim transcripts were content-analyzed using an open coding technique. Common barriers to accessing care that were shared by migrants and Kenyans included waiting times, drug availability, transportation and cost. Barriers unique to migrants were: threat of harassment; cost discrepancies between migrant and Kenyan clients; real or perceived discrimination; documentation requirements and language barriers. Despite articles from the 2010 Constitution of Kenya that assert the right to health for every person in Kenya, migrants continue to experience unique barriers in accessing healthcare. Efforts to eliminate these barriers should address policy-level interventions, strengthened networks and partnerships, improved migrant-sensitive services and especially continued research in migrant health.

From Google Scholar+ [to 3 May 2014]
Selected content from beyond the journals and sources covered above, aggregated from a range of Google Scholar monitoring algorithms and other monitoring strategies.

Tropical Medicine and Health
[Advance Publication] Released 2014/04/23
Review
Current Trends of Immunization in Nigeria: Prospect and Challenges
Endurance A. Ophori1) 2), Musa Y. Tula1), Azuka V. Azih1), Rachel Okojie1), Precious E. Ikpo1)
1) Department of Microbiology (Immunology unit), Faculty of Life Sciences, University of Benin 2) Present address: Novena University
doi: 10.2149/tmh.2013-13
Abstract
Immunization is aimed at the prevention of infectious diseases. In Nigeria, the National Programme on Immunization (NPI) suffers recurrent setbacks due to many factors including ethnicity and religious beliefs. Nigeria is made up of 36 states with its federal capital in Abuja. The country is divided into six geo-political zones; north central, north west, north east, south east, south west and south south. The population is unevenly distributed across the country. The average population density in 2006 was estimated at 150 people per square kilometres with Lagos, Anambra, Imo, Abia, and Akwa Ibom being the most densely populated states. Most of the densely populated states are found in the south east. Kano with an average density of 442 persons per square kilometre, is the most densely populated state in the northern part of the country. This study presents a review on the current immunization programme and the many challenges affecting its success in the eradication of childhood diseases in Nigeria.

The Journal of Law, Medicine & Ethics
Volume 42, Issue 1, pages 72–87, Spring 2014
http://onlinelibrary.wiley.com/doi/10.1111/jlme.12120/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false
Special Issue: SYMPOSIUM: The Right Not to Know
Nonbinding Legal Instruments in Governance for Global Health: Lessons from the Global AIDS Reporting Mechanism
Allyn Taylor1, Tobias Alfoén2, Daniel Hougendobler3 andKent Buse4
Article first published online: 28 APR 2014
DOI: 10.1111/jlme.12120
Abstract
Recent debate over World Health Organization reform has included unprecedented attention to international lawmaking as a future priority function of the Organization. However, the debate is largely focused on the codification of new binding legal instruments. Drawing upon lessons from the success of the Global AIDS Reporting Mechanism, established pursuant to the United Nations’ Declaration of Commitment on HIV/AIDS, we argue that effective global health governance requires consideration of a broad range of instruments, both binding and nonbinding.
A detailed examination of the Global AIDS Reporting Mechanism reveals that the choice of the nonbinding format makes an important contribution to its effectiveness. For instance, the flexibility and adaptability of the nonbinding format have allowed the global community to: (1) undertake commitments in a timely manner; (2) adapt and experiment in the face of a dynamic pandemic; and (3) grant civil society an unparalleled role in monitoring and reporting on state implementation of global commitments. UNAIDS’ institutional support has also played a vital role in ensuring the continuing effectiveness of the Global AIDS Reporting Mechanism. Overall, the experience of the Global AIDS Reporting Mechanism evidences that, at times, nimbler nonbinding instruments can offer benefits over slower, more rigid binding legal approaches to governance, but depend critically, like all instruments, on the perceived legitimacy thereof.

Disaster Prevention and Management
Volume 23 issue 3 – Current Issue
http://www.emeraldinsight.com/journals.htm?issn=0965-3562&volume=23&issue=3
Qualitative research can improve understandings about disaster preparedness for independent older adults in the community
Robyn Tuohy, (Massey University), Christine Stephens, (Massey University), David Johnston, (Massey University)
Abstract
Purpose – Improving older adults’ preparedness for and response to natural disasters has become an important issue. Population ageing, together with concerns about increasing extreme weather related events, has added further impetus to the need to reduce older adults’ vulnerability to disasters.
Design/methodology/approach – Social and environmental influences on community dwelling independent older adults have not been accounted for in models of hazard adjustment, which have invariably used quantitative research methods.
Findings – To date much of the preparedness and response research has focused on organisational responses to preparedness, while perspectives from older adults have received less attention. Furthermore social and environmental influences on community dwelling independent older adults have not been accounted for in models of hazard adjustment, which have invariably used quantitative research methods.
Originality/value – Extending research to include qualitative methodologies, which recognises older adults as active participants in research about themselves, would contribute to increasing understandings about influences on disaster preparedness and response; and inform social policies and prevention programmes.

