Journal of Global Infectious Diseases (JGID)
October-December 2015 Volume 7 | Issue 4 Page Nos. 125-174
http://www.jgid.org/currentissue.asp?sabs=n

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The Ebola outbreak of 2014-2015: From coordinated multilateral action to effective disease containment, vaccine development, and beyond
Thomas R Wojda1, Pamela L Valenza2, Kristine Cornejo2, Thomas McGinley2, Sagar C Galwankar3, Dhanashree Kelkar3, Richard P Sharpe1, Thomas J Papadimos4, Stanislaw P Stawicki1
1 Department of Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania and Phillipsburg, New Jersey, USA
2 Department of Family Medicine, St. Luke’s University Health Network, Bethlehem, Pennsylvania and Phillipsburg, New Jersey, USA
3 Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
4 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
Abstract
The Ebola outbreak of 2014-2015 exacted a terrible toll on major countries of West Africa. Latest estimates from the World Health Organization indicate that over 11,000 lives were lost to the deadly virus since the first documented case was officially recorded. However, significant progress in the fight against Ebola was made thanks to a combination of globally-supported containment efforts, dissemination of key information to the public, the use of modern information technology resources to better track the spread of the outbreak, as well as more effective use of active surveillance, targeted travel restrictions, and quarantine procedures. This article will outline the progress made by the global public health community toward containing and eventually extinguishing this latest outbreak of Ebola. Economic consequences of the outbreak will be discussed. The authors will emphasize policies and procedures thought to be effective in containing the outbreak. In addition, we will outline selected episodes that threatened inter-continental spread of the disease. The emerging topic of post-Ebola syndrome will also be presented. Finally, we will touch on some of the diagnostic (e.g., point-of-care [POC] testing) and therapeutic (e.g., new vaccines and pharmaceuticals) developments in the fight against Ebola, and how these developments may help the global public health community fight future epidemics.

The Lancet
Dec 05, 2015 Volume 386 Number 10010 p2227-2364 e46-e55
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Adolescent health: boys matter too
The Lancet
Summary
It has been a good year for adolescents. Many global health reports and initiatives now mention adolescents. So also does the latest UN Population Fund’s State of the World Population 2015 report, released on Dec 3. Shelter from the Storm: a transformative agenda for women and girls in a crisis-prone world reminds us that there are 26 million women and adolescent girls in their childbearing years in need of humanitarian assistance worldwide. During the past 2 years or so, adolescents have been increasingly included in the women’s and child health agenda, culminating in UN Secretary-General Ban Ki-moon’s updated Global Strategy for Women’s and Children’s Health into the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), presented on Sept 26 at the General Assembly.

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Articles
Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation
Dr Danzhen You, PhD, Lucia Hug, MA, Simon Ejdemyr, MA, Priscila Idele, PhD, Daniel Hogan, PhD, Colin Mathers, PhD, Patrick Gerland, PhD, Jin Rou New, MA, Leontine Alkema, PhD
for the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)
Summary
Background
In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030.
Methods
We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0–4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario.
Results
The global under-5 mortality rate has fallen from 90·6 deaths per 1000 livebirths (90% uncertainty interval 89·3–92·2) in 1990 to 42·5 (40·9–45·6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12·7 million (12·6 million–13·0 million) to 5·9 million (5·7 million–6·4 million). The global under-5 mortality rate reduced by 53% (50–55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions—east Asia and the Pacific, and Latin America and the Caribbean—achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94·4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68·8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56·0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target.
Interpretation
Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia.
Funding
None.

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Articles
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Risk Factors Collaborators*
Summary
Background
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
Methods
Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.
Findings
All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.
Interpretation
Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
Funding
Bill & Melinda Gates Foundation.

