Protein synthesis is a fundamental requirement of all cells for survival and replication. To date, vast numbers of genetic and biochemical studies have been performed to address the mechanisms of translation and its regulation in Escherichia coli, but only a limited number of studies have investigated these processes in other bacteria, particularly in slow growing bacteria like Mycobacterium tuberculosis, the causative agent of human tuberculosis. In this Review, we highlight important differences in the translational machinery of M. tuberculosis compared with E. coli, specifically the presence of two additional proteins and subunit stabilizing elements such as the B9 bridge. We also consider the role of leaderless translation in the ability of M. tuberculosis to establish latent infection and look at the experimental evidence that translational regulatory mechanisms operate in mycobacteria during stress adaptation, particularly focussing on differences in toxin-antitoxin systems between E. coli and M. tuberculosis and on the role of tuneable translational fidelity in conferring phenotypic antibiotic resistance. Finally, we consider the implications of these differences in the context of the biological adaptation of M. tuberculosis and discuss how these regulatory mechanisms could aid in the development of novel therapeutics for tuberculosis.
LSHTM is proud to be hosting the second annual Women Leaders in Global Health Conference on 8-9 November 2018.
Women make up 75% of the healthcare workforce – yet occupy less than 25% of influential leadership positions. WLGH18 supports women in all forms of leadership from local communities to global organisations, from science to politics. Join us at the conference to be part of the conversation and engage in mentoring and skills building opportunities. The current speaker list boasts an impressive list of influential people from the LSHTM alumni community and beyond, and the conference is set to build on last year’s strong foundations of engaging and developing a strong community.
The WLGH Project Team invite applications from citizens of low or middle-income countries in Eastern Europe and South America* to apply for funding support in order to attend the WLGH 2018 conference. To apply, please complete the financial support application form, which also sets out the eligibility and selection criteria. Applications should be completed by 16 July.
To be eligible for funding support applicants must have been born and now reside permanently in one of the following countries: Bolivia, Guyana, Paragua, Argentin, Belize, Brazil, Chile, Colombia,Ecuador, Peru, Suriname, Uruguay, Venezuela, Georgia, Kosovo, Moldovo, Ukraine, Uzbekistan, Albania, Azerbajan, Bosnia & Herzegovina, Macedonia, Kazakhstan or Serbia.
By Nisso Nurova (MSc Public Health Candidate)
The last two decades have shown great political commitment and investment in early child development (ECD), as the third Lancet ECD series, ‘Advancing Early Childhood Development: from Science to Scale’ emphasised the need to focus on how to implement at scale. Moving forward, UNICEF’s ‘Early Moments Matter for Every Child Report’ has called on governments and partners to action with the addition of the soon to launch report Nurturing Care: Framework for Action and Results, led by UNICEF and WHO and the support of Partnership for Maternal Newborn and child health (PMNCH) and Early Child Development Action Network (EDCAN), aiming to provide support to the processes of scaling up ‘nurturing care’ interventions.
This moment therefore marks a ‘tipping point’ for ECD as the global health community embraces this shift in the ECD agenda towards multi-country large-scale implementation. With this in mind, there is a need to ensure that policy processes for programme and implementation efforts remain evidence informed.
“As the focus in ECD shifts from global to local, and frameworks to support action at national level emerge, the dialogue must move from ‘why’ to ‘what’ to ‘how’.” (Milner, et al 2018)
MARCH members Joy Lawn and Kate Milner with co-authors from UNICEF, WHO and Grand Challenges Canada published a short paper in Bernard van Leer Foundation on ‘Learning from Saving Brains: informing policies and scaleup for early childhood’. This paper embraces the unique opportunity to inform processes and understanding towards scaling for ECD through lessons learned from the Saving Brains portfolio, a partnership led by Grand Challenges Canada across 31 low- and middle-income countries which aims to develop scalable and sustainable ways to nurture healthy brain development in the first 1000 days.
The authors highlight that the global political context – which is characterised by a growth in developments in ECD metrics and growing numbers of actors – provides conditions that are favourable for scale up but also pose challenges for framing and governance. Based on the Saving Brains portfolio-level evaluation, the authors suggest three ways to overcome these challenges plus opportunities for strengthening implementation at scale:
“Implementation of ECD interventions at large scale requires; building networks across traditional disciplinary boundaries, clearer definition of challenges and opportunities, and strengthened measurement of implementation processes and outcomes to support every child to thrive.” (Milner et al., 2018)
- Building networks that extend beyond traditional boundaries and engage new actors
Using qualitative methods in the evaluation of the portfolio, feedback highlights that there is immense value in investing in leadership and development that extends beyond grant cycles. This involves building coalitions of diverse stakeholders and strengthening South-South knowledge sharing for long-term policy influence.
- Framing problems and solutions with clarity and consistency
Qualitative feedback of the Saving Brains’ evaluation underlined that training and reporting requirements provided stakeholders with a ‘common language’, which acted as a key strength of the portfolio as it allowed stakeholders across sectors and country contexts to connect through internal consensus on the framing of problems and solutions. However, there remains a disconnect between language used by researchers and implementers – highlighting a need for more clear definitions of ‘what’ and ‘how’ for implementation. Better consensus on key definitions of challenges and solutions will be important for large scale adaptation and implementation of ECD interventions across settings.
- Improved measurement for impact and accountability
While important progress has been made in global child development metrics, such as Saving Brains’ supported development of WHO Indicators for ‘Infant and Young Child Development’ (IYCD) and the Caregiver Reported Early Development Index, there remains a great challenge in measurement of effectiveness across settings, of implementation, and of outcomes in response to interventions (McCoy et al., 2016; Yousafzai et al. 2014). Increased attention to metrics is needed to understand and measure impact.
As we focus attention from global to local, we must take greater measures in investing in the early years of life for a healthy and productive future. Therefore, scaling up necessitates evidence informed processes and measures to support every child to thrive. We look forward to the publication of a series of papers discussing scaled implementation of ECD interventions, led by the MARCH Centre with partners and co-authors from various organisations, later this year.
Today, the nation is celebrating 70 years of the National Health Service. In 1948, leaflets were sent to households throughout England and Wales promising medical care for, ‘Everyone – rich or poor, man, woman, or child – can use it…it will relieve your money worries in times of illness’, a core principle that remains to this day. To mark this important anniversary, the archives team have looked at past LSHTM staff members’ contribution to the NHS.
Sir William Wilson Jameson:
Described by Sir Philip Manson-Bahr as, ‘the most distinguished Dean of the London School of Hygiene & Tropical Medicine’, and a great teacher, who successfully led the School after the tragic death of Sir Andrew Balfour, Jameson was both a respected teacher of public health and guiding force in health policy.
After nine years serving the School, Jameson was appointed Chief Medical Officer in 1940. During his appointment, Jameson gained the reputation for tackling taboo subjects, such as venereal diseases, speaking candidly on national broadcasts. Nevertheless he is probably best known for his role in the development of the NHS. From 1942 to 1944, Jameson developed the hospital surveys that would form the basis of the National Health Service. Jameson was also fundamental in bridging the gap between the government and the medical profession, where he was often used to gauge the latter’s reaction to draft proposals, and he ensured that medical professionals were salaried within the NHS. Jameson’s successful relationship with Aneurin Bevan, Minister of Health, ensured that the plans of the NHS progressed with the support of the medical profession.
Jameson retired in 1950, but continued working in health policy working as a medical adviser at the King Edward VII Hospital Fund for London. He passed away in 1962 at the age of 77.
Sir William Wilson Jameson’s papers, which document his appointment as Professor of Public Health at LSHTM, are available in the archives.
Professor Jerry Morris, CBE:
Jerry Morris is often described as the man who ‘invented exercise’ after discovering the role exercise plays in cardiovascular disease, in 1949, when he compared the health of bus drivers and conductors, however he was also an advocate for social reform in public health.
During the 1960s, Morris, along with Richard Titmus and Brian Abel Smith, helped develop the health policy of the Labour government. It was his involvement in the Seebohm committee and Hunter committee that led Morris to propose the new community physician who would be responsible for community diagnosis, it was intended to be at the foundation of the NHS. This work led to the creation of the MSc in Community Medicine at LSHTM.
In 1980, Morris was part of the Black committee that would later produce the Black Report. It was commissioned by David Ennals, Secretary of State at the time, to establish what caused the inequalities in health since the formation of the NHS. However, the report was not published until 1980, when the Conservatives came to power. Patrick Jenkin, Secretary of State for the Environment wrote the foreword making it clear that he did not agree with the findings that concluded that social factors such as income, housing, education and diet were the cause of inequalities that effected infant mortality rates and life expectancy. The recommendation of the implementation of a social policy to improve social inequalities was rejected. Sir Donald Acheson, former Chief Medical Officer and LSHTM lecturer, would come to the same conclusion in his ‘Independent Inquiry into Inequalities in Health Report’, otherwise known as the Acheson Report in 1998, unlike the Black Report, its findings were reflected in UK health policy up until 2011.
Jerry Morris was an integral member of LSHTM until his death in 2009 at the age of 99.
Jerry Morris’ papers are currently being catalogued and will soon be available to view in the archives.
Dr Jennifer Roberts
Jenny Roberts was a pioneer of Health Economics, becoming the first Health Economist at the School. Throughout her forty year career, Jenny’s research was closely linked with NHS changes and reforms, beginning with the 1974 large-scale administrative reorganisation of the NHS in England which placed all health services into regional and area health authorities.
To prepare for the reform, in 1972 the Centre for Extension Training in Community Medicine (CETCM) was created at 31 Bedford Square, in order to retrain NHS staff. It especially focussed on retraining doctors who were in medical admin moving to new roles in ‘integrated Health Service’. The Centre was funded by the DHSS (Dept.. of Health & Social Security) with Dr Roy Acheson its first Director. Jenny joined in 1973, as Senior Tutor in Health Economics. The Centre was amalgamated with the School’s Department of Community Health in 1976.
In the 1980s, Jenny researched the market-based NHS reforms, in particular looking at the links between the use of contracted-out NHS services, and the increase in Hospital Acquired Infections. She was a passionate teacher, and introduced the Health Policy, Planning and Finance MSc to the School.
Jennifer Roberts’ papers will be available to researchers later this year.
Edit: It was stated that David Ennals rejected the findings of the Black Report, however the report was only published in 1980 under the Conservative party. This has been rectified.
This summer our international alumni chapters will be hosting student and alumni networking events in their respective cities to provide alumni with the opportunity to meet new and prospective students, network and share their experiences of studying at the School before new students begin their studies in October.
So far we have had a student and alumni networking event in Basel.
Look out for upcoming events in Dhaka, Harare, Seattle, Accra, Sydney, Zhejiang, Paris, Toronto and Addis Ababa.
Please visit the Alumni Events page for further information on the student & alumni networking events and all other events.
Are you are planning to host a student & alumni networking event this summer? Please so that we can share your event with our alumni and student community.
Would you like to start a chapter in your city or organise an alumni meet up? Please contact us at email@example.com to find out how to do so.
Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis (July 2018)
Figure: Vital and treatment status of patients lost to follow-up (LTFU), including death, stop of combination antiretroviral therapy (cART), transfer to another clinic, and retention on cART.
Summary written by Nanina Anderegg, Statistician at Institute of Social and Preventive Medicine (ISPM), University of Bern.
Retention in HIV care following a diagnosis, and adherence to treatment, are crucial for viral suppression and preventing HIV-related morbidity/mortality, HIV drug resistance and onward transmission. However, the retention of HIV+ patients in programmes is a matter of concern, as substantial proportions are lost to follow-up (LTFU). Interest has grown in tracing patients LTFU to ascertain their vital and treatment status, and to bring patients back to care. For this collaborative study, outcomes of almost 7500 patients LTFU and traced in 9 HIV treatment programmes in 8 African countries were examined. The study revealed that 4 years after the last clinic visit about one-fifth of patients LTFU had died, a similar proportion had stopped treatment, one-sixth had transferred to another clinic, and about one-third were not found. In addition, patients were more likely to remain LTFU as the delay between LTFU and tracing increased. Mortality was associated with male sex and more advanced disease, transfer with female sex and less advanced disease, and stopping therapy with less advanced disease. Death, stopping antiretroviral therapy, and unsuccessful tracing were all associated with shorter duration of antiretroviral therapy at the time of LTFU.
These findings have several implications. First, as the proportion transferred amongst those LTFU is substantial, program-level retention in care will be underestimated. Clearly, improving communication between clinics and programs, for example, through a national treatment database and unique patient identifiers, is urgently needed for an accurate assessment of overall retention in care. At the same time, program-level mortality will be underestimated if mortality amongst patients LTFU is not taken in to care. In addition, the risk factors for death identified are directly relevant to HIV care and treatment programs in sub-Saharan Africa. Patients who initiated antiretroviral therapy <1 year prior to being lost, especially those with low CD4 counts or advanced clinical stage, were at higher mortality risk. These patients should be prioritised for tracing to trigger early action so that they can be supported to remain in care and on treatment as soon as possible.
This is a summary from the full paper entitled “Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis” which can be found here.
By Natasha Salaria (London School of Hygiene & Tropical Medicine)
Health Policy and Planning has received a new 2017 Impact Factor which has seen an increase to 2.420, placing us 17th out of 79 journals in the Health Policy and Services category (Quartile 1). With a new impact factor comes rehashed conversations about the value of the impact factor and its meaning and use in the publishing world. Nonetheless it still remains an important and recognised calculation associated with journals and their citation rates.
Below are our top 10 most highly cited articles contributing to the 2017 impact factor in Health Policy and Planning:
Top 10 Cited:
- Systematic review: Which intervention design factors influence performance of community health workers in low- and middle-income countries?
- Original article: Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies
- Original article: Surgical and anaesthetic capacity of hospitals in Malawi: key insights
- Review: Opening the ‘black box’ of performance-based financing in low- and lower middle-income countries: a review of the literature
- Original article: Survey using incognito standardized patients shows poor quality care in China’s rural clinics
- Original article: The emergence and effectiveness of global health networks: findings and future research
- Original article: Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries
- Original article: Performance-based financing in the context of selective free health-care: an evaluation of its effects on the use of primary health-care services in Burundi using routine data
- Editor’s choice: 10 Best resources on … intersectionality with an emphasis on low- and middle-income countries
- Original article: Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis
*These data summarize the characteristics of the journal’s published content for the most recent three years, that is, 2017 and the two prior years, combined. This information is based on all listed authors and addresses. It is meant to be descriptive rather than comparative.
The journal has wide reach and publishes papers from authors in over 40 countries including low- and middle-income countries, many of whom take advantage of our reduced rate or free access countries list.
Our blog audience in 2017 also included readers from South Africa, Kenya, India, Nigeria, Ghana, and Tanzania.
Our top 10 contributions by organizations include high performing higher education institutions such as Harvard University, Oxford University and the World Health Organization.
Altmetrics is an alternative measure, not just looking at the impact on the journal level (as the impact factor does) but delivers data on universal popularity and uptake, including within policy documents to be able to determine how research has influenced health policy.
The articles from 2016-2018 with the highest Altmetric score published in Health Policy and Planning are:
Top 10 Accessed:
- 10 best resources: 10 best resources on power in health policy and systems in low- and middle-income countries
- Original article: Minding the gaps: health financing, universal health coverage and gender
- Editor’s choice: Cuban infant mortality and longevity: health care or repression?
- Original article: The cost of not breastfeeding in Southeast Asia
- 10 best resources: 10 Best resources for community engagement in implementation research
- Original article: Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care
- Original article: An evaluation of early countermeasures to reduce the risk of internal radiation exposure after the Fukushima nuclear incident in Japan
- Original article: How to do (or not to do)… gender analysis in health systems research
- Original article: Reimagining infertility: a critical examination of fertility norms, geopolitics and survey bias
- Original article: Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach
We also have a newly launched infographic allowing readers to discover the global impact of the journal in a quick snapshot. Feel free to use and share – until next time!
Anne Stevenson, Health Policy, Planning, and Financing (HPPF) alumna (2007) and Program Director of the Neuropsychiatric Genetics of African Populations-Psychosis project, talks about the study that she is helping lead at the Harvard T.H. Chan School of Public Health & Broad Institute of MIT and Harvard.
Brain disorders, including schizophrenia and bipolar disorder, lead to a lot of death and disability around the world. There is still much we do not know about what causes them. Genetics research is one way to find biological causes to these mental health conditions, by looking at genes and proteins. Recently, scientists have made advances in understanding the genes involved in psychiatric disorders, but their findings are from studies of people of European descent. African populations have not been well studied in genetics research. Leaving out Africans from research has big implications – it means that we are likely missing key genetic discoveries. It is also possible that future drug therapies developed from people of European descent may not work as well for Africans. Our study hopes to address some of this need.
The Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) is a four-year project that aims to advance genetic analysis of schizophrenia and bipolar disorder in Ethiopia, Kenya, Uganda, and South Africa by collecting phenotypic information and DNA from 35,000+ participants. NeuroGAP-Psychosis is part of an ambitious initiative at the Broad Institute to expand large-scale neuropsychiatric genetics around the world.
In my role, I work across all aspects of the study, whether that means helping write the protocol, training the teams in Africa, or setting up contracts. I may not do every component of the study – I work with great people in Boston and in country – but I need to be aware of what is going on at each stage.
This project has not been without its challenges. Doing any kind of research takes time. When you then add multiple countries and multiple collection sites within countries, it takes even longer. We had to go through 12 different ethics committees to get our study approved and it took more than two and a half years of work to recruit our first participant.
At the current stage of the project, we expect recruitment to last for the next four years, so we have a lot of time ahead of us. After that period, depending on funding, I would like to be able to add a site in the West Africa to get additional geographic (and genetic) diversity across the continent.
Outside of my project, colleagues of mine and other researchers are conducting similar studies with partners in China, Japan, Finland, and Mexico. Five years from now, I hope these combined efforts can help crack what we know about schizophrenia and bipolar disorder.
You can follow Anne and the NeuroGAP-Psychosis project on Twitter @annehstevenson. For more information about NeuroGAP-Psychosis, visit the Broad Institute website or read this article from the Wall Street Journal.
Images courtesy of Anne Stevenson.
“Prior to studying at the School I had quite a lot of experience in tropical nursing. I had worked as an expedition nurse on a number of expeditions as well as in clinics in rural Australia, Malawi and Ghana, therefore the Diploma in Tropical Nursing (DTN) seemed like the logical next step.
The DTN has helped me in three main ways: knowledge, outlook, and people. In my job at Raleigh International I look after all of the medical elements of our overseas expedition programmes. This involves preparing the volunteers for their expedition: which includes writing travel health guidance, giving health education, and medical screening participants. My job also entails being on call to give telephone advise to medics on expedition who are providing medical support to volunteers. I therefore use the knowledge I gained from the DTN on a daily basis – I have to have a working knowledge of health problems encountered in the tropics. Our volunteer medics change every 3 months, which means I am supporting clinicians that are relatively inexperienced in the field. This means I need to keep my knowledge fresh and up to date, and the medical system strong and clear. The DTN helped me develop the skills I need to do that.
The DTN also helped open my eyes to what the role of a nurse can include. I have to do a lot of things that are not traditionally thought of as ‘nursing’. This includes recruitment, system management and logistics. However, I still think of myself as a nurse when I am doing these things as I use my clinical judgment to inform my actions in order to provide care that enables volunteers to improve, maintain or recover health on expedition; to achieve that in such a unique environment, I need to use more skills than those traditional seen as ‘nursing skills’. Meeting the speakers and other students on the course helped me understand that nursing can be more than just at the bedside.
During my time at the School I loved all of the lectures and meeting interesting and like minded people. The relationships I formed at LSHTM have been invaluable to me. I have recuited most of my cohort to volunteer with Raleigh. I have also been lucky to make some wonderful friends who continue to give me great professional and personal support and advice; as a result, I have been able to create a wide network of contacts across the sector, which is valuable in many aspects of my work. My advice to current students would be that you can use your DTN and make a difference in more ways than you think. Raleigh is a great way to get your first experience of working in an austere setting in a relatively safe and supported environment.
As I continue developing my career, I would like to help raise the profile of nurses in expedition and extreme medicine. I would also like to help contribute to the limited evidence base that exists in expedition medicine, in order to drive up standards, as well as be a champion for responsible travel and volunteering and its role in global sustainable development.
Images courtesy of Katie Beck.
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Whether you did a short course, studied distance learning, graduated last year or years ago, we would love to hear from you!
Get in touch with the Alumni Office at
LSHTM Archives at the AIDS Histories and Cultures Festival 2018
On Monday 2nd July, the Archives Service took part in the Beat the Bugs event at the Royal College of Nursing. This was one of the first events of the AIDS Histories and Cultures Festival 2018. The festival aims to explore how HIV/AIDS has been experienced, represented, and remembered. Events include workshops, film screenings, party nights, music, talks, and performance. There is more information on the festival here
We chose a selection of material from our seven collections relating to HIV and AIDS which include the AIDS Social History Project and material from the Centre for Sexual and Reproductive Health, there is more information on the AIDS collections on our website. Material displayed included press cuttings, reports, leaflets, trading cards, badges, hats and a t-shirt. The Archives Service holds over 700 posters and a selection of these were displayed on boards and in a powerpoint slide show.
The item which received the most interest was a graphic novel entitled ‘Jo’ which was published in Belgium and written in French, it tells the unfortunate story of a young women called Jo who contracts HIV from drug use and dies from AIDS. Two of the guests at the event remember reading it in their School libraries in France and one described how traumatic she had found it.
We also displayed a selection of collectable trading cards on AIDS Awareness produced by comic book publisher Eclipse Enterprises. The set of 110 cards feature a variety of HIV/AIDS information and organisations, as well as personalities who died from AIDS, or were involved in AIDS Awareness. The cards include entries for Elizabeth Taylor, Freddie Mercury and Rock Hudson and organisations such as ACT UP and The Foundations for AIDS Research (amFAR). The cards provide more information on the topic, individual and theme on the back. They were originally distributed in packs of ten along with a free condom, with 15% of the proceeds were donated to ‘Broadway Cares/Equity Fights AIDS’.
The Archives is fortunate to have this beautiful brooch of an AIDS red ribbon. This item was donated by Lyn Rothman, the founder of AIDS Crisis Trust and patron and board member of the Elton John AIDS Foundation. She kindly offered to donate a Red Ribbon brooch designed by her friend, Andrew Logan, the English artist and jewellery-maker. The pendant was designed when the first AIDS ribbons appeared and having seen many of his friends die from AIDS, Andrew felt it was a fitting celebration of their lives. The original red ribbon was designed by New York-based Visual AIDS Artists Caucus in 1991 as a consciousness raising symbol, not as a commercial or trademark tool, and therefore the original creators wished to remain anonymous and the image is free of copyright.
For more information on the Archives Service, please visit our website.