William and Flora Hewlett Foundation
http://www.hewlett.org/newsroom/search

Hewlett Foundation Announces $45 Million in Grants to MIT, Stanford, UC Berkeley to Establish Major New Academic Centers for Cybersecurity Policy Research
Largest Ever Private Commitment to Field
Nov 18, 2014
MENLO PARK, Calif.—The William and Flora Hewlett Foundation, the Massachusetts Institute of Technology (MIT), Stanford University, and the University of California, Berkeley today announced the establishment of three major new academic initiatives focused on laying the foundations for smart, sustainable public policy to deal with the growing cyber threats faced by governments, businesses, and individuals.

The new programs, established with $45 million in grants from the Hewlett Foundation—$15 million to each school—are supported through the Foundation’s Cyber Initiative. The Foundation has now committed $65 million over the next five years to strengthening the nascent field of cybersecurity, the largest such commitment to date by a private donor.

With the world increasingly dependent on the Internet for everything from banking to medical record keeping, the risk of disruption—from the merely inconvenient to the truly catastrophic—is clear, as is the need to develop workable systems capable of containing these threats over time. But government and industry have largely focused their separate, siloed security efforts on the immediate need to thwart enemies, hackers, and thieves.

The Hewlett Foundation’s Cyber Initiative is designed to foster the development of policy frameworks to help guide these actors toward sustainable solutions, to develop trust and improve communication among the disparate actors, and to train scholars and practitioners with the necessary combination of technological and policy expertise…

MacArthur Foundation
http://www.macfound.org/

Publication
Report Details Global Impact Investing in 2014
November 21, 2014
A report by the Impact Investing Policy Collaborative showcases the use of public policy tools to expand the reach of impact investing across a range of developed and developing countries and regions. Through a number of case studies, it examines the sort of social impacts that public policies affecting impact investing could enable, and are actively addressing in different countries and markets.

Rockefeller Foundation
http://www.rockefellerfoundation.org/newsroom

The Rockefeller Foundation hosts Resilience Summit to help eligible jurisdictions prepare for $1billion National Disaster Resilience Competition.
Nov 18, 2014
The Summit represents is an opportunity for senior representative from each of the 67 eligible jurisdictions to engage with cabinet-level officials and leading experts in resilience to shape their NDRC strategy and projects, and inform their overall resilience planning efforts.

American Journal of Public Health
Volume 104, Issue 12 (December 2014)
http://ajph.aphapublications.org/toc/ajph/current

Transforming Public Health Delivery Systems With Open Science Principles
Glen P. Mays, PhD, MPH, and F. Douglas Scutchfield, MD
Glen Mays is with the National Coordinating Center for Public Health Services and Systems Research, Department of Health Management and Policy, College of Public Health, The University of Kentucky, Lexington. F. Douglas Scutchfield is with the Colleges of Medicine and Public Health, The University of Kentucky.
[No abstract]

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991
Deepak Sobti, MD, Marcos Cueto, PhD, and Yuan He, BS
Abstract
The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America’s story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public–private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru’s Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

BMC Health Services Research
(Accessed 22 November 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Community resistance to a peer education programme in Zimbabwe
Catherine Campbell1*, Kerry Scott2, Zivai Mupambireyi3, Mercy Nhamo3, Constance Nyamukapa34, Morten Skovdal5 and Simon Gregson34
Author Affiliations
BMC Health Services Research 2014, 14:574 doi:10.1186/s12913-014-0574-5
Published: 19 November 2014
Abstract (provisional)
Background
This paper presents community perceptions of a state-of-the-art peer education programme in Manicaland, Zimbabwe. While the intervention succeeded in increasing HIV knowledge among men and condom acceptability among women, and reduced HIV incidence and rates of unprotected sex among men who attended education events, it did not succeed in reducing population-level HIV incidence. To understand the possible reasons for this disappointing result, we conducted a qualitative study of local perspectives of the intervention.
Methods
Eight focus group discussions and 11 interviews with 81 community members and local project staff were conducted. Transcripts were interrogated and analysed thematically.
Results
We identified three factors that may have contributed to the programme’s disappointing outcomes: (1) difficulties of implementing all elements of the programme, particularly the proposed income generation component in the wider context of economic strain; (2) a moralistic approach to commercial sex work by programme staff; and (3) limitations in the programme’s ability to engage with social realities facing community members.
Conclusions
We conclude that externally-imposed programmes that present new information without adequately engaging with local realities and constraints on action can be met by resistance to change.

