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Epidemic risk assessment and response relies on rapid information sharing. Using examples from the past decade, we discuss the limitations of the present system for outbreak notifications, which suffers from ambiguous obligations, fragile incentives, and an overly narrow focus on human outbreaks. We examine existing international legal frameworks, and provide clarity on what a successful One Health approach to proposed international law reforms-including a pandemic treaty and amendments to the International Health Regulations-would require. In particular, we focus on how a treaty would provide opportunities to simultaneously expand reporting obligations, accelerate the sharing of scientific discoveries, and strengthen existing legal frameworks, all while addressing the most complex issues that global health governance currently faces.

Objective To determine the current landscape of international medical volunteerism (IMV) in pediatric urology. Methods A questionnaire regarding IMV participation was distributed to Societies for Pediatric Urology members (SPU), pediatric urology fellows (PUFs), and pediatric urology fellowship program directors (PDs). Questions related to IMV interest, experience, and perceived barriers, as well as the importance of trainee participation. Results 98 of 733 SPU members queried responded; 62/98 (63%) having volunteered. There was no difference in gender, age, or years in practice between volunteers and non-volunteers (P >.05). Non-volunteers were generally interested in participating (26/36; 72%), with lack of time and knowledge of opportunities cited as limitations. 27/46 PUFs and 16/27 PDs submitted responses. 10/27 (37%) of PUFs have participated in IMV. The main perceived barrier to their participation was lack of protected time off. While 2 PUFs (7%) stated IMV was a mandatory component of fellowship, 11/27 (41%) of PUFs vs 2/16 (13%) of PDs believe IMV should be part of the curriculum (P = .11). PUFs and PDs similarly ranked importance of trainee IMV participation on Likert scale (median 73 vs 70, P = 0.67). Volunteering SPU respondents ranked trainee participation higher than non-volunteers (median 80 vs 50, P = 0.0004). Conclusion While pediatric urology IMV opportunities exist, disseminating this information to interested parties and lack of time are barriers to participation. Amongst SPU members, there is a divide in attitudes regarding the importance of trainee participation. Trainees, however, strongly support IMV participation.

Mental disorders (including substance use disorders, dementia, and self-harm) account for a substantial burden of disease and economic costs in low-income and middle-income countries (LMICs), yet they attract little funding. External resources are urgently needed but evidence on investments is scarce. This Health Policy paper uses 35 elite interviews and documentary analyses to examine how and why external organisations have invested in mental health in LMICs over the past three decades, and how this investment has changed over time. Four levels are examined: organisations, source countries, recipient countries, and global landscape. Organisations have invested in numerous internal and external activities. Among the various factors shaping organisational decisions, actors (ie, individuals and organisations concerned with mental health) were the most salient at all four levels. To increase external organisation investments in mental health in LMICs, organisational leadership and understanding are crucial, along with increased political support in source and recipient countries, and a stronger governance structure at the global level.

The life cycle assessment (LCA) of municipal solid waste (MSW) systems in developing countries is a matter of research. Obtain reliable results is challenging since field data and local databases are not always available. The research presented in this paper explores this issue in La Paz (Bolivia), where six environmental impact categories were assessed. The LCA, related to the formal MSW management system of the city, involves a sensitivity analysis of ten parameters and the scenario assessment in relation to the increase of the recycling rate. Results report that the environmental impacts are mostly sensitive in relation to landfill gas collection efficiency, use of plastic bags, the transportation distances of collected waste, and the replacement rate of virgin materials. Global warming potential is the impact category most variable (341.38–551.95 kg CO2-eq tMSW−1), although it is not considerably reduced by recycling, which contributed mostly to the human toxicity and freshwater aquatic ecotoxicity. Doubling the amount of MSW recycled, from 235 t to about 473 t per year, human toxicity potential reduces of about 18% while freshwater aquatic ecotoxicity of about 12%. This research contributes for evaluating the most sensitive parameters in an MSW–LCA and to support policymakers towards waste recycling and sustainable development in Latin America developing cities.

Background We previously reported the Alopecia Areata Consensus of Experts study, which presented results of an international expert opinion on treatments for alopecia areata. Objective To report the results of the Alopecia Areata Consensus of Experts international expert opinion on diagnosis and laboratory evaluation for alopecia areata. Methods Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Consensus threshold was set at greater than or equal to 66%. Results Of 148 questions, expert consensus was achieved in 82 (55%). Round 1 consensus was achieved in 10 of 148 questions (7%). Round 2 achieved consensus in 47 of 77 questions (61%). The final face-to-face achieved consensus in 25 of 32 questions (78%). Consensus was greatest for laboratory evaluation (12 of 14 questions [86%]), followed by diagnosis (11 of 14 questions [79%]) of alopecia areata. Overall, etiopathogenesis achieved the least category consensus (31 of 68 questions [46%]). Limitations The study had low representation from Africa, South America, and Asia. Conclusion There is expert consensus on aspects of epidemiology, etiopathogenesis, clinical features, diagnosis, laboratory evaluation, and prognostic indicators of alopecia areata. The study also highlights areas where future clinical research could be directed to address unresolved hypotheses in alopecia areata patient care.

Background Rheumatic heart disease (RHD) affects more than 33,000,000 individuals, mostly from low- and middle-income countries. The Cape Town Declaration On Access to Cardiac Surgery in the Developing World was published in August 2018, signaling the commitment of the global cardiac surgery and cardiology communities to improving care for RHD patients. Methods As the Cape Town Declaration formed the basis for which the Cardiac Surgery Intersociety Alliance (CSIA) was formed, the purpose of this article is to describe the history of the CSIA, its formation, ongoing activities, and future directions, including the announcement of selected pilot sites. Results The CSIA is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment, and publication of selection criteria for cardiac surgery centers to apply for CSIA support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care, and desire to engage in future research. Eleven applications were received for which three finalist sites were selected and site visits conducted. The two selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda). Conclusions Substantial progress has been made since the passing of the Cape Town Declaration and the formation of the CSIA, but ongoing efforts with collaboration of all committed parties—cardiac surgery, cardiology, industry, and government—will be necessary to improve access to life-saving cardiac surgery for RHD patients.

Recent reporting found that a number of scientists internationally knew about the experiment resulting in the birth of the first gene-edited babies well before the news broke. Because scientists have a responsibility to reveal such activities, an international governance mechanism for reporting unethical gene editing experiments should be established.

Dear Editor, The significant impact of the SARS-CoV-2 (COVID-19) pandemic has been reported in almost every country around the world. 1 , 2 After months of imposed lockdown, many countries are now beginning to cautiously ease their restrictions. In the absence of a vaccine, we face a ‘new normal’ living alongside COVID-19 for an unknown period of time, with the real possibility of a second wave in the months to come. As the dust settles on what has been an incredible international collaborative effort in the acute phase response to COVID-19, we are just starting to look beyond our own borders at the impending humanitarian crisis that will undoubtably face many low- and middle-income countries in the wake of the pandemic. The knock-on effects of the worst financial down-turn in decades coupled with restricted access to humanitarian aid will undoubtably lead to increased poverty, malnutrition and resurgences in preventable diseases. For many Surgeons, annual short-term surgical missions to resource-limited settings give an opportunity to teach and learn from local surgeons and help address some of the major surgical inequalities detailed in the Lancet 2030 commission. 3 Events in recent months will make almost all surgical mission trips dealing with elective cases unlikely for the foreseeable future. Short-term barriers to running future missions include travel restrictions, enforced quarantine of up to 14 days on arrival in new countries, significant risks to patients and volunteers, challenges in obtaining valid indemnity cover, reallocation of equipment and PPE, and a lack of ITU beds. Diverting staff, equipment and hospital beds away from patients and local health care workers in urgent need is clearly unethical at the present time. Now, more than ever, collaboration and innovation, and adapting to a new way of helping those most in need is required. Our experience of short-term surgical missions has been treating children and adults with complex facial disfigurement in Ethiopia, through the charity Project Harar. The Ethiopian government, which has been proactive in its response to coronavirus, has called upon all NGOs to back their response and have been requesting excess supplies and PPE. 4 Many NGOs and their volunteers, from all backgrounds, are now fundraising for water barrels, soap and PPE in a concerted effort to help. Many medical charities will, for the first time, find themselves unable to perform face-to-face patient follow-up in the months or years that follow. Over the past two years we have successfully implemented a remote follow-up programme, employing low cost smart phone technology to take photographs and ask simple triage questions to patients in their rural villages. During our 2018 pilot we were able to follow-up 79 % of patients selected, and identified six patients that had complications requiring further management. Importantly the remaining patients were discharged and did not require to travel back to Addis Ababa for unnecessary follow-up. We hope this technique will be useful in the current climate for many surgical NGOs facing access restrictions and follow-up limitations. Finally, one of the major elements of any surgical mission is education and training. We are pleased to see many of our colleagues from around the world, including Addis Ababa, during the new era of excellent international educational webinars. 5 It is our intention, even if we cannot run our 2021 surgical mission to Addis Ababa, that we will still run our third annual head and neck conference remotely, using now tried and tested virtual platforms. The future of medical missions is currently in doubt. However, fundraising efforts to support colleagues in resource-limited settings and a longer-term commitment to careful patient follow-up, development of remote education opportunities, and ensuring relationships are developed not lost, will build a sustainable platform for future missions after COVID-19 is over. Declaration of Competing Interest None

The COVID-19 pandemic is an alarm call to all on the risks of zoonotic diseases and the delicate relationship between nature and human health. In response, China has taken a proactive step by issuing a legal decision to ban consumption of terrestrial wildlife. However, concerns have been raised and opponents of bans argue that well-regulated trade should be promoted instead. By analyzing China's legal framework and management system regulating wildlife trade, together with state and provincial-level wildlife-trade licenses and wildlife criminal cases, we argue that current wildlife trade regulations do not function as expected. This is due to outdated protected species lists, insufficient cross-sector collaboration, and weak restrictions and law enforcement on farming and trading of species. The lack of quarantine standards for wildlife and increased wildlife farming in recent years pose great risks for food safety and public health. In addition, wildlife consumption is neither required for subsistence nor an essential part of Chinese diets. All these facts make the ban necessary to provoke improvement in wildlife management, such as updating protected species lists, revising laws and changing consumption behaviors. Nonetheless, the ban is not sufficient to address all the problems. To sustain the efficacy of the change, we propose that a long-term mechanism to reduce the demand and improve effective management is needed.

Sarcomas are a rare heterogeneous group of malignant neoplasms that can arise in almost any anatomic site and any age. Close collaboration among adult and pediatric cancer specialists in the management of these tumors is of foremost importance. In this review, we present the current multidisciplinary organization in care of patients with sarcoma in France and we review the main advances made in the last decades in systemic and radiotherapy treatment in the main sarcoma types diagnosed in children, adolescents and young adults (AYA), thanks to the international collaboration.

Background Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. Methods Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. Results Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. Conclusions The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

The Lancet Countdown is an international collaboration, established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. This report represents the findings and consensus of the 35 leading academic institutions and UN agencies that make up the Lancet Countdown, and draws on the expertise of climate scientists, geographers, and engineers; of energy, food, and transport experts; and of economists, social and political scientists, data scientists, public health professionals, and doctors.

The International Pharmaceutical Federation (FIP), as the global leadership body for pharmacists, pharmaceutical scientists and pharmaceutical educators, coordinated and produced as of January 2020 an international response to the COVID-19 pandemic. FIP's response included professional guidance, a programme of digital events and other resources, as well as advocacy and policy tools to support national pharmacists' associations and academic institutions, as well as individual practitioners, in their response at country level. This article describes the strategy adopted by FIP in collaboration with an international group of experts to support the valuable service that pharmacists and their teams provide to communities throughout the pandemic, and their important contribution to easing the huge strain being placed on health systems around the world.

STUDY QUESTION Can consensus definitions for the core outcome set for infertility be identified in order to recommend a standardized approach to reporting? SUMMARY ANSWER Consensus definitions for individual core outcomes, contextual statements and a standardized reporting table have been developed. WHAT IS KNOWN ALREADY Different definitions exist for individual core outcomes for infertility. This variation increases the opportunities for researchers to engage with selective outcome reporting, which undermines secondary research and compromises clinical practice guideline development. STUDY DESIGN, SIZE, DURATION Potential definitions were identified by a systematic review of definition development initiatives and clinical practice guidelines and by reviewing Cochrane Gynaecology and Fertility Group guidelines. These definitions were discussed in a face-to-face consensus development meeting, which agreed consensus definitions. A standardized approach to reporting was also developed as part of the process. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus development methods. MAIN RESULTS AND THE ROLE OF CHANCE Forty-four potential definitions were inventoried across four definition development initiatives, including the Harbin Consensus Conference Workshop Group and International Committee for Monitoring Assisted Reproductive Technologies, 12 clinical practice guidelines and Cochrane Gynaecology and Fertility Group guidelines. Twenty-seven participants, from 11 countries, contributed to the consensus development meeting. Consensus definitions were successfully developed for all core outcomes. Specific recommendations were made to improve reporting. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations. There was limited representation from low- and middle-income countries. WIDER IMPLICATIONS OF THE FINDINGS A minimum data set should assist researchers in populating protocols, case report forms and other data collection tools. The generic reporting table should provide clear guidance to researchers and improve the reporting of their results within journal publications and conference presentations. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials statement, and over 80 specialty journals have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and a financial interest in NexHand. E.H.Y.N. reports research sponsorship from Merck. A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their ‘traffic light’ system for infertility treatment ‘add-ons’. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials Initiative: 1023.