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Series
How to eliminate tuberculosis
Data for action: collection and use of local data to end tuberculosis
Grant Theron, Helen E Jenkins, Frank Cobelens, Ibrahim Abubakar, Aamir J Khan, Ted Cohen, David W Dowdy
2324

How to eliminate tuberculosis
Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment
Courtney M Yuen, Farhana Amanullah, Ashwin Dharmadhikari, Edward A Nardell, James A Seddon, Irina Vasilyeva, Yanlin Zhao, Salmaan Keshavjee, Mercedes C Becerra
2334

How to eliminate tuberculosis
Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection
Molebogeng X Rangaka, Solange C Cavalcante, Ben J Marais, Sok Thim, Neil A Martinson, Soumya Swaminathan, Richard E Chaisson
2344

How to eliminate tuberculosis
Stopping tuberculosis: a biosocial model for sustainable development
Katrina F Ortblad, Joshua A Salomon, Till Bärnighausen, Rifat Atun
2354

The Lancet Infectious Diseases
Dec 2015 Volume 15 Number 12 p1361-1498
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Tuberculosis reaches new milestones, good and bad
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00431-4
Summary
The 20th instalment of WHO’s Global tuberculosis report was published on Oct 28, 2015, heralded by the headline that tuberculosis mortality had nearly halved over the past 25 years. This positive news was closely followed by the sobering announcement that tuberculosis now ranks alongside HIV among the leading infectious causes of death, with the deaths of 1·5 million people being attributable to the disease. Most of these deaths could have been prevented; in fact, tuberculosis has been a curable disease since the 1950s.

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Immunogenicity of the RTS,S/AS01 malaria vaccine and implications for duration of vaccine efficacy: secondary analysis of data from a phase 3 randomised controlled trial
Michael T White, Robert Verity, Jamie T Griffin, Kwaku Poku Asante, Seth Owusu-Agyei, Brian Greenwood, Chris Drakeley, Samwel Gesase, John Lusingu, Daniel Ansong, Samuel Adjei, Tsiri Agbenyega, Bernhards Ogutu, Lucas Otieno, Walter Otieno, Selidji T Agnandji, Bertrand Lell, Peter Kremsner, Irving Hoffman, Francis Martinson, Portia Kamthunzu, Halidou Tinto, Innocent Valea, Hermann Sorgho, Martina Oneko, Kephas Otieno, Mary J Hamel, Nahya Salim, Ali Mtoro, Salim Abdulla, Pedro Aide, Jahit Sacarlal, John J Aponte, Patricia Njuguna, Kevin Marsh, Philip Bejon, Eleanor M Riley, Azra C Ghani
1450
Open Access
Summary
Background
The RTS,S/AS01 malaria vaccine targets the circumsporozoite protein, inducing antibodies associated with the prevention of Plasmodium falciparum infection. We assessed the association between anti-circumsporozoite antibody titres and the magnitude and duration of vaccine efficacy using data from a phase 3 trial done between 2009 and 2014.
Methods
Using data from 8922 African children aged 5–17 months and 6537 African infants aged 6–12 weeks at first vaccination, we analysed the determinants of immunogenicity after RTS,S/AS01 vaccination with or without a booster dose. We assessed the association between the incidence of clinical malaria and anti-circumsporozoite antibody titres using a model of anti-circumsporozoite antibody dynamics and the natural acquisition of protective immunity over time.
Findings
RTS,S/AS01-induced anti-circumsporozoite antibody titres were greater in children aged 5–17 months than in those aged 6–12 weeks. Pre-vaccination anti-circumsporozoite titres were associated with lower immunogenicity in children aged 6–12 weeks and higher immunogenicity in those aged 5–17 months. The immunogenicity of the booster dose was strongly associated with immunogenicity after primary vaccination. Anti-circumsporozoite titres wane according to a biphasic exponential distribution. In participants aged 5–17 months, the half-life of the short-lived component of the antibody response was 45 days (95% credible interval 42–48) and that of the long-lived component was 591 days (557–632). After primary vaccination 12% (11–13) of the response was estimated to be long-lived, rising to 30% (28–32%) after a booster dose. An anti-circumsporozoite antibody titre of 121 EU/mL (98–153) was estimated to prevent 50% of infections. Waning anti-circumsporozoite antibody titres predict the duration of efficacy against clinical malaria across different age categories and transmission intensities, and efficacy wanes more rapidly at higher transmission intensity.
Interpretation
Anti-circumsporozoite antibody titres are a surrogate of protection for the magnitude and duration of RTS,S/AS01 efficacy, with or without a booster dose, providing a valuable surrogate of effectiveness for new RTS,S formulations in the age groups considered.
Funding
UK Medical Research Council.

Maternal and Child Health Journal
Volume 19, Issue 12, December 2015
http://link.springer.com/journal/10995/19/12/page/1

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Original Paper
An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial
Shivaprasad S. Goudar, Richard J. Derman
Abstract
Objectives
This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India.
Methods
The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities.
Results
17,754 Intervention births and 15,954 control births weighing ≥1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95 % CI 0.34–1.06, p = 0.076) as was the PMR (OR 0.74, 95 % CI 0.46–1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures.
Conclusions for Practice
The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery.

Nature
Volume 528 Number 7580 pp7-158 3 December 2015
http://www.nature.com/nature/current_issue.html

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World View
The world must accept that the HPV vaccine is safe
But the science alone will not be enough to build public and political confidence, says Heidi Larson.
01 December 2015

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Supplement: Infectious disease control and elimination: Modelling the impact of improved diagnostics
Diagnostic technologies play a pivotal part in understanding and addressing the burden of infectious diseases. The Diagnostics Modelling Consortium was established in 2013 to facilitate the integration of diagnostic data into models of disease transmission dynamics. In this supplement, the Consortium and its partners report on the latest research outcomes across several major diseases. The outputs demonstrate that improved, well-considered diagnostics could support the elimination of multiple diseases in the field.
Free full access

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Introduction
Expanding the role of diagnostic and prognostic tools for infectious diseases in resource-poor settings
Open Access
Azra C. Ghani, Deborah Hay Burgess, Alison Reynolds & Christine Rousseau
Nature 528, S50-S52 (03 December 2015)

Pediatrics
December 2015, VOLUME 136 / ISSUE 6
http://pediatrics.aappublications.org/content/136/6?current-issue=y

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Special Article
Model for Service Delivery for Developmental Disorders in Low-Income Countries
Syed Usman Hamdani, Fareed Aslam Minhas, Zafar Iqbal, Atif Rahman
Abstract
As in many low-income countries, the treatment gap for developmental disorders in rural Pakistan is near 100%. We integrated social, technological, and business innovations to develop and pilot a potentially sustainable service for children with developmental disorders in 1 rural area. Families with developmental disorders were identified through a mobile phone–based interactive voice response system, and organized into “Family Networks.” “Champion” family volunteers were trained in evidence-based interventions. An Avatar-assisted Cascade Training and information system was developed to assist with training, implementation, monitoring, and supervision. In a population of ∼30 000, we successfully established 1 self-sustaining Family Network consisting of 10 trained champion family volunteers working under supervision of specialists, providing intervention to 70 families of children with developmental disorders. Each champion was responsible for training and providing ongoing support to 5 to 7 families from his or her village, and the families supported each other in management of their children. A pre-post evaluation of the program indicated that there was significant improvement in disability and socioemotional difficulties in the child, reduction in stigmatizing experiences, and greater family empowerment to seek services and community resources for the child. There was no change in caregivers’ well-being. To replicate this service more widely, a social franchise model has been developed whereby the integrated intervention will be “boxed” up and passed on to others to replicate with appropriate support. Such integrated social, technological, and business innovations have the potential to be applied to other areas of health in low-income countries.

