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

Press release
Nine Nonprofits Recognized for Exceptional Creativity and Effectiveness, Awarded Up to $1 Million Each
Published February 4, 2015
MacArthur today named nine organizations as recipients of the MacArthur Award for Creative and Effective Institutions. The Award, which recognizes exceptional nonprofit organizations that are engaged in the Foundation’s core fields of work and helps ensure their long-term sustainability, provides each organization with $350,000 to $1 million, depending on the size of its budget.
“From tracking money in U.S. elections to protecting the vulnerable in Mexico to reinvigorating civics education, these extraordinary organizations are tackling some of the most difficult social challenges and achieving outsized impact,” said MacArthur Vice President Elspeth Revere, who leads the awards program. “This award recognizes their leadership and success, and it is also a significant investment in their long-term future.”
The recipients of the 2015 MacArthur Award for Creative and Effective Institutions are –
:: Asistencia Legal por los Derechos Humanos – Mexico City ($350,000) protects the rights of vulnerable populations amidst justice reform in Mexico
:: Firelight Media – New York City ($500,000) develops diverse documentary filmmakers to tell untold stories
:: Forest Trends – Washington, DC ($1 million) brings the value of forests into the modern economy
:: FrameWorks Institute – Washington, DC ($1 million) improves how we understand and talk about complex social issues
:: Human Rights Center, University of California, Berkeley – Berkeley, CA ($1 million) applies cutting-edge science and research to protect human rights globally
:: iCivics – Washington, DC ($750,000) reinvigorates civics education for a new generation of Americans
:: John Howard Association of Illinois – Chicago, IL ($500,000) ensures humane and fair treatment of the incarcerated in Illinois through independent oversight
:: National Institute on Money in State Politics – Helena, MT ($1 million) brings transparency to campaign finance data in all 50 states
:: Roosevelt Campus Network – New York City ($750,000) galvanizes a new generation to participate in making public policy.
Organizations use this critical support, which is large relative to their budgets, to build cash reserves and endowments, develop strategic plans, and upgrade technology and physical infrastructure…

American Journal of Tropical Medicine and Hygiene
February 2015; 92 (2)
http://www.ajtmh.org/content/current

Editorial
Perspectives on Ebola
Philip J. Rosenthal and Daniel G. Bausch
Am J Trop Med Hyg 2015 92:219-220; Published online January 12, 2015, doi:10.4269/ajtmh.14-0831
[Free Access]
An unprecedented epidemic of Ebola virus disease (EVD) unfolded in West Africa in 2014. The epidemic has been well described in the popular press and in regular reports from public health authorities. The medical literature has necessarily been slower in describing the epidemic, but comprehensive reports are now appearing, offering valuable accounts of the clinical features, epidemiology, and public health consequences of this terrifying disease. The American Society of Tropical Medicine and Hygiene (ASTMH) has been deeply involved with the EVD outbreak. Numerous ASTMH members have played major roles in addressing the epidemic, including clinicians and epidemiologists working at the front lines of the epidemic at great personal risk, public health authorities guiding control efforts in Africa and elsewhere, and drug and vaccine experts working to rush effective products to the field. The annual meeting of the ASTMH served as a forum for timely expert discussions on EVD, but also highlighted the political challenges of this particular crisis, as some experts were prevented from attending the ASTMH meeting as a result of ill-founded concerns about the consequences of their recent travel to West Africa. In this issue of the American Journal of Tropical Medicine and Hygiene (AJTMH) we offer a series of Perspectives from individuals active in addressing the EVD epidemic.

As with other large disasters, the full toll of the EVD epidemic is difficult to fathom. The numbers are clear. As of the end of 2014, nearly 20,000 cases of EVD and 7,000 deaths have been reported to the World Health Organization (WHO). These numbers are likely underestimates caused by underreporting. Furthermore, although these numbers are much lower than those seen for our greatest tropical medicine challenges, the impact of the epidemic can easily be underappreciated. EVD is quite unique, even among severe infectious diseases, in causing massive disruption to societies, and in particular to the healthcare infrastructure. In affected areas of Africa, in addition to the huge direct toll of EVD, all aspects of healthcare have been torn apart. Management and control of the most important serious infectious diseases, including neonatal infections, human immunodeficiency virus (HIV) infection, tuberculosis, malaria, and other neglected diseases have been greatly disrupted. “Band-aid” solutions, such as widespread distribution of artemisinin-based combination therapies to decrease the incidence of non-Ebola febrile illnesses, have unknown efficacy, and may cause new problems, such as selection of drug resistance and loss of community confidence in the healthcare system. Outside of Africa, responses to the EVD epidemic have often been driven by fear, misguided estimates of risk, and political considerations.

