Journal of Infectious Diseases
Volume 211 Issue 8 April 15, 2015
http://jid.oxfordjournals.org/content/current

Large-scale Convalescent Blood and Plasma Transfusion Therapy for Ebola Virus Disease
Robert L. Colebunders1,2 and Robert O. Cannon2
Author Affiliations
1Department of Clinical Sciences, Institute of Tropical Medicine
2Epidemiology and Social Medicine, University of Antwerp, Belgium
(See the major article by Gutfraind and Meyers on pages 1262–7.)
Extract
An effective therapy for Ebola virus disease (EVD) not only will lower the case-fatality rate but also will provide an incentive for patients to seek treatment, thereby enhancing primary and secondary prevention efforts. While several experimental drugs are being considered, the World Health Organization (WHO) has prioritized Ebola convalescent whole blood (CWB) and convalescent plasma (CP) transfusion for evaluation because this can be done relatively quickly and, if proven to be safe and effective, could be implemented without delay [1]. The use of blood from recuperated individuals has a long history of use for treatment of other serious infectious diseases and, with appropriate precautions, is generally considered safe [2].

However, the WHO has indicated that this intervention must be considered as experimental for EVD and, therefore, that initial studies should be conducted within a clinical trial framework [1].

In this issue of The Journal of Infectious Diseases, Gutfraind and Meyers [3] extend an Ebola virus transmission model published by the Centers for Disease Control and Prevention (CDC) [4] to include large-scale hospital-based convalescent donations and transfusions. Using epidemiological estimates for Ebola in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% [5], they calculated that, under a 30% hospitalization rate, CWB and CP transfusions are estimated to reduce the number of deaths in Liberia by 65 (0.37%; 95% confidence interval [CI], .07%–2.6%) and 151 (0.9%; 95% CI, .21%–11%), respectively. They conclude that transfusion therapy for Ebola is a low-cost measure that can potentially save many lives in Liberia but will not measurably influence incidence.

There are, however, at least 8 major issues to consider in determining the advisability of implementing a large-scale CWB…

Journal of Medical Ethics
April 2015, Volume 41, Issue 4
http://jme.bmj.com/content/current

Research ethics
Paper
Results of a self-assessment tool to assess the operational characteristics of research ethics committees in low- and middle-income countries
Henry Silverman1, Hany Sleem2, Keymanthri Moodley3, Nandini Kumar4, Sudeshni Naidoo5,
Thilakavathi Subramanian4, Rola Jaafar6, Malini Moni7
Author Affiliations
1University of Maryland School of Medicine, Baltimore, Maryland, USA
2National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
3University of Stellenbosch, Matieland, South Africa
4Indian Council of Medical Research, Chennai, India
5University of the Western Cape, Matieland, South Africa
6Ain Wazein Hospital, Beirut, Lebanon
7Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Published Online First 19 April 2014
Abstract
Purpose
Many research ethics committees (RECs) have been established in low- and middle-income countries (LMICs) in response to increased research in these countries. How well these RECs are functioning remains largely unknown. Our objective was to assess the usefulness of a self-assessment tool in obtaining benchmarking data on the extent to which RECs are in compliance with recognised international standards.
Methods
REC chairs from several LMICs (Egypt, South Africa and India) were asked to complete an online self-assessment tool for RECs with a maximum score of 200. Individual responses were collected anonymously.
Results
The aggregate mean score was 137.4±35.8 (∼70% of maximum score); mean scores were significantly associated with the presence of a budget (p<0.001), but not with duration of existence, frequency of meetings, or the presence of national guidelines. As a group, RECs achieved more than 80% of the maximum score for the following domains: submission processes and documents received, recording of meeting minutes, criteria for ethical review and criteria for informed consent. RECs achieved less than 80% of the maximum score for the following domains: institutional commitment, policies and procedures of the REC, membership composition and training, policies and procedures for protocol review, elements of a decision letter and criteria for continuing review.
Conclusions
This study highlights areas where RECs from LMICs can improve to be in compliance with recommended international standards for RECs. The self-assessment tool provides valuable benchmarking data for RECs and can serve as a quality improvement method to help RECs enhance their operations.

The Lancet
Mar 28, 2015 Volume 385 Number 9974 p1151-1260
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Dementia: turning fine aspirations into measurable progress
The Lancet
Summary
“I look young, but I am actually quite old”, pronounced WHO Director-General Margaret Chan at the first Ministerial Conference on Global Action Against Dementia, hosted by WHO, the Organisation for Economic Co-operation and Development (OECD), and the UK Department of Health in Geneva on March 16–17. Dr Chan continued, with great clarity and sincerity, to describe her own desire to grow old gracefully and with dignity, contrasting her own aspirations with the plight of 47 million people worldwide who struggle to cope with the debilitating effect of dementia, a disorder that is expected to double in prevalence over the next two decades, and that comes with an estimated health bill worldwide in excess of US$600 billion.

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Editorial
1 year on—lessons from the Ebola outbreak for WHO
The Lancet
Summary
This week has seen what is likely to be the beginning of an onslaught of criticism levelled against WHO for its handling of the Ebola outbreak in west Africa. First, ahead of the 1-year anniversary of the outbreak’s start, an article by the Associated Press (AP) reported that WHO deliberately delayed declaring the Ebola epidemic as an emergency in early June, 2014, waiting instead until Aug 8 to finally make the announcement. AP obtained internal emails and documents suggesting that senior WHO officials were not only told of the desperate situation, but also received anguished pleas for help. Instead of taking urgent and decisive action, the article said WHO decided that managing the political repercussions in countries would outweigh the benefits that declaring an emergency would bring. It “could be seen as a hostile act”, said one memo. Downplaying the epidemic may have cost lives, said AP. In response, WHO insisted that the spread of the virus was unprecedented, and the lack of resources and intelligence on the ground hindered its ability to act.

Second, Médecins Sans Frontières (MSF), who did more than any other organisation to bring the world’s attention to Ebola and who led the operational response against the outbreak, published their searingly critical report—Pushed to the limit and beyond—this week. Despite early warnings about the severity of the outbreak and urgent calls for help, MSF were ignored by governments and WHO. They dubbed the response a “global coalition of inaction”. MSF described the horrors of having to turn patients away because their health centres and staff were simply overwhelmed.

This year will see at least three further international, independent investigations into WHO’s conduct in the Ebola response. Regrettably, it is likely that WHO’s reputation is going to suffer more wounds in the coming months. The Lancet’s focus will be to try and draw larger lessons from the Ebola outbreak. In early May, we will be publishing a collection of essays on global health security, together with one of the first analyses of the deeper consequences of Ebola.

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Series
Health-system reform and universal health coverage in Latin America
Prof Rifat Atun, FRCP, Prof Luiz Odorico Monteiro de Andrade, PhD, Gisele Almeida, PhD, Daniel Cotlear, DPhil, T Dmytraczenko, PhD, Patricia Frenz, PhD, Prof Patrícia Garcia, PhD, Octavio Gómez-Dantés, MPH, Felicia M Knaul, PhD, Prof Carles Muntaner, PhD, Juliana Braga de Paula, MSc, Felix Rígoli, MD, Prof Pastor Castell-Florit Serrate, PhD, Adam Wagstaff, PhD
Published Online: 15 October 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61646-9
Summary
Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.
Series
Overcoming social segregation in health care in Latin America
Dr Daniel Cotlear, DPhil, Octavio Gómez-Dantés, MD, Felicia Knaul, PhD, Prof Rifat Atun, FRCP, Ivana C H C Barreto, PhD, Prof Oscar Cetrángolo, MPhil, Prof Marcos Cueto, PhD, Prof Pedro Francke, MSc, Patricia Frenz, MD, Ramiro Guerrero, MSc, Prof Rafael Lozano, MD, Robert Marten, MPH, Prof Rocío Sáenz, MD
Published Online: 15 October 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61647-0
Summary
Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America’s longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.

The Lancet Infectious Diseases
Apr 2015 Volume 15 Number 4 p361-486
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Comprehensive approach to better malaria control
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)70113-1

Malaria is a complex and deadly disease but is also treatable and preventable. In 2000, an estimated 350 million to 500 million malaria cases led to the death of 1 million people, mostly African children. Since then, the establishment of the Millennium Development Goals for reducing global malaria incidence and mortality, have driven greater awareness and progress towards malaria control, and more than 4 million lives have been saved.

With the aim of accelerating progress toward malaria elimination, the Roll Back Malaria (RBM) partnership has coordinated the development of the Global Malaria Action Plan 2 (GMAP2), Towards a Malaria-Free World: A Global Case for Investment and Action 2016–2030—the second generation of an RBM consensus document that provides a practical, multisectoral, action-oriented guide toward better control of malaria transmission. The draft of the English version of the document was under review until March 18, allowing interested partners and individuals to contribute. Representatives from more than 90 countries participated in the development of the consensus document. The approach is extremely collaborative and involves academia, the private sector, research bodies, and governments. The consensus document will be accompanied by a second document, the Global Technical Strategy (GTS) for Malaria 2016–2030, which will be presented to the World Health Assembly in May, 2015.

The five chapters of GMAP2 provide a comprehensive overview of how resources should be mobilised. Its strategy sets out how to reduce malaria case incidence globally by 90% in 2030 compared with 2015, and how to eliminate malaria from at least 35 countries by 2030 in which malaria was transmitted in 2015. Crucial to reaching global malaria targets is adequate funding, and GMAP2 estimates that US$8 billion of investment will be needed annually between 2026 and 2030 to reach its goals, as well as an additional annual $673 million to fund malaria research and development. If achieved, this will lead to 12 million lives saved and 2•9 billion cases averted. The report highlights that if the 2030 targets are not met, the costs will be catastrophic. If the coverage of malaria interventions were to revert to the 2007 level, there would be an additional 2 billion malaria cases and 4•9 million deaths, leading to $5•8 billion in direct costs to health systems and households. Returns on investment in malaria control, according to the report, will be higher than expected: $4•6 trillion in economic benefits in 2030.

Small investments can bring major returns. The report highlights the case of Neema Gunda, a widow and head of a household in rural Tanzania—thanks to the bednets and instruction on their correct use she and her family get sick less often. Although small investments can make enormous differences to individual lives, substantial investments will have worldwide benefits for billions of people. But to have the greatest effect worldwide, investments will need to be channelled into locally tailored interventions sensitive to the needs of specific nations, regions, and villages.

The report also focuses on how environmental, social, cultural, and biological factors are all interconnected elements in the control of the disease. Biological factors, such as the growing problem of resistance to antimalarial drugs and insecticides, represent one of the biggest threats to reaching the 2030 goal. Agriculture, education, housing, water and sanitation, and tourism are also all important, as well as the interfaces between land use, climate change, and environmental policy. Stakeholders in all these areas need to intensify their engagement.

Despite progress, as of today, about 3 billion people are at risk in 109 countries. Ongoing advances in the fight against malaria will contribute to the realisation of the Sustainable Development Goals (SDG), and progress towards the SDGs will support the continued reduction and elimination of malaria. Tackling malaria is essential if sustainable changes are to be made for people living in areas where it is endemic. For example, it creates healthier, more productive workforces which can help attract trade and commerce, it makes a substantial contribution to improvements in child health, and protects households from lost earnings and the costs of seeking care. The SDGs provide an unprecedented opportunity to widen the circle of engagement and intensify multisectoral action and cross-country collaboration to defeat malaria. The comprehensive approach of GMAP2 will help ensure this opportunity will be taken and will guide us, we hope, towards a brighter future of malaria control.

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Comment
Applied public health research on the frontline
Arto A Palmu, Helena Käyhty
Published Online: 17 February 2015
DOI: http://dx.doi.org/10.1016/S1473-3099(15)70052-6
Summary
Prevention of pneumococcal disease in resource-poor countries, including many Asian countries, is desperately needed. The implementation of pneumococcal conjugate vaccines (PCVs) has been slow due to scarce funding, but also because the burden of pneumococcal disease is poorly known. However, with the financial assistance of the GAVI Alliance, the introduction of PCVs has been accelerated.1

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Comment
Rotavirus vaccines roll-out in resource-deprived regions
Miguel L O’Ryan, Ralf Clemens
Published Online: 28 January 2015
Open Access
DOI: http://dx.doi.org/10.1016/S1473-3099(14)71089-8
Rotaviruses cause 30–50% of severe diarrhoea cases in children younger than 5 years, leading to about 450 000 deaths every year.1 Infections during the first months of life are protective against symptomatic reinfections later on, setting the stage for vaccine development.2, 3 The existence of four major genotypes—G1[P8], G2[P4], G3[P8], and G4[P8]—created a great challenge because in-vitro studies suggested that antibodies to a specific type neutralised only that type, raising the question of whether it would be necessary for a vaccine to include all common genotypes.

During the 1990s the first licensed vaccine, Rotashield (Wyeth Laboratories, Collegeville, PA, USA), which contained an attenuated simian and three simian–human reassortant strains of the virus, showed that 70–90% of cases of severe rotavirus disease could potentially be prevented in lower-middle-income and high-income countries with vaccination.4 However, intestinal intussusception was induced in about one in 11 000 children who received the vaccine, leading to its withdrawal and posing a large challenge for new candidate vaccines because future trials needed to include 60 000 children to reasonably assure safety.5, 6 Post-licensure studies of the second-generation vaccines Rotarix (GlaxoSmithKline, Brentford, UK), which contains a single human attenuated strain, and RotaTeq (Merck, Kenilworth, NJ, USA) based on five human-bovine reassortant strains, suggest an acceptable class effect risk for intestinal intussusception of somewhere between one in 20 000 and one in 100 000 individuals.7 Importantly, both vaccines showed high efficacy (more than 80%) against severe rotavirus disease in prelicensure studies5, 6 and against several predominating genotypes. As trials were progressively done in various regions worldwide, it became clear that protective efficacy for both vaccines was lower in resource-deprived countries than in high-income countries8 and that efficacy might not be the same among serotypes and genotypes, especially against G2[P4].5, 9

First licensed in 2006, these vaccines have been progressively introduced worldwide and dozens of effectiveness trials, done mostly in high or middle-high income countries, have confirmed efficacy rates reported in prelicensure trials. A major unanswered question is how effective these vaccines will be in real-world scenarios in the poorest regions of the world (where diarrhoea mortality is at its highest) and in the presence of varied circulating types. Children might be infected in their first months of life in these regions (where a first infection is not as protective as in higher-income regions) such that children develop several severe episodes of rotavirus disease throughout their first years.3, 10 Vaccine effectiveness could be substantially lower in these regions, and, thus, meticulous prospective studies are essential for policy decisions and for the potential design and assessment of new vaccine strategies.

In The Lancet Infectious Diseases, Naor Bar-Zeev and colleagues11 report results of the second effectiveness study to be done in Africa (Blantyre, Malawi). In the first study, Michelle Groome and colleagues12 showed 57% (95% CI 40–68) effectiveness against rotavirus diarrhoea that required a minimum of overnight hospital admission in children in South Africa younger than 2 years who were vaccinated at 6 and 14 weeks of life. Bar-Zeev and colleagues11 report 64% (24–83) effectiveness for reduction of emergency room visits (compared with rotavirus test-negative controls) for rotavirus in children younger than 5 years (94% of samples tested from children younger than 2 years) using an accelerated 6 and 10 week of age schedule with the monovalent human rotavirus vaccine. Early effect was documented with roughly 10% reductions every year in rotavirus detection rates in infants during their first and second years of age, and an overall rate reduction of near 15% after 2 years for all children younger than 5 years. Genotype G2[P4] was the most commonly detected (25% of samples tested), but the vaccine had a lower non-significant effectiveness point estimate of 53% (95% CI −28 to 83) for G2[P4] than it did for G1[P8] (82%, 42–95), strongly suggesting lower effectiveness against this genotype.

That data for vaccine effectiveness in Malawi are similar to, if not better than, those for other efficacy trials is good news and findings can probably be extrapolated to regions with similar socioeconomic conditions. Differential serotype and genotype effectiveness will have to be continuously monitored and the search for even better vaccines and strategies must continue. Although, the natural history of rotavirus infection and disease in low-resource regions10 suggests that oral vaccines that mimic protection conferred by natural infections might have reached their maximum effectiveness, this figure is still substantial and vaccines could potentially prevent nearly 300 000 deaths of infants and children every year.

Articles
Comparison of two-dose priming plus 9-month booster with a standard three-dose priming schedule for a ten-valent pneumococcal conjugate vaccine in Nepalese infants: a randomised, controlled, open-label, non-inferiority trial
Mainga Hamaluba, Rama Kandasamy, Shyam R Upreti, Giri R Subedi, Shrijana Shrestha, Shiva Bhattarai, Meeru Gurung, Rahul Pradhan, Merryn Voysey, Santosh Gurung, Shachi Pradhan, Anushil K Thapa, Rakesh Maharjan, Usha Kiran, Simon A Kerridge, Jason Hinds, Fiona van der Klis, Matthew D Snape, David R Murdoch, Sarah Kelly, Dominic F Kelly, Neelam Adhikari, Stephen Thorson, Andrew J Pollard

Effectiveness of a monovalent rotavirus vaccine in infants in Malawi after programmatic roll-out: an observational and case-control study
Naor Bar-Zeev, Lester Kapanda, Jacqueline E Tate, Khuzwayo C Jere, Miren Iturriza-Gomara, Osamu Nakagomi, Charles Mwansambo, Anthony Costello, Umesh D Parashar, Robert S Heyderman, Neil French, Nigel A Cunliffe, for the VacSurv Consortium
Open Access

Nature
Volume 519 Number 7544 pp389-498 26 March 2015
http://www.nature.com/nature/current_issue.html

Comment
Sustainability: Five steps for managing Europe’s forests
Support resilience and promote carbon storage, say Silvano Fares and colleagues.
We outline five key issues that European forestry managers should address to develop Europe’s forests sustainably and with resilience in mind4. Policies and plans must account for the trade-offs between forests’ capacity to store carbon, adapt to climate change and yield wood products and other ecosystem services.

Nonprofit and Voluntary Sector Quarterly
April 2015; 44 (2)
http://nvs.sagepub.com/content/current

Being Nonprofit-Like in a Market Economy
Understanding the Mission-Market Tension in Nonprofit Organizing
Matthew L. Sanders1
1Utah State University, Logan, USA
Abstract
Nonprofit organizations experience a tension between pursuing their social missions and meeting the demands of a market economy. This mission-market tension is an everyday, practical concern for nonprofit practitioners. Yet, scholars know very little about how nonprofit practitioners define and manage this tension. Drawing on contradiction-centered perspectives of organizing, data from an ethnographic study of a single U.S. nonprofit organization demonstrate that the mission-market tension was defined and managed by organizational members as both a contradictory and interconnected phenomenon. This framing was enabled by specific communication practices that supported a productive and generative relationship between these seemingly incompatible goals. Findings suggest that the mission-market tension is an inherent condition of nonprofit organizing and highlight the central role of communication in successfully managing mission and market concerns.
Nonprofit Organizational Effectiveness – Analysis of Best Practices
Kellie C. Liket1, Karen Maas1
1Erasmus University Rotterdam, The Netherlands
Abstract
In the face of increased accountability pressures, nonprofits are searching for ways to demonstrate their effectiveness. Because meaningful tools to evaluate effectiveness are largely absent, financial ratios are still the main indicators used to approximate it. However, there is an extensive body of literature on determinants of nonprofit effectiveness. In this study, we test the extent to which these assertions in the literature align with practitioner views. To increase the practical value of our comparative exercise, we create a self-assessment survey on the basis of the practices that find support in both academia and practice. This provides managers with a tool to assess the extent to which the identified practices are present in their organizations and with suggestions, which might lead to improvements in their effectiveness. Intermediaries can use the tool to provide better information to donors. Funders can use it in their selection of grantees, and capacity-building efforts.
The Role of Internal Branding in Nonprofit Brand Management- An Empirical Investigation
Gordon Liu1, Chris Chapleo2, Wai Wai Ko3, Isaac K. Ngugi2
1University of Bath, UK
2Bournemouth University, Dorset, UK
3Brunel University, Uxbridge, UK
Abstract
Internal branding refers to an organization’s attempts to persuade its staff to buy-in to the organization’s brand value and transform it into a reality. Drawing from self-determination theory and leadership theory, we seek to develop a deeper understanding of the process of internal branding in the nonprofit sector. More specifically, we propose and examine the mediating effects of the staff’s emotional brand attachment, staff service involvement, and the moderating effect of charismatic leadership on the brand orientation behavior–organizational performance relationship using data obtained from the representatives of 301 nonprofit organizations in the United Kingdom. On a general level, the findings suggest that staff emotional brand attachment and staff service involvement are linked to brand orientation and organizational performance. Moreover, charismatic leadership increases the strength of this linkage. All of these findings extend the literature on internal branding.

PLOS Currents: Disasters
[Accessed 28 March 2015]
http://currents.plos.org/disasters/

The Hospital Incident Command System: Modified Model for Hospitals in Iran
March 27, 2015 • Brief Incident Report
Introduction: Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran.

Methods: In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS.
Results: The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section.

Conclusion: An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

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An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 – 2014 at Médecins sans Frontières Operations Centre Brussels Projects
March 27, 2015 • Research article
Background: Surgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis.

Methods: All procedures performed in MSF-OCB operating theatres from July 2008 through June 2014 were reviewed. Projects providing only specialty care, not fully operational or not offering elective surgeries were excluded. Annual CSRs and EHRs were calculated for each project. Their relationship was assessed with linear regression.

Results: After applying the exclusion criteria, there were 47,472 cases performed at 13 sites in 8 countries. There were 13,939 CS performed (29% of total cases). Of the 4,632 herniorrhaphies performed (10% of total cases), 30% were emergency procedures. CSRs ranged from 0.06 to 0.65 and EHRs ranged from 0.03 to 1.0. Linear regression of annual ratios at each project did not demonstrate statistical evidence for the CSR to predict EHR [F(2,30)=2.34, p=0.11, R2=0.11]. The regression equation was: EHR = 0.25 + 0.52(CSR) + 0.10(reason for MSF-OCB assistance).

Conclusion: Surgical humanitarian assistance projects operate in areas with critical surgical capacity deficiencies that are further disrupted by crisis. Rapid, accurate assessments of surgical capacity are necessary to plan cost- and clinically-effective humanitarian responses to baseline and acute unmet surgical needs in LICs affected by crisis. Though CSR and EHR may meet these criteria in ‘steady-state’ healthcare systems, they may not be useful during humanitarian emergencies. Further study of the relationship between direct surgical capacity improvements and these ratios is necessary to document their role in humanitarian settings.

New England Journal of Medicine
March 26, 2015 Vol. 372 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Chikungunya Virus and the Global Spread of a Mosquito-Borne Disease
Scott C. Weaver, Ph.D., and Marc Lecuit, M.D., Ph.D.
N Engl J Med 2015; 372:1231-1239 March 26, 2015 DOI: 10.1056/NEJMra1406035
Chikungunya virus infection is a rapid-onset, febrile disease with intense asthenia, arthralgia, myalgia, headache, and rash. This mosquito-borne alphavirus has spread throughout the Caribbean and into much of Central America. Further spread in the Americas seems likely.

New England Journal of Medicine
March 26, 2015 Vol. 372 No. 13
http://www.nejm.org/toc/nejm/medical-journal

Correspondence
Ebola Virus Disease among Children in West Africa
N Engl J Med 2015; 372:1274-1277 March 26, 2015 DOI: 10.1056/NEJMc1415318

To the Editor:
The epidemic of Ebola virus disease (EVD) in West Africa has caused clinical illness and deaths among persons with reported ages ranging from less than 1 year to more than 100 years. Most published estimates of key epidemiologic parameters have been based on patients of all ages1,2 and have thus been dominated by cases in which patients are 16 years of age or older, and as of January 5, 2015, these cases accounted for 79% of the confirmed and probable cases for which age has been reported.

Here we investigate the progression and outcome of EVD in confirmed and probable pediatric cases reported from Guinea, Liberia, and Sierra Leone, stratified according to age. The absolute and per capita case incidence of EVD among children younger than 16 years of age has been significantly and consistently lower than the incidence among adults in all three countries (Figure 1A, 1B, and 1CFigure 1Age-Group–Specific Incidence of Ebola Virus Disease in West Africa, Incubation Period, Intervals from Onset to Death and Onset to Hospitalization, and Case Fatality Rate.). This pattern is similar to that observed in past EVD outbreaks.3,4 However, because the current epidemic is so large, it provides an opportunity to explore the ways in which epidemiologic and clinical parameters vary according to age. Although the age distribution of confirmed, probable, and suspected cases is similar in all three countries (Fig. S3 in the Supplementary Appendix, available with the full text of this letter at NEJM.org), the proportion of pediatric cases (those younger than 16 years of age) among all cases increased over the course of 2014 (Figure 1C, and Fig. S4 in the Supplementary Appendix).

The mean incubation period (the average time from infection until symptom onset) was shortest, on average, in the youngest children, with means ranging from 6.9 days (95% confidence interval [CI], 5.1 to 9.5) in 14 children younger than 1 year of age to 9.8 days (95% CI, 8.7 to 11.1) in 184 children 10 to 15 years of age (Figure 1D, and Table S1 and Fig. S5 in the Supplementary Appendix). Younger children also had shorter times from symptom onset to hospitalization and from symptom onset to death (Figure 1D, and Fig. S6 and S7 and Tables S2 and S3 in the Supplementary Appendix). There was no clear evidence that age affected the distribution of the intervals between symptom onset and hospital discharge, between hospitalization and death, between hospitalization and hospital discharge, or between symptom onset and onward transmission (Fig. S8 to S11 and Tables S4 to S7 in the Supplementary Appendix).

Almost all children with EVD who were younger than 1 year of age had fever (92%) before clinical presentation, and children younger than 16 years of age were more likely than adults to present with fever (P<0.001) (Table S8 and Fig. S13 in the Supplementary Appendix). Children were less likely than adults (i.e., persons 16 years of age or older) to report pain in the abdomen, chest, joints, or muscles, difficulty breathing or swallowing, and hiccups between symptom onset and clinical presentation (P<0.001); however, this finding may reflect the difficulty young children have in reporting such symptoms rather than a different symptom profile (Table S8 and Fig. S12 in the Supplementary Appendix). The case fatality rate (CFR) was lowest among children between 10 and 15 years of age and highest among those 4 years of age or younger (Figure 1E, and Fig. S14 and S15 and Table S9 in the Supplementary Appendix). The CFR for persons younger than 45 years of age (most of whom are 5 to 44 years of age) was lower than that among those 45 years of age or older (Figure 1E), a finding that is in line with that of an earlier report.5

The shorter incubation period in children, the relatively high risk of death among children younger than 5 years of age (as compared with older children), and the more rapid progression to death highlight the importance of including children among case contacts for follow-up, of examining children for early signs of disease during active case finding, and of explaining the risk of EVD to parents, guardians, and caregivers. All persons in whom EVD is suspected, but especially children, need the earliest possible referral for diagnostic testing, and children need age-appropriate treatment. The causes of the relatively rapid disease progression and relatively high CFR in the youngest children requires further investigation.

PLoS Medicine
(Accessed 28 March 2015)
http://www.plosmedicine.org/

Editorial
Testing and Treating the Missing Millions with Tuberculosis
Madhukar Pai, Puneet Dewan
Published: March 24, 2015
DOI: 10.1371/journal.pmed.1001805
[No abstract]

Policy Forum
Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from the West African Ebola Epidemic
Mark J. Siedner, Lawrence O. Gostin, Hilarie H. Cranmer, John D. Kraemer
Published: March 24, 2015
DOI: 10.1371/journal.pmed.1001804
Summary Points
:: The international response to the West African Ebola virus disease epidemic has exemplified the great potential of the global public health community. However, the protracted early response also revealed critical gaps, which likely resulted in exacerbation of the epidemic.
:: It is incumbent on international health partners to learn from missteps that occurred in the early stages of the epidemic and strengthen our public health capacity to better respond to future public health emergencies.
:: Strategies to consider include development of a more precise system to risk stratify geographic settings susceptible to disease outbreaks, reconsideration of the 2005 International Health Regulations Criteria to allow for earlier responses to localized epidemics before they reach epidemic proportions, increasing the flexibility of the World Health Organization director general to characterize epidemics with more granularity, development of guidelines for best practices to promote partnership with local stakeholders and identify locally acceptable response strategies, and, most importantly, making good on international commitments to establish a fund for public health emergency preparedness and response.
:: The recent success of the global action to stem the Ebola virus disease epidemic is laudable but should not encourage complacency in our efforts to improve the global public health infrastructure.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 28 March 2015)

Geographic Distribution and Mortality Risk Factors during the Cholera Outbreak in a Rural Region of Haiti, 2010-2011
Anne-Laure Page, Iza Ciglenecki, Ernest Robert Jasmin, Laurence Desvignes, Francesco Grandesso, Jonathan Polonsky, Sarala Nicholas, Kathryn P. Alberti, Klaudia Porten, Francisco J. Luquero
Research Article | published 26 Mar 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003605
Abstract
Background
In 2010 and 2011, Haiti was heavily affected by a large cholera outbreak that spread throughout the country. Although national health structure-based cholera surveillance was rapidly initiated, a substantial number of community cases might have been missed, particularly in remote areas. We conducted a community-based survey in a large rural, mountainous area across four districts of the Nord department including areas with good versus poor accessibility by road, and rapid versus delayed response to the outbreak to document the true cholera burden and assess geographic distribution and risk factors for cholera mortality.
Methodology/Principal Findings
A two-stage, household-based cluster survey was conducted in 138 clusters of 23 households in four districts of the Nord Department from April 22nd to May 13th 2011. A total of 3,187 households and 16,900 individuals were included in the survey, of whom 2,034 (12.0%) reported at least one episode of watery diarrhea since the beginning of the outbreak. The two more remote districts, Borgne and Pilate were most affected with attack rates up to 16.2%, and case fatality rates up to 15.2% as compared to the two more accessible districts. Care seeking was also less frequent in the more remote areas with as low as 61.6% of reported patients seeking care. Living in remote areas was found as a risk factor for mortality together with older age, greater severity of illness and not seeking care.
Conclusions/Significance
These results highlight important geographical disparities and demonstrate that the epidemic caused the highest burden both in terms of cases and deaths in the most remote areas, where up to 5% of the population may have died during the first months of the epidemic. Adapted strategies are needed to rapidly provide treatment as well as prevention measures in remote communities.
Author Summary
In October 2010, a large cholera outbreak was declared in Haiti and rapidly spread throughout the country, quickly overwhelming the existing health system. Specialized treatment structures were opened rapidly, generally in cities or large villages, and decentralized treatment units or rehydration points were gradually opened later on. To gain insight into the true burden of the cholera outbreak in the community and on potential geographical differences due to accessibility, we conducted a survey in April–May 2011 in a large rural area across four mountainous districts in the Nord department. We interviewed 3,187 households, corresponding to 16,900 individuals, of whom 2,034 (12%) had had diarrhea, probably cholera, since the beginning of the outbreak. The two most remote districts showed higher proportions of population affected by the disease, up to 16.2%, and higher proportions of deaths among patients with probable cholera, up to 15.2%, than the two districts with better accessibility. Remote populations, older patients, severe cases and those not seeking care were at increased risk of dying of the disease. These results show the very high burden of the cholera outbreak in remote areas, emphasizing the need to develop strategies to rapidly provide treatment and prevention measures in remote communities.

PLoS One
[Accessed 28 March 2015]
http://www.plosone.org/

Homologous and heterologous protection of nonhuman primates by ebola and Sudan virus-like particles
Warfield KL1, Dye JM2, Wells JB2, Unfer RC1, Holtsberg FW1, Shulenin S1, Vu H1, Swenson DL2, Bavari S2, Aman MJ1.
Author information
2015 Mar 20;10(3):e0118881. doi: 10.1371/journal.pone.0118881. eCollection 2015.
Abstract
Filoviruses cause hemorrhagic fever resulting in significant morbidity and mortality in humans. Several vaccine platforms that include multiple virus-vectored approaches and virus-like particles (VLPs) have shown efficacy in nonhuman primates. Previous studies have shown protection of cynomolgus macaques against homologous infection for Ebola virus (EBOV) and Marburg virus (MARV) following a three-dose vaccine regimen of EBOV or MARV VLPs, as well as heterologous protection against Ravn Virus (RAVV) following vaccination with MARV VLPs. The objectives of the current studies were to determine the minimum number of vaccine doses required for protection (using EBOV as the test system) and then demonstrate protection against Sudan virus (SUDV) and Taï Forest virus (TAFV). Using the EBOV nonhuman primate model, we show that one or two doses of VLP vaccine can confer protection from lethal infection. VLPs containing the SUDV glycoprotein, nucleoprotein and VP40 matrix protein provide complete protection against lethal SUDV infection in macaques. Finally, we demonstrate protective efficacy mediated by EBOV, but not SUDV, VLPs against TAFV; this is the first demonstration of complete cross-filovirus protection using a single component heterologous vaccine within the Ebolavirus genus. Along with our previous results, this observation provides strong evidence that it will be possible to develop and administer a broad-spectrum VLP-based vaccine that will protect against multiple filoviruses by combining only three EBOV, SUDV and MARV components.

PLoS One
[Accessed 28 March 2015]
http://www.plosone.org/

Research Article
Linking Human Health and Livestock Health: A “One-Health” Platform for Integrated Analysis of Human Health, Livestock Health, and Economic Welfare in Livestock Dependent Communities
S. M. Thumbi, M. Kariuki Njenga, Thomas L. Marsh, Susan Noh, Elkanah Otiang, Peninah Munyua, Linus Ochieng, Eric Ogola, Jonathan Yoder, Allan Audi, Joel M. Montgomery, Godfrey Bigogo, Robert F. Breiman, Guy H. Palmer, Terry F. McElwain
Published: March 23, 2015
DOI: 10.1371/journal.pone.0120761
Abstract
Background
For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status.
Method
We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households.
Findings
Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16–1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size.
Conclusion
This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.

Prehospital & Disaster Medicine
Volume 30 – Issue 02 – April 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Original Research
Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions
Lauren Walsha1 c1 id1, Hillary Craddocka1, Kelly Gulleya1, Kandra Strauss-Riggsa1 and Kenneth W. Schora1
a1 National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Rockville, Maryland USA
Abstract
Introduction
This research aimed to learn from the experiences of leaders of well-developed, disaster preparedness-focused health care coalitions (HCCs), both the challenges and the successes, for the purposes of identifying common areas for improvement and sharing “promising practices.”
Hypothesis/Problem
Little data have been collected regarding the successes and challenges of disaster preparedness-focused HCCs in augmenting health care system preparedness for disasters.
Methods
Semi-structured interviews were conducted with a sample of nine HCC leaders. Transcripts were analyzed qualitatively.
Results
The commonly noted benefits of HCCs were: community-wide and regional partnership building, providing an impartial forum for capacity building, sharing of education and training opportunities, staff- and resource-sharing, incentivizing the participation of clinical partners in preparedness activities, better communication with the public, and the ability to surge. Frequently noted challenges included: stakeholder engagement, staffing, funding, rural needs, cross-border partnerships, education and training, and grant requirements. Promising practices addressed: stakeholder engagement, communicating value and purpose, simplifying processes, formalizing connections, and incentivizing participation.
Conclusions
Strengthening HCCs and their underlying systems could lead to improved national resilience to disasters. However, despite many successes, coalition leaders are faced with obstacles that may preclude optimal system functioning. Additional research could: provide further insight regarding the benefit of HCCs to local communities, uncover obstacles that prohibit local disaster-response capacity building, and identify opportunities for an improved system capacity to respond to, and recover from, disasters.

Brief Report
Preparing for Euro 2012: Developing a Hazard Risk Assessment
Evan G. Wonga1, Tarek Razeka1, Artem Luhovya1, Irina Mogilevkinaa2, Yuriy Prudnikova2, Fedor Klimovitskiya2, Yuriy Yutovetsa2, Kosar A. Khwajaa1 and Dan L. Deckelbauma1 c1
a1 Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
a2 Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk National Medical University, Donetsk, Ukraine
Abstract
Introduction
Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery.
Hypothesis/Problem To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012.
Methods
In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures.
Results
This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication.
Conclusion
This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events.

Comprehensive Review
Literature Review on Medical Incident Command
Rune Rimstada1a2a3 c1 and Geir Sverre Brauta4a5
a1 Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
a2 Department of Industrial Economics, Risk Management, and Planning, University of Stavanger, Stavanger, Norway
a3 Medicine, Health, and Development, Oslo University Hospital, Oslo, Norway
a4 Department of Research, Stavanger University Hospital, Stavanger, Norway
a5 Stord Haugesund University College, Haugesund, Norway
Abstract
Introduction
It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published.
Problem
This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders’ performances be measured and assessed?
Methods
A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis.
Results
The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders’ tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted. There are no widely acknowledged measurement tools of commanders’ performances, though several performance indicators have been suggested.
Conclusion
The competence and experience of the commanders, upon which an efficient ICS has to rely, cannot be compensated significantly by plans and procedures, or even by guidance from superior organizational elements such as coordination centers. This study finds that neither a certain system or structure, or a specific set of plans, are better than others, nor can it conclude what system prerequisites are necessary or sufficient for efficient incident management. Commanders need to be sure about their authority, responsibility, and the functional demands posed upon them.

Comprehensive Review
A Literature Review of Medical Record Keeping by Foreign Medical Teams in Sudden Onset Disasters
Anisa J. N. Jafara1 c1, Ian Nortona2, Fiona Leckya3 and Anthony D. Redmonda1
a1 HCRI, Ellen Wilkinson Building, University of Manchester, Manchester, United Kingdom
a2 National Critical Care and Trauma Response Center, Darwin, Australia
a3 EMRiS Group, ScHARR, Sheffield, United Kingdom
Abstract
Background Medical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention.
Methods The objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs.
Findings The style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used.
Interpretation Without standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.

Public Health Ethics
Volume 8 Issue 1 April 2015
http://phe.oxfordjournals.org/content/current

Public Health: Beyond the Role of the State
Angus Dawson*
University of Birmingham, UK
Marcel Verweij
Wageningen University, The Netherlands
Extract
Most of the papers in this issue of Public Health Ethics—more generally a large part of academic work in our field—are concerned with ethical problems of disease prevention and health promotion activities within nation states. Such discussions often involve reflection on the exact obligations of governments and public health officials acting on behalf of the state while pursuing these ends. In liberal approaches to such discussions, it is common to see a minimal role for the state and a focus on promoting the freedom and responsibility of individual citizens. Indeed, some choose to see public health ethics as being centrally about the conflict between individuals and the state (Holland, 2007; Nuffield Council on Bioethics 2007; Krebs 2008). In various places we have argued that public health ethics should not be conceptualized as being centred on conflicts between individual liberty and the responsibility of the state to protect health (Dawson 2010; Dawson 2011; Verweij & Dawson 2013, Verweij 2014). In this editorial, we suggest that we can see another problem that arises from the individual-vs-state way of structuring such discussions. Public health as an activity goes beyond the role of the state.
Some may argue that public health necessarily involves state action (Rothstein, 2002). This makes some sense, as it is certainly true that many interventions to protect health involve the exertion of power over citizens or even coercive policies, through, for example, the enforcement of legislation. In a previous paper, we have taken and argued for a broader view of public health, legitimate public health activity and public health ethics (Verweij and Dawson, 2007). There we argued that public health ought to be seen as involving collective interventions to protect and promote population health…

Science
27 March 2015 vol 347, issue 6229, pages 1389-1512
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
A reassuring snapshot of Ebola
Gretchen Vogel
Summary
As Ebola has taken its horrific toll across West Africa, passing from person to person in its longest known chains of human infections, researchers worried the virus might mutate to become even more threatening. New viral genome data from Mali suggest a glimmer of good news: The Ebola virus that infected eight people there in October and November had not changed significantly from the one that infected people at the beginning of the known outbreak, back in March 2014. Diagnostic tests, experimental antibody-based treatments, and potential vaccines for Ebola are all developed based on the virus’s recent sequence. If it were to change too much, cases could go unrecognized, and treatments and vaccines could become ineffective. Mutations might even lead to more dramatic symptoms or allow the virus to pass from person to person more easily. But genome sequences of four recent Ebola virus samples suggest that the virus, so far, has remained fairly stable.

In Depth
Social Sciences
Measuring child abuse’s legacy
Emily Underwood
Summary
The notion that victims of physical abuse as kids are more likely to abuse their own children, often described as the “cycle of violence,” is widely held but sparsely documented. Now, the first large, longitudinal study to track how victims of child abuse treat their own children has found little evidence of a cycle of violence, but suggests that sexual abuse and neglect may indeed be passed down the generations. The study, published this week in Science, also makes a controversial claim: that heightened surveillance of families with a history of abuse may have biased some studies taken as evidence for the cycle of violence.

Report
Intergenerational transmission of child abuse and neglect: Real or detection bias?
Cathy Spatz Widom1,*, Sally J. Czaja1, Kimberly A. DuMont2
Author Affiliations
1Psychology Department, John Jay College of Criminal Justice, and Graduate Center, City University of New York, New York, NY, USA.
2William T. Grant Foundation, New York, NY, USA.
Abstract
The literature has been contradictory regarding whether parents who were abused as children have a greater tendency to abuse their own children. A prospective 30-year follow-up study interviewed individuals with documented histories of childhood abuse and neglect and matched comparisons and a subset of their children. The study assessed maltreatment based on child protective service (CPS) agency records and reports by parents, nonparents, and offspring. The extent of the intergenerational transmission of abuse and neglect depended in large part on the source of the information used. Individuals with histories of childhood abuse and neglect have higher rates of being reported to CPS for child maltreatment but do not self-report more physical and sexual abuse than matched comparisons. Offspring of parents with histories of childhood abuse and neglect are more likely to report sexual abuse and neglect and that CPS was concerned about them at some point in their lives. The strongest evidence for the intergenerational transmission of maltreatment indicates that offspring are at risk for childhood neglect and sexual abuse, but detection or surveillance bias may account for the greater likelihood of CPS reports.

Vaccine
Volume 33, Issue 16, Pages 1897-1998 (15 April 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/16

Brief Report
Immunogenicity and safety of 3-dose primary vaccination with combined DTPa-HBV-IPV/Hib vaccine in Canadian Aboriginal and non-Aboriginal infants
Pages 1897-1900
David W. Scheifele, Murdo Ferguson, Gerald Predy, Meena Dawar, Deepak Assudani, Sherine Kuriyakose, Olivier Van Der Meeren, Htay-Htay Han
Abstract
This study compared immune responses of healthy Aboriginal and non-Aboriginal infants to Haemophilus influenzae type b (Hib) and hepatitis B virus (HBV) components of a DTaP-HBV-IPV/Hib combination vaccine, 1 month after completing dosing at 2, 4 and 6 months of age. Of 112 infants enrolled in each group, 94 Aboriginal and 107 non-Aboriginal infants qualified for the immunogenicity analysis. Anti-PRP concentrations exceeded the protective minimum (≥0.15 μg/ml) in ≥97% of infants in both groups but geometric mean concentrations (GMCs) were higher in Aboriginal infants (6.12 μg/ml versus 3.51 μg/ml). All subjects were seroprotected (anti-HBs ≥10 mIU/mL) against HBV, with groups having similar GMCs (1797.9 versus 1544.4 mIU/mL, Aboriginal versus non-Aboriginal, respectively). No safety concerns were identified. We conclude that 3-dose primary vaccination with DTaP-HBV-IPV/Hib combination vaccine elicited immune responses to Hib and HBV components that were at least as high in Aboriginal as in non-Aboriginal Canadian infants.
Clinical Trial Registration NCT00753649.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 21 March 2015

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortiums and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ week ending 21 March 2015

blog edition: comprised of the 35+ entries to be posted below on 22 March 2015

Sendai Framework for Disaster Risk Reduction 2015-2030
A/CONF.224/CRP.1
18 March 2015 :: 25 pages
Pdf: http://www.wcdrr.org/uploads/Sendai_Framework_for_Disaster_Risk_Reduction_2015-2030.pdf

[from Contents]
Priorities for action:
Priority 1: Understanding disaster risk
Priority 2: Strengthening disaster risk governance to manage disaster risk
Priority 3: Investing in disaster risk reduction for resilience
Priority 4: Enhancing disaster preparedness for effective response, and to “Build Back Better” in recovery, rehabilitation and reconstruction

.
Press Release
World Conference adopts new international framework for disaster risk reduction after marathon negotiations
18 March 2015, SENDAI – Representatives from 187 UN member States today adopted the first major agreement of the Post-2015 development agenda, a far reaching new framework for disaster risk reduction with seven targets and four priorities for action.

Conference President, Ms. Eriko Yamatani, Minister of State for Disaster Management, announced agreement on the text, the Sendai Framework for Disaster Risk Reduction 2015-2030 – the new international framework for disaster risk reduction, following a marathon final round of negotiations which went on for over 30 hours.

Margareta Wahlström, the Secretary-General’s Special Representative for Disaster Risk Reduction and the Head of the UN Office for Disaster Risk Reduction, said: “The adoption of this new framework for disaster risk reduction opens a major new chapter in sustainable development as it outlines clear targets and priorities for action which will lead to a substantial reduction of disaster risk and losses in lives, livelihoods and health.

“Implementation of the Sendai Framework for Disaster Risk Reduction over the next 15 years will require strong commitment and political leadership and will be vital to the achievement of future agreements on sustainable development goals and climate later this year. As the UN Secretary-General said here on the opening day, sustainability starts in Sendai.”

The framework outlines seven global targets to be achieved over the next 15 years:
:: a substantial reduction in global disaster mortality;
:: a substantial reduction in numbers of affected people;
:: a reduction in economic losses in relation to global GDP;
:: substantial reduction in disaster damage to critical infrastructure and disruption of basic services, including health and education facilities;
:: an increase in the number of countries with national and local disaster risk reduction strategies by 2020;
:: enhanced international cooperation; and
:: increased access to multi-hazard early warning systems and disaster risk information and assessments.

…Conference Main Committee Co-Chair, Ambassador Päivi Kairamo from Finland, said: “Delegates have taken into account the experience gained through implementation of the current Hyogo Framework for Action. We have agreed on four priorities for action focussed on a better understanding of risk, strengthened disaster risk governance and more investment.

“A final priority calls for more effective disaster preparedness and embedding the ‘build back better’ principle into recovery, rehabilitation and reconstruction. These will be the four points of the DRR compass for the next 15 years.”

…The World Conference was attended by over 6,500 participants including 2,800 government representatives from 187 governments. The Public Forum had 143,000 visitors over the five days of the conference making it one of the largest UN gatherings ever held in Japan.

WMO World Meteorological Organization [to 21 March 2015]
https://www.wmo.int/media/?q=news

World Meteorological Day 23 March 2015: Climate Knowledge for Climate Action
20 March 2015
Climate Knowledge for Climate Action is the theme of World Meteorological Day on 23 March, highlighting both recent advances in climate science and the need for decisive measures to limit climate change. Ceremonies and events around the world will showcase the contribution of National Meteorological Services to safety, well-being and sustainable development. Over the last twelve months, thousands of lives have been saved around the world by improved weather forecasting, early-warning systems and disaster readiness. The economic benefits of climate services such as seasonal outlooks have been worth hundreds of millions of dollars.

.
USAID, NOAA, AND WORLD METEOROLOGICAL ORGANIZATION ANNOUNCE NEW WEATHER-READY NATIONS INITIATIVE
16 March 2015
SENDAI, JAPAN – This weekend, at the 3rd UN World Conference on Disaster Risk Reduction the U.S. Agency for International Development, the National Oceanic and Atmospheric Administration, and the World Meteorological Organization announced the creation of Weather-Ready Nations, a new program to improve the understanding of high impact weather, water, and climate events.

The devastating effects of extreme events such as cyclones, floods, and tsunamis can be greatly reduced through improved communication of expected impacts and risk, better delivery of warning information to communities under a threat, and clearer actions that individuals, businesses, and communities can take to be more resilient. Even in places where the crucial step of establishing early warning systems has been completed, advanced warnings are only beneficial if they lead to a public response that moves people out of harm’s way. The basic need is for more actionable information to reduce the number of weather, water, and climate related fatalities and improve the economic value of weather, water, and climate information.