Global Fund Watch [to 29 November 2014]

Global Fund Watch [to 29 November 2014]
:: Global Fund Calls for End to Compulsory Treatment
26 November 2014
The Global Fund called for the closure of compulsory treatment programs to change sexual orientation, compulsory rehabilitation of sex workers and compulsory drug detention centers. The Global Fund committed not to finance programs in such facilities.

The Strategy, Investment and Impact Committee of the Global Fund Board reported to a meeting of the full Board on 20-21 November that under a new policy the Global Fund explicitly refuses to fund programs with compulsory treatment.

The Global Fund is committed to ensuring that programs it supports do not infringe upon human rights. The United Nations Special Rapporteur on the Right to Health and other UN experts have found that these programs frequently include torture, cruel, inhuman and degrading treatment, as well as forced labor, among other abuses. Twelve UN agencies have called for the closure of compulsory drug detention and rehabilitation programs.

“The evidence is overwhelming that compulsory treatment facilities for sex workers and drug users, and programs that seek to change sexual orientation, are not scientifically valid and undermine the fight against HIV, TB and malaria,” said Mark Dybul, Executive Director of the Global Fund. “Trust is essential in the relationship between health workers and patients. The fear of compulsory treatment drives people underground and makes it harder to reach them.”

While opposing compulsory treatment facilities, the Global Fund may in exceptional circumstances finance scientifically sound medical services to save lives, where there are heightened processes and scrutiny. For instance, to provide lifesaving treatment to people detained in a compulsory treatment facility, the Global Fund may fund health services for detainees in a voluntary, community-based treatment program located outside the detention facility. Exceptions would be determined based on consultation with UN partners.

:: Global Fund Analysis of Audits and Investigations
25 November 2014
At the 32nd Board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, held 20-21 November, the Board was informed of an analysis of audits and investigations, reaffirming a policy of zero tolerance for corruption and a commitment to a high degree of transparency. The Global Fund reports all cases of misused funds, publishing audits and investigations reports on its website.

The analysis found that 1.8 percent of funding that was audited or investigated from 2005-2014 was misspent, fraudulently misappropriated or inadequately accounted for. The Global Fund has recovered a key portion of those funds, and is actively pursuing the remaining amount…

…Of the 1.8 percent of funds that were detected as misused, 0.4 percent were lost to fraud, 0.7 percent were unsupported by proper accounting, and 0.6 percent were deemed ineligible, or spent on activities not covered by the grant agreements. A further 0.1 percent were not adequately reported.

Cees Klumper, Chief Risk Officer, reported to the Board that the analysis is a factual rendering of the percentages of funding revealed in audits and investigations to be ineligible, misappropriated or inadequately accounted for. He cautioned that the analysis did not reflect a representative sampling of all Global Fund grants, as audits and investigations tend to focus where specific risks have been identified.

The analysis shows that US$103 million were misused and recoverable by the Global Fund, equivalent to 1.8 percent of US$5.7 billion in grants that were audited or investigated. US$30.4 million has already been recovered. Written commitments to repay a further US$16.8 million have been received and US$1 million has been adjusted. Efforts are being pursued to recover the remaining amount….

Foundation/Major Donor Watch [to 29 November 2014]

:: Foundation/Major Donor Watch
We will monitor media releases announcing key initiatives and new research from a growing number of global foundations and donors engaged in the human rights, humanitarian response and development spheres of action. This Watch section is not intended to be exhaustive, but indicative.
.

Kellogg Foundation
http://www.wkkf.org/news-and-media#pp=10&p=1&f1=news
Nov. 24, 2014
Statement on Ferguson: Our nation must reject violence, strive toward racial equity, and embrace the common good in all
.

MacArthur Foundation
http://www.macfound.org/
Publication
Evaluation of the Digital Media & Learning Competition
Published November 26, 2014

Increasing availability and accessibility of digital media have changed the ways in which young people learn, socialize, play, and engage in civic life. Seeking to understand how learning environments and institutions should transform to respond to these changes, the MacArthur Foundation (the Foundation) launched the Digital Media and Learning (DML) Initiative in 2005. The DML Competition (the Competition), one component of the DML Initiative, identifies innovators and invests in prototypes of games, mobile phone applications, virtual worlds, social networks, digital badge platforms, and more in support of connected learning. The Competition completed four cycles between 2007 and 2014, awarding over $10 million to individuals, universities, for-profit organizations, and nonprofit organizations within and outside the United States.

In 2013, the Foundation engaged Informing Change to evaluate the DML Competition, assessing the Competition’s goals, processes, and impacts on awardees, awarded projects, the DML landscape, and the Foundation. Along with site visits and a review of relevant Competition and grantee documents, the mixed-methods evaluation incorporated interview and survey data collected from Foundation staff, HASTAC (Humanities, Arts, Science, and Technology Alliance and Collaboratory) staff who implement the Competition, Competition awardees and finalists, and key field leaders…

American Journal of Infection Control [December 2014]

American Journal of Infection Control
Volume 42, Issue 12, p1255-1346 December 2014
http://www.ajicjournal.org/current

Commentary
Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste
John J. Lowe, Shawn G. Gibbs, Shelly S. Schwedhelm, John Nguyen, Philip W. Smith
p1256–1257
Preview
Clinical practices surrounding the current Ebola epidemic have been center stage in discourse concerning research and practice of care. As the medical community becomes more sophisticated in understanding the many facets of treating and containing this virus, the Nebraska Biocontainment Unit has identified Ebola medical waste disposal as a key area of concern for U.S. hospitals. The requirements for processing Ebola medical waste stand to impact most U.S. hospitals currently preparing readiness plans to receive and treat patients with suspected or confirmed Ebola virus disease (EVD).

Middle East respiratory syndrome coronavirus infection control: The missing piece?
Ziad A. Memish, Jaffar A. Al-Tawfiq
p1258–1260
Preview
Since the initial occurrence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012,1,2 the disease had caused 837 cases, with a case fatality rate of 34.7%.3 As with any emerging infectious diseases of pandemic potential there is a concern of the global spread of the disease. It is therefore the first priority of the global public health community to develop and implement the required infection control practices to prevent the dissemination of these emerging organisms within health care facilities (HCFs) and worldwide based on the best available evidence and previous experience with similar or related groups of pathogens.

Middle East respiratory syndrome coronavirus: Implications for health care facilities
Helena C. Maltezou, MD, PhD, Sotirios Tsiodras, MD, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2014.06.019
Highlights
:: Health care–associated transmission plays a pivotal role in the Middle East respiratory syndrome coronavirus epidemic.
:: Gaps in infection control were noted in all health care–associated events.
:: There is a need to increase infection control capacity.
:: Studies about the effectiveness of infection control measures are needed.
:: Vaccines and antiviral agents against Middle East respiratory syndrome coronavirus are urgently needed.
Abstract
Background
Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.
Methods
Review of publicly available data about MERS-CoV health care–associated transmission.
Results
We identified 11 events of possible or confirmed health care–associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care–associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.
Conclusion
There is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed.

Environmental sampling for respiratory pathogens in Jeddah airport during the 2013 Hajj season
Ziad A. Memish, MD, Malak Almasri, RN, Abdullah Assirri, MD, Ali M. Al-Shangiti, PhD, Gregory C. Gray, MD, John A. Lednicky, PhD, Saber Yezli, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2014.07.027
Abstract
Background
Respiratory tract infections (RTIs) are common during the Hajj season and are caused by a variety of organisms, which can be transmitted via the air or contaminated surfaces. We conducted a study aimed at sampling the environment in the King Abdul Aziz International (KAAI) Airport, Pilgrims City, Jeddah, during Hajj season to detect respiratory pathogens.
Methods
Active air sampling was conducted using air biosamplers, and swabs were used to sample frequently touched surfaces. A respiratory multiplex array was used to detect bacterial and viral respiratory pathogens.
Results
Of the 58 environmental samples, 8 were positive for at least 1 pathogen. One air sample (1 of 18 samples, 5.5%) tested positive for influenza B virus. Of the 40 surface samples, 7 (17.5%) were positive for pathogens. These were human adenovirus (3 out of 7, 42.8%), human coronavirus OC43/HKU1 (3 out of 7, 42.8%), Haemophilus influenzae (1 out of 7, 14.2%), and Moraxella catarrhalis (1 out of 7, 14.2%). Chair handles were the most commonly contaminated surfaces. The handles of 1 chair were cocontaminated with coronavirus OC43/HKU1 and H influenzae.
Conclusion
Respiratory pathogens were detected in the air and on surfaces in the KAAI Airport in Pilgrims City. Larger-scale studies based on our study are warranted to determine the role of the environment in transmission of respiratory pathogens during mass gathering events (eg, Hajj) such that public health preventative measures might be better targeted.

Adult Vaccination Disparities Among Foreign-Born Populations in the U.S., 2012

American Journal of Preventive Medicine
Volume 47, Issue 6, p689-852, e11-e14 December 2014
http://www.ajpmonline.org/current

Adult Vaccination Disparities Among Foreign-Born Populations in the U.S., 2012
Peng-jun Lu, MD, PhD, Alfonso Rodriguez-Lainz, PhD, DVM, MPVM, Alissa O’Halloran, MSPH, Stacie Greby, DVM, Walter W. Williams, MD, MPH
Published Online: October 06, 2014
DOI: http://dx.doi.org/10.1016/j.amepre.2014.08.009
Abstract
Background
Foreign-born persons are considered at higher risk of undervaccination and exposure to many vaccine-preventable diseases. Information on vaccination coverage among foreign-born populations is limited.
Purpose
To assess adult vaccination coverage disparities among foreign-born populations in the U.S.
Methods
Data from the 2012 National Health Interview Survey were analyzed in 2013. For non-influenza vaccines, the weighted proportion vaccinated was calculated. For influenza vaccination, Kaplan–Meier survival analysis was used to assess coverage among individuals interviewed during September 2011–June 2012 and vaccinated in August 2011–May 2012.
Results
Overall, unadjusted vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents: influenza, age ≥18 years (40.4% vs 33.8%); pneumococcal polysaccharide vaccine (PPV), 18–64 years with high-risk conditions (20.8% vs 13.7%); PPV, ≥65 years (62.6% vs 40.5%); tetanus vaccination, ≥18 years (65.0% vs 50.6%); tetanus, diphtheria, and acellular pertussis (Tdap), ≥18 years (15.5% vs 9.3%); hepatitis B, 18–49 years (37.2% vs 28.4%); shingles, ≥60 years (21.3% vs 12.0%); and human papilloma virus (HPV), women 18–26 years (38.7% vs 14.7%). Among the foreign born, vaccination coverage was generally lower for non-U.S. citizens, recent immigrants, and those interviewed in a language other than English. Foreign-born individuals were less likely than U.S.-born people to be vaccinated for pneumococcal (≥65 years), tetanus, Tdap, and HPV (women) after adjusting for confounders.
Conclusions
Vaccination coverage is lower among foreign-born adults than those born in the U.S. It is important to consider foreign birth and immigration status when assessing vaccination disparities and planning interventions.

BMC Public Health (Accessed 29 November 2014)

BMC Public Health
(Accessed 29 November 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model
Jorge Alberto Gomez, Alejandro Lepetic and Nadia Demarteau
Author Affiliations
BMC Public Health 2014, 14:1222 doi:10.1186/1471-2458-14-1222
Published: 26 November 2014
Abstract (provisional)
Background
In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination.
Methods
The present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile.
Results
Projected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively.
Conclusions
The findings indicate that the addition of any HPV vaccine to the current cervical screening program of Chile will be advantageous. However, this cost-effectiveness model shows that the HPV-16/18 AS04-adjuvanted vaccine dominated the HPV-6/11/16/18 vaccine. Beyond the context of Chile, the data from this modelling exercise may support healthcare policy and decision-making pertaining to introduction of HPV vaccination in similar resource settings in the region.

Research article
The evolution of health literacy assessment tools: a systematic review
Sibel Vildan Altin, Isabelle Finke, Sibylle Kautz-Freimuth and Stephanie Stock
Author Affiliations
BMC Public Health 2014, 14:1207 doi:10.1186/1471-2458-14-1207
Published: 24 November 2014
Abstract (provisional)
Background
Health literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument.
Methods
We performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE.
Results
We identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline.
Conclusions
Scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear “consensus” on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.

Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews

British Medical Journal
29 November 2014(vol 349, issue 7985)
http://www.bmj.com/content/349/7985

Research
Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6501 (Published 21 November 2014) Cite this as: BMJ 2014;349:g6501
Pooja Saini, research associate1, Yoon K Loke, professor2, Carrol Gamble, professor3, Douglas G Altman, professor4, Paula R Williamson, professor3, Jamie J Kirkham, lecturer3
Abstract
Objective
To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews.
Design
Cohort study of systematic reviews from two databases.
Setting
Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events.
Participants 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort).
Methods
A 13 point classification system for missing outcome data on harm was developed and applied to the studies.
Results
86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393).
Conclusions
The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews.

Evaluating the use of locally-based health facility assessments in Afghanistan: a pilot study of a novel research method

Conflict and Health
[Accessed 29 November 2014]
http://www.conflictandhealth.com/

Research
Evaluating the use of locally-based health facility assessments in Afghanistan: a pilot study of a novel research method
Jack S Rowe, Kayhan Natiq, Olakunle Alonge, Shivam Gupta, Anubhav Agarwal and David H Peters
Author Affiliations
Conflict and Health 2014, 8:24 doi:10.1186/1752-1505-8-24
Published: 25 November 2014
Abstract (provisional)
Background
Through the Balanced Scorecard program there have been independent, annual and nationwide assessments of the Afghan health system from 2004 to 2013. During this period, Afghanistan remained in a dynamic state of conflict, requiring innovative approaches to health service evaluation in insecure areas. The primary objective of this pilot study was to evaluate the reliability of health facility assessments conducted by a novel, locally-based data collection method compared to a standard survey team.
Methods
In this cross-sectional study, one standard survey team of clinicians and multiple rapidly trained locally-based survey teams of teachers conducted health facility assessments in Badghis province, Afghanistan from March – August, 2010. Outpatient facilities covered under the country’s Basic Package of Health Services were eligible for inclusion. Both approaches attempted to survey as many health facilities as safely possible, up to 25 total facilities per method. Each facility assessed was scored on 23 health services indicators used to evaluate performance in the annual Balanced Scorecard national assessment. For facilities assessed by both survey methods, the indicator scores produced by each method were compared using Spearman’s correlation coefficients and linear regression analysis with generalized estimating equations.
Results
The standard survey team was able to assess 11 facilities; the locally-based approach was able to assess these 11 facilities, as well as 13 additional facilities in areas of greater insecurity. Among the 11 facilities assessed by both approaches, 19 of 23 indicators were statistically similar by survey method (p < .05). Spearman’s coefficients varied widely from (-0.39) to (0.71). The differences were greatest for items requiring specialized data collector knowledge on reviewing patient records, patient examination and counseling, and health worker reported satisfaction.
Conclusions
This pilot study of a novel method of data collection in health facility assessments showed that an approach using locally-based survey teams provided markedly increased access to areas of insecurity. Though analysis was limited by small sample size, indicator scores used for facility evaluation were relatively comparable overall, but less reliable for items requiring clinical knowledge or when asking health worker opinions, suggesting that alternative approaches may be needed to assess these parameters in insecure environments.

System dynamics model of cervical cancer vaccination and screening interventions in Kenya

Cost Effectiveness and Resource Allocation
(Accessed 29 November 2014)
http://www.resource-allocation.com/

Research
System dynamics model of cervical cancer vaccination and screening interventions in Kenya
Lucy W Kivuti-Bitok, Geoff McDonnell, Roudsari Abdul and Ganesh P Pokhariyal
Author Affiliations
Cost Effectiveness and Resource Allocation 2014, 12:26 doi:10.1186/1478-7547-12-26
Published: 27 November 2014
Abstract (provisional)
Objectives
This paper presents a simulation model for evaluating the possible effects of a screening and vaccination campaign against Human Papillomavirus [HPV] in Kenya.
Method
A System Dynamics model was developed using the iThinkTM computer simulation package. The model was based on data extracted from epidemiological, demographic and published research and where data was not available, expert opinion was sought. The deterministic model stratified the population by vaccination status, screening status and HPV infection status. The model was simulated to estimate outputs for the next 50 years from 2011. Cost Utility indicators of Disability Adjusted Life Years (DALYs) and cost per averted DALY were used for economic evaluation.
Results
The model predicted that catch up vaccination had the greatest impact in reducing the prevalence of cervical cancer. This was followed by Primary vaccination, with early detection through Screening having the lowest impact of the three choices of interventions in respect of averted cases of cervical cancer and DALY estimates.
Conclusion
Kenya as a country should consider adoption of secondary /catch up vaccination as an immediate measure to curb cervical cancer followed by primary vaccination of pre-adolescent girls. Screening should be a complementary measure(s). This model provides a policy decision support vehicle that can allow for choice between different interventions based on their expected outcomes. It also allows modification to accommodate new research results and information to assess the clinical impact of different policies and interventions in cervical cancer management in Kenya.

Emergency Medicine Journal [December 2014]

Emergency Medicine Journal
December 2014, Volume 31, Issue 12
http://emj.bmj.com/content/current

The view from here
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives
Dov Albukrek1,2, Joseph Mendlovic1,2, Tal Marom1,3
Author Affiliations
1Israeli Defense Forces Medical Corps, Tel Hashomer, Israel
2Israel Ministry of Health, Jerusalem, Israel
3Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel
Extract
In November 2013, super-typhoon Haiyan made several landfalls in the Philippines archipelago. It was one of the strongest cyclones ever recorded, with gusting winds and giant waves that left enormous damage in its wake: more than 6000 people were killed, almost 28 000 were injured and over four million lost their homes. Most basic infrastructure ceased to function, including electricity and water supplies, transportation and communication. Ten million Filipinos were affected overall.
Our medical task force
Following a formal aid request from the Filipino government, the Israeli Defense Forces (IDF) mobilised a medical response team to the island of Cebu, some 10 000 kms away. Because of the immense destruction, there were many casualties and only a few injured patients alive at the scene, making trauma care less a priority than ambulatory medical services for acute and chronic diseases. Of the 148 IDF mission participants, 56 were medical personnel. Others included logistics, support and rescue personnel from the IDF Home Front Command. Among 24 physicians, there were four paediatricians (including an emergency medicine specialist) and three paediatric nurses. Portable facilities included an imaging unit (portable digital X-ray and ultrasound machines), clinical laboratory (chemistry and haematology analyses, bacterial cultures and virology studies) and a fully supplied pharmacy.
Integrated field hospital
In coordination with the Filipino authorities, we reached our destination of Bogo city, in the northern part of the island of Cebu. We were the first medical task force and the only paediatric multidisciplinary team operating in the area, where most primary clinics were destroyed or closed. Unlike other paediatric field hospitals in disaster areas,1 ,2 we decided to create an integrated paediatric emergency unit (PEU), together with the staff of Bogo district hospital. This 80-bed urban hospital, staffed by four physicians (including one paediatrician) and 15 nurses, had already admitted more than 100 patients by the time of our arrival…

Review
Critical care paramedics: where is the evidence? a systematic review
Johannes von Vopelius-Feldt1, John Wood2, Jonathan Benger1,3
Author Affiliations
1Academic Department of Emergency Care, Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2South Western Ambulance Service NHS Trust, Bristol, UK
3Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
Abstract
Objectives Paramedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP).
Methods A systematic search of electronic databases was performed: CENTRAL, EMBASE, MEDLINE (through EMBASE and Web of Knowledge) and Web of Science (through Web of Knowledge).
Results The search identified 12 relevant publications, one of which was a randomised controlled trial. The remaining 11 were retrospective studies. Five studies compared CCPs with physician-led care. Three of these publications demonstrated improved outcomes with physician care, while two showed no difference. Four further publications examined CCPs versus non-physician-led care and found improved outcomes (two studies), mixed effects (one study) and no difference (one study) for CCPs. Finally, three publications addressed the addition of skills to CCP competencies. A randomised controlled trial of CCP rapid sequence induction (RSI) and tracheal intubation demonstrated improved neurologic outcomes. CCP tube thoracostomy was shown to have similar complication rates to the same procedure performed in the emergency department, while addition of a non-invasive ventilation protocol to CCP practice had no effect on long-term mortality.
Conclusions There is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome.

Cultures of evidence across policy sectors: systematic review of qualitative evidence

The European Journal of Public Health
Volume 24, Issue 6, 01 December 2014
http://eurpub.oxfordjournals.org/content/24/6

Cultures of evidence across policy sectors: systematic review of qualitative evidence
Theo Lorenc, Elizabeth F. Tyner, Mark Petticrew, Steven Duffy, Fred P. Martineau, Gemma Phillips, Karen Lock
DOI: http://dx.doi.org/10.1093/eurpub/cku038 1040-1046 First published online: 28 March 2014
Abstract
Background: It is important to understand the decision-making process, and the role of research evidence within it, across sectors other than health, as interventions delivered within these sectors may have substantial impacts on public health and health inequalities. Methods: Systematic review of qualitative evidence. Twenty-eight databases covering a range of sectors were searched. Studies were eligible if they included local decision-makers in a policy field relevant to the social determinants of health (including housing, transport, urban planning and regeneration, crime, licensing or trading standards), were conducted in a high-income country, and reported primary qualitative data on perceptions of research evidence. Study quality was assessed and a thematic synthesis undertaken. Results: Sixteen studies were included, most using interview designs, and most focusing on planning or transport policy. Several factors are seen to influence decision-makers’ views of evidence, including practical factors such as resources or organizational support; the credibility of the evidence; its relevance or applicability to practice; considerations of political support or feasibility; and legislative constraints. There are limited data on how evidence is used: it is sometimes used to not only support decision-making, but also to lend legitimacy to decisions that have already been made. Conclusion: Although cultures of evidence in non-health sectors are similar to those in health in some ways, there are some key differences, particularly as regards the political context of decision-making. Intersectoral public health research could benefit from taking into account non-health decision makers’ needs and preferences, particularly around relevance and political feasibility.

Human Service Organizations Management, Leadership & Governance [Volume 38, Issue 5, 2014]

Human Service Organizations Management, Leadership & Governance
Volume 38, Issue 5, 2014
http://www.tandfonline.com/toc/wasw21/current#.U0sFzFcWNdc

Guest Editorial
Leadership Challenges Facing Nonprofit Human Service Organizations in a Post-Recession Era
Karen Hopkins, Megan Meyer, Wes Shera & S. Colby Peters
pages 419-422
[No abstract]

Multiple Relationship-Management Roles Among Communicators in Not-For-Profit Organizations
Wenjun June Zhua & Monit Cheunga*
DOI:10.1080/23303131.2014.943918
pages 423-434
Accepted author version posted online: 11 Nov 2014
Published online: 24 Nov 2014
Abstract
This qualitative study explores communication strategies and the multiple roles of 13 communicators at the agency and in nonprofit sector. Interview data were grouped into six themes with three factors: antecedent factors of organizational behaviors, contextual factors of the environment, and convergent factors that determine internal and external communication strategies. The communicators attended to internal and external dimensions of their roles when working on interpersonal strategies that fall into the areas of balancing their multiple roles to establish public relationships. Resolving conflicts created by these roles is an area for nonprofit leaders to consider in future staff training.

Journal of Sustainable Development [December 2014]

Journal of Sustainable Development
Vol 7, No 6 (2014) December 2014
http://www.ccsenet.org/journal/index.php/jsd/issue/current

Potential Benefits of Introducing Integrated Solid Waste Management Approach in Developing Countries: A Case Study in Kathmandu City
Rajeev K. Singh, Helmut Yabar, Takeshi Mizunoya, Yoshiro Higano, Randeep Rakwal

Women’s Participation in Nigeria’s Industrial Development Process: Obstacles and Options for Change
Grace Reuben Etuk, Felicitas Gabriel Coker, Abdul Joshua Ogrimah

Improving the Management and Use of Water Resources for Small-Scale Irrigation Farming in the Garu Tempane District of Ghana
Amosah Jonah, Tanko Daniel Dawda

Human Ebola virus infection in West Africa: a review of available therapeutic agents that target different steps of the life cycle of Ebola virus

Infectious Diseases of Poverty
[Accessed 29 November 2014]
http://www.idpjournal.com/content

Opinion
Human Ebola virus infection in West Africa: a review of available therapeutic agents that target different steps of the life cycle of Ebola virus
Kang Yiu Lai, Wing Yiu Ng and Fan Fanny Cheng
Author Affiliations
Infectious Diseases of Poverty 2014, 3:43 doi:10.1186/2049-9957-3-43
Published: 28 November 2014
Abstract (provisional)
The recent outbreak of the human Zaire ebolavirus (EBOV) epidemic is spiraling out of control in West Africa. Human EBOV hemorrhagic fever has a case fatality rate of up to 90%. The EBOV is classified as a biosafety level 4 pathogen and is considered a category A agent of bioterrorism by Centers for Disease Control and Prevention, with no approved therapies and vaccines available for its treatment apart from supportive care. Although several promising therapeutic agents and vaccines against EBOV are undergoing the Phase I human trial, the current epidemic might be outpacing the speed at which drugs and vaccines can be produced. Like all viruses, the EBOV largely relies on host cell factors and physiological processes for its entry, replication, and egress. We have reviewed currently available therapeutic agents that have been shown to be effective in suppressing the proliferation of the EBOV in cell cultures or animal studies. Most of the therapeutic agents in this review are directed against non-mutable targets of the host, which is independent of viral mutation. These medications are approved by the Food and Drug Administration (FDA) for the treatment of other diseases. They are available and stockpileable for immediate use. They may also have a complementary role to those therapeutic agents under development that are directed against the mutable targets of the EBOV.

The Lancet [Nov 29, 2014]

The Lancet
Nov 29, 2014 Volume 384 Number 9958 p1901 – 1998 e58 – 61
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The health of India: a future that must be devoid of caste
The Lancet
Preview |
In 2011, The Lancet published a special Series on the progress and future of health in India. The central message was a call for universal health coverage by 2020. Despite India’s Prime Minister at the time, Manmohan Singh, being supportive of this goal, the move towards universal health coverage in India has gained little traction. Public health spending remains desperately low at 1•3% of gross domestic product, while more than 40 million Indians are driven into impoverishment from out-of-pocket health expenditure every year.

Migrants’ health in China
The Lancet
Preview |
During the past three decades, China has experienced the largest migration in human history, with hundreds of millions of rural inhabitants moving temporarily or permanently to cities. By the end of 2013, China’s internal migrant population was 245 million, comprising more than a sixth of the nation’s total population, according to the Development Report on China’s Migrant Population 2014 released by China’s National Health and Family Planning Commission last week.

Ebola opportunity – A slowdown in new cases offers a chance for control efforts to get ahead of the epidemic.

Nature
Volume 515 Number 7528 pp465-600 27 November 2014
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Ebola opportunity A slowdown in new cases offers a chance for control efforts to get ahead of the epidemic.
26 November 2014
An apparent slowdown in new cases of Ebola disease in Liberia and Guinea should be taken advantage of. Almost one year after an Ebola epidemic began in West Africa there are at last encouraging signs that it may be receding in some regions. But those responding to the epidemic must not drop their guard — rather, they should seize upon the chance to finish the job.

“Today, we — two dumbfounded doctors — stare at our empty blackboard. We have no more patients.” Last week, that declaration was blogged by a doctor with the humanitarian agency Médecins Sans Frontières (MSF), also known as Doctors Without Borders, at an Ebola treatment centre in the Foya region of Liberia. It is the same story in many parts of the country: empty beds that would have been unthinkable just a few weeks ago when Ebola treatment centres were overflowing. Nationally, the growth in the numbers of those infected in Liberia, the worst-affected country, is no longer exponential but has flattened off.

The epidemic has also stabilized in Guinea. But a resurgence of cases in Sierra Leone is a timely reminder that until Ebola is eliminated throughout West Africa, it remains a major threat. As of 18 November, Ebola has infected at least 15,000 people and killed 5,440 of them in these three main affected countries. But the worst-case scenarios predicted by mathematical modellers, which projected a steady apocalyptic rise in Ebola case numbers, have proved far off the mark (see Nature 515,18; 2014).

Although complacency is as unwise as it is hopefully unlikely — a lull in Ebola cases in the spring prompted authorities to drop their guard, only to see the virus return with a vengeance — there are reasons to believe that the current lull in Liberia and Guinea may continue. And that offers an opportunity to roll back the epidemic at last.

The exact causes of the lull are unclear. Belated international Ebola control efforts are only now beginning to kick in, and have no doubt contributed. But much of the slowdown is perhaps due to Africans themselves coming to terms with the epidemic and blocking its main routes of transmission. In particular, there has been a reduction in traditional burial practices, which are a key source of spread.

The slowing of new cases in Liberia and Guinea is a welcome reprieve for the health-care workers and scientists who have toiled to control a virus that for months has held the advantage. It is an opportunity to regroup, to consolidate gains, and to go all the more on the offensive.

Until recently, MSF, based in Geneva, Switzerland, was the only serious international presence fighting Ebola on the ground, but logistics meant that it could operate only a few large centralized treatment centres. These large centres, often with hundreds of beds, are still needed to absorb any resurgence, particularly in urban areas. But having only large centres is not ideal. Patients often have to travel for many hours or even days to reach them, and by the time they make it are often beyond recovery. They are also likely to have contaminated others en route, so fuelling the spread of the virus.

With its caseloads falling in recent weeks, MSF is coming out of the trenches and taking the fight to the virus, sending mobile teams and smaller treatment centres to the sites of new outbreaks to try to nip them in the bud. MSF sensibly wants other aid groups to adapt in a similar way. It will be a challenge for the more bureaucratic UN Mission for Ebola Emergency Response, and the US and other national Ebola-treatment efforts, to quickly change their plans, because they are mainly based around large centres. But it is crucial that the response to Ebola is flexible in the face of the shifting epidemiology.

The slowdown is also buying precious time for the testing of drugs and vaccines: clinical trials of vaccines in particular are being fast-tracked, with the first results due at the end of 2014. Unfortunately, however, drugs and vaccines have captured the spotlight and resources, while more mundane interventions that could have an immediate impact have been neglected. Better rehydration and electrolyte control can dramatically reduce mortality: the case fatality rate for patients treated in rich countries has been a fraction of the 70% seen in West Africa. Testing convalescent blood and serum from survivors — a potentially game-changing treatment — should also be a priority.

At the start of October, the United Nations and the World Health Organization set quantitative targets for safe burials, contact tracing and other key public-health control measures, which the international community was to meet by 1 December. It is already obvious that most of these targets will not be met. The breathing space offered by the current lull in Liberia and Guinea offers an opportunity to fill gaps and ramp up coverage of countermeasures. It must not be wasted.

New England Journal of Medicine [November 20, 2014]

New England Journal of Medicine
November 20, 2014 Vol. 371 No. 21
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Ebola Virus Disease in West Africa — Clinical Manifestations and Management
Daniel S. Chertow, M.D., M.P.H., Christian Kleine, M.D., Jeffrey K. Edwards, M.D., M.P.H., Roberto Scaini, M.D., Ruggero Giuliani, M.D., and Armand Sprecher, M.D., M.P.H.
N Engl J Med 2014; 371:2054-2057
November 27, 2014
DOI: 10.1056/NEJMp1413084
[Free full text]

Original Article
Ebola Virus Disease in the Democratic Republic of Congo
Gaël D. Maganga, D.V.M., Ph.D., Jimmy Kapetshi, M.D., Nicolas Berthet, Pharm.D., Ph.D., Benoît Kebela Ilunga, M.D., Felix Kabange, M.D., Placide Mbala Kingebeni, M.D., Vital Mondonge, M.D., Jean-Jacques T. Muyembe, M.D., Ph.D., Eric Bertherat, M.D., Sylvie Briand, M.D., Joseph Cabore, M.D., Alain Epelboin, M.D., Pierre Formenty, D.V.M., M.P.H., Gary Kobinger, M.D., Licé González-Angulo, M.Sc., Ingrid Labouba, Ph.D., Jean-Claude Manuguerra, Ph.D., Jean-Marie Okwo-Bele, M.D., Christopher Dye, D. Phil., and Eric M. Leroy, D.V.M., Ph.D.
N Engl J Med 2014; 371:2083-2091 November 27, 2014 DOI: 10.1056/NEJMoa1411099
[Free full text]
Conclusions
The current EVD outbreak in the DRC has clinical and epidemiologic characteristics that are similar to those of previous EVD outbreaks in equatorial Africa. The causal agent is a local EBOV variant, and this outbreak has a zoonotic origin different from that in the 2014 epidemic in West Africa. (Funded by the Centre International de Recherches Médicales de Franceville and others.)

Original Article
Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
John S. Schieffelin, M.D., M.S.P.H., Jeffrey G. Shaffer, Ph.D., Augustine Goba, B.Sc., Michael Gbakie, R.N., Stephen K. Gire, M.P.H., Andres Colubri, Ph.D., Rachel S.G. Sealfon, S.M., Lansana Kanneh, Alex Moigboi, R.N., Mambu Momoh, Mohammed Fullah, Lina M. Moses, Ph.D., Bethany L. Brown, M.S.C.S., Kristian G. Andersen, Ph.D., Sarah Winnicki, M.S., Stephen F. Schaffner, Ph.D., Daniel J. Park, Ph.D., Nathan L. Yozwiak, Ph.D., Pan-Pan Jiang, Ph.D., David Kargbo, Simbirie Jalloh, Mbalu Fonnie, R.N., Vandi Sinnah, Issa French, Alice Kovoma, Fatima K. Kamara, R.N., Veronica Tucker, Edwin Konuwa, R.N., Josephine Sellu, R.N., Ibrahim Mustapha, Momoh Foday, Mohamed Yillah, Franklyn Kanneh, Sidiki Saffa, James L.B. Massally, Matt L. Boisen, Luis M. Branco, Ph.D., Mohamed A. Vandi, M.B., Ch.B., Donald S. Grant, M.B., Ch.B., Christian Happi, Ph.D., Sahr M. Gevao, M.B., Ch.B., Thomas E. Fletcher, M.D., Robert A. Fowler, M.D., Daniel G. Bausch, M.D., M.P.H.T.M., Pardis C. Sabeti, M.D., D.Phil., S. Humarr Khan, M.B., Ch.B., and Robert F. Garry, Ph.D. for the KGH Lassa Fever Program, the Viral Hemorrhagic Fever Consortium, and the WHO Clinical Response Team
N Engl J Med 2014; 371:2092-2100 November 27, 2014 DOI: 10.1056/NEJMoa1411680
[Free full text]
Conclusions
The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.)

The Definition of Placebo in the Informed Consent Forms of Clinical Trials

PLoS One
[Accessed 29 November 2014]
http://www.plosone.org/

Research Article
The Definition of Placebo in the Informed Consent Forms of Clinical Trials
Astrid Hernández, Josep-E. Baños mail, Cristina Llop, Magí Farré
Published: November 25, 2014
DOI: 10.1371/journal.pone.0113654
Abstract
Aim
Lack of knowledge concerning the nature of placebo and why it is necessary may influence the participation of patients in clinical trials. The objective of the present study is to review how placebo is described in written information for participants in clinical trials to be evaluated by a Human Research Ethics Committee.
Methods
All research protocols submitted for evaluation in a Spanish hospital during 2007–2013 were reviewed. The main characteristics of the studies using a placebo were collected. Three authors read each of them to determine how the term “placebo” was explained and if there was any comment on its efficacy and safety.
Results
Two thousand seven-hundred and forty research protocols were evaluated, of which three hundred and fifty-nine used a placebo. Pharmaceutical companies sponsored most placebo-controlled clinical trials (91.9%), and phase III studies were the commonest (59.9%). Oncology (15.0%), cardiology (14.2%), and neurology (13.1%) made the greatest contributions. A review of the informed consent forms showed that placebo was described in a similar manner in most studies: the explanation was limited to between four and eight words. Very few gave information about the risks of its use or adverse reactions from its administration. None of the studies provided details about the placebo effect. And 23 lacked any information about placebo at all.
Conclusions
Explanations about placebo in informed consent forms is often scarce, and information about the placebo effect and associated risks are absent. This situation may influence a full understanding of placebo by participants in clinical trials and might reduce their informed decision to participate.

Livestock/Animal Assets Buffer the Impact of Conflict-Related Traumatic Events on Mental Health Symptoms for Rural Women

PLoS One
[Accessed 29 November 2014]
http://www.plosone.org/

Research Article
Livestock/Animal Assets Buffer the Impact of Conflict-Related Traumatic Events on Mental Health Symptoms for Rural Women
Nancy Glass mail, Nancy A. Perrin, Anjalee Kohli, Mitima Mpanano Remy
Published: November 24, 2014
DOI: 10.1371/journal.pone.011170
Abstract
Background
In the context of multiple adversities, women are demonstrating resilience in rebuilding their futures, through participation in microfinance programs. In addition to the economic benefits of microfinance, there is evidence to suggest that it is an effective vehicle for improving health.
Methods
The parent study is a community-based trial to evaluate the effectiveness of a livestock microfinance intervention, Pigs for Peace (PFP), on health and economic outcomes with households in 10 villages in eastern Democratic Republic of Congo. The analysis for this manuscript includes only baseline data from female participants enrolled in the ongoing parent study. Multiple regression analysis was used to examine if livestock/animal asset value moderates the relationship between conflict-related traumatic events and current mental health symptoms.
Findings
The majority of women are 25 years or older, married, have on average 4 children in the home and have never attended school. Nearly 50% of women report having at least one livestock/animal asset at baseline. Over the past 10 years, women report on average more than 4 (M = 4.31, SD 3•64) traumatic events (range 0–18). Women reported symptoms consistent with PTSD with a mean score of •2.30 (SD = 0•66range 0–4) and depression with a mean score of 1.86 (SD = 0•49, range 0–3.47). The livestock/animal asset value by conflict-related traumatic events interaction was significant for both the PTSD (p = 0•021) and depression (p = 0•002) symptom models.
Interpretation
The study provides evidence of the moderating affect of livestock/animal assets on mental health symptoms for women who have experienced conflict. The findings supports evidence about the importance of livestock/animal assets to economics in rural households but expands on previous research by demonstrating the psychosocial effects of these assets on women’s health.
Trial Registration
clinicaltrials.gov NCT02008708

Editorial: (How) Can We Reduce Violence Against Women by 50% over the Next 30 Years?

PLoS Medicine
(Accessed 29 November 2014)
http://www.plosmedicine.org

Editorial
(How) Can We Reduce Violence Against Women by 50% over the Next 30 Years?
Rachel Jewkes mail
Published: November 25, 2014
DOI: 10.1371/journal.pmed.1001761
Open Access
[Initial text]
Each year, interpersonal violence is experienced and perpetrated by millions of people worldwide. In 2010, it was the 27th cause of death globally, causing an estimated 456,268 deaths worldwide [1]. Violence against women has been shown to be highly prevalent globally, with partner violence affecting one in three women, and one in 15 women (7%) having been raped by a man who was not a partner [2],[3]. Recognising this huge global burden, the 67th World Health Assembly adopted the resolution “Strengthening the Role of the Health System in Addressing Violence, in Particular against Women and Girls, and against Children” [4] and mandated countries globally to develop violence prevention through their health sector. The goal of reducing violence by 50% over the next 30 years has been mooted by the World Health Organization as a rallying point for the global violence prevention community and was the subject of critical debate at the recent Global Violence Reduction Conference 2014 at King’s College, Cambridge University, UK, which was hosted by the Institute of Criminology Violence Research Centre and the World Health Organization [5]. Whilst ostensibly ambitious, several high-income countries, including the United States, have reduced rates of some forms of violence by 50% or more over a very short period of time, and such reductions are supported by historical trends of reduced homicide over several centuries in several European countries [6]–[8]. There is no real evidence, however, that violence against women is reducing in low- and middle-income countries [3]. Indeed, in South Africa, where there has been considerable gender activism and growth in women’s empowerment, non-fatal rape and intimate partner violence seem quite resistant to change, notwithstanding the measured reductions in female homicide [9],[10]. The key question, then, is how can we secure substantial reductions in violence against women in low- and middle-income countries?

Science [28 November 2014 ]

Science
28 November 2014 vol 346, issue 6213, pages 1029-1148
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
A new phase in the Ebola war
Kai Kupferschmidt*
Summary
The number of new Ebola cases in Liberia, one of the hardest hit countries in the current epidemic, has come down to about 20 per day, far fewer than models predicted a few months ago. Ebola treatment units now have hundreds of empty beds, and the fight against the virus is entering a new phase. Back in September, the key job was building clinics, removing the dead, and keeping as many patients as possible isolated. Now, it’s about setting up a flexible system to respond to new outbreaks, identifying patients quickly, and tracing their contacts to prevent more infections. Meanwhile, outbreaks are still flaring up in the remote districts, making it unlikely that Liberia can put a stop to the epidemic anytime soon

Perspective
Medicine
Big data meets public health
Muin J. Khoury1,2, John P. A. Ioannidis3
Author Affiliations
1Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
2Epidemiology and Genomics Research Program, National Cancer Institute, Bethesda, MD 20850, USA.
3Stanford Prevention Research Center and Meta-Research Innovation Center at Stanford, Stanford University, Palo Alto, CA 94305, USA.
Summary
In 1854, as cholera swept through London, John Snow, the father of modern epidemiology, painstakingly recorded the locations of affected homes. After long, laborious work, he implicated the Broad Street water pump as the source of the outbreak, even without knowing that a Vibrio organism caused cholera. “Today, Snow might have crunched Global Positioning System information and disease prevalence data, solving the problem within hours” (1). That is the potential impact of “Big Data” on the public’s health. But the promise of Big Data is also accompanied by claims that “the scientific method itself is becoming obsolete” (2), as next-generation computers, such as IBM’s Watson (3), sift through the digital world to provide predictive models based on massive information. Separating the true signal from the gigantic amount of noise is neither easy nor straightforward, but it is a challenge that must be tackled if information is ever to be translated into societal well-being.