BMC Public Health
(Accessed 31 May 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Correlates of stunting among children in Ghana
Eugene Kofuor Darteh, Evelyn Acquah and Akwasi Kumi-Kyereme
Author Affiliations
BMC Public Health 2014, 14:504 doi:10.1186/1471-2458-14-504
Published: 26 May 2014
Abstract (provisional)
Background
Stunting, is a linear growth retardation, which results from inadequate intake of food over a long period of time that may be worsened by chronic illness. Over a long period of time, inadequate nutrition or its effects could result in stunting. This paper examines the correlates of stunting among children in Ghana using data from the 2008 Ghana Demographic and Health Survey (GDHS).
Methods
The paper uses data from the children recode file of the 2008 Demographic and Health Survey (DHS), a nationally representative cross sectional survey conducted in Ghana. A total of 2379 children under five years who had valid anthropometric data were used for the study. Data on the stunting of children were collected by measuring the height of all children under six years of age. Measuring board produced by Shorr Productions was used to obtain the height of the children. Children under 2 years of age were measured lying down on the board while those above 2 years were measured standing. In the DHS data, a z-score is given for the child’s height relative to the age. Both bi-variate and multi-variate statistics are used to examine the correlates of stunting.
Results
Stunting was common among males than females. Age of child was a significant determinant of stunting with the highest odd of stunting been among children aged 36-47 months. Region was significantly related to stunting. Children from the Eastern Region were more likely to be stunted than children from the Western Region which is the reference group (OR = 1.7 at p < 0.05). Number of children in household was significantly related to stunting. Children in households with 5-8 children were 1.3 times more likely to be stunted compared to those with 1-4 children (p < .05). Mothers age was a significant predictor of stunting with children whose mothers were aged 35-44 years being more likely to be stunted.
Conclusion
Culturally appropriate interventions and policies should be put in place to minimise the effects of the distal, proximal and intermediate factors on stunting among under 5 children in Ghana.

Development in Practice
Volume 24, Issue 2, 2014
http://www.tandfonline.com/toc/cdip20/current
“Perennial issues Around agriculture, rural development and related water management…”

Cultivating “success” and “failure” in policy: participatory irrigation management in Nepal
Manpriet Singh*, Janwillem Liebrand & Deepa Joshi
DOI: 10.1080/09614524.2014.885494
Abstract
Introduced over a decade ago and considered largely successful by irrigation professionals, Irrigation Management Transfer and Participatory Irrigation Management (IMT/PIM) policies were recently reviewed and seen to have resulted in more cases of “failure” than “success”. Primary research on two IMT/PIM projects in Nepal, which were among the few “successes” in the assessment supporting a “failed” PIM, shows how such policy-driven evaluations, when defining success, overlook incongruities between policies, institutions, and the evolving dynamics around class, caste, ethnicity, and gender. Without exploring the dynamics of practice, the process of “cultivating” success and/or failure in evaluations provides little insight on how irrigation management works on the ground.

Social compacts for long-term inclusive economic growth in developing countries
John M. Luiz*
DOI: 10.1080/09614524.2014.885496
pages 234-244
Abstract
The notion of a social compact between government, business, and civil society as a basis for long-term economic development and growth underpins economic models in many industrialised countries. The search for a new social order is pressing in developing countries where high levels of economic growth exposes the growing gaps between those who participate economically and those who are left behind. This creates new interest groups and alliances and sees old social orders collapse. Finding ways to bring about more inclusive development in developing countries through a social compact is the focus of this paper.

Globalization and Health
[Accessed 31 May 2014]
http://www.globalizationandhealth.com/

Research
Scaling up antiretroviral treatment and improving patient retention in care: lessons from Ethiopia, 2005-2013
Yibeltal Assefa, Achamyeleh Alebachew, Meskele Lera, Lut Lynen, Edwin Wouters and Wim Van Damme
Abstract (provisional)
Background
Antiretroviral treatment (ART) was provided to more than nine million people by the end of 2012. Although ART programs in resource-limited settings have expanded treatment, inadequate retention in care has been a challenge. Ethiopia has been scaling up ART and improving retention (defined as continuous engagement of patients in care) in care. We aimed to analyze the ART program in Ethiopia.
Methods
A mix of quantitative and qualitative methods was used. Routine ART program data was used to study ART scale up and patient retention in care. In-depth interviews and focus group discussions were conducted with program managers.
Results
The number of people receiving ART in Ethiopia increased from less than 9,000 in 2005 to more than 439, 000 in 2013. Initially, the public health approach, health system strengthening, community mobilization and provision of care and support services allowed scaling up of ART services. While ART was being scaled up, retention was recognized to be insufficient. To improve retention, a second wave of interventions, related to programmatic, structural, socio-cultural, and patient information systems, have been implemented. Retention rate increased from 77% in 2004/5 to 92% in 2012/13.
Conclusion
Ethiopia has been able to scale up ART and improve retention in care in spite of its limited resources. This has been possible due to interventions by the ART program, supported by health systems strengthening, community-based organizations and the communities themselves. ART programs in resource-limited settings need to put in place similar measures to scale up ART and retain patients in care.

Global Public Health
Volume 9, Issue 5, 2014
http://www.tandfonline.com/toc/rgph20/.Uq0DgeKy-F9#.U4onnCjDU1w

Locating global health in social medicine
Seth M. Holmesab*, Jeremy A. Greenec & Scott D. Stoningtonde
DOI: 10.1080/17441692.2014.897361
pages 475-480
Abstract
Global health’s goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health’s important agendas. This understanding – of global health as global social medicine – can coalesce global health’s unclear identity into a coherent framework effective for addressing the world’s most pressing health issues.

Religious coping among women with obstetric fistula in Tanzania
Melissa H. Watta*, Sarah M. Wilsonab, Mercykutty Josephc, Gileard Masengac, Jessica C. MacFarlanea, Olola Onekoc & Kathleen J. Sikkemaab
DOI: 10.1080/17441692.2014.903988
pages 516-527
Abstract
Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study aimed to examine religious coping among women with obstetric fistulae. Fifty-four women receiving fistula repair at a Tanzanian hospital completed a structured survey. The Brief RCOPE assessed positive and negative religious coping strategies. Analyses included associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). Forty-five women also completed individual in-depth interviews where religion was discussed. Although participants utilised positive religious coping strategies more frequently than negative strategies (p < .001), 76% reported at least one form of negative religious coping. In univariate analysis, negative religious coping was associated with stigma, depression and low social support. In multivariate analysis, only depression remained significant, explaining 42% of the variance in coping. Qualitative data confirmed reliance upon religion to deal with fistula-related distress, and suggested that negative forms of religious coping may be an expression of depressive symptoms. Results suggest that negative religious coping could reflect cognitive distortions and negative emotionality, characteristic of depression. Religious leaders should be engaged to recognise signs of depression and provide appropriate pastoral/spiritual counselling and general psychosocial support for this population.

Generating political priority for newborn survival in three low-income countries
Stephanie L. Smitha*, Jeremy Shiffmanb & Abigail Kazembec
Free access
DOI: 10.1080/17441692.2014.904918
pages 538-554
Abstract
Deaths to babies in their first 28 days of life now account for more than 40% of global under-5 child mortality. High neonatal mortality poses a significant barrier to achieving the child survival Millennium Development Goal. Surmounting the problem requires national-level political commitment, yet only a few nation-states have prioritised this issue. We compare Bolivia, Malawi and Nepal, three low-income countries with high neonatal mortality, with a view to understanding why countries prioritise or neglect the issue. The three have had markedly different trajectories since 2000: attention grew steadily in Nepal, stagnated then grew in Malawi and grew then stagnated in Bolivia. The comparison suggests three implications for proponents seeking to advance attention to neglected health issues in low-income countries: the value of (1) advancing solutions with demonstrated efficacy in low-resource settings, (2) building on existing and emerging national priorities and (3) developing a strong network of domestic and international allies. Such actions help policy communities to weather political storms and take advantage of policy windows.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 31 May 2014]

Scoping Review
Surveillance-response systems: the key to elimination of tropical diseases
Ernest Tambo, Lin Ai, Xia Zhou, Jun-Hu Chen, Wei Hu, Robert Bergquist, Jia-Gang Guo, Jürg Utzinger, Marcel Tanner and Xiao-Nong Zhou
Author Affiliations
Infectious Diseases of Poverty 2014, 3:17 doi:10.1186/2049-9957-3-17
Published: 27 May 2014
Abstract (provisional)
Tropical diseases remain a major cause of morbidity and mortality in developing countries. Although combined health efforts brought about significant improvements over the past 20 years, communities in resource-constrained settings lack the means of strengthening their environment in directions that would provide less favourable conditions for pathogens. Still, the impact of infectious diseases is declining worldwide along with progress made regarding responses to basic health problems and improving health services delivery to the most vulnerable populations. The London Declaration on Neglected Tropical Diseases (NTDs), initiated by the World Health Organization’s NTD roadmap, set out the path towards control and eventual elimination of several tropical diseases by 2020, providing an impetus for local and regional disease elimination programmes. Tropical diseases are often patchy and erratic, and there are differing priorities in resources-limited and endemic countries at various levels of their public health systems. In order to identify and prioritize strategic research on elimination of tropical diseases, the ‘1st Forum on Surveillance-Response System Leading to Tropical Diseases Elimination’ was convened in Shanghai in June 2012. Current strategies and the NTD roadmap were reviewed, followed by discussions on how to identify and critically examine prevailing challenges and opportunities, including inter-sectoral collaboration and approaches for elimination of several infectious, tropical diseases. A priority research agenda within a ‘One Health-One World’ frame of global health was developed, including the establishment of (i) a platform for resource-sharing and effective surveillance-response systems for Asia Pacific and Africa with an initial focus on elimination of lymphatic filariasis, malaria and schistosomiasis; (ii) development of new strategies, tools and approaches, such as improved diagnostics and antimalarial therapies; (iii) rigorous validation of surveillance-response systems; and (iv) designing pilot studies to transfer Chinese experiences of successful surveillance-response systems to endemic countries with limited resources.

JAMA
May 28, 2014, Vol 311, No. 20
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Commitment Devices – Using Initiatives to Change Behavior
Todd Rogers, PhD1; Katherine L. Milkman, PhD2; Kevin G. Volpp, MD, PhD3
Initial text
Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes.1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees’ health-related behaviors. According to one survey, 81% of large employers provide incentives for healthy behavior change.2 In this Viewpoint, we discuss the potential and limitations of an approach that behavioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices…

Journal of Immigrant and Minority Health
Volume 16, Issue 3, June 2014
http://link.springer.com/journal/10903/16/3/page/1

HPV Awareness and Vaccine Acceptability in Hispanic Women Living Along the US-Mexico Border
Jennifer Molokwu Norma P. Fernandez Charmaine Martin
Abstract
Despite advances in prevention of cervical cancer in the US, women of Hispanic origin still bear an unequal burden in cervical cancer incidence, morbidity and mortality. Our objective was to determine the HPV vaccine knowledge and acceptability in a group of mostly Hispanic females. In this cross sectional survey, 62 % of participants heard of HPV; 34.9 % identified HPV as a cause of cervical cancer. 63 % of participants reported willingness to receive vaccine and 77 % were willing to vaccinate daughters. Those with previous abnormal PAPs were more likely to have heard of HPV and Vaccine. No other factors examined showed association with willingness to get vaccine or administer to daughters. Knowledge level remains low in this high risk population. Willingness to receive vaccine is high despite lack of access to care. Increased targeted community based education and vaccination programs may be useful in closing disparity in cervical cancer morbidity.

Journal of Immigrant & Refugee Studies
Volume 12, Issue 2, 2014
http://www.tandfonline.com/toc/wimm20/current#.UyWnvIUWNdc

Special Issue: Irregular Migration in Southern European Islands
Islands and Undesirables: Introduction to the Special Issue on Irregular Migration in Southern European Islands
Nathalie Bernardie-Tahira & Camille Schmollb*
DOI: 10.1080/15562948.2014.899657
pages 87-102
Abstract
This introduction presents the challenges to studying irregular migration in the southern European islands. After presenting the debates surrounding the category of irregular migration and recent developments in irregular migration to southern European islands, we argue that the situation of islands needs to be contextualized within the broader scheme of Euro-Mediterranean irregular migration. We then propose considering islands as remarkable “places of condensation” in the Euro-Mediterranean migratory setting. The article introduces two themes that will be developed throughout the special issue: (1) analyzing and challenging narratives of islandness and (2) policing and bordering the islands.

