Gordon and Betty Moore Foundation [to 23 April 2016]
https://www.moore.org/news

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April 21, 2016
Architecture of DNA gatekeeper solved
Moore Foundation grantees at Caltech have produced the most detailed map yet of the massive protein machine that controls access to the DNA-containing heart of the cell.

In a new study, a team led by André Hoelz reports the successful mapping of the structure of the symmetric core of the nuclear pore complex (NPC), a cellular gatekeeper that determines what molecules can enter and exit the nucleus, where a cell’s genetic information is stored…
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April 21, 2016
This Earth Day, let’s celebrate experimentation in environmental grantmaking
Aileen Lee, J.D., incoming chief program officer for the environmental conservation program at the Gordon and Betty Moore Foundation
As we near the forty-sixth anniversary of Earth Day, let’s all take a moment to celebrate the diversity and breadth of approaches to conserving this special planet we call home. Like so many other organizations in the conservation field, the Gordon and Betty Moore Foundation grapples with the question of how to make sure — while there is time — Earth and its vital ecosystems flourish long into the future.

When Gordon and Betty Moore established the foundation in late 2000, they asked us to find ways for humans and other species to share the limited resources of our small but amazing planet. Fifteen years in, we’ve been both encouraged and humbled by how much our grantees and others working alongside them have accomplished — whether it’s conserving wild salmon ecosystems across the North Pacific, the long-term health of the Amazon basin, or North America’s marine environments.

As much progress as we have made, however, we also recognize that we need to scale and accelerate these gains…
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April 20, 2016
Unveiling an elusive state of superconductors
Foundation grantees at Cornell University have produced the first direct evidence of “Cooper pairs”– coupled electrons that can carry electricity with zero resistance, or behave as a wave whose density varies across space.

Now, EPiQS investigator and physicist J.C. Séamus Davis and colleagues at Max-Planck Institute CPMS in Dresden, Germany have unveiled direct evidence of a Cooper pair density wave state in a high-temperature superconductor.

The team used a scanning tunneling microscope to scan the surface of a high-temperature superconductor. By briefly lowering the tip of the microscope probe to touch the surface and pick up a flake of the superconducting material, Cooper pairs could then tunnel between the superconductor surface and the tip…

:: Journal Watch [posts below]

The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

Annals of Internal Medicine
19 April 2016, Vol. 164. No. 8
http://annals.org/issue.aspx

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History of Medicine
Judging the Past: How History Should Inform Bioethics
Barron H. Lerner, MD, PhD; and Arthur L. Caplan, PhD
Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the “bad old days” of physicians behaving immorally.

Bioethical discourse—both in the classroom and in practice—should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 23 April 2016)

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Research article
Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia
Arebu I. Bilal, Ebrahim D. Osman and Anwar Mulugeta
BMC Health Services Research 2016 16:144
Published on: 23 April 2016 Abstract
Abstract
Background
About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines. The objective of the study was to assess the patterns of medicine use among health facilities in eastern Ethiopia using World Health Organization’s Prescribing, Patient Care and Health facility indicators.
Methods
A cross sectional study was carried out in eight randomly selected health centers and data were collected retrospectively as well as prospectively. Prescribing indicators were assessed retrospectively using 636 prescriptions selected by systematic random sampling technique among prescriptions filled between September 2013 and September 2014. Patient care indicators were assessed prospectively by interviewing 708 patients from the health facilities. Health facilities were assessed through observation. Data were entered and analyzed using Statistical Packages for Social Sciences version 20. P-value less than 0.05 at 95 % confidence interval considered for significance of relationships for associations in statistical tests.
Results
The average number of medicines per prescription was 2.2 with standard deviation of 0.8. The proportion of medicines prescribed by generic name was 97 and 92 % of the prescribed medicines were included in List of Essential Medicines for Ethiopia, Prescriptions containing antibiotics and injections constituted (82.5 and 11.2 %) respectively. Of the total of 1426 medicines prescribed, 49.6 % were antibiotics, with amoxicillin (33.3 %) and co-trimoxazole (16.0 %) being the most commonly prescribed agents. The average consultation and dispensing times were 5.6 and 2.7 min, respectively. Among the medicines dispensed, 64.0 % were adequately labeled and the proportion of patients with adequate knowledge about medicines was 69 %.
Conclusion
The prescribing and dispensing practices in the health facilities are fairly good and are not that far from the standard WHO requirements. However, there is a need to do more on some issues, including prescribing practice of antibiotics, average number of medicines per prescription, and patients’ dosage form knowledge

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 23 April 2016)

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Research article
Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia
Mohammed Al Ghamdi, Khalid M. Alghamdi, Yasmeen Ghandoora, Ameera Alzahrani, Fatmah Salah, Abdulmoatani Alsulami, Mayada F. Bawayan, Dhananjay Vaidya, Trish M. Perl and Geeta Sood
BMC Infectious Diseases 2016 16:174
Published on: 21 April 2016
Abstract
Background
Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia.
Methods
In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered.
Results
Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival.
Conclusions
Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 23 April 2016)

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Research article
The obstetric care subsidy policy in Burkina Faso: what are the effects after five years of implementation? Findings of a complex evaluation
Burkina Faso, like many low and middle income countries, has been taking a range of actions to address its poor maternal and neonatal health indicators.
Rasmané Ganaba, Patrick G. C. Ilboudo, Jenny A. Cresswell, Maurice Yaogo, Cheick Omar Diallo, Fabienne Richard, Nadia Cunden, Veronique Filippi and Sophie Witter
BMC Pregnancy and Childbirth 2016 16:84
Published on: 21 April 2016

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Research article
Factors associated with adoption of beneficial newborn care practices in rural Eastern Uganda: a cross-sectional study
Beneficial newborn care practices can improve newborn survival. However, little is known about the factors that affect adoption of these practices.
Michael O. Owor, Joseph K. B. Matovu, Daniel Murokora, Rhoda K. Wanyenze and Peter Waiswa
BMC Pregnancy and Childbirth 2016 16:83
Published on: 21 April 2016

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 23 April 2016]

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Methodology
Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings
A. L. Wirtz, N. Glass, K. Pham, N. Perrin, L. S. Rubenstein, S. Singh and A. Vu
Published on: 20 April 2016
Abstract
Background
Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia.
Results
The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool.
Conclusion
The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.

Development Policy Review
May 2016 Volume 34, Issue 3 Pages 321–461
http://onlinelibrary.wiley.com/doi/10.1111/dpr.2016.34.issue-3/issuetoc

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Original Articles
Applied ethics and allocation of foreign aid: disparity in pretensions and practice (pages 345–363)
Jónína Einarsdóttir and Geir Gunnlaugsson
Article first published online: 5 APR 2016 | DOI: 10.1111/dpr.12156
Abstract
We explore the applied ethics of development aid and humanitarian assistance, and juxtapose these with claimed objectives and factors that influence the choice of recipients. Despite some diversity among donors, ethical considerations appear not to be a prominent factor for allocation of aid. Although recipients’ need is not entirely ignored, donors’ self-interest and herd behaviour, and recipients’ merits and voting in the United Nations, play crucial roles in allocation decisions. Likely to be shunned are complex emergencies and fragile states, the overlapping settings for action of development and humanitarian aid. Donors should take to heart and put into practice that allocation of aid is an ethical endeavour that should rest on proper needs assessment, established objectives and adopted agreements.

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Original Articles
‘Going Out’ or Staying In? The Expansion of Chinese NGOs in Africa (pages 423–439)
Jennifer Y.J. Hsu, Timothy Hildebrandt and Reza Hasmath
Article first published online: 5 APR 2016 | DOI: 10.1111/dpr.12157
Abstract
This article examines the overseas behaviour of Chinese non-governmental organisations (NGOs) in two African nations, Ethiopia and Malawi, with varying political regime types. Our findings suggest that, irrespective of regime type, Chinese NGOs have yet to make a substantial impact in either nation. We argue that, despite the strength of the Chinese state and high levels of international development assistance given, domestic politics and regulatory frameworks in host nations still matter a great deal. Our study suggests that the Chinese model of international development will continue to be one in which temporary one-off projects are favoured; and, insofar as social organisations will play a role, they will be in the domain of government-organised NGOs rather than grassroots NGOs.

Eurosurveillance
Volume 21, Issue 16, 21 April 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Review articles
Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union, European Economic Area, and candidate countries, 1973 to 2013
by T Derrough, A Salekeen

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 23 April 2016]

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Review
The Pan-University Network for Global Health: framework for collaboration and review of global health needs
M. S. Winchester, R. BeLue, T. Oni, U. Wittwer-Backofen, D. Deobagkar, H. Onya, T. A. Samuels, S. A. Matthews, C. Stone and C. Airhihenbuwa
Published on: 21 April 2016
Abstract
In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Health Affairs
April 2016; Volume 35, Issue 4
http://content.healthaffairs.org/content/current

Issue Focus: Patients’ & Consumers’ Use Of Evidence
ANALYSIS & COMMENTARY: The Ethical Imperative And Moral Challenges Of Engaging Patients And The Public With Evidence
Mildred Z. Solomon, Michael K. Gusmano, and Karen J. Maschke
Health Aff April 2016 35:583-589; doi:10.1377/hlthaff.2015.1392
Abstract
Engaging patients and the public with evidence is an ethical imperative because engagement is central to respect for persons and will likely improve health outcomes, facilitate the stewardship of resources, enhance prospects for justice, and build public trust. However, patient and public engagement is also morally complex, because evidence alone is never definitive. As patients and the public engage with evidence, value conflicts will arise and must be managed to achieve trustworthy decision making. We outline value conflicts likely to emerge in the following five settings: clinical care, health care organizations, public health, the regulatory context, and among payers. Using a variety of examples, we offer suggestions about how such conflicts may be managed, including providing more opportunities for democratic deliberation and having more explicit community discussion of how to balance personal choice and community well-being, transparent discussions of cost and quality outcomes, and greater patient engagement in community-based participatory research and the governance of learning health systems.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 23 April 2016]

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Research
The West African Health Organization’s experience in improving the health research environment in the ECOWAS region
Jude Aidam and Issiaka Sombié
Published on: 20 April 2016
Abstract
Background
The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009–2013 using the Knowledge for Better Health Research Capacity Development Framework, developed by Pang et al. (Bull World Health Organ 81(11):815–820, 2003), on strategies used to improve the research environment. The framework has the following components: stewardship, financing, sustainable resourcing and research utilization. This paper describes how WAHO implemented this research development program in the West African region to help improve the research environment and lessons learnt.
Methods
This is a retrospective review of the regional research development program using a triangulation of activity reports, an independent evaluation and the authors’ experiences with stakeholders. This program was designed to address gaps along the components of the framework and to improve partnership. The activities, results and challenges are summarised for each component of the framework. The independent evaluation was conducted using over 180 semi-structured interviews of key stakeholders in the West African region and activity reports. WAHO and major stakeholders validated these findings during a regional meeting.
Results
All 15 ECOWAS countries benefited from this regional research development program. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance. WAHO, along with other technical and financial partners, organised many capacity-strengthening trainings in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions. Further, WAHO developed strategic research partnerships and mobilised additional funding to support the program. The program supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during program activity implementation.
Conclusion
The regional collaborative approach to health research development using this framework was effective given the challenges in the West African region. The achievements particularly with improved research partnerships and funding helped strengthen local health research environments. This highlights WAHO’s role and the common experiences in the West African region in improving health research.

Humanitarian Exchange Magazine
Number 66 A pril 2016
http://odihpn.org/magazine/humanitarian-innovation/

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Special Focus: Humanitarian Innovation
by Humanitarian Practice Network and Kim Scriven April 2016
This edition of Humanitarian Exchange, co-edited with ELRHA Humanitarian Innovation Fund (HIF) manager Kim Scriven, focuses on innovation in the humanitarian sector.
:: Kim Scriven provides an overview of the rising interest in and funding for innovation, while highlighting what more needs to be done to improve the evidence base, relocate capacity and develop guidance.
:: In her article, Alice Obrecht proposes three success criteria for innovation based on case studies of HIF-funded innovation projects.
:: Nathaniel A. Raymond and Casey S. Harrity argue for clear ethnical and technical doctrine to guide the use of technology innovation.
:: Rahel Dette and Julia Steets explore the role of technology in monitoring aid in insecure environments.
:: Monica Zikusooka and colleagues report on using technology to conduct simulated field visits in Somalia.
:: Karen Kisakeni Sørensen highlights the challenges of innovating in the midst of armed conflict in her article on the use of technology in mine action in Ukraine.
:: Andrew Schroeder and Patrick Meier explore the opportunities and challenges posed by robotics.
:: Josiah Kaplan and Evan Easton-Calabria look at the opportunities and hazards of military innovation for the humanitarian sector.
:: Ben Ramalingam shares lessons on innovation in the Nepal earthquake response.
:: Elizabeth Gilmour discusses crowd-sourced mapping during the Nepal earthquake response.
:: Ronak Patel and Mihir Bhatt discuss a small-business micro-insurance programme in India.
:: Robert Hakiza and Evan Easton-Calabria elaborate on their research into urban micro-finance programmes run by refugees in Uganda.
:: Caetano Dorea describes the development of a new water filtration product.
:: Eric James and Laura James explore the potential of 3D printing of humanitarian supplies in the field.
:: Paul Currion offers personal reflection on the rise and decline of Humanitarian Information Centres (HICs).

Infectious Diseases of Poverty

[Accessed 23 April 2016]

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Opinion
The global spread of Zika virus: is public and media concern justified in regions currently unaffected?
Narayan Gyawali, Richard S. Bradbury and Andrew W. Taylor-Robinson
Published on: 19 April 2016

International Journal of Disaster Risk Reduction
Volume 16, In Progress (June 2016)
http://www.sciencedirect.com/science/journal/22124209/16

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Original Research Article
Responsibility and liability in emergency management to natural disasters: A Canadian example
Pages 12-18
Jonathan Raikes, Gordon McBean
Abstract
Most provincial emergency management legislation (Quebec excepted) fails to include regulatory guidelines as to how local authorities reduce community vulnerability. This exposes individual(s) and groups to greater vulnerability to disasters if the local authority decides not to act or provide inadequate management. In addition, access to financial resources to assist or compensate local governments and/or private landowners for damages endured often come with attachments or do not exist. When damages result from a government’s action or inaction in the event of an emergency, provisions in provincial legislation and court findings have reduced government exposure to civil liability at common law further exposing private landowners to financial risk.
This paper argues that a lack of standards in emergency management legislation, restrictive access to financial assistance and/or compensation and reduced government exposure to civil liability at common law expose private landowners to greater vulnerability to disasters and the liability attached. It is essential that those responsible for proactive/preventative planning for disasters work from a standard playbook, one which sets minimum safeguards for the public. Absent of clear and fulsome compensation guidelines, private landowners will bear an unfair and disproportionate financial risk.

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Event monitoring in emergency scenarios using energy efficient wireless sensor nodes for the disaster information management
Original Research Article
Pages 33-42
Metin Erd, Frank Schaeffer, Milos Kostic, Leonhard M. Reindl
Abstract
Information gathering in tunnels, buildings, bridges, etc. during disasters is of vital importance in speeding up rescue efforts and for protecting the fire fighters. The collected data can be used by the emergency services in the planning of rescue operations and allocation of human resources at a local level. In this article we present design and implementation of a wireless sensor network, which consists of energy-efficient wireless sensor nodes with an integrated ultrasonic sensor, which establish a collision free data transmission in an emergency scenario. The developed network was tested in a field experiment in an explosion within a building to confirm its functionality and reliability. The wireless sensor network was able to pass critical data to the emergency units to initiate the rescue procedures during this disaster scenario.

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Social determinants of mid- to long-term disaster impacts on health: A systematic review
Original Research Article
Pages 53-67
Shuhei Nomura, Alexander J.Q. Parsons, Mayo Hirabayashi, Ryo Kinoshita, Yi Liao, Susan Hodgson
Abstract
Disasters cause a wide range of health impacts. Although there remains a need to understand and improve acute disaster management, a stronger understanding of how health is affected in the medium and longer term is also required to inform the design and delivery of measures to manage post-disaster health risks, and to guide actions taken before and during events which will also lead to reduction in health impact. Social determinants exert a powerful influence on different elements of risk, principally vulnerability, exposure and capacity, and thus, on people’s health. As disaster health data and research has tended to focus on the short-term health impacts, no systematic assessment of the social determinants of the mid- to long-term health impacts of disasters has been identified. We assessed the chronic health impacts of disasters and explored the potential socioeconomic determinants of health impact through a systematic review. Our findings, based on 28 studies, highlighted that regardless of health outcomes and event types, the influence of disasters on chronic heath persists beyond the initial disaster period, affecting people’s health for months to years. Using the World Health Organization’s conceptual framework for the social determinants of health, we identified a total of 35 themes across the three conceptual domains (determinants related to the socioeconomic and political context, structural determinants, and intermediate determinants) as potentially influencing disaster impact. Investment to tackle modifiable underlying determinants could aid disaster risk management, improve medium and long-term health outcomes from disasters, and build community resilience.

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Emergent system behaviour as a tool for understanding disaster resilience: The case of Southern African subsistence agriculture
Original Research Article
Pages 115-122
Christo Coetzee, Dewald Van Niekerk, Emmanuel Raju
Abstract
Prominent international policy documents such as the Sendai Framework for Disaster Risk Reduction 2015–2030 and contemporary academic discourses on disasters reiterate the importance of understanding and prioritising building societal resilience. However, despite its prominent position in current and future disaster risk management, much confusion still exists on what exactly resilience entails and how it can be enhanced. This paper attempts to provide a perspective on this problem from the point of view of Complex Adaptive Systems Theory, with specific focus on the notion of emergence within adaptive systems. The paper explores the presence of emergent behaviour that could generates disaster resilience by reviewing statistical correlations between four agricultural interventions (small-scale irrigation system, farmers’ associative mechanisms, appropriate crop varieties, and cropping techniques) and prominent indicators of disaster resilience (coping strategies and hazard adaptation/avoidance behaviour) in subsistence agricultural activities in Mozambique, Malawi and Madagascar. The results from the analysis illustrates that emergent behaviour in the form of various coping strategies and hazard avoidance behaviour is indeed observable in agricultural communities that use all or a combination of agricultural interventions such as small-scale irrigation systems, farmers’ associative mechanisms, appropriate crop varieties, and cropping techniques. These resilience abilities are newly formed macro-level behaviours that emerge due to the interactions of agricultural interventions at a micro-level.

JAMA
April 19, 2016, Vol 315, No. 15
http://jama.jamanetwork.com/issue.aspx

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Preliminary Communication
Safety and Immunogenicity of Novel Adenovirus Type 26– and Modified Vaccinia Ankara–Vectored Ebola Vaccines: A Randomized Clinical Trial
Iain D. Milligan, MRCP; Malick M. Gibani, MRCP; Richard Sewell, BA; Elizabeth A. Clutterbuck, PhD; Danielle Campbell, BScN; Emma Plested; Elizabeth Nuthall, BSc; Merryn Voysey, MBiostat; Laura Silva-Reyes, MSc; M. Juliana McElrath, MD, PhD; Stephen C. De Rosa, MD; Nicole Frahm, PhD; Kristen W. Cohen, PhD; Georgi Shukarev, MD; Nicola Orzabal, BSc; Wilbert van Duijnhoven, MSc; Carla Truyers, PhD; Nora Bachmayer, PhD; Daniel Splinter, PhD; Nathaly Samy, MD; Maria Grazia Pau, PhD; Hanneke Schuitemaker, PhD; Kerstin Luhn, PhD; Benoit Callendret, PhD; Johan Van Hoof, MD; Macaya Douoguih, MD, MPH; Katie Ewer, PhD; Brian Angus, MD; Andrew J. Pollard, FRCPCH, PhD; Matthew D. Snape, FRCPCH, MD
Author Affiliations
1Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
3Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
4Janssen, Pharmaceutical Companies of Johnson & Johnson, Leiden, the Netherlands
5Bavarian Nordic, Martinsried, Germany
6Jenner Institute, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
7National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, United Kingdom
8Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Includes: Supplemental Content
JAMA. 2016;315(15):1610-1623. doi:10.1001/jama.2016.4218.

Abstract
Importance
Developing effective vaccines against Ebola virus is a global priority.
Objective
To evaluate an adenovirus type 26 vector vaccine encoding Ebola glycoprotein (Ad26.ZEBOV) and a modified vaccinia Ankara vector vaccine, encoding glycoproteins from Ebola virus, Sudan virus, Marburg virus, and Tai Forest virus nucleoprotein (MVA-BN-Filo).
Design, Setting, and Participants
Single-center, randomized, placebo-controlled, observer-blind, phase 1 trial performed in Oxford, United Kingdom, enrolling healthy 18- to 50-year-olds from December 2014; 8-month follow-up was completed October 2015.
Interventions
Participants were randomized into 4 groups, within which they were simultaneously randomized 5:1 to receive study vaccines or placebo. Those receiving active vaccines were primed with Ad26.ZEBOV (5 × 1010 viral particles) or MVA-BN-Filo (1 × 108 median tissue culture infective dose) and boosted with the alternative vaccine 28 or 56 days later. A fifth, open-label group received Ad26.ZEBOV boosted by MVA-BN-Filo 14 days later.
Main Outcomes and Measures
The primary outcomes were safety and tolerability. All adverse events were recorded until 21 days after each immunization; serious adverse events were recorded throughout the trial. Secondary outcomes were humoral and cellular immune responses to immunization, as assessed by enzyme-linked immunosorbent assay and enzyme-linked immunospot performed at baseline and from 7 days after each immunization until 8 months after priming immunizations.
Results
Among 87 study participants (median age, 38.5 years; 66.7% female), 72 were randomized into 4 groups of 18, and 15 were included in the open-label group. Four participants did not receive a booster dose; 67 of 75 study vaccine recipients were followed up at 8 months. No vaccine-related serious adverse events occurred. No participant became febrile after MVA-BN-Filo, compared with 3 of 60 participants (5%; 95% CI, 1%-14%) receiving Ad26.ZEBOV in the randomized groups. In the open-label group, 4 of 15 Ad26.ZEBOV recipients (27%; 95% CI, 8%-55%) experienced fever. In the randomized groups, 28 of 29 Ad26.ZEBOV recipients (97%; 95% CI, 82%- 99.9%) and 7 of 30 MVA-BN-Filo recipients (23%; 95% CI, 10%-42%) had detectable Ebola glycoprotein-specific IgG 28 days after primary immunization. All vaccine recipients had specific IgG detectable 21 days postboost and at 8-month follow-up. Within randomized groups, at 7 days postboost, at least 86% of vaccine recipients showed Ebola-specific T-cell responses.
Conclusions and Relevance
In this phase 1 study of healthy volunteers, immunization with Ad26.ZEBOV or MVA-BN-Filo did not result in any vaccine-related serious adverse events. An immune response was observed after primary immunization with Ad26.ZEBOV; boosting by MVA-BN-Filo resulted in sustained elevation of specific immunity. These vaccines are being further assessed in phase 2 and 3 studies.
Trial Registration
clinicaltrials.gov Identifier: NCT02313077

The Lancet
Apr 23, 2016 Volume 387 Number 10029 p1693-1788
http://www.thelancet.com/journals/lancet/issue/current

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Review
The path to eradication: a progress report on the malaria-eliminating countries
Gretchen Newby, Adam Bennett, Erika Larson, Chris Cotter, Rima Shretta, Allison A Phillips, Richard G A Feachem
Summary
In the past several years, as worldwide morbidity and mortality due to malaria have continued to decrease, the global malaria community has grown increasingly supportive of the idea of malaria eradication. In 2015, three noteworthy global documents were released—the WHO’s Global Technical Strategy for Malaria 2016–2030, the Roll Back Malaria Partnership’s Action and Investment to defeat Malaria 2016–2030, and From Aspiration to Action: What Will It Take to End Malaria?—that collectively advocate for malaria elimination and eradication and outline key operational, technical, and financial strategies to achieve progress toward malaria eradication. In light of this remarkable change in global attitudes toward malaria elimination and eradication, and as the malaria community debates how and when to embark on this ambitious goal, it is important to assess current progress along the path to eradication. Although low-income, high-burden countries are often the focus when discussing the substantial challenges of eradication, the progress toward elimination in middle-income, low-burden countries is a major driver of global progress and deserves better recognition. Additionally, although global support and guidance is essential for success, malaria elimination and eradication efforts will ultimately be driven at the country level and achieved in a collaborative manner, region by region. In this Review, we examine the present status of the 35 malaria-eliminating countries, summarise existing national and regional elimination goals and the regional frameworks that support them, and identify the most crucial enabling factors and potential barriers to achieving eradication by a theoretical end date of 2040.

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Public Health
Averting a malaria disaster: will insecticide resistance derail malaria control?
Janet Hemingway, Hilary Ranson, Alan Magill, Jan Kolaczinski, Christen Fornadel, John Gimnig, Maureen Coetzee, Frederic Simard, Dabiré K Roch, Clément Kerah Hinzoumbe, John Pickett, David Schellenberg, Peter Gething, Mark Hoppé, Nicholas Hamon
Summary
World Malaria Day 2015 highlighted the progress made in the development of new methods of prevention (vaccines and insecticides) and treatment (single dose drugs) of the disease. However, increasing drug and insecticide resistance threatens the successes made with existing methods. Insecticide resistance has decreased the efficacy of the most commonly used insecticide class of pyrethroids. This decreased efficacy has increased mosquito survival, which is a prelude to rising incidence of malaria and fatalities. Despite intensive research efforts, new insecticides will not reach the market for at least 5 years. Elimination of malaria is not possible without effective mosquito control. Therefore, to combat the threat of resistance, key stakeholders need to rapidly embrace a multifaceted approach including a reduction in the cost of bringing new resistance management methods to market and the streamlining of associated development, policy, and implementation pathways to counter this looming public health catastrophe.

Nature
Volume 532 Number 7599 pp282-408 21 April 2016
http://www.nature.com/nature/current_issue.html

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Editorials
Monkeying around
China, with its freedom from the ethical pressures experienced by researchers elsewhere, is poised to become the go-to country for work on non-human primates.

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World View
The Paris Agreement has solved a troubling problem
By endorsing a limit of 1.5 °C, the climate negotiations have effectively defined what society considers dangerous, says Simon L. Lewis.

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Comment
Track climate pledges of cities and companies
Data transparency is key to accounting for how local governments and the private sector are contributing to global emissions reduction, say Angel Hsu and colleagues.

New England Journal of Medicine
April 21, 2016 Vol. 374 No. 16
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Partnerships, Not Parachutists, for Zika Research
David L. Heymann, M.D., Joanne Liu, M.D., and Louis Lillywhite, M.B., B.Ch.
[Free full-text]
N Engl J Med 2016; 374:1504-1505 April 21, 2016 DOI: 10.1056/NEJMp1602278
Initial text
When the director-general of the World Health Organization (WHO) declared that the recently reported clusters of microcephaly and other neurologic disorders represent a Public Health Emergency of International Concern (PHEIC), she called for increased research into their cause, including the question of whether the Zika virus is the source of the problem.1 The declaration provides an opportunity to step up the pace of research in order to find the answer to some important questions more quickly. It could not only facilitate the accumulation of knowledge about the relationship between the Zika virus and microcephaly, but also accelerate the study of newer technologies for mosquito control, which could have far-reaching effects on global health security beyond controlling Zika infections.
But to answer these research questions effectively and maximize their contribution to enhancing health security, we believe it is critical that research be conducted collaboratively. Building and strengthening public health capacities (in part through collaborative research) are central to the International Health Regulations, an international agreement of all WHO member countries designed to strengthen health security…

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Perspective
Zika Virus as a Cause of Neurologic Disorders
Nathalie Broutet, M.D., Ph.D., Fabienne Krauer, M.Sc., Maurane Riesen, M.Sc., Asheena Khalakdina, Ph.D., Maria Almiron, M.Sc., Sylvain Aldighieri, M.D., Marcos Espinal, M.D., Nicola Low, M.D., and Christopher Dye, D.Phil.
N Engl J Med 2016; 374:1506-1509 April 21, 2016 DOI: 10.1056/NEJMp1602708
Final text
… Even with limited evidence linking Zika virus to neurologic disorders, the severe potential risks demand decisive, immediate action to protect public health. The WHO recommends applying key interventions such as intensive mosquito control; personal protection against mosquito bites; provision of appropriate clinical care for all patients with Guillain–Barré syndrome and for women before, during, and after pregnancy; and prevention of Zika virus transmission through sexual contact or blood transfusion.4 Most of these are not new interventions, but they do need strengthening. Populations must be informed of the potential current and future risks of neurologic disorders, wherever the virus is being or could be locally transmitted and in other regions inhabited by the mosquito vectors. As the putative link between Zika virus and neurologic disorders is reinforced, refined, or even refuted, public health measures will be adjusted accordingly.

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Review Article
Zika Virus
Lindsey R. Baden, M.D., editor; Lyle R. Petersen, M.D., M.P.H., Denise J. Jamieson, M.D., M.P.H., Ann M. Powers, Ph.D., and Margaret A. Honein, Ph.D., M.P.H.
N Engl J Med 2016; 374:1552-1563 April 21, 2016 DOI: 10.1056/NEJMra1602113

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 23 April 2016]

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Effectiveness of Interventions, Programs and Strategies for Gender-based Violence Prevention in Refugee Populations: An Integrative Review
April 19, 2016 · Brief Report
Background: Gender based violence (GBV) remains one of the most serious threats to the health and safety of women and girls worldwide. The problem is even more pronounced in refugee populations where women and girls are at increased risk of violence. In 2015, UNHCR reported the highest number of forcibly displaced people in recorded history. Despite growing need, there have been few rigorous evaluations of interventions aimed at primary GBV prevention and no systematic reviews of GBV prevention efforts specifically focused on refugee populations; reviews to date have primarily examined prevention of conflict related sexual violence, with very limited focus on other forms of GBV such as intimate partner violence
Methods: This study reviewed the scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations over the past ten years (2006 to 2015). Narrative content analysis methods were used to extract findings related to prevention activities/programs recommended by the global humanitarian community, such as sociocultural norms change, rebuilding family and community support structures, improving accountability systems, designing effective services and facilities, working with formal and traditional legal systems, monitoring and documenting GBV, and/or engaging men and boys in GBV prevention and response.
Results: Study findings indicate that a range of GBV prevention activities recommended by the global humanitarian community are currently being applied in a variety of settings. However, there remains a limited body of evidence on the effectiveness of GBV prevention programs, interventions, and strategies, especially among refugee populations.
Conclusion: Commonly agreed upon standards or guidelines for evaluation of GBV prevention programming, and publication of evaluations conducted using these guidelines, could assist humanitarian stakeholders to build and disseminate an evidence base of effective GBV prevention interventions, programs and strategies. Evaluation of GBV prevention efforts, especially among refugee populations, must be given higher priority to justify continuation or revision of recommended GBV activities/programs being implemented in diverse humanitarian settings.