The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels., Graphical abstract

Joe Biden will assume the US presidency at a time of unprecedented global health crises, with the COVID-19 pandemic and major setbacks in reducing poverty, hunger, and disease. The COVID-19 pandemic offers rare opportunities for the US President-elect to spearhead long-overdue structural changes and revitalise global health leadership. Building trust among global partners will be challenging, given the USA's withdrawal from, and disruption of, international cooperation under the presidency of Donald Trump. The USA will have to lead in a different, more collaborative way. Here, we offer a Global Action Agenda for the Biden Administration.

The Vascular Implant Surveillance and Interventional Outcomes Network (VISION) is a Coordinated Registry Network (CRN) a member of Medical Device Epidemiology Network, a U.S. Food and Drug Administration (FDA)-supported global public-private partnership that seeks to advance the collection and use of real-world data to improve patient outcomes. The VISION CRN began in September 2015 and held its first strategic meeting on September 10, 2018, at the FDA headquarters in Silver Spring, Maryland. VISION is a collaboration of the Vascular Quality Initiative (VQI), the FDA, and other stakeholders. At this annual meeting, leaders from the FDA, VQI, industry representatives, population health researchers, and regulatory science experts gathered to discuss strategic goals and opportunities for VISION. One of the key focus areas for VISION is linkage of VQI registry data to Medicare, longitudinal data sources maintained by various states, and other relevant data sources, as a model for efficient, cost-saving, and effectual evidence generation and appraisal. This would provide the means to expand data collection, assess long-term procedural outcomes across the carotid, lower extremity, aortic, and venous intervention datasets, and execute registry-based trials through the CRN structure in an efficient, cost-effective manner. Looking forward, VISION strives to validate long-term outcome data in the VQI using industry datasets, in hopes of using CRNs to make device regulatory decisions. With the guidance of a steering committee, VISION will provide vascular surgeons, industry, and regulators the appropriate data to improve care for patients with vascular disease.

There is increasing attention to international collaborations in health services research with a number of benefits. For developing and nurturing international collaboration, a growing number of funding opportunities are available globally. Having observed and experienced the growth of international collaborations in the global health research field, the authors reflect upon their own experiences in international collaboration between the United Kingdom and many different countries in the process of health services and educational research and discuss challenges and opportunities to conduct impactful research in international settings. The commentary also highlights key issues and strategies for learning and achieving more impact from global health research, including: communication, co-creation, strong leadership and sustainability.

Gastroschisis silos are often unavailable in sub-Saharan Africa (SSA), contributing to high mortality. We describe a collaboration between engineers and surgeons in the United States and Uganda to develop a silo from locally available materials.Design criteria included the following:$5 cost, 5 ± 0.25 cm opening diameter, deformability of the opening construct, ≥ 500 mL volume, ≥ 30 N tensile strength, no statistical difference in the leakage rate between the low-cost silo and preformed silo, ease of manufacturing, and reusability. Pugh scoring matrices were used to assess designs. Materials considered included the following: urine collection bags, intravenous bags, or zipper storage bags for the silo and female condom rings or O-rings for the silo opening construct. Silos were assembled with clothing irons and sewn with thread. Colleagues in Uganda, Malawi, Tanzania, and Kenya investigated material cost and availability.Urine collection bags and female condom rings were chosen as the most accessible materials. Silos were estimated to cost $1 in SSA. Silos yielded a diameter of 5.01 ± 0.11 cm and a volume of 675 ± 7 mL. The iron + sewn seal, sewn seal, and ironed seal on the silos yielded tensile strengths of 31.1 ± 5.3 N, 30.1 ± 2.9 N, and 14.7 ± 2.4 N, respectively, compared with the seal of the current standard-of-care silo of 41.8 ± 6.1 N. The low-cost silos had comparable leakage rates along the opening and along the seal with the spring-loaded preformed silo. The silos were easily constructed by biomedical engineering students within 15 min. All silos were able to be sterilized by submersion.A low-cost gastroschisis silo was constructed from materials locally available in SSA. Further in vivo and clinical studies are needed to determine if mortality can be improved with this design.

Highlights • About two thirds of caregivers intend to vaccinate their children against COVID-19. • Most common reason for acceptance was to protect the child. • Most common reason for refusal was the vaccine’s novelty. • Child age, chronic illness, vaccination history affects willingness. • Caregiver gender, vaccination history, concern about infection affect willingness., Background More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic. Purpose To investigate predictors associated with global caregivers’ intent to vaccinate their children against COVID-19, when the vaccine becomes available. Method An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020. Results 65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine’s novelty (52%). Conclusions The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine’s safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.

Summary Background Each year, billions of US$ are spent globally on infectious disease research and development. However, there is little systematic tracking of global research and development. We present research on investments into infectious diseases research from funders in the G20 countries across an 18-year time period spanning 2000–17, comparing amounts invested for different conditions and considering the global burden of disease to identify potential areas of relative underfunding. Methods The study examined research awards made between 2000 and 2017 for infectious disease research from G20-based public and philanthropic funders. We searched research databases using a range of keywords, and open access data were extracted from funder websites. Awards were categorised by type of science, specialty, and disease or pathogen. Data collected included study title, abstract, award amount, funder, and year. We used descriptive statistics and Spearman's correlation coefficient to investigate the association between research investment and disease burden, using Global Burden of Disease 2017 study data. Findings The final 2000–17 dataset included 94 074 awards for infectious disease research, with a sum investment of $104·9 billion (annual range 4·1 billion to 8·4 billion) and a median award size of $257 176 (IQR 62 562–770 661). Pre-clinical research received $61·1 billion (58·2%) across 70 337 (74·8%) awards and public health research received $29·5 billion (28·1%) from 19 197 (20·4%) awards. HIV/AIDS received $42·1 billion (40·1%), tuberculosis received $7·0 billion (6·7%), malaria received $5·6 billion (5·3%), and pneumonia received $3·5 billion (3·3%). Funding for Ebola virus ($1·2 billion), Zika virus ($0·3 billion), influenza ($4·4 billion), and coronavirus ($0·5 billion) was typically highest soon after a high-profile outbreak. There was a general increase in year-on-year investment in infectious disease research between 2000 and 2006, with a decline between 2007 and 2017. Funders based in the USA provided $81·6 billion (77·8%). Based on funding per 2017 disability-adjusted life years (DALYs), HIV/AIDS received the greatest relative investment ($772 per DALY), compared with tuberculosis ($156 per DALY), malaria ($125 per DALY), and pneumonia ($33 per DALY). Syphilis and scabies received the least relative investment (both $9 per DALY). We observed weak positive correlation (r=0·30) between investment and 2017 disease burden. Interpretation HIV research received the highest amount of investment relative to DALY burden. Scabies and syphilis received the lowest relative funding. Investments for high-threat pathogens (eg, Ebola virus and coronavirus) were often reactive and followed outbreaks. We found little evidence that funding is proactively guided by global burden or pandemic risk. Our findings show how research investments are allocated and how this relates to disease burden and diseases with pandemic potential. Funding Bill & Melinda Gates Foundation.

Highlights • COVID-19 has prompted vastly more clinical trials than previous health emergencies. • Trials started faster, are collectively larger, and are more diverse geographically. • The initial trials so far are mostly not funded by industry. • Lack of coordination will lead to inefficiency and duplication., The clinical trial landscape for Coronavirus 2019 (COVID-19) is radically different from that of previous epidemics. Compared with H1N1, Ebola, and Zika, COVID-19 had an order of magnitude more clinical trials within the first 3 months following the declaration of a Public Health Emergency of International Concern (PHEIC). These trials have started much faster, are more geographically diverse, and are less likely to be funded by industry. However, the almost simultaneous design and initiation of hundreds of trials with 0.3 million participants across 78 countries creates the potential for congestion and inefficiencies and enhances risks for investors. Thus, an international coordination mechanism for clinical trials could be valuable in this and other situations.

To better understand and interpret the trends in cutaneous research, we carried out a network analysis of all the titles of the submitted abstracts of the annual meetings of the European Society of Dermatological Research (ESDR), including the International Investigative Dermatology (IID) meetings between 2010 and 2019. Network analysis is a data science tool to process, analyze, and visualize big sets of data. As expected, psoriasis was the frontrunner in each of the annual meetings, followed by dermatitis and melanoma. Interestingly, alopecia, acne, squamous cell carcinoma, pruritus, basal cell carcinoma, and hidradenitis suppurativa were among the next most frequently named diseases and/or terms. We also looked at diversity to assess how broad the interest of the submitting community is and to identify whether "blockbusters" such as psoriasis and atopic dermatitis expand in expense of other interests. In contrast to our expectations, the diversity of submissions to the ESDR annual meetings remained high over the 10 years of our observation period. Interestingly, the diversity increased in the years of the IID, indicating an outreach to other research areas worldwide compared with the ESDR meetings. This is true for both 2013 in Edinburgh, UK, and 2018 in Orlando, USA. During these meetings, this rise in diversity was associated with a relative decrease of the three most often named diseases. Network analysis thus may be a useful tool for research societies like the ESDR to identify trends and allocate resources such as reviewers and sessions accordingly. In addition, it can serve as quality control monitoring whether the ESDR continues to offer a platform for all researchers in cutaneous biology or implements or focuses on emerging fields.

Global surgery, especially academic global surgery, is of tremendous interest to many surgeons. Classically, it entails personnel from high-income countries going to low- and middle-income countries and engaging in educational activities as well as procedures. Academic medical personnel have included students, residents, and attendings. The pervasive notion is that this is a win-win situation for the volunteers and the hosts, that is, a pathway to bilateral academic success. However, a critical examination demonstrates that it can easily become the bold new face of colonialism of a low- and middle-income country by a high-income country.

The collection and clinical use of COVID-19 convalescent plasma (CCP) as a therapy for COVID-19 infection is under development and early use in many centers worldwide. We conducted an international survey of centers undertaking studies of CCP to provide understanding of the common themes and differences between them. 64 studies in 22. countries were identified from clinical trial registries and personal contacts of the authors. 20 of the 64 centers (31%) from 12 of 22 countries (55%) responded to the survey. Of the 20 studies, 11 were randomized controlled trials (RCTs) and 9 were case series. Only 4 of the RCTs plan to recruit 400 patients or more, and only 3 RCTs were blinded. The majority of studies will study the effect of CCP on sick patients requiring hospitalization and those requiring critical care, and none is examining the role of CCP in non-infected at-risk individuals. A wide variety of primary and secondary outcomes are being used. The donor eligibility criteria among the studies are very similar, and the use of plasmapheresis for the collection of CCP is almost universal. The planned dose of CCP ranges from as little as 200 mL to well over 1 liter, but is 400-800 mL or 4 mL/kg or greater in all the RCTs. There is considerable variability in donor antibody testing with no consistency regarding the cut-off for antibody titer for acceptance as CCP or the use of pathogen-inactivation. Our survey provides an understanding of the similarities and differences among the studies of CCP, and that by virtue of their design some studies may be more informative than others., Highlights • 20 of the 64 centers (31%) from 12 of 22 countries (55%) responded to a survey about studies of COVID-19 convalescent plasma (CCP); 11 were randomized controlled trials (RCTs) and 9 were case series. • The majority of studies are studying the effect of CCP on sick patients requiring hospitalization and those requiring critical care. • A wide variety of primary and secondary outcomes are being used. • The donor eligibility criteria among the studies are very similar, and the use of plasmapheresis for the collection of CCP is almost universal. • Our survey provides an understanding of the similarities and differences among the studies of CCP, and that by virtue of their design some studies may be more informative than others.

This first International Alliance for Biological Standardization Covid-19 webinar brought together a broad range of international stakeholders, including academia, regulators, funders and industry, with a considerable delegation from low- and middle-income countries, to discuss the virology, epidemiology and immunology of, and the vaccine development for SARS-CoV-2., SCOPUS: ar.j, info:eu-repo/semantics/published

Prior publications on small subsets of cancer patients infected with SARS CoV-2 have shown an increased risk of mortality compared to the general population. Furthermore, patients with thoracic malignancies are thought to be at particularly high risk given their older age, smoking habits, and pre-existing cardio-pulmonary comorbidities. For this reason, physicians around the world have formed TERAVOLT, a global consortium dedicated to understanding the impact of COVID-19 on patients with thoracic malignancies.

In reproductive medicine, the needs and desires of infertility patients drive future research, with the most important outcome being live birth of a baby. Large, multicenter, randomized clinical trials are considered the best research tool to evaluate the effectiveness of medical interventions, but they can often take a long time to find definitive answers. Advances in individual participant data (IPD) and network meta-analysis have enabled research questions to be answered more quickly, but better planning could streamline this process further. To harmonize research findings that are taking place globally in this way, it is crucial that the same outcomes are collected in clinical trials conducted in reproductive medicine. Furthermore, the conduct of clinical trials often requires collaboration on an international scale; however, individual countries have their own processes for research prioritization and delivery. We describe the perspective of high- and low-resourced settings and industry as well as the mechanisms of prioritization and coordination that are in place in different settings. In addition, we discuss the importance of the patient perspective, which can help shape the research question, clinical trial design, and the logistical operations of trial delivery. The need for increased global collaboration and coalitions within and between stakeholders is evident for the research community to accelerate advances and maximize benefits in reproductive medicine.

Background/objective Participation in the Active Healthy Kids Global Alliance (AHKGA) Global Matrix initiative represents a significant work and resource investment for Report Card teams. The objective of this paper was to evaluate the process and findings of the Global Matrix 3.0 and formulate recommendations for improvement. Methods The evaluation of the Global Matrix 3.0 was planned prior to its development and a list of potential process, impact, and outcome indicators were pre-identified. These indicators were informed by online surveys, direct reports, MailChimp’s statistics, Google Analytics of the AHKGA website, and emails sent to the AHKGA Board of Directors. Results Five online surveys were completed by 88%–100% of the targeted respondents. High satisfaction ratings were observed for most of the Global Matrix 3.0 methods, key steps, concepts, and the resources (e-blasts and website) provided by the AHKGA. A total of 496 open-ended comments were provided in the five surveys, including 199 comments reporting issue(s), and 38 reporting both positive feedback and issue(s). The participating Report Card teams successfully assigned a grade to each physical activity indicator, produced a Report Card document, and wrote a short Report Card article. Conclusion This evaluation process allowed for the identification of needed improvements and the formulation of recommendations for future Global Matrix initiatives. This work highlighted the need for the development of physical activity behavior assessment tools that would be internationally adopted and culturally adaptable to varying contexts to improve the standardization of physical activity surveillance at the global scale.

AIM: In 1999, a cooperative tripartite cancer research and training agreement was signed between Ireland (IE), Northern Ireland (NI) and the United States (US) National Cancer Institute, giving rise to the All-Ireland Cancer Consortium (AICC). We wished to consider if AICC increased the amount/impact of cancer research on the island of Ireland and what effect this enhanced research activity had on cancer services and cancer outcomes.METHODS: As comparator, we chose the city regions of Copenhagen and Lund & Malmö, whose physical connection was greatly improved following construction of bridges between Denmark and Sweden around the time AICC was established. We analysed cancer research outputs from all four geographical regions in the Web of Science (1988-2017), with a particular focus on citations and journal impact factors. We evaluated disability-adjusted life years (DALYs) as an indicator of change in health status.RESULTS: Research outputs increased in all four regions, but more in IE/NI than in the Scandinavian cities, while collaboration between IE and NI and both the US and the Rest of Europe increased even more substantially. Citation scores also showed a greater improvement for IE and NI. Journal citation impact factors indicated that IE/NI papers were increasingly being published in more highly cited journals. Research-enabled cancer service provision improved on the island of Ireland, with concomitant increases in cancer survival.CONCLUSION: The AICC collaborative agreement delivered significant additionality on the island of Ireland, promoting transnational cooperation, enhancing cancer research activity, and underpinning improved cancer services and better cancer outcomes.

Made available in DSpace on 2020-12-12T01:08:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 Background and objectives: This study provides a longitudinal scientometric analysis of global trypanosomiasis research between 1988 and 2017 as indexed in Clarivate Analytics’ Web of Science (WoS). Contributions by researchers from different countries and continents are outlined based on publication productivity, international collaborations, citation analysis, and keyword analysis. Methods: Bibliographic records of research publications indexed by WoS were downloaded based on a broad search of related terms. The authors compared the growth of literature by continent using 5-year increments, conducted a citation and co-authorship analysis by country, and a keyword analysis by publication using the scientometric visualization software VOSviewer. Results: The trypanosomiasis research literature has seen more than a fourfold annual increase in production over the study period. Contributions by authors affiliated with European and South American countries proportionately account for the most research literature. The United States and Brazil, however, occupy central roles for citations and as national contributors to the literature. The terms ‘trypanosomiasis cruzi’ and ‘chagas disease’ have become more prominent, reflecting the regional growth of research from South America. Interpretation and conclusion: Relative contributions from regions where the disease is prevalent show mixed developments. Contributions by African authors have declined proportionately to other areas of the world. However, South American contributions have increased during the study period. The contributing countries to the literature do not necessarily represent regions in which the diseases are prevalent. The same is true of the citation relationships, where European and North American contributions are more frequently cited. School of Information Studies University of Wisconsin – Milwaukee, P.O. Box 413 Universidade Estadual Paulista (UNESP/Marilia), 737 Hygino Muzzi Filho Avenue Universidade Estadual Paulista (UNESP/Marilia), 737 Hygino Muzzi Filho Avenue

Mechanical circulatory support (MCS) using left ventricular assist devices (LVAD) have considerably improved the quality of life and survival rate of patients with end-stage heart failure. Despite substantial technological progress, major challenges with regard to VAD-specific and VAD-related infections have hitherto hindered the broader application of this promising therapy approach. Driveline infections (DLI) range among the main adverse events experienced in LVAD patients. However, many centers still apply their own protocol for driveline exit site (DLES) care and an international standard on prevention, reduction and early treatment of DLI after the perioperative period has not yet been defined. In March 2019, VAD coordinators and cardiac surgeons from Germany and Austria met to develop a standard of care procedure (SOP) as well as a new staging approach with recommended actions for treatment of VAD carriers. In this Driveline Expert STagINg and carE (DESTINE) study group we developed a 10-step SOP for DLES care with emphasis on essentials such as clean and save preparation, sterile dressing change and secure driveline immobilization. An advanced wound staging approach was defined with recommended actions for prevention, early detection and stage-related management of DLI. Broad consensus was reached on the fact that an interdisciplinary approach both in DLES care and DLES healing disorder awareness is required to prolong infect-free survival times on MCS as well as to ensure high patient compliance and quality of life. In conclusion, a new detailed SOP for appropriate DLES care and an advanced wound staging approach for prevention and management of DLI were defined on an expert level applicable for VAD clinicians, practitioners and care givers in Central Europe.

BACKGROUND: Computer vision has promise in image-based cutaneous melanoma diagnosis but clinical utility is uncertain. OBJECTIVE: To determine if computer algorithms from an international melanoma detection challenge can improve dermatologist melanoma diagnostic accuracy. METHODS: Cross-sectional study using 150 dermoscopy images (50 melanomas, 50 nevi, 50 seborrheic keratoses) from the test dataset of a melanoma detection challenge, along with algorithm results from twenty-three teams. Eight dermatologists and nine dermatology residents classified dermoscopic lesion images in an online reader study and provided their confidence level. RESULTS: The top-ranked computer algorithm had a ROC area of 0.87, which was higher than the dermatologists (0.74) and the residents (0.66) (p

Influenza causes significant morbidity and mortality worldwide. Owing to its ability to rapidly evolve and spread, the influenza virus is of global public health importance. Information on the burden, seasonality and risk factors of influenza in countries of the World Health Organization Eastern Mediterranean Region is emerging because of collaborative efforts between countries, WHO and its partners over the past 10 years. The fourth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance network was held in Amman, Jordan on 11–14 December 2017. The meeting reviewed the progress and achievements reported by the countries in the areas of surveillance of and response to seasonal, zoonotic and pandemic influenza. The first scientific conference on acute respiratory infection in the Eastern Mediterranean Region was held at the same time and 38 abstracts from young researchers across the Region were presented on epidemiological and virological surveillance, outbreak detection and response, influenza at the animal-human interface, use and efficacy of new vaccines to control respiratory diseases and pandemic influenza threats. The meeting identified a number of challenges and ways to improve the quality of the surveillance system for influenza, sustain the system so as to address pandemic threats and use the data generated from the surveillance system to inform decision-making, policies and practices to reduce the burden of influenza-associated illnesses in the Region. Keywords: EMARIS, Influenza, Eastern Mediterranean Region, WHO

Critical care is a young specialty in Kenya. From its humble beginnings in the 1960s to present day Kenya, the bulk of this service has largely been provided by anaesthetists. We provide a detailed account of the growth and development of this specialty in our country, the attempts made by our people to grow this service within our borders and the vital role our international partners have played throughout this process. We also share a selection of our successes over the years, the challenges we have faced and our aspirations as we look to the future.