PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/

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Sackler Colloquium on Coupled Human and Environmental Systems – Biological Sciences – Sustainability Science:
Quantifying and sustaining biodiversity in tropical agricultural landscapes
Chase D. Mendenhall, Analisa Shields-Estrada, Arjun J. Krishnaswami, and Gretchen C. Daily
PNAS 2016 ; published ahead of print October 24, 2016, doi:10.1073/pnas.1604981113
Abstract
Decision-makers increasingly seek scientific guidance on investing in nature, but biodiversity remains difficult to estimate across diverse landscapes. Here, we develop empirically based models for quantifying biodiversity across space. We focus on agricultural lands in the tropical forest biome, wherein lies the greatest potential to conserve or lose biodiversity. We explore two questions, drawing from empirical research oriented toward pioneering policies in Costa Rica. First, can remotely sensed tree cover serve as a reliable basis for improved estimation of biodiversity, from plots to regions? Second, how does tropical biodiversity change across the land-use gradient from native forest to deforested cropland and pasture? We report on understory plants, nonflying mammals, bats, birds, reptiles, and amphibians. Using data from 67,737 observations of 908 species, we test how tree cover influences biodiversity across space. First, we find that fine-scale mapping of tree cover predicts biodiversity within a taxon-specific radius (of 30–70 m) about a point in the landscape. Second, nearly 50% of the tree cover in our study region is embedded in countryside forest elements, small (typically 0.05–100 ha) clusters or strips of trees on private property. Third, most species use multiple habitat types, including crop fields and pastures (to which 15% of species are restricted), although some taxa depend on forest (57% of species are restricted to forest elements). Our findings are supported by comparisons of 90 studies across Latin America. They provide a basis for a planning tool that guides investments in tropical forest biodiversity similar to those for securing ecosystem services.

Science
28 October 2016 Vol 354, Issue 6311
http://www.sciencemag.org/current.dtl
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EDITORIAL
Dealing with details in Marrakesh
Patricia Espinosa
Summary
Over the next few weeks, two major events will take place—the 2015 Paris Agreement on climate change will enter into force on 4 November, and 3 days later, nearly 200 countries will convene in Marrakesh, Morocco, at the 22nd United Nations (UN) Conference of the Parties (COP22) to decide on how to rapidly implement the agreement. Indeed, the agreement’s governing body will hold its first meeting during COP22. This swift action to commit and come up with climate action plans is a welcome departure for the international community, and it sends a clear message that success in tackling climate challenges requires more than just a historic political agreement.

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Policy Forum
Making climate science more relevant
By Charles F. Kennel, Stephen Briggs, David G. Victor
Science28 Oct 2016 : 421-422 Full Access
Better indicators for risk management are needed after Paris
Summary
For nearly three decades, the central goal in international climate policy had been to set the political agenda—to engage all countries on the need for action. So long as that was the goal, it was sufficient for policy-makers to focus on simple indicators of climate change, such as global average surface temperature With the 2015 Paris Agreement, governments launched a process that can move beyond setting agendas to coordinating national policies to manage the climate. Next month in Marrakesh, diplomats will convene to flesh out the Agreement. They need to focus on the infrastructure of data and analysis that will be needed as the Agreement becomes operational. The scientific community can help by identifying better lagging indicators to describe what has changed as policy efforts progress, and leading indicators to focus policy on the right risks as the planet warms.