Nature
Volume 509 Number 7502 pp533-656 29 May 2014
http://www.nature.com/nature/current_issue.html

Global health: Deadly dinners
Polluting biomass stoves, used by one-third of the global population, take a terrible toll. But efforts to clean them up are failing.
Meera Subramanian

New England Journal of Medicine
May 29, 2014 Vol. 370 No. 22
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Embracing Oral Cholera Vaccine — The Shifting Response to Cholera
Jean William Pape, M.D., and Vanessa Rouzier, M.D.
N Engl J Med 2014; 370:2067-2069 May 29, 2014 DOI: 10.1056/NEJMp1402837
Cholera, a rapidly dehydrating diarrheal disease, is caused by ingestion of Vibrio cholerae, serogroup O1 or O139. The World Health Organization (WHO) estimates that 1.4 billion people were at risk for cholera in 2012.1 More than 90% of reported cases occur in Africa, and most of the remainder occur in southern Asia. In 2010, only 10 months after it was hit by a major earthquake, Haiti experienced the most severe cholera epidemic of the past century, with 699,579 cases and 8539 related deaths reported as of February 11, 2014. This was the first time cholera had been documented in Haiti, despite the occurrence of devastating outbreaks in the Caribbean in the 19th century and in Latin America between 1991 and 2001 (see
Cholera is a disease of poverty, linked to poor sanitation and a lack of potable water.

Establishment of an adequate sanitation and potable-water system is the most definitive way to prevent and limit its spread. However, the cost of instituting adequate sanitation systems, one of the United Nations Millennium Development Goals, is prohibitive for the countries that are affected by cholera: it would cost an estimated $2.2 billion, for example, to adequately improve access to water and sanitation in Haiti. Water, sanitation, and hygiene (WASH) practices are the cornerstones of cholera prevention and control. The promotion of WASH practices, the creation of rehydration centers, use of antibiotics, and training of health personnel during the first months of the Haitian epidemic led to a dramatic reduction in cholera-associated mortality, from 4% to 1.5%.2 Yet a survey in the slums of Port-au-Prince showed that although people were aware of hand-washing methods, they did not have soap and water to implement them. What role should oral cholera vaccine (OCV) play, in combination with WASH practices, in epidemic conditions?

The three currently licensed OCVs are formulations of killed V. cholerae cells. Two of them, Dukoral and Shanchol, have been prequalified by the WHO for purchase by United Nations agencies. The third one, mORCVAX, is licensed and produced exclusively in Vietnam. For all three vaccines, there is evidence of safety and efficacy (66 to 85%) after two doses, with inferred herd protection and immunity lasting up to 5 years (in the case of Shanchol). Dukoral includes a cholera toxin B subunit requiring administration with a buffer, and it costs $3.64 to $6.00 per dose. Shanchol does not require a buffer and costs $1.85 per dose. Despite the evidence of safety and efficacy, international agencies cited several reasons for not including OCV in the prevention package during the 2010 Haitian epidemic.2

First, there was a limited number of OCV doses available worldwide. Second, Shanchol, the cheaper and easier-to-administer vaccine, could not be purchased by United Nations agencies until it received WHO approval in 2011. Third, there was concern that OCV implementation would compete with other WASH interventions in countries with fragile health systems.

After sustained lobbying by multiple institutions and organizations, a pilot intervention was initiated in Haiti using OCV with other WASH measures to control the outbreak (“reactive vaccination”). An urban project was conducted by the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), and a rural project was conducted by Partners in Health, both in collaboration with the Haitian Ministry of Health. The outcomes showed that OCV can be effectively employed as part of a comprehensive cholera-control program: 91% of 97,774 participants received two vaccine doses during a 90-day period.3,4

The WHO has since changed its policy and promotes OCV use in outbreaks worldwide.5 During the past 3 years, more than 1.6 million doses of Shanchol have been administered in Asia, Africa, and the Caribbean. A remaining challenge to OCV implementation was the lack of field evidence for its effectiveness early in an epidemic. The matched case–control study in Guinea, reported on by Luquero et al. in this issue of the Journal (pages 2111–2120), clearly illustrates the role OCV can play in countering cholera epidemics, with greater than 86% protection after administration of two doses.

Although the global stockpile of Shanchol is growing — the WHO has 2 million doses, and the Global Alliance for Vaccines and Immunization (GAVI) has pledged support for 20 million doses over the next 5 years — the world will need millions more doses. Moreover, many questions remain. For instance, how should priorities be set for use of the stockpile when there are multiple simultaneous epidemics (requiring reactive vaccination), other high-risk situations (e.g., encampments of refugees who could benefit from preemptive vaccination), and regions where cholera is endemic and peaks in incidence are expected during the rainy season? Risk evaluation and cost-effectiveness will certainly be important considerations.

In addition, because of their study’s small sample size, Luquero et al. could not test the efficacy of one versus two doses of OCV. A one-dose regimen would reduce the cost and logistic constraints for national scale-up programs. A collaborative double-blind, placebo-controlled study that the International Vaccine Institute and the International Center for Diarrheal Disease Research, Bangladesh, are conducting in Dhaka may provide this information.

Another question is whether OCV can be stored at room temperature so that the cold-chain requirement can be bypassed. In the study by Luquero et al., the vaccine was refrigerated during storage, but the cold chain was not maintained in the field. It will be important to determine how long the vaccine can retain its efficacy at room temperature.

Furthermore, can Shanchol be used in pregnancy and in children younger than 1 year of age? Although WHO recommendations suggest targeting pregnant women at high risk for cholera, the manufacturer has not approved use of the vaccine in pregnancy, and there are no guidelines for children under 1 year old.

Since 2010, some major obstacles preventing the use of OCV have been overcome. Shanchol, the cheapest and easiest-to-administer vaccine, is being stockpiled. OCV has been used in 13 countries on three continents (Asia, Africa, and the North American Caribbean) and in three risk settings. The study by Luquero et al. provides further evidence in favor of using OCV in emerging outbreaks.

Original Article
Use of Vibrio cholerae Vaccine in an Outbreak in Guinea
Francisco J. Luquero, M.D., M.P.H., Lise Grout, D.V.M., M.P.H., Iza Ciglenecki, M.D., Keita Sakoba, M.D., Bala Traore, M.D., Melat Heile, N.P., Alpha Amadou Diallo, M.Sc., Christian Itama, M.D., Anne-Laure Page, Ph.D., Marie-Laure Quilici, Ph.D., Martin A. Mengel, M.D., Jose Maria Eiros, M.D., Ph.D., Micaela Serafini, M.D., M.P.H., Dominique Legros, M.D., M.P.H., and Rebecca F. Grais, Ph.D.
N Engl J Med 2014; 370:2111-2120 May 29, 2014 DOI: 10.1056/NEJMoa1312680
Abstract
The use of vaccines to prevent and control cholera is currently under debate. Shanchol is one of the two oral cholera vaccines prequalified by the World Health Organization; however, its effectiveness under field conditions and the protection it confers in the first months after administration remain unknown. The main objective of this study was to estimate the short-term effectiveness of two doses of Shanchol used as a part of the integrated response to a cholera outbreak in Africa.
Full Text of Background…
Methods
We conducted a matched case–control study in Guinea between May 20 and October 19, 2012. Suspected cholera cases were confirmed by means of a rapid test, and controls were selected among neighbors of the same age and sex as the case patients. The odds of vaccination were compared between case patients and controls in bivariate and adjusted conditional logistic-regression models. Vaccine effectiveness was calculated as (1−odds ratio)×100.
Full Text of Methods…
Results
Between June 8 and October 19, 2012, we enrolled 40 case patients and 160 controls in the study for the primary analysis. After adjustment for potentially confounding variables, vaccination with two complete doses was associated with significant protection against cholera (effectiveness, 86.6%; 95% confidence interval, 56.7 to 95.8; P=0.001).
Full Text of Results…
Conclusions
In this study, Shanchol was effective when used in response to a cholera outbreak in Guinea. This study provides evidence supporting the addition of vaccination as part of the response to an outbreak. It also supports the ongoing efforts to establish a cholera vaccine stockpile for emergency use, which would enhance outbreak prevention and control strategies. (Funded by Médecins sans Frontières.)
Full Text of Discussion…
Read the Full Article…

PLoS One
[Accessed 31 May 2014]
http://www.plosone.org/

Research Article
Identifying the Science and Technology Dimensions of Emerging Public Policy Issues through Horizon Scanning
Miles Parker mail, Andrew Acland, Harry J. Armstrong, Jim R. Bellingham, Jessica Bland, Helen C. Bodmer, Simon Burall, Sarah Castell, Jason Chilvers, David D. Cleevely, David Cope, Lucia Costanzo, James A. Dolan, [ … ], William J. Sutherland , [ view all ]
Abstract
Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 31 May 2014)

Editorial
The Role of Open Access in Reducing Waste in Medical Research
Paul Glasziou mail
Published: May 27, 2014
DOI: 10.1371/journal.pmed.1001651
[Full text]
Twenty years ago an editorial by Doug Altman in the BMJ [1], “The Scandal of Poor Medical Research”, decried the poor design and reporting of research, stating that “huge sums of money are spent annually on research that is seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation”. Since then, change has been gradual, while the list of problems has lengthened, and documentation of their magnitude has accumulated. Recent years, however, have seen a crescendo of concern. Public awareness has been accelerated with the publication of Ben Goldacre’s Bad Pharma [2], which clearly articulated the problems posed by biased non-publication and reporting of pharmaceutical research. Wider awareness of these issues helped spark the AllTrials campaign (http://www.alltrials.net/), which asks for “all trials registered; all results reported”. Of course, the problems of poor design and reporting, as well as selective non-publication, extend well beyond drug trials to most areas of research: drug and non-drug, basic and applied, interventional and observational, animal and human. A 2009 paper in The Lancet [3] estimated that three problems—flawed design, non-publication, and poor reporting—together meant over 85% of research funds were wasted, implying a global total loss of over US$100 billion per year. This year, a follow-up series [4] more extensively documented this wastage, confirming the earlier estimate, but adding details and a series of more explicit recommendations for action.

The waste sounds bad, but the reality is worse. The estimate that 85% of research is wasted referred only to activities prior to the point of publication. Much waste clearly occurs after publication: from poor access, poor dissemination, and poor uptake of the findings of research. The development of open access to research [5] is important to reduce this post-publication waste. Poor access—including paywalls, restrictions on re-publication and re-use, etc.—limits both researcher-to-researcher and researcher-to-clinician communications. As PLOS Medicine editorial leaders pointed out in a PubMed Commons response to the Lancet series [6], open access is more than free access and includes “free, immediate access online; unrestricted distribution and re-use rights in perpetuity for humans and technological applications; author(s) retains rights to attribution; papers are immediately deposited in a public online archive, such as PubMed Central” [7]. Globally, the most important access problem is arguably due to language barriers, and with the growth of research in non-English-speaking countries, particularly China, this problem is likely to grow. Language barriers make even free-access research unusable, but by eliminating restrictions on re-publication and re-use, open access can at least reduce barriers to translation.

Solving the problems of pre-publication waste and post-publication access could hugely accelerate medical research. Even the complete solution of these problems, however, would be insufficient to close the research–practice gap. Paradoxically, the plethora of research is itself a barrier to its use. A recent analysis of trials and reviews by specialty found an unmanageable scatter of research [8]. For example, in neurology the annual output was 2,770 trials across 896 journals, and 547 systematic reviews across 292 journals. So, in addition to access, clever systems of synthesis, filtering, findability, and usability are needed if the users of research are to cope with this information deluge [9]. The enormous marketing budgets of pharmaceutical companies demonstrate the importance they place on investing resources in getting the message of their research to decision makers. Unfortunately, little such investment is made in non-commercial research, and this research is consequently neglected. This concern has led to the development of different approaches given names such as “evidence-based medicine”, “knowledge translation”, and “implementation science”.

To get full value from research investment, we need to reduce both the annual US$100 billion of pre-publication (research production) waste and the unquantified cost of post-publication (research dissemination) barriers (Figure 1). Open access will not in itself fix the problems of poor research question selection, poor study design, selective non-publication, or poor or biased reporting, but these can be ameliorated considerably through appropriate editorial policies and peer review processes. Open-access medical journals must maintain particularly high standards for these processes in order to avoid merely increasing access to a biased selection of (often flawed) research. At the same time, improving research quality but keeping access restricted would mean continued waste in the use and uptake of good science.

“As the system encourages poor research,” wrote Altman in 1994 [1], “it is the system that should be changed. We need less research, better research, and research done for the right reasons.” To that must be added a need for research that is communicated effectively to those who need it. If over a 100 billion dollars of medical research money were being wasted by corruption, the public and political outcry would be overwhelming. That resources of this magnitude are being wasted through incompetence and inattention should be seen as a similar scandal. Badly designed and poorly thought through systems of research and dissemination subtract massively from global human health: they demand attention—and action.
References
1. Altman DG (1994) The scandal of poor medical research. BMJ 308: 283.
View Article
PubMed/NCBI
Google Scholar
2. Goldacre B (2012) Bad pharma: how drug companies mislead doctors and harm patients. London: Fourth Estate.
3. Chalmers I, Glasziou P (2009) Avoidable waste in the production and reporting of research evidence. Lancet 374: 86–89 Accessed 23 April 2014.
View Article
PubMed/NCBI
Google Scholar
4. Macleod MR, Michie S, Roberts I, Dirnagl U, Chalmers I, et al. (2014) Biomedical research: increasing value, reducing waste. Lancet 6736: 1–6.
View Article
PubMed/NCBI
Google Scholar
5. Joseph H (2013) The open access movement grows up: taking stock of a revolution. PLoS Biol 11: e1001686 Accessed 23 April 2014.
View Article
PubMed/NCBI
Google Scholar
6. Glasziou P, Altman DG, Bossuyt P, Boutron I, Clarke M, et al. (2014) Research: increasing value, reducing waste 5 Reducing waste from incomplete or unusable reports of biomedical research. Lancet 383: 267–276.
View Article
PubMed/NCBI
Google Scholar
7. Barbour V, Peiperl L (2014) Comment on PMID 24411647: Reducing waste from incomplete or unusable reports of biomedical research. PubMed Commons. Accessed 28 April 2014.
View Article
PubMed/NCBI
Google Scholar
8. Hoffmann T, Erueti C, Thorning S, Glasziou P (2012) The scatter of research: cross sectional comparison of randomised trials and systematic reviews across specialties. BMJ 3223: 1–9 doi:10.1136/bmj.e3223.
View Article
PubMed/NCBI
Google Scholar
9. Glasziou P, Haynes RB (2005) The paths from research to improved health outcomes. Evid Based Med 10: 4–7.
View Article
PubMed/NCBI
Google Scholar

PLoS Neglected Tropical Diseases
May 2014
http://www.plosntds.org/article/browseIssue.action

Editorial
Ten Global “Hotspots” for the Neglected Tropical Diseases
Peter J. Hotez mail
Published: May 29, 2014
DOI: 10.1371/journal.pntd.0002496
Initial text
Since the founding of PLOS Neglected Tropical Diseases more than six years ago, I have written about the interface between disease and geopolitics. The neglected tropical diseases (NTDs) are the world’s most common infections of people living in poverty [1]. Where they are widespread in affected communities and nations, NTDs can be highly destabilizing and ultimately may promote conflict and affect international and foreign policy [2]. Many of the published papers in this area were recently re-organized in a PLOS “Geopolitics of Neglected Tropical Diseases” collection that was posted on our website in the fall of 2012, coinciding with the start of our sixth anniversary [3]. From this information, a number of new and interesting findings emerged about the populations who are most vulnerable to the NTDs, including the extreme poor who live in the large, middle-income countries and even some wealthy countries (such as the United States) that comprise the Group of Twenty (G20) countries [4], as well as selected Aboriginal populations [5]. Together, the PLOS “Geopolitics of Neglected Tropical Diseases” collection and the G20 analyses identified more than a dozen areas of the world that repeatedly show up as ones where NTDs disproportionately affect the poorest people living at the margins. Here, I summarize what I view as ten of the worst global “hotspots” where NTDs predominate (Figure 1). They represent regions of the world that will require special emphasis for NTD control and elimination if we still aspire to meet Millennium Development Goals (MDGs) and targets by 2015; they are regions that may need to be highlighted again as we consider post-MDG aspirations and new Sustainable Development Goals (SDGs).

Viewpoints
The Gulf Coast: A New American Underbelly of Tropical Diseases and Poverty
Peter J. Hotez, Kristy O. Murray, Pierre Buekens
PLOS Neglected Tropical Diseases: published 15 May 2014 | info:doi/10.1371/journal.pntd.0002760

From Haiti to the Amazon: Public Health Issues Related to the Recent Immigration of Haitians to Brazil
Tom Rawlinson, André Machado Siqueira, Gilberto Fontes, Renata Paula Lima Beltrão, Wuelton Marcelo Monteiro, Marilaine Martins, Edson Fidelis Silva-Júnior, Maria Paula Gomes Mourão, Bernardino Albuquerque, Maria das Graças Costa Alecrim, Marcus Vinícius Guimarães Lacerda
PLOS Neglected Tropical Diseases: published 08 May 2014 | info:doi/10.1371/journal.pntd.0002685

Building Endogenous Capacity for the Management of Neglected Tropical Diseases in Africa: The Pioneering Role of ICIPE
Daniel K. Masiga, Lilian Igweta, Rajinder Saini, James P. Ochieng’-Odero, Christian Borgemeister
PLOS Neglected Tropical Diseases: published 15 May 2014 | info:doi/10.1371/journal.pntd.0002687

Refugee Survey Quarterly
Volume 33 Issue 2 June 2014
http://rsq.oxfordjournals.org/content/current

Despair as a Governing Strategy: Australia and the Offshore Processing of Asylum-Seekers on Nauru
Caroline Fleay and Sue Hoffman*
Abstract
As part of its efforts to deter the arrival of asylum-seekers by boat to Australia in 2001, Prime Minister John Howard’s Coalition Government established the offshore processing of refugee claims. Known as the Pacific Solution, this policy included an agreement with Nauru and Papua New Guinea’s Manus Island for asylum-seekers arriving to Australia by boat to be transported to either of these islands where they would wait in camps while their refugee claims were processed. The majority of the asylum-seekers subjected to offshore processing at this time were held on Nauru, and most had fled Afghanistan. Governmentality, as introduced by Michel Foucault and developed by later scholars, provides insight into the institutions, methods, techniques, strategies, and tactics used by governments to achieve its ends. This article explores Australian Government policy and the experience of Afghan asylum-seekers held on Nauru from 2001 using a governmentality approach. Given that people seeking asylum in Australia are once again being transported to Nauru and Papua New Guinea, this time initiated by a Labor Government and continued by the current Coalition Government, this article’s findings are pertinent for insight into understanding current Australian policy.

From Google Scholar+ [to 31 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.

The Lancet Oncology
Volume 15, Issue 7, June 2014, Pages e290–e297
http://www.sciencedirect.com/science/journal/14702045/15/7
Policy Review
Cancer in refugees in Jordan and Syria between 2009 and 2012: challenges and the way forward in humanitarian emergencies
Paul Spiegel, MDa, Adam Khalifa, MDb, Farrah J Mateen, MDc, d
Summary
Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses.

.

SPIE Proceedings | Volume 9118
Independent Component Analyses, Compressive Sampling, Wavelets, Neural Net, Biosystems, and Nanoengineering XII, 91180B
(May 22, 2014); doi:10.1117/12.2051420Volume 9118
Proceedings Article
3D printed rapid disaster response
Alberto Lacaze ; Karl Murphy ; Edward Mottern ; Katrina Corley ; Kai-Dee Chu
[+] Author Affiliations
Abstract
Under the Department of Homeland Security-sponsored Sensor-smart Affordable Autonomous Robotic Platforms (SAARP) project, Robotic Research, LLC is developing an affordable and adaptable method to provide disaster response robots developed with 3D printer technology. The SAARP Store contains a library of robots, a developer storefront, and a user storefront. The SAARP Store allows the user to select, print, assemble, and operate the robot. In addition to the SAARP Store, two platforms are currently being developed. They use a set of common non-printed components that will allow the later design of other platforms that share non-printed components. During disasters, new challenges are faced that require customized tools or platforms. Instead of prebuilt and prepositioned supplies, a library of validated robots will be catalogued to satisfy various challenges at the scene. 3D printing components will allow these customized tools to be deployed in a fraction of the time that would normally be required. While the current system is focused on supporting disaster response personnel, this system will be expandable to a range of customers, including domestic law enforcement, the armed services, universities, and research facilities.