Most often, we in the scientific community appropriately focus on the data—the numbers of cases, the epidemiologic characteristics, and the efficacies of new interventions. In this process we may lose sight of the fact that a crisis such as the EVD epidemic is inherently personal. People are getting infected, suffering, and dying. In the case of this epidemic, much more so than in most humanitarian disasters, many of the victims are the healthcare workers and scientists who have willingly put themselves in harm’s way to help alleviate the suffering of others. In this issue of the AJTMH we offer Perspectives focusing on the personal side of the epidemic, considering in particular the points of view of health workers as caregivers at risk, as patients, and as those working to improve our ability to manage and control this epidemic. Two perspectives, from Adaora Igonoh and Will Pooley, offer accounts from those who put themselves at personal risk caring for patients with EVD, and then contracted the disease themselves. Another, from Lewis Rubinson, offers an account of a potential Ebola virus exposure that led to complex consequences. Susan McClellan offers an account from one of the many non-African healthcare providers who eagerly put themselves at risk. Perspectives addressing an improved response to EVD include a discussion of how, despite some steps in the right direction, the public health community failed to best prepare for a potential hemorrhagic fever outbreak by Daniel Bausch, a consideration of rethinking discharge policy in seriously stressed EVD clinics by Tim O’Dempsey and others, and a comprehensive commentary on clinical preparedness for those providing EVD care from David Brett-Major and many others. Considering the political consequences of responses to the epidemic outside Africa, perspectives from groups led by Ramin Asgary and Piero Olliaro detail the consequences of the misguided effort of the State of Louisiana to protect public health by preventing attendance at the annual meeting of the ASTMH in New Orleans by anyone who had recently traveled to affected countries in West Africa.

The West African EVD epidemic is still unfolding. This enormous disaster is likely to have long-range consequences, with impacts on efforts to control all tropical diseases in addition to specific effects on viral hemorrhagic fever preparedness and far-reaching impacts on the affected countries. Regardless of the future overall course, the epidemic will remain deeply personal, with obvious consequences on affected patients and families, but also on health workers. We hope that the Perspectives in this issue of the AJTMH will help readers to appreciate the personal side of this epidemic, both as a major humanitarian disaster and as a formidable challenge for the international public health community.

Perspective Pieces
My Experience as an Ebola Patient
Adaora K. Igonoh
Am J Trop Med Hyg 2015 92:221-222; Published online December 22, 2014, doi:10.4269/ajtmh.14-0763
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Ebola: Perspectives from a Nurse and Patient
Will Pooley
Am J Trop Med Hyg 2015 92:223-224; Published online January 5, 2015, doi:10.4269/ajtmh.14-0762
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

From Clinician to Suspect Case: My Experience After a Needle Stick in an Ebola Treatment Unit in Sierra Leone
Lewis Rubinson
Am J Trop Med Hyg 2015 92:225-226; Published online December 15, 2014, doi:10.4269/ajtmh.14-0769
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Ebola: My Head is Full of Stories
Susan L. F. McLellan
Am J Trop Med Hyg 2015 92:227-228; Published online December 22, 2014, doi:10.4269/ajtmh.14-0801
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

The Year That Ebola Virus Took Over West Africa: Missed Opportunities for Prevention
Daniel G. Bausch
Am J Trop Med Hyg 2015 92:229-232; Published online January 5, 2015, doi:10.4269/ajtmh.14-0818
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Being Ready to Treat Ebola Virus Disease Patients
David M. Brett-Major, Shevin T. Jacob, Frederique A. Jacquerioz, George F. Risi, William A. Fischer II, Yasuyuki Kato, Catherine F. Houlihan, Ian Crozier, Henry Kyobe Bosa, James V. Lawler, Takuya Adachi, Sara K. Hurley, Louise E. Berry, John C. Carlson, Thomas. C. Button, Susan L. McLellan, Barbara J. Shea, Gary G. Kuniyoshi, Mauricio Ferri, Srinivas G. Murthy, Nicola Petrosillo, Francois Lamontagne, David T. Porembka, John S. Schieffelin, Lewis Rubinson, Tim O’Dempsey, Suzanne M. Donovan, Daniel G. Bausch, Robert A. Fowler, and Thomas E. Fletcher
Am J Trop Med Hyg 2015 92:233-237; Published online December 15, 2014, doi:10.4269/ajtmh.14-0746
Abstract Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Rethinking the Discharge Policy for Ebola Convalescents in an Accelerating Epidemic
Tim O’Dempsey, S. Humarr Khan, and Daniel G. Bausch
Am J Trop Med Hyg 2015 92:238-239; Published online December 1, 2014, doi:10.4269/ajtmh.14-0719
Abstract Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Ebola Policies That Hinder Epidemic Response by Limiting Scientific Discourse
Ramin Asgary, Julie A. Pavlin, Jonathan A. Ripp, Richard Reithinger, and Christina S. Polyak
Am J Trop Med Hyg 2015 92:240-241; Published online January 5, 2015, doi:10.4269/ajtmh.14-0803
Abstract Full Text Full Text (PDF) OPEN ACCESS ARTICLE

Out of (West) Africa—Who Lost in the End?
Piero Olliaro, Estrella Lasry, and Amanda Tiffany
Am J Trop Med Hyg 2015 92:242-243; Published online December 15, 2014, doi:10.4269/ajtmh.14-0753
Full Text Full Text (PDF) OPEN ACCESS ARTICLE

International Aid and Natural Disasters: A Pre- and Post-Earthquake Longitudinal Study of the Healthcare Infrastructure in Leogane, Haiti
Maxwell Kligerman, Michele Barry, David Walmer, and Eran Bendavid
Am J Trop Med Hyg 2015 92:448-453; Published online December 15, 2014, doi:10.4269/ajtmh.14-0379
Abstract Full Text Full Text (PDF) Supplementary File OPEN ACCESS ARTICLE

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 7 February 2015)

Research article
Streamlined research funding using short proposals and accelerated peer review: an observational study
Adrian G Barnett12*, Danielle L Herbert13, Megan Campbell12, Naomi Daly24, Jason A Roberts24, Alison Mudge24 and Nicholas Graves12
Author Affiliations
BMC Health Services Research 2015, 15:55 doi:10.1186/s12913-015-0721-7
Published: 7 February 2015
Abstract (provisional)
Background
Despite the widely recognised importance of sustainable health care systems, health services research remains generally underfunded in Australia. The Australian Centre for Health Services Innovation (AusHSI) is funding health services research in the state of Queensland. AusHSI has developed a streamlined protocol for applying and awarding funding using a short proposal and accelerated peer review.
Method
An observational study of proposals for four health services research funding rounds from May 2012 to November 2013. A short proposal of less than 1,200 words was submitted using a secure web-based portal. The primary outcome measures are: time spent preparing proposals; a simplified scoring of grant proposals (reject, revise or accept for interview) by a scientific review committee; and progressing from submission to funding outcomes within eight weeks. Proposals outside of health services research were deemed ineligible.
Results
There were 228 eligible proposals across 4 funding rounds: from 29% to 79% were shortlisted and 9% to 32% were accepted for interview. Success rates increased from 6% (in 2012) to 16% (in 2013) of eligible proposals. Applicants were notified of the outcomes within two weeks from the interview; which was a maximum of eight weeks after the submission deadline. Applicants spent 7 days on average preparing their proposal. Applicants with a ranking of reject or revise received written feedback and suggested improvements for their proposals, and resubmissions composed one third of the 2013 rounds.
Conclusions
The AusHSI funding scheme is a streamlined application process that has simplified the process of allocating health services research funding for both applicants and peer reviewers. The AusHSI process has minimised the time from submission to notification of funding outcomes.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 7 February 2015)

Research article
An outbreak following importation of wild poliovirus in Xinjiang Uyghur Autonomous Region, China, 2011
Hai-Bo Wang, Wen-Zhou Yu, Xin-Qi Wang, Fuerhati Wushouer, Jian-Ping Wang, Dong-Yan Wang, Fu-Qiang Cui, Jing-Shan Zheng, Ning Wen, Yi-Xin Ji, Chun-Xiang Fan, Hui-Ling Wang, Gui-Jun Ning, Guo-Hong Huang, Dong-Mei Yan, Qi-Ru Su, Da-Wei Liu, Guo-Ming Zhang, Kathleen H Reilly, Jing Ning, Jian-Ping Fu, Sha-Sha Mi, Hui-Ming Luo, Wei-Zhong Yang BMC Infectious Diseases 2015, 15:34 (31 January 2015)
Abstract | Provisional PDF | PubMed

BMC Public Health
(Accessed 7 February 2015)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Using a community-based definition of poverty for targeting poor households for premium subsidies in the context of a community health insurance in Burkina Faso
Germain Savadogo, Aurelia Souarès, Ali Sié, Divya Parmar, Gilles Bibeau, Rainer Sauerborn BMC Public Health 2015, 15:84 (6 February 2015)
Abstract (provisional) Provisional PDF
Background
One of the biggest challenges in subsidizing premiums of poor households for community health insurance is the identification and selection of these households. Generally, poverty assessments in developing countries are based on monetary terms. The household is regarded as poor if its income or consumption is lower than a predefined poverty cut-off. These measures fail to recognize the multi-dimensional character of poverty, ignoring community members? perception and understanding of poverty, leaving them voiceless and powerless in the identification process. Realizing this, the steering committee of Nouna’s health insurance devised a method to involve community members to better define `perceived? poverty, using this as a key element for the poor selection. The community-identified poor were then used to effectively target premium subsidies for the insurance scheme.
Methods
The study was conducted in the Nouna’s Health District located in northwest Burkina Faso. Participants in each village were selected to take part in focus-group discussions (FGD) organized in 41 villages and 7 sectors of Nouna’s town to discuss criteria and perceptions of poverty. The discussions were audio recorded, transcribed and analyzed in French using the software NVivo 9.
Results
From the FGD on poverty and the subjective definitions and perceptions of the community members, we found that poverty was mainly seen as scarcity of basic needs, vulnerability, deprivation of capacities, powerlessness, voicelessness, indecent living conditions, and absence of social capital and community networks for support in times of need. Criteria and poverty groups as described by community members can be used to identify poor who can then be targeted for subsidies.
Conclusion
Policies targeting the poorest require the establishment of effective selection strategies. These policies are well-conditioned by proper identification of the poor people. Community perceptions and criteria of poverty are grounded in reality, to better appreciate the issue. It is crucial to take these perceptions into account in undertaking community development actions which target the poor. For most community-based health insurance schemes with limited financial resources, using a community-based definition of poverty in the targeting of the poorest might be a less costly alternative.

British Medical Journal
07 February 2015(vol 350, issue 7994)
http://www.bmj.com/content/350/7994

Analysis
International donations to the Ebola virus outbreak: too little, too late?
BMJ 2015;350:h376 (Published 03 February 2015)
Karen Grépin examines the pledges made to the Ebola crisis, how much has actually reached affected countries, and the lessons to be learnt
…In this article, I examine the level and speed of the international donations to tackle the Ebola epidemic and how they aligned with evolving estimates of funds required to bring the epidemic under control. Understanding what has and has not worked well in the early phases of this crisis can help us learn from it and prepare for future humanitarian and public health emergencies. My analysis considers only international donations captured in the UN Office for the Coordination of Humanitarian Affairs’ (OCHA) financial tracking system (http://fts.unocha.org, box), which does not capture all resources that have been pledged to the outbreak…
Key messages
:: Pledges to the Ebola outbreak have reached at least $2.89bn
:: However, only about one third of these resources have been be disbursed to countries
:: Delays have occurred in requests for funding and translating pledges into paid contributions
:: New mechanisms to speed up disbursements could help in future crises

Cost Effectiveness and Resource Allocation
(Accessed 7 February 2015)
http://www.resource-allocation.com/

Research
Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar
Bishai D, Sachathep K, LeFevre A, Thant HNN, Zaw M, Aung T, McFarland W, Montagu D et al. Cost Effectiveness and Resource Allocation 2015, 13:3 (5 February 2015)
Abstract (provisional)
Introduction
This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL.
Background
The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices.
Methods
Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods.
Findings
Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted.
Interpretation
Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.

Globalization and Health
[Accessed 7 February 2015]
http://www.globalizationandhealth.com/

Research
Reverse innovation: an opportunity for strengthening health systems
Anne W Snowdon12*, Harpreet Bassi12, Andrew D Scarffe12 and Alexander D Smith12
Author Affiliations
Globalization and Health 2015, $article.volume.volumeNumber:2 doi:10.1186/s12992-015-0088-x
Published: 7 February 2015
Abstract (provisional)
Background
Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada.
Methods
An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team.
Results
The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women?s health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize.
Conclusions
The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 7 February 2015]

Commentary
Informing the establishment of the WHO global observatory on health research and development: a call for papers
Taghreed Adam, John-Arne Røttingen, Marie-Paule Kieny Health Research Policy and Systems 2015

Infectious Diseases of Poverty
[Accessed 7 February 2015]
http://www.idpjournal.com/content

Research Article
Incidence of human rabies exposure and associated factors at the Gondar Health Center, Ethiopia: a three-year retrospective study
Meseret Yibrah, Debasu Damtie Infectious Diseases of Poverty 2015, 4:3 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
A three year retrospective study revealed a significant incidence of human rabies exposure in Ethiopia. This study also depicted being male and living in urban areas as a potential risk factor for human rabies exposure. Image: Canine rabies is a significant problem in Ethiopia.

Research Article
Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database
Waleed M Sweileh, Samah W Al-Jabi, Alaeddin Abuzanat, Ansam F Sawalha, Adham S AbuTaha, Mustafa A Ghanim, Sa¿ed H Zyoud Infectious Diseases of Poverty 2015, 4:2 (2 February 2015)
Abstract | Provisional PDF | Editor’s summary
Arab countries, like other developing poor countries, suffer from various types of infectious diseases. Some of these diseases might be endemic or unique to the Arab countries. However, Arab countries are still lagging behind in research in the field of infectious diseases. More efforts and further financial support are needed to encourage research and publications in this field. Image: Dr. Adham Abu Taha doing microbiological testing for specimens at An-Najah National University.

JAMA
February 3, 2015, Vol 313, No. 5
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 3, 2015
Digital Multimedia: A New Approach for Informed Consent?
Alan R. Tait, PhD1,2; Terri Voepel-Lewis, PhD, RN1
1Department of Anesthesiology, University of Michigan Health System, Ann Arbor
2Center for Bioethics and Social Sciences in Medicine, University of Michigan Health System, Ann Arbor
JAMA. 2015;313(5):463-464. doi:10.1001/jama.2014.17122.
This Viewpoint discusses use of digital multimedia as a strategy to enhance study participants’ understanding of research information.
The bioethical principle of respect for persons requires that individuals participating in research studies are provided with sufficient information to allow them to make autonomous and informed decisions. In general, the process of informed consent requires that investigators disclose pertinent information regarding procedures to be performed, risks, and benefits, etc, in a manner that participants can understand. In most cases, this information is reinforced by having the study participant or parent/guardian read a consent document, which is then signed to authorize participation…

Journal of Global Infectious Diseases (JGID)
January-March 2015 Volume 7 | Issue 1 Page Nos. 1-50
http://www.jgid.org/currentissue.asp?sabs=n

Editorial
State of Globe: Rabies: The lethality since antiquity!
Inder Maurya, Ketan Vagholkar, Bhavesh Patel, Mohsin Siddiqui, Shreshtha Tiwari, Premkumar Maurya
DOI:10.4103/0974-777X.150880

The Lancet
Feb 07, 2015 Volume 385 Number 9967 p481-576 e5-e6
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Don’t forget health when you talk about human rights
The Lancet
Last week, Human Rights Watch (HRW) released World Report 2015, their 25th annual global review documenting human rights practices in more than 90 countries and territories in 2014. The content is based on a comprehensive investigation by HRW staff, together with in-country human rights activists. In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence.

Comment
FGM: the mutilation of girls and young women must stop
Audrey Ceschia
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60176-3
Summary
Feb 6, 2015, marks International Day of Zero Tolerance for Female Genital Mutilation/Cutting, a day to reflect on one of the most cruel of human practices—an ancestral tradition that became a social norm—which has been tolerated for far too long. “Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”, according to WHO’s definition. More than 125 million women have undergone FGM in 29 countries across Africa and the Middle East where FGM is concentrated.

Comment
Health in an ageing world—what do we know?
Richard Suzman, John R Beard, Ties Boerma, Somnath Chatterji
Published Online: 05 November 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61597-X
Summary
The ageing of populations is poised to become the next global public health challenge. During the next 5 years, for the first time in history, people aged 65 years and older in the world will outnumber children aged younger than 5 years.1 Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanisation, modernisation, globalisation, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic conditions.

Series
Ageing
Causes of international increases in older age life expectancy
Colin D Mathers, Gretchen A Stevens, Ties Boerma, Richard A White, Martin I Tobias

Ageing
The burden of disease in older people and implications for health policy and practice
Martin J Prince, Fan Wu, Yanfei Guo, Luis M Gutierrez Robledo, Martin O’Donnell, Richard Sullivan, Salim Yusuf

Ageing
Health, functioning, and disability in older adults—present status and future implications
Somnath Chatterji, Julie Byles, David Cutler, Teresa Seeman, Emese Verdes

The Lancet Global Health
Feb 2015 Volume 3 Number 2 e62-e112
http://www.thelancet.com/journals/langlo/issue/current

Editorial
All about the money
Zoë Mullan
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70003-3
Summary
It’s finally 2015: a year by the end of which extreme poverty and hunger are to be eradicated, maternal and child mortality are to be drastically reduced, and the trajectory of the global incidence of HIV, tuberculosis, and malaria are to be reversed. Much has been written about where the Millennium Development Goals succeeded and failed as global targets, and what has changed in the world since 2000. Much work has also been done to establish what happens next. In his synthesis report on the post-2015 agenda released last month, UN Secretary-General Ban Ki-Moon summarised and annotated this work, ultimately backing the 17 goals proposed by the Open Working Group on Sustainable Development Goals as the basis for a truly transformative agenda.

Articles
Effect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial
Dr Silvina Arrossi, PhD, Laura Thouyaret, BSc, Rolando Herrero, PhD, Alicia Campanera, MD, Adriana Magdaleno, BSc, Milca Cuberli, MSc, Paula Barletta, BSc, Rosa Laudi, MD, Liliana Orellana, PhD, the EMA Study team
EMA Study team members listed at end of reportOpen Access
DOI: http://dx.doi.org/10.1016/S2214-109X(14)70354-7
Open access funded by the Author(s)
Summary
Background
Control of cervical cancer in developing countries has been hampered by a failure to achieve high screening uptake. HPV DNA self-collection could increase screening coverage, but implementation of this technology is difficult in countries of middle and low income. We investigated whether offering HPV DNA self-collection during routine home visits by community health workers could increase cervical screening.
Methods
We did a population-based cluster-randomised trial in the province of Jujuy, Argentina, between July 1, 2012, and Dec 31, 2012. Community health workers were eligible for the study if they scored highly on a performance score, and women aged 30 years or older were eligible for enrolment by the community health worker. 200 community health workers were randomly allocated in a 1:1 ratio to either the intervention group (offered women the chance to self-collect a sample for cervical screening during a home visit) or the control group (advised women to attend a health clinic for cervical screening). The primary outcome was screening uptake, measured as the proportion of women having any HPV screening test within 6 months of the community health worker visit. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02095561.
Findings
100 community health workers were randomly allocated to the intervention group and 100 were assigned to the control group; nine did not take part. 191 participating community health workers (94 in the intervention group and 97 in the control group) initially contacted 7650 women; of 3632 women contacted by community health workers in the intervention group, 3049 agreed to participate; of 4018 women contacted by community health workers in the control group, 2964 agreed to participate. 2618 (86%) of 3049 women in the intervention group had any HPV test within 6 months of the community health worker visit, compared with 599 (20%) of 2964 in the control group (risk ratio 4•02, 95% CI 3•44–4•71).
Interpretation
Offering self-collection of samples for HPV testing by community health workers during home visits resulted in a four-fold increase in screening uptake, showing that this strategy is effective to improve cervical screening coverage. This intervention reduces women’s barriers to screening and results in a substantial and rapid increase in coverage. Our findings suggest that HPV testing could be extended throughout Argentina and in other countries to increase cervical screening coverage.
Funding
Instituto Nacional del Cáncer (Argentina).

New England Journal of Medicine
February 5, 2015 Vol. 372 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Editorial
Ebola in West Africa at One Year — From Ignorance to Fear to Roadblocks
Jeffrey M. Drazen, M.D., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2015; 372:563-564 February 5, 2015 DOI: 10.1056/NEJMe1415398

It has been a year since the first case associated with the current Ebola virus outbreak in West Africa was identified and just over 8 months since we first started reporting on the outbreaks that stemmed from that patient in Guinea.1 Today’s posts at NEJM.org include an anniversary update on the fight against Ebola virus disease (EVD).2 It is painfully clear that the world’s initial handling of this dangerous outbreak was far from optimal, but we now appear to be making progress in the battle. This headway is evidenced by the observations that the rate of appearance of new cases is not as high as had been predicted by the World Health Organization or the U.S. Centers for Disease Control and Prevention in September 2014 and that outcomes may be improving at some Ebola treatment units.2,3

Patients in the hardest-hit areas are able to receive care at one of many Ebola treatment units that have been set up in West Africa. These units now offer hope for patients with EVD in places where 6 months ago there was little care available and little hope. The ongoing case finding and contact tracing are essential to preventing new outbreak clusters. Staffing the treatment units, tracing contacts, and providing basic health care services for the populations in the most severely affected areas, where the health care infrastructure has been devastated, are just a few of the tasks that must be performed if the battle against Ebola is to be won. If we don’t bring this outbreak to a halt now, it may again expand throughout the region and spread to other parts of the world. To deliver a victory, we need more volunteers who are willing to serve, to live in austere conditions, and to put themselves in harm’s way. All estimates indicate that the number of personnel needed far exceeds the current supply. We need to make it easier for those who want to help in the fight against Ebola to do so.

That brings us to academic medical centers in the United States. As the Ebola outbreak has burned its way deep into Guinea, Liberia, and Sierra Leone, in one of the worst acute public health crises in 50 years, our academic medical centers have sat largely on the sidelines. They have spent a fortune preparing their facilities and staff for the much-feared scenario of a local patient with possible Ebola virus infection. What has been lacking is leadership to help quell the crisis where it is actually happening. The problem is more than a lack of effective, positive leadership, as Rosenbaum reports4: the difficulties created by many academic medical centers for trainees and staff who want to go to West Africa to help control this outbreak are more akin to roadblocks. This response stands in contrast to that in the United Kingdom, where the Wellcome Trust has encouraged academic institutions to join the fight and has provided emergency funding for their research initiatives, and to that of the U.S. National Institute of Allergy and Infectious Diseases, which is offering extensions for grant renewals to people who have taken time to participate in Ebola mitigation efforts.

The medical centers that have helped pave the way for their personnel to fight Ebola deserve praise. The leaders of academic medical centers that have put roadblocks in the path of those wishing to serve need to rethink their priorities. They should be making it easier, not harder, for altruistic physicians, nurses, and other health care providers to help care for the sick and control the Ebola epidemic in West Africa. Our medical centers have immense resources and expertise; the countries wracked by Ebola have almost none. Something is wrong when some of the greatest health care centers in the world are not helping in the fight against this disastrously dangerous threat to human health. We ask the leaders of every medical center in the country to figure out how to make it possible for their staff, and even qualified trainees, to help on the ground in West Africa. And once the leaders have decided what to do, they need to tell their risk managers and their lawyers to make it work, rather than make decisions based on the worst-case scenarios and risks to their reputation, image, and market share painted by corporate advisors and legal staff. If in a year’s time this epidemic has not been controlled, we will have only ourselves to blame.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 7 February 2015)

Measles Vaccination Coverage Survey in Moba, Katanga, Democratic Republic of Congo, 2013: Need to Adapt Routine and Mass Vaccination Campaigns to Reach the Unreached
February 2, 2015 • Research
Julita Gil Cuesta, Narcisse Mukembe, Palle Valentiner-Branth, Pawel Stefanoff, Annick Lenglet
The Democratic Republic of Congo (DRC) has committed to eliminate measles by 2020. In 2013, in response to a large outbreak, Médecins Sans Frontières conducted a mass vaccination campaign (MVC) in Moba, Katanga, DRC. We estimated the measles vaccination coverage for the MVC, the Expanded Programme on Immunization routine measles vaccination (EPI) and assessed reasons for non-vaccination.
We conducted a household-based survey among caretakers of children aged 6 months-15 years in Moba from November to December 2013. We used a two-stage-cluster-sampling, where clusters were allocated proportionally to village size and households were randomly selected from each cluster. The questionnaire included demographic variables, vaccination status (card or oral history) during MVC and EPI and reasons for non-vaccination. We estimated the coverage by gender, age and the reasons for non-vaccination and calculated 95% confidence intervals (95% CI).
We recruited 4,768 children living in 1,684 households. The MVC coverage by vaccination card and oral history was 87% (95% CI 84-90) and 66% (95% CI 61-70) if documented by card. The EPI coverage was 76% (95% CI 72-81) and 3% (95% CI 1-4) respectively. The MVC coverage was significantly higher among children previously vaccinated during EPI 91% (95% CI 88-93), compared to 74% (95% CI 66-80) among those not previously vaccinated. Six percent (n=317) of children were never vaccinated. The main reason for non-vaccination was family absence 68% (95% CI 58-78).
The MVC and EPI measles coverage was insufficient to prevent the recurrence of outbreaks in Moba. Lack of EPI vaccination and lack of accessibility by road were associated with lower MVC coverage. We recommend intensified social mobilization and extended EPI and MVCs to increase the coverage of absent residents and unreached children. Routine and MVCs need to be adapted accordingly to improve coverage in hard-to-reach populations in DRC.
Conclusions
We estimated 87% coverage of the MVC in response to the measles outbreak in Moba territory. This coverage may be insufficient to prevent future outbreaks. Lack of a EPI vaccination and lack of accessibility by road were associated with lower MVC campaign coverage. Absence during the MVC and EPI vaccination were the main reasons for non-vaccination. On the basis of these conclusions, we recommend more accessible vaccination sites for each village in order to improve vaccination coverage during EPI and MVCs. We recommend improved social mobilization of the population through extended vaccination time in less accessible villages and to give notice well ahead of vaccination days. Campaign staff must emphasise children and their parents the importance of keeping the vaccination cards. EPI and MVCs need to be adapted accordingly to face these logistical and communication barriers. Hence, the vaccination of hard-to-reach children can contribute to meet the goal of measles elimination in DRC and similar settings.

PLoS Medicine
(Accessed 7 February 2015)
http://www.plosmedicine.org/

Enabling Dynamic Partnerships through Joint Degrees between Low- and High-Income Countries for Capacity Development in Global Health Research: Experience from the Karolinska Institutet/Makerere University Partnership
Nelson Sewankambo, James K. Tumwine, Göran Tomson, Celestino Obua, Freddie Bwanga, Peter Waiswa, Elly Katabira, Hannah Akuffo, Kristina Persson, Stefan Peterson
Health in Action | published 03 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001784
Summary Points
:: Partnerships between universities in high- and low-income countries have the potential to increase research capacity in both settings.
:: We describe a partnership between the Karolinska Institutet in Sweden and Makerere University in Uganda that includes a joint PhD degree program and sharing of scientific ideas and resources.
:: Ten years of financial support from the Swedish International Development Cooperation Agency has enabled 44 graduated PhD students and more than 500 peer-reviewed articles, the majority with a Ugandan as first author.
:: The collaborative research environment is addressing Ugandan health and health system priorities, in several cases resulting in policy and practice reforms.
:: Even though all Ugandan PhD graduates have remained in the country and 13 have embarked on postdoc training, remaining institutional challenges include developing functioning research groups, grant writing, network building at Makerere, and continued funding on both sides of the partnership.

Prehospital & Disaster Medicine
Volume 30 – Issue 01 – February 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Professionalization of Anesthesiologists and Critical Care Specialists in Humanitarian Action: A Nationwide Poll Among Italian Residents
Alba Ripoll Gallardo, Pier Luigi Ingrassia, Luca Ragazzoni, Ahmadreza Djalali, Luca Carenzo, Frederick M. Burkle, Jr. and Francesco Della Corte
Prehospital and Disaster Medicine / Volume 30 / Issue 01 / February 2015, pp 16 – 21
DOI: http://dx.doi.org/10.1017/S1049023X14001320 (About DOI), Published online: 15 December 2014

Comprehensive Review
Multi-disciplinary Care for the Elderly in Disasters: An Integrative Review
Heather L. Johnsona1 c1, Catherine G. Linga1 and Elexis C. McBeea2
a1 The Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland USA
a2 The Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine and Biometrics, Bethesda, Maryland USA
Abstract
Introduction
Older adults are disproportionately affected by disaster. Frail elders, individuals with chronic diseases, conditions, or disabilities, and those who live in long-term care facilities are especially vulnerable.
Purpose
The purpose of this integrative review of the literature was to describe the system-wide knowledge and skills that multi-disciplinary health care providers need to provide appropriate care for the elderly during domestic-humanitarian and disaster-relief efforts.
Data sources
A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed, CINAHL, and PsycINFO were conducted using terms such as Disaster, Geological Processes, Aged, Disaster Planning, and Vulnerable Populations. Forty-six articles met criteria for inclusion in the review.
Conclusions
Policies and guidance regarding evacuating versus sheltering in place are lacking. Tenets of elderly-focused disaster planning/preparation and clarification of legal and ethical standards of care and liability issues are needed. Functional capacity, capabilities, or impairments, rather than age, should be considered in disaster preparation. Older adults should be included in disaster planning as population-specific experts.
Implications for Practice
A multifaceted approach to population-specific disaster planning and curriculum development should include consideration of the biophysical and psychosocial aspects of care, ethical and legal issues, logistics, and resources.

Special Report
Cardiopulmonary Resuscitation in Resource-limited Health Systems–Considerations for Training and Delivery
Jason Friesen, Dean Patterson and Kevin Munjal
Prehospital and Disaster Medicine / Volume 30 / Issue 01 / February 2015, pp 97 – 101
Copyright © World Association for Disaster and Emergency Medicine 2014
DOI: http://dx.doi.org/10.1017/S1049023X14001265 (About DOI), Published online: 19 November 2014

World Heritage Review
n°74 – January 2015
http://whc.unesco.org/en/review/74/

World Heritage: Fostering resilience
In focus
:: Fostering resilience: Towards reducing disaster risks to World Heritage, p. 4
World Heritage sites are exposed to a wide variety of natural and human-induced hazards, such as earthquakes, cyclones or fires, which can have devastating effects on their value as well as on the lives and assets of the communities concerned.

:: Post-disaster reconstruction: Xijie historic quarter in Dujiangyan, Sichuan province, p. 16
The reconstruction project combined the objectives of heritage conservation, post-disaster reconstruction and social equity through broad community participation and close cooperation among concerned government agencies, stateowned enterprises, local residents and universities.

:: Building resilience at iSimangaliso Wetland Park, p. 22
iSimangaliso has built ecological and social resilience, dealing with risks to the site, and is implementing a broad-based strategy that will mitigate the social and ecological stressors associated with predicted environmental change.

:: Post-disaster heritage initiative in Pakistan, p. 28
The post-disaster development programmes undertaken by the Heritage Foundation of Pakistan are designed to nurture traditional and creative skills, particularly of women in marginalized sections of society.

:: The 3rd World Conference on Disaster Risk Reduction, p. 38
The 3rd UN World Conference on Disaster Risk Reduction, which will take place in Sendai (Japan) from 14 to 18 March 2015, is the most important intergovernmental gathering on disaster risks in ten years. The conference is expected to adopt the post-2015 international policy on Disaster Risk Reduction…