PharmacoEconomics
Volume 33, Issue 12, December 2015
http://link.springer.com/journal/40273/33/12/page/1

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Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice
James F. O’Mahony, Anthony T. Newall, Joost van Rosmalen
Abstract
Time is an important aspect of health economic evaluation, as the timing and duration of clinical events, healthcare interventions and their consequences all affect estimated costs and effects. These issues should be reflected in the design of health economic models. This article considers three important aspects of time in modelling: (1) which cohorts to simulate and how far into the future to extend the analysis; (2) the simulation of time, including the difference between discrete-time and continuous-time models, cycle lengths, and converting rates and probabilities; and (3) discounting future costs and effects to their present values. We provide a methodological overview of these issues and make recommendations to help inform both the conduct of cost-effectiveness analyses and the interpretation of their results. For choosing which cohorts to simulate and how many, we suggest analysts carefully assess potential reasons for variation in cost effectiveness between cohorts and the feasibility of subgroup-specific recommendations. For the simulation of time, we recommend using short cycles or continuous-time models to avoid biases and the need for half-cycle corrections, and provide advice on the correct conversion of transition probabilities in state transition models. Finally, for discounting, analysts should not only follow current guidance and report how discounting was conducted, especially in the case of differential discounting, but also seek to develop an understanding of its rationale. Our overall recommendations are that analysts explicitly state and justify their modelling choices regarding time and consider how alternative choices may impact on results.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 5 December 2015)

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The Ebola Vaccine, Iatrogenic Injuries, and Legal Liability
Amir Attaran, Kumanan Wilson
Policy Forum | published 01 Dec 2015 | PLOS Medicine
10.1371/journal.pmed.1001911
Summary Points
:: The development and eventual deployment of an Ebola vaccine was delayed for various technical and financial reasons, but with the apparent success of a vaccine candidate in a recently reported clinical trial, an urgent problem is the lack of any system to protect vaccine firms from the risks of legal liability caused by vaccine-related injuries.
:: Without indemnity or security against the legal risks, vaccine firms are less likely to engage in research and development of vaccines, particularly for rare diseases of poor countries such as Ebola.
:: WHO’s traditional method of mitigating the legal risks through indemnification agreements with countries appears too slow to implement in urgent pandemic situations. Also, the enforceability of any WHO-backed legal agreement is placed in doubt because the United Nations has the option to claim immunity from lawsuits.
:: Creating a compensation system for vaccine injuries, based on no-fault principles and, most likely, overseen by the World Bank, could address the liability concerns and facilitate getting novel vaccines into clinical trials and to the market. This system would also ensure that recipients of these vaccines are fairly compensated in the rare instances that they are harmed.

PLoS One
http://www.plosone.org/
[Accessed 5 December 2015]

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Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda
Lumbwe Chola, Lars T. Fadnes, Ingunn M. S. Engebretsen, Lungiswa Nkonki, Victoria Nankabirwa, Halvor Sommerfelt, James K. Tumwine, Thorkild Tylleskar, Bjarne Robberstad, PROMISE-EBF Study Group
Research Article | published 30 Nov 2015 | PLOS ONE
10.1371/journal.pone.0142718

Prehospital & Disaster Medicine
Volume 30 – Issue 06 – December 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue
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Frameworks for Disaster Research and Evaluation
Samuel J. Stratton
DOI: http://dx.doi.org/10.1017/S1049023X15005397 (About DOI), Published online: 11 November 2015

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Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part III: Framework for the Temporal Phases of Disasters
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Research and Evaluations of the Health Aspects of Disasters, Part V: Epidemiological Disaster Research
Marvin L. Birnbaum, Elaine K. Daily and Ann P. O’Rourke

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 5 December 2015]

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Research
Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda
Wilson Muhwezi, Anne Katahoire, Cecily Banura, Herbert Mugooda, Doris Kwesiga, Sheri Bastien, Knut-Inge Klepp Reproductive Health 2015, 12:110 (30 November 2015)

Science
4 December 2015 vol 350, issue 6265, pages 1125-1288
http://www.sciencemag.org/current.dtl

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Introduction to Special Issue – Toward Healthy Aging
Putting Off the Inevitable
Stella Hurtley, Leslie Roberts, L. Bryan Ray, Beverly A. Purnell, Caroline Ash
The dream of cheating death has evolved into a scientific quest to extend healthy life span. Scientists and doctors are looking for ways to maximize the number of years that we live free of chronic diseases, cancer, and cognitive decline. But before we can intervene, we have to understand the cellular and molecular mechanisms that drive aging and senescence. Some clues reside in our telomeres, the tips of our chromosomes that shrink with age. Others lie in our stem cells, which can only go on for so long repairing our tissues. Our mitochondria, too, the so-called powerhouses of the cell, may hold some answers to prolonging youthfulness. Other research points to changes in the gut microbiota associated with frailty in the aged. At a mechanistic level, the modulation of coenzyme NAD+ usage or production can prolong both health span and life span. Current geroscience initiatives aim to harness basic insights in aging research to promote general advances in healthy aging.

Questions remain throughout the aging field. By tweaking everything from genes to diets to environmental temperature and mating, scientists have created Methuselah flies and other remarkably long-lived animals while garnering fundamental insights into the biology of aging. Still, researchers puzzle over the most basic questions, such as what determines the life spans of animals. Meanwhile, a handful of molecular biologists are searching for ways to measure a person’s biological, as opposed to chronological, age, but that quest, too, has proved elusive.

An ever-growing literature addresses both theoretical and pragmatic approaches to the challenge of aging. In this special issue, we have focused mainly on the cellular aspects of mammalian aging, with the goal of spurring future developments in promoting health span, if not life span.

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Policy Forum
Climate Policy
Can Paris pledges avert severe climate change?
Allen A. Fawcett, Gokul C. Iyer, Leon E. Clarke, James A. Edmonds, Nathan E. Hultman, Haewon C. McJeon, Joeri Rogelj, Reed Schuler, Jameel Alsalam, Ghassem R. Asrar, Jared Creason, Minji Jeong, James McFarland, Anupriya Mundra, and Wenjing Shi
Science 4 December 2015: 1168-1169.
Published online 26 November 2015 [DOI:10.1126/science.aad5761]
Reducing risks of severe outcomes and improving chances of limiting warming to 2°C
Current international climate negotiations seek to catalyze global emissions reductions through a system of nationally determined country-level emissions reduction targets that would be regularly updated. These “Intended Nationally Determined Contributions” (INDCs) would constitute the core of mitigation commitments under any agreement struck at the upcoming Paris Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC) (1). With INDCs now reported from more than 150 countries and covering around 90% of global emissions, we can begin to assess the role of this round of INDCs in facilitating or frustrating achievement of longer-term climate goals. In this context, it is important to understand what these INDCs collectively deliver in terms of two objectives. First, how much do they reduce the probability of the highest levels of global mean surface temperature change? Second, how much do they improve the odds of achieving the international goal of limiting temperature change to under 2°C relative to preindustrial levels (2)? Although much discussion has focused on the latter objective (3–5), the former is equally important when viewing climate mitigation from a risk-management perspective.

Social Science & Medicine
Volume 145, Pages 1-248 (November 2015)
http://www.sciencedirect.com/science/journal/02779536/145

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Special issue section Health Systems in Asia 2013; Edited by Kai Hong Phua, Shenglan Tang and Kabir Sheikh
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Editorial – Health Systems of Asia: Equity, Governance and Social Impact
Pages 141-144
Kai Hong Phua, Kabir Sheikh, Sheng-Lan Tang, Vivian Lin
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District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure
Original Research Article
Pages 163-172
Anu Rammohan, Niyi Awofeso
Abstract
Routine childhood immunizations against measles and DPT are part of the World Health Organization’s (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the district’s income per capita is a strong predictor of better immunization outcomes for children. Mother’s education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models.
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Emerging challenges in implementing universal health coverage in Asia
Original Research Article
Pages 243-248
Caryn Bredenkamp, Timothy Evans, Leizel Lagrada, John Langenbrunner, Stefan Nachuk, Toomas Palu
Abstract
As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure “supply-side readiness”, i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed.
On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint.
While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia – and across the world.

Stanford Social Innovation Review
http://ssir.org/

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Measurement & Evaluation
Imagine a World of Good Data
By Peter L. Levin & Hallie Schneir 1
Unless we prioritize government collection, analysis, and distribution of data, public officials will continue to make decisions with limited facts, and citizens will get poorer services from the government than from the private sector.

Sustainability
Volume 7, Issue 11 (November 2015), Pages 14427-15784
http://www.mdpi.com/2071-1050/7/9

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Editorial: Planning, Development and Management of Sustainable Cities: A Commentary from the Guest Editors
by Tan Yigitcanlar and Md. Kamruzzaman
Sustainability 2015, 7(11), 14677-14688; doi:10.3390/su71114677
Received: 27 October 2015 / Revised: 27 October 2015 / Accepted: 27 October 2015 / Published: 3 November 2015
Abstract:
Cities are the most dramatic manifestations of human activities on the surface of the earth. These human-dominated organisms—i.e., cities—degrade natural habitats, simplify species composition, disrupt hydrological systems, and modify energy flow and nutrient cycling. Today, these consequential impacts of human activities, originated from population increase, rapid urbanization, high private motor vehicle dependency, deregulated industrialization and mass livestock production, are increasing exponentially and causing great deal of environmental, social, and economic challenges both at global and local scales. In such a situation, establishment of sustainable cities, through sustainable urban development practices, is seen as a potential panacea to combat these challenges responsibly, effectively, and efficiently. This paper offers a critical review of the key literature on the issues relating to planning, development and management of sustainable cities, introduces the contributions from the Special Issue, and speculates on the prospective research directions to place necessary mechanisms to secure a sustainable urban future for all.

TORTURE Journal
Volume 25, Nr. 2, 2015
http://www.irct.org/torture-journal

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Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors
Deborah Larson-Stoa, Gerard A. Jacobs, Abraham Jonathan, Bhava Poudyal

Geographical distribution of torture: An epidemiological study of torture reported by asylum applicants examined at the Department of Forensic Medicine, University of Copenhagen
J. Busch, S.H. Hansen, H.P. Hougen

Testimonial Therapy: Impact on social participation and emotional wellbeing among Indian survivors of torture and organized violence
Mia Myhre Jørgensen, Jens Modvig, Inger Agger, Lenin Raghuvanshi, Shirin Shabana Khan, Peter Polatin

Descriptive, inferential, functional outcome data on 9,025 torture survivors in the United States
Member Centers of the National Consortium of Torture Treatment Programs (NCTTP)

Elusive retributive justice in post-Khmer Rouge Cambodia: Challenges of using ECCC Victim Information Forms as a victim participatory rights mechanism
Leakhena Nou

Tropical Medicine & International Health
December 2015 Volume 20, Issue 12 Pages 1591–1854
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2015.20.issue-12/issuetoc

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Systematic Reviews
Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia (pages 1607–1620)
Daniel E. Roth, Michelle F. Gaffey, Evelyn Smith-Romero, Tiffany Fitzpatrick and Shaun K. Morris
Article first published online: 20 SEP 2015 | DOI: 10.1111/tmi.12592

Systematic Reviews
Who, What, Where: an analysis of private sector family planning provision in 57 low- and middle-income countries (pages 1639–1656)
Oona M. R. Campbell, Lenka Benova, David Macleod, Catherine Goodman, Katharine Footman, Audrey L. Pereira and Caroline A. Lynch
Article first published online: 28 SEP 2015 | DOI: 10.1111/tmi.12597

Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys (pages 1657–1673)
Lenka Benova, David Macleod, Katharine Footman, Francesca Cavallaro, Caroline A. Lynch and Oona M. R. Campbell
Article first published online: 28 SEP 2015 | DOI: 10.1111/tmi.12598

Vulnerable Children and Youth Studies
An International Interdisciplinary Journal for Research, Policy and Care
Volume 10, Issue 4, 2015
http://www.tandfonline.com/toc/rvch20/current

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Mind the gap: a review of mental health service delivery for transition age youth
Javeed Sukhera, Sandra Fisman & Simon Davidson
pages 271-280
DOI:10.1080/17450128.2015.1080393
Abstract
This narrative review examines evidence on mental health services and transitions for mentally ill patients moving from adolescence to adulthood. Authors found that current mental health systems in several jurisdictions lack the capacity to effectively transition youth between the ages of 16 and 25 to adult systems of care. A review of the literature reveals that key elements of effective transition can be divided into systemic, organizational and program-based categories. Systems of care must be coordinated with optimal communication; organizations should align institutional and developmental transitions while emphasizing flexibility in services and across organizations. Programs should incorporate authentic youth and caregiver engagement, include skills training and emphasize a community-based approach. There is evidence of positive outcome data for effective transitions, notably in educational advancement and employment. Existing models vary from clearly organized interventions targeted toward youth with severe emotional and behavioural disturbance to specific individual components that can be integrated in existing organizations or built into novel systems of care. The authors suggest that meeting the mental health needs of transition age youth requires optimization at systemic, organizational and programmatic levels and an ideal model of care should incorporate evidence-based approaches that are adapted to unique youth and community needs.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 28 November 2015

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

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

pdf version: The Sentinel_ week ending 28 November 2015

blog edition: comprised of the 35+ entries  posted below on 29 November 2015

Unless we act now: The impact of climate change on children
UNICEF
November 2015 :: 81 pages ISBN: 978-92-806-4826-3
Pdf: http://www.unicef.org/publications/index_86337.html#
Overview
Today’s children, and their children, are the ones who will live with the consequences of climate change. This report looks at how children, and particularly the most vulnerable, are affected and what concrete steps need to be taken to protect them.

Key Messages [Excerpt]
…Now is the time for action
The world must embark on low carbon development to reduce greenhouse gas emissions, and needs to adapt to the impacts of climate change that cannot be halted. We can take steps now to safeguard our children’s future, notably:
:: Cutting greenhouse gas emissions so that the average rise in the global temperature is limited to a maximum of 2º Celsius, and ideally to 1.5ºC.

:: Prioritizing the needs of the most vulnerable in climate change adaptation efforts, particularly children – who will bear the brunt of climate change far longer than adults.

:: Reducing inequities among children now to promote their future resilience to climate change and other disasters or crises.

:: Listening to and acting on children’s perspectives on climate change.

:: Providing children and youth with climate change education, awareness raising and training.

:: Aligning and coordinating work on climate change adaptation, preparedness and disaster risk reduction at national and sub-national levels.

:: Protecting children and their families who are forced to move as a result of climate change.

:: Investing in children as part of national climate plans on mitigation and adaptation.

:: Scale-up proven approaches to address the changing needs of children.

Children deserve to live in a world free from the life-threatening effects of climate change. Given the overwhelming scientific evidence on the dangers of climate change, and the clear opportunities we have for altering its course, there is no excuse for not acting ambitiously.

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Press Release
Children will bear the brunt of climate change: UNICEF
More than half a billion children live in areas with extremely high flood occurrence, 160 million live in high drought severity areas
NEW YORK/GENEVA, 24 November 2015 – More than half a billion children live in areas with extremely high flood occurrence and 160 million in high drought severity zones, leaving them highly exposed to the impacts of climate change, UNICEF said in a report released ahead of the 21st United Nations climate change conference, known as COP21.

Of the 530 million children in the flood-prone zones, some 300 million live in countries where more than half the population lives in poverty – on less than $3.10 a day. Of those living in high drought severity areas, 50 million are in countries where more than half the population lives in poverty.

“The sheer numbers underline the urgency of acting now,” said UNICEF Executive Director Anthony Lake. “Today’s children are the least responsible for climate change, but they, and their children, are the ones who will live with its consequences. And, as is so often the case, disadvantaged communities face the gravest threat.”

Climate change means more droughts, floods, heatwaves and other severe weather conditions. These events can cause death and devastation, and can also contribute to the increased spread of major killers of children, such as malnutrition, malaria and diarrhoea. This can create a vicious circle: A child deprived of adequate water and sanitation before a crisis will be more affected by a flood, drought, or severe storm, less likely to recover quickly, and at even greater risk when faced with a subsequent crisis.

The vast majority of the children living in areas at extremely high risk of floods are in Asia, and the majority of those in areas at risk of drought are in Africa…