Research on Social Work Practice (RSWP)
March 2014; 24 (2)
http://rsw.sagepub.com/content/current
Haiti and the Earthquake Examining the Experience of Psychological Stress and Trauma
Ed Risler1, Sara Kintzle1, Larry Nackerud1
1School of Social Work, The University of Georgia, Athens, GA, USA
Abstract
For approximately 35 seconds on January 10, 2010, an earthquake measuring 7.0 on the Richter scale struck the small Caribbean nation of Haiti. This research used a preexperimental one-shot posttest to examine the incidence of posttraumatic stress disorder (PTSD) and associated trauma symptomatology from the earthquake experienced by a sample of adult Haitians who were living in temporary shelters located in “tent cities” in Port-au-Prince and a comparative group of displaced individuals who left the capital city and took up residence in the northern rural town of Terrier Rouge. Sixty-five (N-65) participants completed the Impact of Events Scale–Revised (IES-R) to assess the severity of trauma symptomology in the study groups. Data presented are comparisons between the groups on total IES-R scores and the measure subscales for intrusion, avoidance, and hyperarousal. Based on the scores on the measure for the comparison groups 4 months after the earthquake, the findings suggests that all participants in the study exceeded the threshold of an acute stress disorder and most likely experienced PTSD. Implications of using the data in future longitudinal studies on trauma in Haiti are also discussed.

International Journal of Mass Emergencies & Disasters
Mar 2014, Vol. 32 Issue 1, p220-240. 21p.
Fifteen Years of Disaster Volunteers in Japan: A Longitudinal Fieldwork Assessment of a Disaster Non-Profit Organization.
Atsumi, Tomohide; Goltz, James D.
Abstract:
Since the 1995 Great Hanshin-Awaji (Kobe) Earthquake, Japanese society has become accustomed to the presence of volunteers in the pre- and post-disaster environments, more specifically, in preparedness, response and recovery. The present study draws on the disaster research literature in exploring the social contexts in which groups of Kobe earthquake volunteers converged in January 1995 and formed organizations that continued to respond to national and international disasters during the 15 years that followed the 1995 earthquake. Based on the first author’s own longitudinal participant observation at a non-profit organization, the Nippon Volunteer Network Active in Disaster (NVNAD), the present study traces the development of the NVNAD over the last 15 years. The study’s basic conclusion is that, over the years, organized volunteerism in Japan has witnessed a struggle between the development of formal organizations emphasizing interagency cooperation and coordination of volunteers on one hand and the maintenance of a more affective social support-oriented approach with volunteers being physically and emotionally present to disaster survivors on the other.

International Journal of Environmental Research and Public Health
2014, 11(5), 4607-4618
doi:10.3390/ijerph110504607
Behavioural Change, Indoor Air Pollution and Child Respiratory Health in Developing Countries: A Review
Review
Brendon R. Barnes
Received: 8 December 2013; in revised form: 31 March 2014 / Accepted: 1 April 2014 /
Published: 25 April 2014
Abstract
Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983–2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%–98% in laboratory settings and 31%–94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice.

Weather and Climate Extremes
Available online 24 April 2014
Adapting to Climate Change and Addressing Drought– learning from the Red Cross Red Crescent experiences in the Horn of Africa
Joy C.-Y. Muller,
http://dx.doi.org/10.1016/j.wace.2014.03.009
Abstract
The paper presented here is intended to share lessons learnt from the operations that the International Federation of Red Cross and Red Crescent Societies (IFRC) and its National Societies undertook from 2008 to 2010 in the Horn of Africa related to the adaption to climate change and addressing drought. It acknowledges that to avoid further suffering from drought, not only in Africa (in the Horn and the Sahel region) but also other parts of the world, we need to change the way we invest. The IFRC advocates that for a national drought policy to be effective in its implementation, the policy itself will need to be developed with an integrated approach, a strong linkage to climate change adaptation and disaster risk reduction in a country.