Setting Research Priorities To Reduce Global Mortality from Childhood Diarrhoea by 2015

Olivier Fontaine and colleagues applied a priority-setting methodology to identify research priorities aimed at reducing global diarrhea mortality by 2015

Broadband Transmission Spectroscopy of the super-Earth GJ 1214b suggests a Low Mean Molecular Weight Atmosphere

We used WIRCam on CFHT to observe four transits of the super-Earth GJ 1214b in the near-infrared. For each transit we observed in two bands nearly-simultaneously by rapidly switching the WIRCam filter wheel back and forth for the duration of the observations. By combining all our J-band (~1.25 microns) observations we find a transit depth in this band of 1.338\pm0.013% - a value consistent with the optical transit depth reported by Charbonneau and collaborators. However, our best-fit combined Ks-band (~2.15 microns) transit depth is deeper: 1.438\pm0.019%. Formally our Ks-band transits are deeper than the J-band transits observed simultaneously by a factor of 1.072\pm0.018 - a 4-sigma discrepancy. The most straightforward explanation for our deeper Ks-band depth is a spectral absorption feature from the limb of the atmosphere of the planet; for the spectral absorption feature to be this prominent the atmosphere of GJ 1214b must have a large scale height and a low mean molecular weight. That is, it would have to be hydrogen/helium dominated and this planet would be better described as a mini-Neptune. However, recently published observations from 0.78 - 1.0 microns, by Bean and collaborators, show a lack of spectral features and transit depths consistent with those obtained by Charbonneau and collaborators. The most likely atmospheric composition for GJ 1214b that arises from combining all these observations is less clear; if the atmosphere of GJ 1214b is hydrogen/helium dominated then it must have either a haze layer that is obscuring transit depth differences at shorter wavelengths, or significantly different spectral features than current models predict. Our observations disfavour a water-world composition, but such a composition will remain a possibility until observations reconfirm our deeper Ks-band transit depth or detect features at other wavelengths. [Abridged]Comment: ApJ accepted. 12 pages, 6 figures, in EmulateApJ forma

Near-infrared Thermal Emission from WASP-12b: detections of the secondary eclipse in Ks, H & J

We present Ks, H & J-band photometry of the very highly irradiated hot Jupiter WASP-12b using the Wide-field Infrared Camera on the Canada-France-Hawaii telescope. Our photometry brackets the secondary eclipse of WASP-12b in the Ks and H-bands, and in J-band starts in mid-eclipse and continues until well after the end of the eclipse. We detect its thermal emission in all three near-infrared bands. Our secondary eclipse depths are 0.309 +/- 0.013% in Ks-band (24-sigma), 0.176 +/- 0.020% in H-band (9-sigma) and 0.131 +/- 0.028% in J-band (4-sigma). All three secondary eclipses are best-fit with a consistent phase that is compatible with a circular orbit. By combining our secondary eclipse times with others published in the literature, as well as the radial velocity and transit timing data for this system, we show that there is no evidence that WASP-12b is precessing at a detectable rate, and show that its orbital eccentricity is likely zero. Our thermal emission measurements also allow us to constrain the characteristics of the planet's atmosphere; our Ks-band eclipse depth argues in favour of inefficient day to nightside redistribution of heat and a low Bond albedo for this very highly irradiated hot Jupiter. The J and H-band brightness temperatures are slightly cooler than the Ks-band brightness temperature, and thus hint at the possibility of a modest temperature inversion deep in the atmosphere of WASP-12b; the high pressure, deep atmospheric layers probed by our J and H-band observations are likely more homogenized than the higher altitude layer. Lastly, our best-fit Ks-band eclipse has a marginally longer duration than would otherwise be expected; this may be tentative evidence for material being tidally stripped from the planet - as was predicted for this system by Li & collaborators, and for which observational confirmation was recently arguably provided by Fossati & collaborators.Comment: AJ accepted. 12 pages, 11 figures, in EmulateApJ format. Version 2 removes two figures that were added by mistak

Improving the Quantitative Basis of the Surgical Burden in Low-Income Countries

Theo Vos discusses how surgery is beginning to be considered an essential component of primary health care in low-income countries, and how we need to improve our understanding of the burden of surgical conditions in these settings

Measuring Under-Five Mortality: Validation of New Low-Cost Methods

n/

Packaging Health Services When Resources Are Limited: The Example of a Cervical Cancer Screening Visit

BACKGROUND: Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services. We present an analytic framework for packaging multiple interventions during a single point of contact, explicitly taking into account a budget and scarce human resources, constraints acknowledged as significant obstacles for provision of health services in poor countries. METHODS AND FINDINGS: We developed a binary integer programming (IP) model capable of identifying an optimal package of health services to be provided during a single visit for a particular target population. Inputs to the IP model are derived using state-transition models, which compute lifetime costs and health benefits associated with each intervention. In a simplified example of a single lifetime cervical cancer screening visit, we identified packages of interventions among six diseases that maximized disability-adjusted life years (DALYs) averted subject to budget and human resource constraints in four resource-poor regions. Data were obtained from regional reports and surveys from the World Health Organization, international databases, the published literature, and expert opinion. With only a budget constraint, interventions for depression and iron deficiency anemia were packaged with cervical cancer screening, while the more costly breast cancer and cardiovascular disease interventions were not. Including personnel constraints resulted in shifting of interventions included in the package, not only across diseases but also between low- and high-intensity intervention options within diseases. CONCLUSIONS: The results of our example suggest several key themes: Packaging other interventions during a one-time visit has the potential to increase health gains; the shortage of personnel represents a real-world constraint that can impact the optimal package of services; and the shortage of different types of personnel may influence the contents of the package of services. Our methods provide a general framework to enhance a decision maker's ability to simultaneously consider costs, benefits, and important nonmonetary constraints. We encourage analysts working on real-world problems to shift from considering costs and benefits of interventions for a single disease to exploring what synergies might be achievable by thinking across disease burdens

Setting Research Priorities to Reduce Global Mortality from Childhood Pneumonia by 2015

Igor Rudan and colleagues report the results of their consensus building exercise that identified health research priorities to help reduce child mortality from pneumonia

Policy challenges for the pediatric rheumatology workforce: Part III. the international situation

Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day). Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled