Working towards development of a sustainable brucellosis control programme, the Azerbaijan example.

Brucellosis caused by Brucella abortus and Brucella melitensis is endemic in the Republic of Azerbaijan but a complex mix of fiscal, political and technical constraints has impeded regulatory authority decision making for adoption of a sustainable national control programme. This paper reports a series of epidemiologic studies of the disease in animals and humans which we conducted between 2009 and 2020. A preliminary study and a subsequent larger study using vaccination of all non-pregnant female sheep and goats of breeding age and all females between 3 and 8 months with conjunctival Rev1 vaccine both recorded significant reduction in small ruminant seroprevalences. A case control study of winter pasture flocks found many case and control farmers used raw milk to make dairy products for sale, ate fresh cheese and sold dairy products in unregulated markets. Almost all farmers expressed willingness to pay a portion of the costs associated with elimination of brucellosis from their flocks. A pilot human study in 2009 led to a large study in 2017 which recorded an overall seroprevalence of 8.1% in humans. Persons in farm related occupations were at greater risk than urban persons and males were more likely to be seropositive than females. Risk factors included keeping small ruminants, using raw milk cheese and slaughtering animals whereas having heard education information about brucellosis and vaccinating against brucellosis were protective.

Preferences of livestock owners for sharing the cost of brucellosis control in Tajikistan.

In the context of significant public health benefits of brucellosis control and shrinking public resources for livestock vaccination, this paper considers the willingness of small ruminant livestock owners to pay for vaccination of their animals against brucellosis. The willingness to pay is estimated through a binary choice contingent valuation approach using data from a rural household survey specially designed for this purpose. The survey was conducted in southern Tajikistan, one of its poorest regions, in March 2009. The study used a non-parametric method for estimating the willingness to pay and a parametric (Probit) model for identifying determinants. The results show that households, including poor households, were willing to pay for continuing vaccination of their sheep and goats against brucellosis. Controlling for other attributes of willingness to pay, there was practically no correlation between willingness to pay and household asset level. This means both poor and rich alike are willing to pay for the service. On the other hand, the results also show that the willingness to pay was comparatively higher in households with relatively higher levels of education of adult females. This suggests that an awareness campaign targeted at female members of households would enhance the ownership and coverage of cost recovery programs and should form an integral part of any efforts towards introducing financial participation from sheep and goat owners for brucellosis vaccination.

Catholic Charities U.S.A. Providing a Voice for the Poor.

Think you know Catholic Charities? Look deeper--I bet you'll be surprised. People often tell me they know all about Catholic Charities' soup kitchens, coat drives, an annual Christmas fund-raiser. Some might mention local resume-writing classes or social enterprise endeavors like bake and furniture sales and other services for people struggling to lift themselves out of poverty. But only a few know that, as a movement, Catholic Charities has a dual mission and is committed to living out both components providing charity and seeking justice.

Beyond drug use: a systematic consideration of other outcomes in evaluations of treatments for substance use disorders.

Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review papers. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of 'other' measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.

Ten take home lessons from the first 10 years of the CTN and 10 recommendations for the future.

BACKGROUND: The first 10 years of the National Institute on Drug Abuse's Clinical Trials Network (CTN) yielded a wealth of data on the effectiveness of a number of behavioral, pharmacological, and combined approaches in community-based settings. METHODS: We summarize some of the methodological contributions and lessons learned from the behavioral trials conducted during its first ten years, including the capacity and enormous potential of this national research infrastructure. RESULTS: The CTN made contributions to the methodology of effectiveness research; new insights from secondary analyses; the extent to which approaches with strong evidence bases, such as contingency management, extend their effectiveness to real world clinical settings; new data on 'standard treatment' as actually practiced in community programs, the extent to which retention remains a major issue in the field; important data on the safety of specific behavioral therapies for addiction; and heightened the importance of continued sustained attention to bridging the gap between treatment and research. CONCLUSIONS: Areas of focus for the CTN's future include defining common outcome measures to be used in treatment outcome studies for illicit drugs; incorporating performance indicators and measures of clinical significance; conducting comparative outcome studies; contributing to the understanding of effective treatments of comorbidity; reaching underserved populations; building implementation science; understanding long-term outcomes of current treatments and sustaining treatment effects; and conducting future trials more efficiently.

Effects of tympanomeatal blunting on sound transfer function.

OBJECTIVE: (1) To measure the peak-to-peak displacement of the round window membrane (RWM) prior to blunting procedure. (2) To evaluate the impact of blunting the anterior tympanomeatal angle (ATA) on middle ear sound transfer function. STUDY DESIGN: Basic science study. Setting. Cadaveric temporal bone research laboratory. SUBJECTS AND METHODS: Six fresh human temporal bones were prepared using a mastoidectomy and facial recess approach. Baseline RWM peak-to-peak displacements were obtained by single-point laser Doppler vibrometry (LDV) at 90-dB sound pressure level over a spectrum of 250 to 8000 Hz. Temporalis muscle was harvested and then fashioned into a graft for each temporal bone, mimicking ATA blunting. RWM displacement responses with the blunted ATA were measured using the LDV to judge the impact on middle ear transfer function. RESULTS: For each of the 6 temporal bones, the average displacement decreased across all sound frequencies with the ATA blunting when compared with baseline (no blunting). Baseline velocity measurements for all sound signals averaged 4.5 × 10(-3) ± 1.892 × 10(-3) (mean ± SEM) mm/s, while measurements averaged 2.2 ± 6.62 × 10(-4) mm/s with blunting of the ATA (P < .001). This amounted to a 52% decrease in velocity of the RWM following blunting of the ATA. CONCLUSION: Blunting of the ATA decreases the sound transfer function of the tympanic membrane and middle ear. Prevention of blunting at the ATA during tympanoplasty should be emphasized.

The first decade of the National Drug Abuse Treatment Clinical Trials Network: bridging the gap between research and practice to improve drug abuse treatment.

The National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999 to improve the quality of addiction treatment using science as the vehicle. The network brings providers from community-based drug abuse treatment programs and scientists from university-based research centers together in an alliance that fosters bidirectional communication and collaboration. Collaboration enhanced the relevance of research to practice and facilitated the development and implementation of evidence-based treatments in community practice settings. The CTN's 20 completed trials tested pharmacological, behavioral, and integrated treatment interventions for adolescents and adults; more than 11,000 individuals participated in the trials. This article reviews the rationale for the CTN, describes the translation of its guiding principles into research endeavors, and anticipates the future evolution of clinical research within the Network.

Spatio-temporal epidemiology of highly pathogenic avian influenza outbreaks in the two deltas of Vietnam during 2003-2007.

Outbreaks of highly pathogenic avian influenza A subtype H5N1 have occurred in Vietnam as a series of epidemic waves since December 2003. We describe the spatial and temporal patterns of the HPAI H5N1 epidemics in the Red River Delta in the north (785 outbreaks in 606 communes) and the Mekong River Delta in the south of Vietnam (1313 outbreaks in 837 communes), where the epidemics were concentrated. Throughout the study period the percentage of outbreaks affecting ducks increased steadily to a peak of 78% during the 2006/2007 epidemic in both deltas. Five of the seven epidemic waves occurred in the period of active poultry population buildup immediately prior to the Vietnamese New Year (Tet festival). Recorded outbreaks were clustered in space and time within both deltas, consistent with infection transmission occurring via a combination of local and long-distance spread. Our analyses demonstrate that the epidemiology of HPAI in Vietnam has changed over the 4-year study period, with outbreaks now occurring in the warmer months of the year and ducks featuring more prominently as affected species. To determine the relative importance of local and long-distance spread on infection transmission, precise details of outbreak location, date of onset of clinical signs, and size and composition of the poultry population at risk need to be recorded during future outbreak responses.

Influence of contact heterogeneity on TB reproduction ratio R0 in a free-living brushtail possum Trichosurus vulpecula population.

Social network analyses were used to investigate contact patterns in a free-living possum Trichosurus vulpecula population and to estimate the influence of contact on R(0) for bovine tuberculosis (TB). Using data collected during a five-year capture-mark-recapture study of a free-living possum population, observed estimates of R(0) were computed and compared with R(0) computed from random networks of similar size that approximated a random mixing process. All networks displayed a heterogeneous pattern of contact with the average number of contacts per possum ranging from 20 to 26 per year. The networks consistently showed small-world and single-scale features. The mean estimates of R(0) for TB using the observed contact networks were 1.78, 1.53, 1.53, 1.51, and 1.52 times greater than the corresponding random networks (P <0.05). We estimate that TB would spread if an average of between 1.94 and 1.97 infective contacts occurred per year per infected possum, which is approximately half of that expected from a random network. These results have implications for the management of TB in New Zealand where the possum is the principal wildlife reservoir host of Mycobacterium bovis, the causal agent of bovine TB. This study argues the relevance of refining epidemiological models used to inform disease management policy to account for contact heterogeneity.

Risk factors for distortion product otoacoustic emissions in young men with normal hearing.

The purpose of this study was to evaluate the possible effects of risk factors on distortion product otoacoustic emissions (DPOAEs) in young adult men with normal hearing. Four hundred thirty-six United States Marine recruit men (mean age = 19.2 years +/- 1.8 years; age range = 17-29 years) participated in this study. Questionnaires were given to each recruit to obtain demographic data and history of noise exposure, solvent exposure, smoking history, and hearing-related histories. Otoscopy, tympanometry, pure-tone air-conduction audiometry (2.0-8.0 kHz) and DPOAEs (2.3-8.0 kHz) were measured. DPOAE levels were lower in Not Hispanic or Latino recruits, in heavy smokers, in recruits who reported loud live music exposure and ringing in their ears after noise exposure. These differences were not statistically significant at all frequencies. Recruits with multiple risk factors had the lowest DPOAEs as compared to recruits with fewer, or no, risk factors; these differences were not statistically significant. Obtaining risk factor data as part of an audiometric evaluation is important even though the individual may have normal hearing.