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Climate change: The 2015 Paris Agreement thresholds and Mediterranean basin ecosystems
By Joel Guiot, Wolfgang Cramer
Science 28 Oct 2016 : 465-468 Restricted Access
Global warming above 1.5°C will likely change Mediterranean ecosystems in ways unprecedented in the Holocene record.
Editor’s Summary
A warming limit for the Mediterranean basin
Pollen cores from sediments provide rich detail on the history of vegetation and climate in the Mediterranean during the Holocene (the most recent ~10,000 years). Guiot and Cramer used this information as a baseline against which to compare predictions of future climate and vegetation under different climate-change scenarios. Vegetation and land-use systems observed in the Holocene records may persist under a 1.5°C warming above preindustrial temperature levels. A 2°C warming, however, is likely over the next century to produce ecosystems in the Mediterranean basin that have no analog in the past 10,000 years.
Abstract
The United Nations Framework Convention on Climate Change Paris Agreement of December 2015 aims to maintain the global average warming well below 2°C above the preindustrial level. In the Mediterranean basin, recent pollen-based reconstructions of climate and ecosystem variability over the past 10,000 years provide insights regarding the implications of warming thresholds for biodiversity and land-use potential. We compare scenarios of climate-driven future change in land ecosystems with reconstructed ecosystem dynamics during the past 10,000 years. Only a 1.5°C warming scenario permits ecosystems to remain within the Holocene variability. At or above 2°C of warming, climatic change will generate Mediterranean land ecosystem changes that are unmatched in the Holocene, a period characterized by recurring precipitation deficits rather than temperature anomalies.

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169
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Original Research Article
Financing the HIV response in sub-Saharan Africa from domestic sources: Moving beyond a normative approach
Pages 66-76
Michelle Remme, Mariana Siapka, Olivier Sterck, Mthuli Ncube, Charlotte Watts, Anna Vassall
Abstract
Despite optimism about the end of AIDS, the HIV response requires sustained financing into the future. Given flat-lining international aid, countries’ willingness and ability to shoulder this responsibility will be central to access to HIV care. This paper examines the potential to expand public HIV financing, and the extent to which governments have been utilising these options.
We develop and compare a normative and empirical approach. First, with data from the 14 most HIV-affected countries in sub-Saharan Africa, we estimate the potential increase in public HIV financing from economic growth, increased general revenue generation, greater health and HIV prioritisation, as well as from more unconventional and innovative sources, including borrowing, health-earmarked resources, efficiency gains, and complementary non-HIV investments. We then adopt a novel empirical approach to explore which options are most likely to translate into tangible public financing, based on cross-sectional econometric analyses of 92 low and middle-income country governments’ most recent HIV expenditure between 2008 and 2012.
If all fiscal sources were simultaneously leveraged in the next five years, public HIV spending in these 14 countries could increase from US$3.04 to US$10.84 billion per year. This could cover resource requirements in South Africa, Botswana, Namibia, Kenya, Nigeria, Ethiopia, and Swaziland, but not even half the requirements in the remaining countries. Our empirical results suggest that, in reality, even less fiscal space could be created (a reduction by over half) and only from more conventional sources. International financing may also crowd in public financing.
Most HIV-affected lower-income countries in sub-Saharan Africa will not be able to generate sufficient public resources for HIV in the medium-term, even if they take very bold measures. Considerable international financing will be required for years to come. HIV funders will need to engage with broader health and development financing to improve government revenue-raising and efficiencies.

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169
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Review Article
Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women’s perceptions and experiences
Pages 157-170
Susan Bradley, Christine McCourt, Juliet Rayment, Divya Parmar
Abstract
The psycho-social elements of labour and delivery are central to any woman’s birth experience, but international efforts to reduce maternal mortality in low-income contexts have neglected these aspects and focused on technological birth. In many contexts, maternity care is seen as dehumanised and disrespectful, which can have a negative impact on utilisation of services. We undertook a systematic review and meta-synthesis of the growing literature on women’s experiences of facility-based delivery in sub-Saharan Africa to examine the drivers of disrespectful intrapartum care. Using PRISMA guidelines, databases were searched from 1990 to 06 May 2015, and 25 original studies were included for thematic synthesis. Analytical themes, that were theoretically informed and cognisant of the cultural and social context in which the dynamics of disrespectful care occur, enabled a fresh interpretation of the factors driving midwives’ behaviour. A conceptual framework was developed to show how macro-, meso- and micro-level drivers of disrespectful care interact. The synthesis revealed a prevailing model of maternity care that is institution-centred, rather than woman-centred. Women’s experiences illuminate midwives’ efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge.
Midwives and women are caught between medical and social models of birth. Global policies encouraging facility-based delivery are forcing women to swap the psycho-emotional care they would receive from traditional midwives for the technical care that professional midwives are currently offering. Any action to change the current performance and dynamic of birth relies on the participation of midwives, but their voices are largely missing from the discourse. Future research should explore their perceptions of the value and practice of interpersonal aspects of maternity care and the impact of disrespectful care on their sense of professionalism and personal ethics