BMC Infectious Diseases
(Accessed 22 November 2014)
http://www.biomedcentral.com/bmcinfectdis/content

Research article
Tuberculosis care for pregnant women: a systematic review
Hang Thanh Nguyen1*, Chiara Pandolfini1, Peter Chiodini2 and Maurizio Bonati1
Author Affiliations
BMC Infectious Diseases 2014, 14:617 doi:10.1186/s12879-014-0617-x
Published: 19 November 2014
Abstract
Background
Tuberculosis (TB) during pregnancy may lead to severe consequences affecting both mother and child. Prenatal care could be a very good opportunity for TB care, especially for women who have limited access to health services. The aim of this review was to gather and evaluate studies on TB care for pregnant women.
Methods
We used a combination of the terms “tuberculosis” and “pregnancy”, limited to human, to search for published articles. Studies reflecting original data and focusing on TB care for pregnant women were included. All references retrieved were collected using the Reference Manager software (Version 11).
Results
Thirty five studies were selected for review and their data showed that diagnosis was often delayed because TB symptoms during pregnancy were not typical. TB prophylaxis and anti-TB therapy appeared to be safe and effective for pregnant women and their babies when suitable follow up and early initiation were present, but the compliance rate to TB prophylaxis is still low due to lack of follow up and referral services. TB care practices in the reviewed studies were in line in principle with the WHO International Standards for Tuberculosis Care (ISTC).
Conclusions
Integration of TB care within prenatal care would improve TB diagnosis and treatment for pregnant women. To improve the quality of TB care, it is necessary to develop national level guidelines based on the ISTC with detailed guidelines for pregnant women.

BMC Medical Ethics
(Accessed 22 November 2014)
http://www.biomedcentral.com/bmcmedethics/content

Research article
Consenting for current genetic research: is Canadian practice adequate?
Iris Jaitovich Groisman, Nathalie Egalite and Beatrice Godard
Author Affiliations
BMC Medical Ethics 2014, 15:80 doi:10.1186/1472-6939-15-80
Published: 20 November 2014
Abstract (provisional)
Background
In order to ensure an adequate and ongoing protection of individuals participating in scientific research, the impacts of new biomedical technologies, such as Next Generation Sequencing (NGS), need to be assessed. In this light, a necessary reexamination of the ethical and legal structures framing research could lead to requisite changes in informed consent modalities. This would have implications for Institutional Review Boards (IRBs), who bear the responsibility of guaranteeing that participants are verifiably informed, and in sufficient detail, to understand the reality of genetic research as it is practiced now. Current literature allowed the identification of key emergent themes related to the consent process when NGS was used in a research setting.
Methods
We examined the subjects of secondary use, sharing of materials and data, and recontacting participants as outlined in the Canadian Informed Consent templates and the accompanying IRB instructions for the conduct of genetic research. The research ethics policy applied by the three Canadian research agencies (Tri-Council Policy Statement, 2nd Edition) was used to frame our content analysis. We also obtained IRB-approved consent forms for genetic research projects on brain and mental health disorders as an example of a setting where participants might present higher-than-average vulnerability.
Results
Eighty percent of documents addressed different modalities for the secondary use of material and/or data, although the message was not conveyed in a systematic way. Information on the sharing of genetic sequencing data in a manner completely independent of the material from which it originated was absent. Grounds for recontacting participants were limited, and mainly mentioned to obtain consent for secondary use. A feature of the IRB-approved consent documents for genetic studies on brain and mental health disorders using NGS technologies, offered a complete explanation on sharing material and data and the use of databases.
Conclusions
The results of our work show that in Canada, many NGS research needs are already dealt with. Our analysis led us to propose the addition of well-defined categories for future use, adding options on the sharing of genetic data, and widening the grounds on which research participants could consent to be recontacted.

BMC Public Health
(Accessed 22 November 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Geographic information analysis and web-based geoportals to explore malnutrition in Sub-Saharan Africa: a systematic review of approaches
Sabrina Marx, Revati Phalkey, Clara Aranda, Jörn Profe, Rainer Sauerborn and Bernhard Höfle
Author Affiliations
BMC Public Health 2014, 14:1189 doi:10.1186/1471-2458-14-1189
Published: 20 November 2014
Abstract (provisional)
Background
Childhood malnutrition is a serious challenge in Sub-Saharan Africa (SSA) and a major underlying cause of death. It is the result of a dynamic and complex interaction between political, social, economic, environmental and other factors. As spatially oriented research has been established in health sciences in recent years, developments in Geographic Information Science (GIScience) provide beneficial tools to get an improved understanding of malnutrition.
Methods
In order to assess the current state of knowledge regarding the use of geoinformation analyses for exploring malnutrition in SSA, a systematic literature review of peer-reviewed literature is conducted using Scopus, ISI Web of Science and PubMed. As a supplement to the review, we carry on to investigate the establishment of web-based geoportals for providing freely accessible malnutrition geodata to a broad community. Based on these findings, we identify current limitations and discuss how new developments in GIScience might help to overcome impending barriers.
Results
563 articles are identified from the searches, from which a total of nine articles and eight geoportals meet inclusion criteria. The review suggests that the spatial dimension of malnutrition is analyzed most often at the regional and national level using geostatistical analysis methods. Therefore, heterogeneous geographic information at different spatial scales and from multiple sources is combined by applying geoinformation analysis methods such as spatial interpolation, aggregation and downscaling techniques. Geocoded malnutrition data from the Demographic and Health Survey Program are the most common information source to quantify the prevalence of malnutrition on a local scale and are frequently combined with regional data on climate, population, agriculture and/or infrastructure. Only aggregated geoinformation about malnutrition prevalence is freely accessible, mostly displayed via web map visualizations or downloadable map images. The lack of detailed geographic data at household and local level is a major limitation for an in-depth assessment of malnutrition and links to potential impact factors.
Conclusions
We propose that the combination of malnutrition-related studies with most recent GIScience developments such as crowd-sourced geodata collection, (web-based) interoperable spatial health data infrastructures as well as (dynamic) information fusion approaches are beneficial to deepen the understanding of this complex phenomenon.

Research article
Implementing effective hygiene promotion: lessons from the process evaluation of an intervention to promote handwashing with soap in rural India
Divya Rajaraman, Kiruba Sankar Varadharajan, Katie Greenland, Val Curtis, Raja Kumar, Wolf-Peter Schmidt, Robert Aunger and Adam Biran
Author Affiliations
BMC Public Health 2014, 14:1179 doi:10.1186/1471-2458-14-1179
Published: 19 November 2014
Abstract (provisional)
Background
An intervention trial of the ‘SuperAmma’ http://www.superamma.org/
village-level intervention to promote handwashing with soap (HWWS) in rural India demonstrated substantial increases in HWWS amongst the target population. We carried out a process evaluation to assess the implementation of the intervention and the evidence that it had changed the perceived benefits and social norms associated with HWWS. The evaluation also aimed to inform the design of a streamlined shorter intervention and estimate scale up costs.
Methods
Intervention implementation was observed in 7 villages. Semi-structured interviews were conducted with the implementation team, village leaders and representatives of the target population. A questionnaire survey was administered in 174 households in intervention villages and 171 households in control villages to assess exposure to intervention activities, recall of intervention components and evidence that the intervention had produced changes in perceptions that were consistent with the intervention core messages. Costs were estimated for the intervention as delivered, as well as for a hypothetical scale-up to 1,000 villages.
Results
We found that the intervention was largely acceptable to the target population, maintained high fidelity (after some starting problems), and resulted in a high level of exposure to most components. There was a high recall of most intervention activities and subjects in the intervention villages were more likely than those in control villages to cite reasons for HWWS that were in line with intervention messaging and to believe that HWWS was a social norm. There were no major differences between socio-economic and caste groups in exposure to intervention activities. Reducing the intervention from 4 to 2 contact days, in a scale up scenario, cut the estimated implementation cost from $2,293 to $1,097 per village.
Conclusions
The SuperAmma intervention is capable of achieving good reach across men and women of varied social and economic status, is affordable, and has the potential to be effective at scale provided that sufficient attention is given to ensuring the quality of intervention delivery.

Research article
Descriptive characterization of the 2010 cholera outbreak in Nigeria
Mahmood Muazu Dalhat1*, Aisha Nasiru Isa1, Patrick Nguku1, Sani-Gwarzo Nasir2, Katharina Urban1, Mohammed Abdulaziz1, Raymond Salanga Dankoli1, Peter Nsubuga3 and Gabriele Poggensee1
Author Affiliations
BMC Public Health 2014, 14:1167 doi:10.1186/1471-2458-14-1167
Published: 16 November 2014
Abstract
Background
In 2010, 18 States of Nigeria reported cholera outbreaks with a total of 41,787 cases including 1,716 deaths (case-fatality rate [CFR]: 4.1%). This exceeded the mean overall CFR of 2.4% reported in Africa from 2000–2005 and the WHO acceptable rate of 1%. We conducted a descriptive analysis of the 2010 cholera outbreak to determine its epidemiological and spatio-temporal characteristics.
Methods
We conducted retrospective analysis of line lists obtained from 10 of the 18 states that submitted line lists to the Federal Ministry of Health (FMOH). We described the outbreak by time, place and person and calculated the attack rates by state as well as the age- and sex-specific CFR from cholera cases for whom information on age, sex, place of residence, onset of symptoms and outcome were available.
Results
A total of 21,111 cases were reported with an overall attack rate and CFR of 47.8 cases /100,000 population and 5.1%, respectively. The CFR ranged in the states between 3.8% and 8.9%. The age-specific CFR was highest among individuals 65 years and above (14.6%). The epidemiological curve showed three peaks with increasing number of weekly reported cases. A geographical clustering of LGAs reporting cholera cases could be seen in all ten states. During the third peak which coincided with flooding in five states the majority of newly affected LGAs were situated next to LGAs with previously reported cholera cases, only few isolated outbreaks were seen.
Conclusion
Our study showed a cholera outbreak that grew in magnitude and spread to involve the whole northern part of the country. It also highlights challenges of suboptimal surveillance and response in developing countries as well as potential endemicity of cholera in the northern part of Nigeria. There is the need for a harmonized, coordinated approach to cholera outbreaks through effective surveillance and response with emphasis on training and motivating front line health workers towards timely detection, reporting and response. Findings from the report should be interpreted with caution due to the high number of cases with incomplete information, and lack of data from eight states.

Cost Effectiveness and Resource Allocation
(Accessed 22 November 2014)
http://www.resource-allocation.com/

Review
Health research priority setting in selected high income countries: a narrative review of methods used and recommendations for future practice
Jamie Bryant, Rob Sanson-Fisher, Justin Walsh and Jessica Stewart
Author Affiliations
Cost Effectiveness and Resource Allocation 2014, 12:23 doi:10.1186/1478-7547-12-23
Published: 18 November 2014
Abstract (provisional)
Research priority setting aims to gain consensus about areas where research effort will have wide benefits to society. While general principles for setting health research priorities have been suggested, there has been no critical review of the different approaches used. This review aims to: (i) examine methods, models and frameworks used to set health research priorities; (ii) identify barriers and facilitators to priority setting processes; and (iii) determine the outcomes of priority setting processes in relation to their objectives and impact on policy and practice. Medline, Cochrane, and PsycINFO databases were searched for relevant peer-reviewed studies published from 1990 to March 2012. A review of grey literature was also conducted. Priority setting exercises that aimed to develop population health and health services research priorities conducted in Australia, New Zealand, North America, Europe and the UK were included. Two authors extracted data from identified studies. Eleven diverse priority setting exercises across a range of health areas were identified. Strategies including calls for submission, stakeholder surveys, questionnaires, interviews, workshops, focus groups, roundtables, the Nominal Group and Delphi technique were used to generate research priorities. Nine priority setting exercises used a core steering or advisory group to oversee and supervise the priority setting process. None of the models conducted a systematic assessment of the outcomes of the priority setting processes, or assessed the impact of the generated priorities on policy or practice. A number of barriers and facilitators to undertaking research priority setting were identified. The methods used to undertake research priority setting should be selected based upon the context of the priority setting process and time and resource constraints. Ideally, priority setting should be overseen by a multi-disciplinary advisory group, involve a broad representation of stakeholders, utilise objective and clearly defined criteria for generating priorities, and be evaluated.

Globalization and Health
[Accessed 22 November 2014]
http://www.globalizationandhealth.com/

Debate
Contract Research Organizations (CROs) in China: integrating Chinese research and development capabilities for global drug innovation
Yun-Zhen Shi, Hao Hu* and Chunming Wang
Author Affiliations
State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
Globalization and Health 2014, 10:78 doi:10.1186/s12992-014-0078-4
Abstract
The significance of R&D capabilities of China has become increasingly important as an emerging force in the context of globalization of pharmaceutical research and development (R&D). While China has prospered in its R&D capability in the past decade, how to integrate the rising pharmaceutical R&D capability of China into the global development chain for innovative drugs remains challenging. For many multinational corporations and research organizations overseas, their attempt to integrate China’s pharmaceutical R&D capabilities into their own is always hindered by policy constraints and reluctance of local universities and pharmaceutical firms. In light of the situation, contract research organizations (CROs) in China have made great innovation in value proposition, value chain and value networking to be at a unique position to facilitate global and local R&D integration. Chinese CROs are now being considered as the essentially important and highly versatile integrator of local R&D capability for global drug discovery and innovation.

Humanitarian Exchange Magazine
ISSUE 62 September 2014
http://www.odihpn.org/humanitarian-exchange-magazine/issue-62
Theme: The crisis in the Central African Republic

This edition of Humanitarian Exchange focuses on the crisis in the Central African Republic (CAR), where spiralling violence has left thousands dead and more than a million displaced.
– In her lead article, Enrica Picco highlights the slow and inadequate response to the crisis, and questions whether the humanitarian system has the will and capacity to respond in such contexts.
– Alison Giffen and Marla Keenan argue that protecting civilians should be the top priority of MINUSCA, the new peacekeeping mission.
– Emma Fanning emphasises the need for the mission to safeguard the distinction between humanitarian and political and military decision-making.
– Josep Zapater explores strategies to protect Muslims besieged in Bangui.
– Anthony Neal reports on efforts to promote reconciliation and enhance social cohesion.
– David Loquercio reflects on his temporary deployment to CAR as an interagency coordinator responsible for promoting accountability.
– Keith Chibafa reports on a pilot of a digital system to manage relief distributions.
– Jacobo Quintanilla and Jonathan Pedneault discuss the role of the local media in enhancing dialogue and reconciliation.
– Sean Maguire outlines the International Committee of the Red Cross’ support for health services
– Diana Trimiño Mora and her co-authors describe the International Rescue Committee’s efforts to address violence against women and girls.
– Lola Wilhelm presents the key findings from the Assessment Capacities Project’s recent analysis of humanitarian needs assessments.
Articles in the Practice and Policy Notes examine:
– UNMISS’ experience of protection of civilians sites in South Sudan
– The use of social protection systems to implement emergency cash transfers in Lesotho
Lessons on engagement with armed groups in Afghanistan and Somalia.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 25, Number 4, November 2014
http://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.25.4.html

Commentary
Microfinance: Untapped Potential for Global Health
pp. 1718-1722
Ronak B. Patel

Report from the Field
An Integrated Chronic Disease Management Model: A Diagonal Approach to Health System Strengthening in South Africa
pp. 1723-1729
Ozayr Haroon Mahomed, Shaidah Asmall, Melvyn Freeman

Journal of Infectious Diseases
Volume 210 Issue 12 December 15, 2014
http://jid.oxfordjournals.org/content/current

Emergency Settings: Be Prepared to Vaccinate Persons Aged 15 and Over Against Measles
Reinhard Kaiser
Author Affiliations
Immunization, Vaccines, and Emergencies, WHO Regional Office for Africa, Inter-country Support Team, East and Southern Africa, Harare, Zimbabwe
[Initial text]
In their landmark article on measles prevention in emergency settings, Toole and colleagues recommended in 1989 that all children aged 6 months to 5 years should be immunized with measles vaccine at the time they enter an organized camp or settlement [1]. In 2000, Salama and colleagues documented substantial mortality during a famine emergency in Ethiopia, with measles and malnutrition as major contributing factors. In a retrospective study of mortality, measles alone, or in combination with wasting, accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5–14 years. The setting was a rural population without routine childhood immunization and exposure to natural measles virus infection [2]. The authors concluded that measles vaccination, in combination with vitamin A distribution, should be implemented in all types of complex emergencies. Vaccination coverage should be 90% and extended to children up to age 12–15 years [2]. A vaccination age range up to 14 years was included in the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) statement to reduce measles mortality in emergencies [3], and the revised SPHERE project guidelines [4]. However, since then, the discussion about target age groups has increasingly included the potential need to vaccinate adults. As early as 2000–2001, Kamugisha and colleagues documented 21% of measles cases that were 16 years and older in a major outbreak in Tanzanian camps with refugees from Burundi [5]. The authors concluded that in some emergency settings, achieving population immunity adequate to prevent virus transmission may require vaccinating persons older than 15 years, and the selection of …

Measles Outbreak Response Among Adolescent and Adult Somali Refugees Displaced by Famine in Kenya and Ethiopia, 2011
Carlos Navarro-Colorado1, Abdirahman Mahamud1,a, Ann Burton2,a, Christopher Haskew3, Gidraf K. Maina4, John B. Wagacha2, Jamal A. Ahmed5,a, Sharmila Shetty1,a, Susan Cookson1,
James L. Goodson1, Marian Schilperoord3 and Paul Spiegel3
Author Affiliations
1Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
2United Nations High Commissioner for Refugees (UNHCR), Nairobi, Kenya
3UNHCR, Geneva, Switzerland
4UNHCR, Addis Ababa, Ethiopia
5CDC, Nairobi, Kenya
Abstract
Background
The refugee complexes of Dadaab, Kenya, and Dollo-Ado, Ethiopia, experienced measles outbreaks during June–November 2011, following a large influx of refugees from Somalia.
Methods
Line-lists from health facilities were used to describe the outbreak in terms of age, sex, vaccination status, arrival date, attack rates (ARs), and case fatality ratios (CFRs) for each camp. Vaccination data and coverage surveys were reviewed.
Results
In Dadaab, 1370 measles cases and 32 deaths (CFR, 2.3%) were reported. A total of 821 cases (60.1%) were aged ≥15 years, 906 (82.1%) arrived to the camps in 2011, and 1027 (79.6%) were unvaccinated. Camp-specific ARs ranged from 212 to 506 cases per 100 000 people. In Dollo-Ado, 407 cases and 23 deaths (CFR, 5.7%) were reported. Adults aged ≥15 years represented 178 cases (43.7%) and 6 deaths (26.0%). Camp-specific ARs ranged from 21 to 1100 cases per 100 000 people. Immunization activities that were part of the outbreak responses initially targeted children aged 6 months to 14 years and were later expanded to include individuals up to 30 years of age.
Conclusions
The target age group for outbreak response–associated immunization activities at the start of the outbreaks was inconsistent with the numbers of cases among unvaccinated adolescents and adults in the new population. In displacement of populations from areas affected by measles outbreaks, health authorities should consider vaccinating adults in routine and outbreak response activities.

The Lancet
Nov 22, 2014 Volume 384 Number 9957 p1821 – 1900
http://www.thelancet.com/journals/lancet/issue/current

Ethical considerations of experimental interventions in the Ebola outbreak
Dr Annette Rid MD a, Prof Ezekiel J Emanuel MD b
[Free full text]
Background
The outbreak of Ebola virus raging in west Africa is special in two respects. First, with more than 2100 infections and 1100 deaths,1 it has already become the most severe and largest documented Ebola outbreak. It is also occurring in some of the world’s least developed countries,2 and is therefore extremely complex to address. Second, experimental interventions that are still in the preclinical trial phase—and hence untested in human beings—were first given to health-care workers from high-income countries, focusing extensive attention and controversy on investigational treatments and vaccines for Ebola.3—5
The rapidly evolving situation raises three fundamental questions: how much emphasis should the international community place on experimental interventions in response to the Ebola epidemic; what are the ethical considerations if experimental treatments or vaccines are deployed; and if any interventions prove safe and effective, how can they be made more widely available?…

For debate: a new wave in public health improvement
Sally C Davies MBChB a, Eleanor Winpenny PhD b, Sarah Ball PhD b, Tom Fowler PhD a c d, Jennifer Rubin PhD b, Dr Ellen Nolte PhD b
Summary
The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.

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

Editorial
Ebola and Quarantine
Jeffrey M. Drazen, M.D., Rupa Kanapathipillai, M.B., B.S., M.P.H., D.T.M.&H., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Scott M. Hammer, M.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2014; 371:2029-2030 November 20, 2014 DOI: 10.1056/NEJMe1413139
The governors of a number of states, including New York and New Jersey, recently imposed 21-day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease. We understand their motivation for this policy — to protect the citizens of their states from contracting this often-fatal illness. This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal. The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.

Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan’s family members who were living in the same household for days as he was at the start of his illness did not become infected.

A cynic would say that all these “facts” are derived from observation and that it pays to be 100% safe and to isolate anyone with a remote chance of carrying the virus. What harm can that approach do besides inconveniencing a few health care workers? We strongly disagree. Hundreds of years of experience show that to stop an epidemic of this type requires controlling it at its source. Médecins sans Frontières, the World Health Organization, the U.S. Agency for International Development (USAID), and many other organizations say we need tens of thousands of additional volunteers to control the epidemic. We are far short of that goal, so the need for workers on the ground is great. These responsible, skilled health care workers who are risking their lives to help others are also helping by stemming the epidemic at its source. If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves.

In the end, the calculus is simple, and we think the governors have it wrong. The health care workers returning from West Africa have been helping others and helping to end the epidemic that has killed thousands of people and scared millions. At this point the public does need assurances that returning workers will have their temperatures and health status monitored according to a set, documented protocol. In the unlikely event that they become febrile, they can follow the example of Craig Spencer, the physician from New York who alerted public health officials of his fever. As we continue to learn more about this virus, its transmission, and associated illness, we must continue to revisit our approach to its control and treatment. We should be guided by the science and not the tremendous fear that this virus evokes.

We should be honoring, not quarantining, health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also to help achieve source control, bringing the world closer to stopping the spread of this killer epidemic.

PLoS Neglected Tropical Diseases
(Accessed 22 November 2014)
http://www.plosntds.org/

Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy
Joilda Silva Nery, Susan Martins Pereira, Davide Rasella, Maria Lúcia Fernandes Penna, Rosana Aquino, Laura Cunha Rodrigues, Mauricio Lima Barreto, Gerson Oliveira Penna
Research Article | published 20 Nov 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003357

Assessing Progress in Reducing the At-Risk Population after 13 Years of the Global Programme to Eliminate Lymphatic Filariasis
Pamela J. Hooper, Brian K. Chu, Alexei Mikhailov, Eric A. Ottesen, Mark Bradley
Research Article | published 20 Nov 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003333

Household Transmission of Vibrio cholerae in Bangladesh
Jonathan D. Sugimoto, Amanda A. Koepke, Eben E. Kenah, M. Elizabeth Halloran, Fahima Chowdhury, Ashraful I. Khan, Regina C. LaRocque, Yang Yang, Edward T. Ryan, Firdausi Qadri, Stephen B. Calderwood, Jason B. Harris, Ira M. Longini
Research Article | published 20 Nov 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003314

Approaches to Refining Estimates of Global Burden and Economics of Dengue
Donald S. Shepard, Eduardo A. Undurraga, Miguel Betancourt-Cravioto, María G. Guzmán, Scott B. Halstead, Eva Harris, Rose Nani Mudin, Kristy O. Murray, Roberto Tapia-Conyer, Duane J. Gubler
Research Article | published 20 Nov 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003306

Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin
Janine de Zeeuw, Till F. Omansen, Marlies Douwstra, Yves T. Barogui, Chantal Agossadou, Ghislain E. Sopoh, Richard O. Phillips, Christian Johnson, K. Mohammed Abass, Paul Saunderson, Pieter U. Dijkstra, Tjip S. van der Werf, Ymkje Stientstra
Research Article | published 13 Nov 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003303

Public Health Ethics
Volume 7 Issue 3 November 2014
http://phe.oxfordjournals.org/content/current
Special Symposium on Dual Loyalities: Health Providers Working for the State

Dual Loyalties and Impossible Dilemmas: Health care in Immigration Detention
Linda Briskman* – Swinburne University of Technology
Deborah Zion – Victoria University
Abstract
Dual loyalty issues confront health and welfare professionals in immigration detention centres in Australia. There are four apparent ways they deal with the ethical tensions. One group provides services as required by their employing body with little questioning of moral dilemmas. A second group is more overtly aware of the conflicts and works in a mildly subversive manner to provide the best possible care available within a harsh environment. A third group retreats by relinquishing employment in the detention setting. A fourth group is activist in intent and actions. Derived from research and ethnography conducted in Australia, the article explores the moral dilemmas confronting those who are duty-bound by professional codes of ethics while also bound by loyalty to their employers and silenced by confidentiality statements. It provides particular focus on psychiatry, nursing and social work. We conclude by speculating whether a politics of compassion and acts of solidarity can forge a pathway through the ethical terrain. In doing so we draw upon human rights considerations as well as on the works of Joan Tronto and Elisabeth Porter.

Refugee Survey Quarterly
Volume 33 Issue 4 December 2014
http://rsq.oxfordjournals.org/content/current

Protection Closer to Home? A Legal Case for Claiming Asylum at Embassies and Consulates
Kate Ogg*
Lecturer in Law, Australian National University.
Abstract
If a person enters an embassy or consulate and claims asylum, is there a legal obligation under international refugee law or human rights law to consider that claim and, if the requirements are satisfied, grant protection? Previous research on this question has concluded that no such obligation exists pursuant to the non-refoulement obligations in the Convention Relating to the Status of Refugees, the Convention against Torture and the International Covenant on Civil and Political Rights. However, case-law over the past decade has shifted and strengthened the reach of non-refoulement under international refugee law and human rights law. This article will demonstrate that this more recent jurisprudence provides strong grounds to argue that embassies and consulates are, in certain circumstances, obligated to consider a claim for asylum and, if the requirements are met, grant protection.

Filling in the Gap: Refugee Returnees Deploy Higher Education Skills to Peacebuilding
Amanda Coffie*
Amanda Coffie is a part-time lecturer at the Department of Political Science and Institute of African Studies, Carleton University, Ottawa, Ontario, Canada.
Abstract
An urgently needed resource for peacebuilding is a professional and skilled workforce, however, this is lacking in many post-conflict countries. In this article it is suggested that although fewer refugees in developing countries have access to the level of education required for such professions, countries engaged in peacebuilding can benefit from the returnees with such skills. This study therefore, examines the differences in the levels of higher education of 40 Liberian returnees from Ghana and Guinea and the deployment of their skills towards their integration which have links to the broader peacebuilding agenda of Liberia. While the number of returnees with post-secondary education was generally low, the data indicate that comparatively those from Guinea had limited higher education opportunities to those who were in Ghana. Following from these cases, the article argues that insecurity and non-conducive asylum policies and programmes are the major challenges towards the provision of and refugee access to higher education skills training. Some examples of returnees’ deployment of asylum acquired profession and skills towards peacebuilding are discussed as evidence that the provision of higher education for refugees is not simply a tool for empowering refugees, but also an investment in future peacebuilding.

Risk Analysis
October 2014 Volume 34, Issue 10 Pages 1775–1967
http://onlinelibrary.wiley.com/doi/10.1111/risa.2014.34.issue-9/issuetoc

Original Research Article
Near-Misses and Future Disaster Preparedness
Robin L. Dillon1,*, Catherine H. Tinsley1 and William J. Burns2,3
Article first published online: 28 APR 2014
DOI: 10.1111/risa.12209
Abstract
Disasters garner attention when they occur, and organizations commonly extract valuable lessons from visible failures, adopting new behaviors in response. For example, the United States saw numerous security policy changes following the September 11 terrorist attacks and emergency management and shelter policy changes following Hurricane Katrina. But what about those events that occur that fall short of disaster? Research that examines prior hazard experience shows that this experience can be a mixed blessing. Prior experience can stimulate protective measures, but sometimes prior experience can deceive people into feeling an unwarranted sense of safety. This research focuses on how people interpret near-miss experiences. We demonstrate that when near-misses are interpreted as disasters that did not occur and thus provide the perception that the system is resilient to the hazard, people illegitimately underestimate the danger of subsequent hazardous situations and make riskier decisions. On the other hand, if near-misses can be recognized and interpreted as disasters that almost happened and thus provide the perception that the system is vulnerable to the hazard, this will counter the basic “near-miss” effect and encourage mitigation. In this article, we use these distinctions between resilient and vulnerable near-misses to examine how people come to define an event as either a resilient or vulnerable near-miss, as well as how this interpretation influences their perceptions of risk and their future preparedness behavior. Our contribution is in highlighting the critical role that people’s interpretation of the prior experience has on their subsequent behavior and in measuring what shapes this interpretation.

Science
21 November 2014 vol 346, issue 6212, pages 885-1028
http://www.sciencemag.org/current.dtl

Feature
Saving lives without new drugs
Jon Cohen
Many people treated for Ebola in West Africa have received bare-bones care in overwhelmed facilities that had few resources, contributing to a case fatality rate (CFR) of about 70%. Of the 20 patients treated in the United States and Europe, only five have died, a CRF of 25%, and the ones who did not recover tended to begin their care at the latest stages of disease. Now, a push is on for what’s dubbed Maximum Use of Supportive Care (MUST), which would offer Ebola patients in West Africa the basic life-saving interventions common in wealthier countries. MUST includes intravenous fluids to combat dehydration; balancing of electrolytes; nasogastric tubes for feedings; and medicines to counter diarrhea, vomiting, and secondary infections like bacterial sepsis and malaria. Estimates suggest that MUST would cost no more than $600 per patient.

Report
Strategies for containing Ebola in West Africa
Abhishek Pandey1,*, Katherine E. Atkins1,2,*, Jan Medlock3, Natasha Wenzel1, Jeffrey P. Townsend4, James E. Childs5, Tolbert G. Nyenswah6, Martial L. Ndeffo-Mbah1, Alison P. Galvani1,5,
Author Affiliations
1Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
2Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
3Department of Biomedical Sciences, Oregon State University, Corvallis, OR, USA.
4Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
5Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
6Ministry of Health and Social Welfare, Monrovia, Liberia.
Abstract
The ongoing Ebola outbreak poses an alarming risk to the countries of West Africa and beyond. To assess the effectiveness of containment strategies, we developed a stochastic model of Ebola transmission between and within the general community, hospitals, and funerals, calibrated to incidence data from Liberia. We find that a combined approach of case isolation, contact-tracing with quarantine, and sanitary funeral practices must be implemented with utmost urgency in order to reverse the growth of the outbreak. As of 19 September, under status quo, our model predicts that the epidemic will continue to spread, generating a predicted 224 (134 to 358) daily cases by 1 December, 280 (184 to 441) by 15 December, and 348 (249 to 545) by 30 December.