SummaryBackgroundViral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.MethodsWe did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.Findings1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.InterpretationViruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.FundingMeningitis Research Foundation and UK National Institute for Health Research.

Over the past decade and a half, the Indonesian government has progressed fitfully and inconsistently toward a stricter tobacco-control policy regime, albeit without much impact on the country's worsening tobacco epidemic. This article explains this pattern of reform in terms of the unequal but changing relationship of power between tobacco companies and tobacco farmers, on the one hand, and tobacco-control advocates based in NGOs, health professional organizations, universities, and international organizations, on the other. The first of these coalitions has had greater structural leverage, better political connections, stronger organizational capacity, greater ability to mobilize popular forces, and more capacity to cultivate a positive public image. But the second coalition has been able to exercise some influence over policy because of changes wrought by democratization. In this analysis, the author engages with the literatures on (1) Indonesia's political economy in the post-New Order period and (2) the politics of tobacco control in developing countries. With regard to the former, the author argues that we need to give greater attention to the role of actors previously excluded from the policy-making process than is currently the case. With regard to the latter, the author contends that more focus is needed on domestic actors and political institutions in shaping tobacco-control policy. Looking to the future, the author suggests that further progress in Indonesia's tobacco-control policies will be contingent upon an ongoing process of struggle; however, there are signs that the tide is turning in favor of the second coalition.

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Resuscitation promoting factors (Rpf) are peptidoglycan-hydrolyzing enzymes that are pivotal in the resuscitation of quiescent actinobacteria including Mycobacterium tuberculosis. From the published data, it is clear that Rpf are required for the resuscitation of non-replicating bacilli and pathogenesis in murine infection model of tuberculosis, although their direct influence on human Mycobacterium tuberculosis infection is ill-defined. In this review, we describe the progress in the understanding of the roles that Rpf play in human tuberculosis pathogenesis and importance of bacilli dependent upon Rpf for growth for the outcome of human tuberculosis. We outline how this research is opening up important opportunities for the diagnosis, treatment and prevention of human disease, progress in which is essential to attain the ultimate goal of tuberculosis eradication.ARTICLE HISTORY

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Several developing countries have recently introduced policies supporting universal basic free education (UFBE). Experience suggests such policies often fail to increase access and quality of education, and illegal fees are widely prevalent. The literature identifies several reasons including the lack of replacement funding in place of fees and the loss of quality due to overcrowding and subsequent high drop-out rates. This article, using evidence from Indonesia's experience, argues that the underlying problem is political. We suggest that fee-free education is an attainable goal, but only if pro-UFBE interest groups are empowered to influence policy, demand accountability and seek redress against illegal fees.

for providing useful feedback on the study design and early results and an earlier draft of the paper. We also want to thank Sumarna Surapranata, Director General for Teacher and Education Personnel, for his review of the paper. Finally, and most importantly, we wish to thank the numerous government officials, academics, donor officials, journalists, teachers, teacher and NGO activists and other individuals who gave up their time to be interviewed, particularly in our four focus regions. The views and opinions expressed in this paper are those of the authors only. DFAT and the World Bank do not accept legal liability for material contained in this document.