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169

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Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world
Review Article
Pages 119-131
Pierre Pratley
Abstract
Research on the association between women’s empowerment and maternal and child health has rapidly expanded. However, questions concerning the measurement and aggregation of quantitative indicators of women’s empowerment and their associations with measures of maternal and child health status and healthcare utilization remain unanswered. Major challenges include complexity in measuring progress in several dimensions and the situational, context dependent nature of the empowerment process as it relates to improvements in maternal and child health status and maternal care seeking behaviors. This systematic literature review summarizes recent evidence from the developing world regarding the role women’s empowerment plays as a social determinant of maternal and child health outcomes. A search of quantitative evidence previously reported in the economic, socio-demographic and public health literature finds 67 eligible studies that report on direct indicators of women’s empowerment and their association with indicators capturing maternal and child health outcomes. Statistically significant associations were found between women’s empowerment and maternal and child health outcomes such as antenatal care, skilled attendance at birth, contraceptive use, child mortality, full vaccination, nutritional status and exposure to violence. Although associations differ in magnitude and direction, the studies reviewed generally support the hypothesis that women’s empowerment is significantly and positively associated with maternal and child health outcomes. While major challenges remain regarding comparability between studies and lack of direct indicators in key dimensions of empowerment, these results suggest that policy makers and practitioners must consider women’s empowerment as a viable strategy to improve maternal and child health, but also as a merit in itself. Recommendations include collection of indicators on psychological, legal and political dimensions of women’s empowerment and development of a comprehensive conceptual framework that can guide research and policy making.

Sustainability
Volume 8, Issue 10 (October 2016)
http://www.mdpi.com/2071-1050/8/10

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Adopters and Non-Adopters of Low-Cost Household Latrines: A Study of Corbelled Pit Latrines in 15 Districts of Malawi
by Rochelle Holm, Mavuto Tembo, Dalo Njera, Victor Kasulo, Mphatso Malota, Willy Chipeta, Wales Singini and Joshua Mchenga
Published: 27 September 2016
Abstract
The Sustainable Development Goals will challenge low- and middle-income settings to look at new approaches for rural sanitation. In 2013, Mzuzu University, in partnership with United Nations Children’s Fund (UNICEF) Malawi, started a low-cost latrine program in rural areas using the corbelled latrine design supported by locally owned sustainable businesses. The objective of this work was to trace customers (early household adopters) and non-customers through field observations and interviews in 15 districts of Malawi. The research team spent 193 personnel work days in data collection and found 21 households as adopters in 7 districts. Most respondents had a preference with regard to the design of the sanitation facility they would like to use. Although sharing of sanitation facilities was common, the corbelled latrine is promoted as a single household pit latrine design. Unfortunately, 8% (23/304) of non-adopters responded they practiced open defecation. Households were satisfied with the corbelled latrine design, and no latrine was found to have collapsed during field visits. To promote the corbelled latrine in Malawi, the following are recommended: (1) education of frontline government extension workers towards non-subsidized household latrines; (2) identification of rural low-income households as the best target for potential adopters; and (3) linkage of low-cost sanitation technologies to community mobilization campaigns led by the government, such as Community Led Total Sanitation.

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How Frugal Innovation Promotes Social Sustainability
by Rakhshanda Khan
Sustainability 2016, 8(10), 1034; doi:10.3390/su8101034
Received: 27 June 2016 / Revised: 5 October 2016 / Accepted: 11 October 2016 / Published: 15 October 2016
Abstract
There is a need to develop an understanding of how frugal innovation promotes social sustainability. The objective of this paper is to find the connections between the two concepts of social sustainability and frugal innovation, by reviewing the existing literature concerning both fields. This paper presents a framework that identifies essential themes of social sustainability and explores them through frugal innovation. The framework builds on the important themes of social sustainability and shows their relevance in practice through frugal innovation. The notion of frugal innovation can be viewed as an approach towards realizing social sustainability and fulfilling the United Nations’ Sustainable Development Goals.

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Critical Review of the Millennium Project in Nepal
by Ashma Vaidya and Audrey L. Mayer
Sustainability 2016, 8(10), 1043; doi:10.3390/su8101043
Published: 18 October 2016
Abstract
“Our Common Future” harmonized development policies around a new sustainable development (SD) paradigm, and experts also emphasize the importance of a democratic and equitable approach to define and achieve sustainable development. However, SD targets and indicators are often defined by a suite of experts or a few stakeholder groups, far removed from on-the-ground conditions. The most common expert-led development framework, the United Nations’ Millennium Development Goals (MDGs), promoted one set of targets and indicators for all developing countries. While progress towards these targets was routinely reported at the national scale, these targets may not reflect context-specific sustainable development. We evaluated the relevance and comprehensiveness of MDG 7 (environmental sustainability) for Nepal. Although Nepal has met most of the MDG 7 (e.g., forest cover, protected areas coverage, water and sanitation), on closer inspection these indicators do not provide adequate context for ensuring that these targets provide the intended levels of development. Simple forest cover and protected area indicators belie the dearth of ecological conservation on the ground, and water and sanitation indicators do not reflect the inequality of access based on poverty and regions. While the Millennium Development Goals align with broad sustainability concerns in Nepal, these indicators do not reveal its true development conditions.

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The Impact of Conditional Cash Transfer on Toilet Use in eThekwini, South Africa
by Elizabeth Tilley and Isabel Günther
Sustainability 2016, 8(10), 1070; doi:10.3390/su8101070
Published: 22 October 2016
Abstract
In the developing world, having access to a toilet does not necessarily imply use: infrequent or non-use limits the desired health outcomes of improved sanitation. We examine the sanitation situation in a rural part of South Africa where recipients of novel, waterless “urine-diverting dry toilets” are not regularly using them. In order to determine if small, conditional cash transfers (CCT) could motivate families to use their toilets more, we paid for urine via different incentive-based interventions: two were based on volumetric pricing and the third was a flat-rate payment (irrespective of volume). A flat-rate payment (approx. €1) resulted in the highest rates of regular (weekly) participation at 59%. The low volumetric payment (approx. €0.05/L) led to regular participation rates of only 12% and no increase in toilet use. The high volumetric payment (approx. €0.1/L) resulted in lower rates of regular participation (35%), but increased the average urine production per household per day by 74%. As a first example of conditional cash transfers being used in the sanitation sector, we show that they are an accepted and effective tool for increasing toilet use, while putting small cash payments in the hands of poor, largely unemployed populations in rural South Africa.

TORTURE Journal
Volume 26, Nr. 2, 2016
http://www.irct.org/Default.aspx?ID=5768
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Scientific Articles
Creating community life among immigrant survivors of torture and their allies
Nancy Bothne, Christopher B. Keys

Measuring change and changing measures: The development of a torture survivor specific measure of change
Rebecca Horn, Andy Keefe

Prevalence of torture and other war-related traumatic events in forced migrants: A systematic review
Erika Sigvardsdotter, Marjan Vaez, Ann-Marie Rydholm Hedman, Fredrik Saboonchi

Torture survivors’ symptom load compared to chronic pain and psychiatric in-patients
Uwe Harlacher, Linda Nordin, Peter Polatin
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Statement
Statement on Anal Examinations in Cases of Alleged Homosexuality
Independent Forensic Expert Group

UN Chronicle
Vol. LIII No. 3 2016 October 2016
http://unchronicle.un.org/
Human Habits, Human Habitats
At the United Nations Conference on Housing and Sustainable Development (Habitat III), to be held in Quito, Ecuador, from 17 to 20 October 2016, world leaders will discuss and agree on ways to address the pressing issues faced by cities today and in the years to come. This issue of the UN Chronicle, under the theme “Human Habits, Human Habitats”, provides a variety of perspectives on sustainable urbanization and the future of human settlements.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 29 October 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version:the-sentinel_-week-ending-29-october-2016-docx

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 22 October 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version:the-sentinel_-week-ending-22-october-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 15 October 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version:the-sentinel_-week-ending-15-october-2016-docx

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 8 October 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-8-october-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 1 October 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-1-october-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 24 September 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-24-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 17 September 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-17-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 10 September 2016

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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-10-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

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
6 September 2016, Vol. 165. No. 5
http://annals.org/issue.aspx

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Original Research
The Anticipated Clinical and Economic Effects of 90–90–90 in South Africa
Rochelle P. Walensky, MD, MPH; Ethan D. Borre, BA; Linda-Gail Bekker, MD, PhD; Stephen C. Resch, PhD; Emily P. Hyle, MD, SM; Robin Wood, MMed, DSc (Med); Milton C. Weinstein, PhD; Andrea L. Ciaranello, MD, MPH; Kenneth A. Freedberg, MD, MSc; and A. David Paltiel, MBA, PhD
Abstract
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 global treatment target aims to achieve 73% virologic suppression among HIV-infected persons worldwide by 2020.
Objective: To estimate the clinical and economic value of reaching this ambitious goal in South Africa, by using a microsimulation model of HIV detection, disease, and treatment.
Design: Modeling of the “current pace” strategy, which simulates existing scale-up efforts and gradual increases in overall virologic suppression from 24% to 36% in 5 years, and the UNAIDS target strategy, which simulates 73% virologic suppression in 5 years.
Data Sources: Published estimates and South African survey data on HIV transmission rates (0.16 to 9.03 per 100 person-years), HIV-specific age-stratified fertility rates (1.0 to 9.1 per 100 person-years), and costs of care ($11 to $31 per month for antiretroviral therapy and $20 to $157 per month for routine care).
Target Population: South African HIV-infected population, including incident infections over the next 10 years.
Perspective: Modified societal perspective, excluding time and productivity costs.
Time Horizon: 5 and 10 years.
Intervention: Aggressive HIV case detection, efficient linkage to care, rapid treatment scale-up, and adherence and retention interventions toward the UNAIDS target strategy.
Outcome Measures: HIV transmissions, deaths, years of life saved, maternal orphans, costs (2014 U.S. dollars), and cost-effectiveness.
Results of Base-Case Analysis: Compared with the current pace strategy, over 5 years the UNAIDS target strategy would avert 873 000 HIV transmissions, 1 174 000 deaths, and 726 000 maternal orphans while saving 3 002 000 life-years; over 10 years, it would avert 2 051 000 HIV transmissions, 2 478 000 deaths, and 1 689 000 maternal orphans while saving 13 340 000 life-years. The additional budget required for the UNAIDS target strategy would be $7.965 billion over 5 years and $15.979 billion over 10 years, yielding an incremental cost-effectiveness ratio of $2720 and $1260 per year of life saved, respectively.
Results of Sensitivity Analysis: Outcomes generally varied less than 20% from base-case outcomes when key input parameters were varied within plausible ranges.
Limitation: Several pathways may lead to 73% overall virologic suppression; these were examined in sensitivity analyses.
Conclusion: Reaching the 90–90–90 HIV suppression target would be costly but very effective and cost-effective in South Africa. Global health policymakers should mobilize the political and economic support to realize this target.
Primary Funding Source: National Institutes of Health and the Steve and Deborah Gorlin MGH Research Scholars Award.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 10 September 2016)

Research article
Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization
Katherine Kentoffio, John D. Kraemer, Thomas Griffiths, Avi Kenny, Rajesh Panjabi, G. Andrew Sechler, Stephen Selinsky and Mark J. Siedner
BMC Health Services Research 2016 16:478
Published on: 7 September 2016
Abstract
Background
Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.
Methods
We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.
Results
Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).
Conclusions
Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.

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BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 10 September 2016)

Debate
Research involving adults lacking capacity to consent: the impact of research regulation on ‘evidence biased’ medicine
Victoria Shepherd
Published on: 8 September 2016
Abstract
Background
Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a result of ‘evidence biased’ medicine.
Main Text
This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use (Clinical Trials) Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs.
Conclusion
The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented.