Identifying inconsistencies in exotic pet regulations that perpetuate trade in risky species.

Regulatory inconsistencies at different jurisdictional levels have contributed to the global expansion of the exotic pet trade, with resultant increases in the spread of invasive species and pathogens. Researchers have enumerated multiple limitations and environmental risks posed by international and national rules that govern the exotic pet trade, yet little attention has focused on the regulation of the exotic pet trade within national borders. We reviewed state-level regulations that apply to the trade of vertebrate animal taxa in the United States. Definitions and classifications for regulating different vertebrate taxa varied greatly across states, and the terms pet and companion animal were poorly defined and inconsistent across states. States implemented regulations that permit trade in exotic vertebrate pets that are banned from import into the United States owing to public health and conservation concerns. Once species have been imported into the United States, inconsistent internal regulations facilitate the movement of animals that pose substantial invasion and disease risks. Violations of state laws were typically listed as misdemeanors, and the median fine for violating state wildlife trade laws was $1000. Inconsistent and incomplete regulation of exotic vertebrate pets across state borders, in conjunction with limited penalties for violating regulations, has facilitated continued possession of exotic pets in states where these animals are banned. Based on our review of regulatory weaknesses, we conclude that a transition to a federally enforced list of vertebrate species that may be traded as pets is needed, with all other vertebrate species banned from the exotic pet trade unless their potential invasion and disease risks have been assessed and demonstrated to be low or nonexistent.

Identificación de las inconsistencias en las regulaciones de las mascotas exóticas que perpetúan el mercado de especies riesgosas Resumen Las inconsistencias regulatorias en diferentes niveles regulatorios han contribuido a la expansión mundial del mercado de mascotas exóticas, con un incremento resultante en la dispersión de especies invasoras y patógenos. Los investigadores han enumerado varias limitaciones y riesgos ambientales que representan las normas nacionales e internacionales que dictan el mercado de mascotas exóticas, pero se ha puesto poca atención en la regulación de este mercado dentro de las fronteras nacionales. Revisamos las regulaciones a nivel estatal que aplican al mercado de taxones de vertebrados en los Estados Unidos (EU). Entre los estados, las definiciones y clasificaciones para regular el mercado de los diferentes taxones de vertebrados variaron mucho y los términos mascota y animal de compañía contaban con definiciones deficientes e incoherentes. Los estados implementaron regulaciones que permiten el mercado de vertebrados como mascotas exóticas cuya importación está prohibida para los EU debido a cuestiones de salud pública y conservación. Una vez que las especies han sido importadas a los EU, las regulaciones internas incoherentes facilitan el traslado de animales que representan un riesgo importante de invasión y de enfermedad. Con frecuencia, las violaciones a las leyes estatales se denominaban delitos menores y la multa promedio por violar las leyes estatales de comercio de fauna era de $1,000. La regulación incompleta e incoherente del mercado de mascotas exóticas entre los límites estatales, en conjunto con las penalizaciones limitadas por violar las regulaciones, ha facilitado la posesión continua de mascotas exóticas en estados en donde estos animales están prohibidos. Con base en nuestra revisión de las debilidades regulatorias, concluimos que se necesita transitar a una lista con aplicación federal de especies de vertebrados que pueden ser comercializadas como mascotas, con todas las demás especies de vertebrados vetadas del mercado a menos de que se haya evaluado su riesgo potencial de invasión y de enfermedad y se haya demostrado que es bajo o inexistente.

Understanding rabbit owners' willingness to engage in disease prevention behaviors.

Rabbit hemorrhagic disease virus 2 (RHDV2) is a fatal, highly contagious pathogen that infects wild and domestic lagomorphs (rabbits and hares). RHDV2 is an important cause of disease in pet and companion rabbits, has resulted in economic losses for the commercial rabbit industry, and has caused declines of wild lagomorph populations. It is essential for domestic rabbit owners to engage in appropriate actions (e.g., using effective disinfectants, creating secure barriers between domestic and wild rabbits) to protect the health and welfare of their rabbits and reduce the risk of human-mediated spread of RHDV2. Thus, we investigated rabbit owners' stated willingness to engage in nine commonly recommended biosecurity practices and their support for seven potential government-implemented management actions. We administered an online survey to 1790 rabbit owners in the United States between April and August 2021. Respondents were likely to engage in all biosecurity measures and were supportive of most management actions that could be implemented by government agencies. Respondents' willingness to engage in and support biosecurity measures was positively correlated with their perceptions of the importance of biosecurity, risk perceptions pertaining to the impact of RHDV2 on lagomorphs and rabbit-related industries, knowledge of RHDV2, and trust in government to manage RHDV2. Respondents' motivations for owning rabbits, husbandry behaviors, and demographic characteristics also influenced their willingness to engage in or support biosecurity measures. Engaging domestic rabbit owners in collaborative biosecurity measures is critical for protecting domestic rabbit health and preventing potential spillover between domestic and free-roaming lagomorphs, as there are still many uncertainties about how RHDV2 is spreading across the United States and the world. Implementing outreach strategies that communicate the importance and effectiveness of biosecurity practices in protecting rabbit welfare, rabbit-related activities, and wild lagomorph populations may increase the likelihood of rabbit owners adopting biosecurity measures.

Overview of Tools and Measures Investigating Vaccine Hesitancy in a Ten Year Period: A Scoping Review.

The challenge of vaccine hesitancy, a growing global concern in the last decade, has been aggravated by the COVID-19 pandemic. The need for monitoring vaccine sentiments and early detection of vaccine hesitancy in a population recommended by the WHO calls for the availability of contextually relevant tools and measures. This scoping review covers a ten year-period from 2010-2019 which included the first nine years of the decade of vaccines and aims to give a broad overview of tools and measures, and present a summary of their nature, similarities, and differences. We conducted the review using the framework for scoping reviews by Arksey and O'Malley (2005) and reported it following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. Of the 26 studies included, only one was conducted in the WHO African Region. Measures for routine childhood vaccines were found to be the most preponderant in the reviewed literature. The need for validated, contextually relevant tools in the WHO Africa Region is essential, and made more so by the scourge of the ongoing pandemic in which vaccination is critical for curtailment.

Investigating public support for biosecurity measures to mitigate pathogen transmission through the herpetological trade.

The expanding global trade in herpetofauna has contributed to new infectious disease dynamics and pathways that allow for the rapid spread of pathogens geographically. Improved biosecurity is needed to mitigate adverse biodiversity, economic and human health impacts associated with pathogen transmission through the herpetological trade. However, general lack of knowledge of the pathogen transmission risks associated with the global trade in herpetofauna and public opposition to biosecurity measures are critical obstacles to successfully preventing pathogen transmission. In 2019 we administered a survey to 2,007 members of the public in the United States of America to ascertain their support for interventions to prevent the spread of Batrachochytrium dendrobatidis (Bd), Batrachochytrium salamandrivorans (Bsal), ranaviruses, and Salmonella through the herpetological trade. We presented survey respondents with different potential hazards associated with pathogen transmission through this trade, namely ecological, economic, and human health impacts. We used structural equation models to determine how these different hazards and respondents' characteristics influenced respondents' support for quarantine and veterinary observation of herpetofauna imported into the United States, mandatory tests for diseases of concern, and best practices to reduce stress and improve the care of live herpetofauna during transport to the United States. Respondents' values and their perceived susceptibility and sensitivity to different hazards associated with pathogen transmission were key determinants of their support for biosecurity. Respondents with strong biospheric and altruistic values demonstrated sensitivity to ecological and human health impacts associated with pathogen transmission, whereas respondents with strong egoistic values demonstrated sensitivity to economic impacts. Respondents had limited knowledge of Bd, Bsal or ranaviruses, the size of the herpetological trade, or how this trade may contribute to pathogen transmission. Improved outreach and education on pathogen transmission through the herpetological trade is required, but it is important that messages are tailored to people with different values to elicit their support for biosecurity.

Practices and trends in clinical trial registration in the Pan African Clinical Trials Registry (PACTR): a descriptive analysis of registration data.

BACKGROUND: The Pan African Clinical Trials Registry (PACTR) is a WHO International Clinical Trials Registry Platform primary register, which caters for clinical trials conducted in Africa. PACTR is the first and, at present, the only member of the Network of WHO Primary Registers in Africa. The aim is to describe and report on the trends of trial records registered in PACTR. METHODS: PACTR was established in 2007 as the AIDS, Tuberculosis, and Malaria Clinical Trials Registry. The scope of the registry was then expanded in 2009 to include all diseases. This is a cross-sectional study of trials registered in PACTR from inception to 18 August 2021. A descriptive analysis of the use and trends of the following data fields: study intervention, disease condition, sex of the participants, sample size, ethics, funding and availability of results was conducted using Microsoft Excel. RESULTS: The number of trials registered has increased year on year, reaching 606 trials registered in 2020. The total number of trials registered at the time of the analysis was 2998. More than half of the trials in the registry (1655 of 2998, ie, 55%) were prospectively registered. Ethical approval was received by 90% (2691 of 2998) of the registered trials. Factorial assignment as an intervention model was in 20% (589 of 2998) of the trials registered. There were 36% (1083 of 2998) completed trials, of which 3% (94 of 1083) had results available in the registry. The most dominant funding source indicated was self-funding in 23% (693 of 2998) of the registered trials, and 55% (1639 of 2998) had no funding. CONCLUSION: Registration on PACTR continues to grow; however, our analysis shows that researchers' capacity-building is needed to understand the importance of the registry and how this information informs healthcare decisions. Promoting prospective trial registration remains critical to avoid selective reporting bias to inform research gaps.

Conserving alpha and beta diversity in wood-production landscapes.

International demand for wood and other forest products continues to grow rapidly, and uncertainties remain about how animal communities will respond to intensifying resource extraction associated with woody bioenergy production. We examined changes in alpha and beta diversity of bats, bees, birds, and reptiles across wood production landscapes in the southeastern United States, a biodiversity hotspot that is one of the principal sources of woody biomass globally. We sampled across a spatial gradient of paired forest land-uses (representing pre and postharvest) that allowed us to evaluate biological community changes resulting from several types of biomass harvest. Short-rotation practices and residue removal following clearcuts were associated with reduced alpha diversity (-14.1 and -13.9 species, respectively) and lower beta diversity (i.e., Jaccard dissimilarity) between land-use pairs (0.46 and 0.50, respectively), whereas midrotation thinning increased alpha (+3.5 species) and beta diversity (0.59). Over the course of a stand rotation in a single location, biomass harvesting generally led to less biodiversity. Cross-taxa responses to resource extraction were poorly predicted by alpha diversity: correlations in responses between taxonomic groups were highly variable (-0.2 to 0.4) with large uncertainties. In contrast, beta diversity patterns were highly consistent and predictable across taxa, where correlations in responses between taxonomic groups were all positive (0.05-0.4) with more narrow uncertainties. Beta diversity may, therefore, be a more reliable and information-rich indicator than alpha diversity in understanding animal community response to landscape change. Patterns in beta diversity were primarily driven by turnover instead of species loss or gain, indicating that wood extraction generates habitats that support different biological communities.

Conservación de la Diversidad Alfa y Beta en Paisajes de Producción Maderera Resumen La demanda internacional de madera y otros productos forestales sigue creciendo rápidamente mientras permanecen las incertidumbres sobre cómo responderán las comunidades animales a la intensificación de la extracción de recursos asociada con la producción de bioenergía leñosa. Examinamos los cambios en la diversidad alfa y beta de murciélagos, abejas, aves y reptiles en los paisajes de producción maderera en el sureste de los Estados Unidos, un punto caliente de biodiversidad y una de las fuentes principales de biomasa leñosa a nivel mundial. Muestreamos a lo largo de un gradiente espacial de usos de suelo forestales emparejados (representando la pre- y postcosecha) que nos permitió evaluar los cambios en las comunidades biológicas resultantes de varios tipos de recolección de biomasa. Las prácticas de corta rotación y de eliminación de residuos después de la tala estuvieron asociadas con la reducción de la diversidad alfa (−14.1 y −13.9 especies, respectivamente) y una diversidad beta más baja (es decir, diferencia de Jaccard) entre los pares de uso de suelo (0.46 y 0.50, respectivamente), mientras que el raleo de rotación media incrementó la diversidad alfa (+3.5 especies) y beta (0.59). Durante la duración de una rotación permanente en una sola ubicación, la cosecha de biomasa generalmente derivó en menos biodiversidad. La respuesta de los taxones a la extracción de recursos estuvo muy mal pronosticada por la diversidad alfa: la correlación de las respuestas entre los grupos taxonómicos fue altamente variable (−0.2 a 0.4) con muchas incertidumbres. Como contraste, los patrones de diversidad beta fueron fuertemente coherentes y predecibles en todos los taxones, mientras que la correlación de las respuestas entre los grupos taxonómicos siempre fue positiva (0.05 a 0.4) con incertidumbres más limitadas. Por lo tanto, la diversidad beta puede ser un indicador más confiable y rico en información que la diversidad alfa para entender las respuestas de la comunidad animal a los cambios en el paisaje. Los patrones de la diversidad beta estuvieron impulsados principalmente por la rotación en lugar de la pérdida o ganancia de especies, lo que indica que la extracción de madera genera hábitats que mantienen a diferentes comunidades biológicas.

Down the Rabbit Hole: Domestic Rabbit Owners' Perceptions of Rabbit Hemorrhagic Disease Virus 2.

Rabbit hemorrhagic disease virus 2 (RHDV2) is a highly contagious pathogen that infects wild and domestic rabbits and hares (lagomorphs). Globally, RHDV2 has resulted in substantial economic losses for commercial rabbit trade and caused wild lagomorph population declines. Previous research on RHDV2 suggests that human-mediated movement of rabbits may contribute to the spread of RHDV2. We conducted the first survey of individuals who own or interact with domestic rabbits to identify their rabbit husbandry behaviors and knowledge of, and concerns about, RHDV2. In 2021, we surveyed 1807 rabbit owners, breeders, and rescue staff in the USA. Respondents had a high level of knowledge about RHDV2. Respondents believed RHDV2 posed a high risk to rabbit-related activities and were concerned about its economic and ecological impacts. Nearly half of respondents always kept their rabbits indoors, but 10.7% of respondents allowed their rabbits outside frequently on properties used by wild lagomorphs. Respondents with five rabbits or less were generally willing to vaccinate their rabbits, but respondents with larger herds argued that vaccines were cost prohibitive. Given respondents' concerns about RHDV2, communication about disease prevention should highlight the adverse ecological and economic consequences of RHDV2.

A global bibliometric analysis of research productivity on vaccine hesitancy from 1974 to 2019.

Vaccine hesitancy is a phenomenon where individuals delay or refuse to take some or all vaccines. The objective of this study was to conduct a global bibliometric analysis of research productivity and identify country level indicators that could be associated with publications on vaccine hesitancy. We searched PubMed and Web of Science for publications from 1974 to 2019, and selected articles focused on behavioral and social aspects of vaccination. Data on country-level indicators were obtained from the World Bank. We used Spearman's correlation and zero-inflated negative-binomial regression models to ascertain the association between country level indicators and the number of publications. We identified 4314 articles, with 1099 eligible for inclusion. The United States of America (461 publications, 41.9%), Canada (84 publications, 7.6%) and the United Kingdom (68 publications, 6.2%) had the highest number of publications. Although various country indicators had significant correlations with vaccine hesitancy publications, only gross domestic product (GDP) and gross national income (GNI) per capita were independent positive predictors of the number of publications. When the number of publications were standardized by GDP, the Gambia, Somalia and Malawi ranked highest in decreasing order. The United States, Canada and United Kingdom ranked highest (in that order) when standardized by current health expenditure. Overall, high-income countries were more productive in vaccine hesitancy research than low-and-middle-income countries. There is a need for more investment in research on vaccine hesitancy in low-and-middle-income countries.

Tuberculosis treatment intervention trials in Africa: A cross-sectional bibliographic study and spatial analysis.

BACKGROUND: Mycobacterium Tuberculosis (TB) poses a substantial burden in sub-Saharan Africa and is the leading cause of death amongst infectious diseases. Randomised controlled trials (RCTs) are regarded as the gold standard for evaluating the effectiveness of interventions. We aimed to describe published TB treatment trials conducted in Africa. METHODS: This is a cross-sectional study of published TB trials conducted in at least one African country. In November 2019, we searched three databases using the validated Africa search filter and Cochrane's sensitive trial string. Published RCTs conducted in at least one African country were included for analysis. Records were screened for eligibility. Co-reviewers assisted with duplicate data extraction. Extracted data included: the country where studies were conducted, publication dates, ethics statement, trial registration number, participant's age range. We used Cochrane's Risk of Bias criteria to assess methodological quality. RESULTS: We identified 10,495 records; 175 trials were eligible for inclusion. RCTs were published between 1952 and 2019. The median sample size was 206 participants (interquartile range: 73-657). Most trials were conducted in South Africa (n = 83) and were drug therapy trials (n = 130). First authors were from 30 countries globally. South Africa had the most first authors (n = 55); followed by the United States of America (USA) (n = 28) and Great Britain (n = 14) with fewer other African countries contributing to the first author tally. Children under 13 years of age eligible to participate in the trials made up 17/175 trials (9.71%). International governments (n = 29) were the most prevalent funders. Ninety-four trials provided CONSORT flow diagrams. Methodological quality such as allocation concealment and blinding were poorly reported or unclear in most trials. CONCLUSIONS: By mapping African TB trials, we were able to identify potential research gaps. Many of the global north's researchers were found to be the lead authors in these African trials. Few trials tested behavioural interventions compared to drugs, and far fewer tested interventions on children compared to adults to improve TB outcomes. Lastly, funders and researchers should ensure better methodological quality reporting of trials.

Correction: Public preferences for ecological indicators used in Everglades restoration.

[This corrects the article DOI: 10.1371/journal.pone.0234051.].

A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region.

INTRODUCTION: To describe vaccine stock-outs at national, district, and health facility levels in the WHO African region. AREAS COVERED: We conducted a systematic review to identify studies reporting on vaccine stock-outs at national, district, and health facility levels in 47 African countries. We searched both published and unpublished literature, including the WHO/UNICEF Joint Reporting Form (JRF), for eligible studies. EXPERT OPINION: Countries within the WHO African region continue to face the challenge of vaccine stock-outs at national, district, and health facility levels and this impacts on the delivery of immunization services. The frequency and the proportion of stock-outs vary between countries and between regions within a country. Countries need to put more efforts toward finding lasting solutions to vaccine shortages. We look forward to having more countries reporting vaccine stock-outs especially at the health facility level. Furthermore, countries are currently exploring different approaches for improving vaccine stock management. It is expected that in half a decade from now, more well-designed studies will be available that will inform decision-making.

Public preferences for ecological indicators used in Everglades restoration.

The Everglades is one of the largest wetland ecosystems in the world covering almost 18,000 square miles from central Florida southward to Florida Bay. Over the 20th century, efforts to drain the Everglades for agriculture and development severely damaged the ecosystem so that today roughly 50% of the historic flow of water through the Everglades has been diverted elsewhere. In an attempt to restore the Everglades, the U.S. Congress authorized the Comprehensive Everglades Restoration Plan (CERP) in 2000, expected to cost over $16 billion and to take several decades to complete. We used the results from a stated preference choice experiment (SPCE) survey of Florida households to estimate the willingness to pay for several ecological attributes related to CERP performance indicators likely to be impacted by Everglades restoration. We also used a latent class model (LCM) to explore preference heterogeneity among respondents. On average, survey respondents were willing to pay for improvements in all of the attributes included in the survey, namely increased populations of wading birds, American alligators, endangered snail kites, and spotted seatrout, and reduced polluted discharges from Lake Okeechobee to the Caloosahatchee and St. Lucie rivers. Willingness to pay was highest for reduced polluted discharges from Lake Okeechobee.

Current tools available for investigating vaccine hesitancy: a scoping review protocol.

INTRODUCTION: Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services is responsible in part for suboptimal levels of vaccination coverage worldwide. The WHO recommends that countries incorporate plans to measure and address vaccine hesitancy into their immunisation programmes. This requires that governments and health institutions be able to detect concerns about vaccination in the population and monitor changes in vaccination behaviours. To do this effectively, tools to detect and measure vaccine hesitancy are required. The purpose of this scoping review is to give a broad overview of currently available vaccine hesitancy measuring tools and present a summary of their nature, similarities and differences. METHODS AND ANALYSIS: The review will be conducted using the framework for scoping review proffered by Arksey and O'Malley. It will comply with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' guidelines. The broader research question of this review is: what vaccine hesitancy measuring tools are currently available?Search strategies will be developed using controlled vocabulary and selected keywords. PubMed, Web of Science, Scopus and reference lists of relevant publications will be searched. Titles and abstracts will be independently screened by two authors and data from full-text articles meeting the inclusion criteria will be extracted independently by two authors using a pretested data charting form. Discrepancies will be resolved by discussion and consensus. Results will be presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Narrative analysis will be used to summarise the findings of the review. ETHICS AND DISSEMINATION: Ethics approval is not required for the review. It will be submitted as part of a doctoral thesis, presented at conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: https://osf.io/x8fjk/.

Effects of vaccines in protecting against Ebola virus disease: protocol for a systematic review.

INTRODUCTION: Ebola virus disease is one of the most devastating infectious diseases in the world with up to 90% case fatality observed. There are at least 13 candidate vaccines developed and being tested to prevent the occurrence of the Ebola virus disease. While none of these candidate vaccines has received regulatory approval for use, one candidate vaccine (rVSVΔG-ZEBOV-GP) has been granted access for emergency use. Two other candidate vaccines (GamEvac-Combi and Ad5-EBOV) have been licensed for emergency use in their countries of origin. The objective of this systematic review is to summarise the effects of the Ebola candidate vaccines in humans. METHODS AND ANALYSIS: We will search for potentially eligible studies, with no language or date restrictions, in the Cochrane Central Register of Controlled Trials, PubMed, Scopus, the WHO International Clinical Trial Registry Platform, and reference lists of relevant publications. The Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effect (DARE) will be searched for related reviews. Two review authors will independently screen search records, assess study eligibility, perform data extraction, and assess the risk of bias; and reconcile their findings. We will pool data from similar studies using Mantel-Haenszel's fixed-effect model. ETHICS AND DISSEMINATION: This study is exempted from ethical consideration since the data collected are publicly available and at no point will confidential information from human participants be used. We will disseminate our results through publications in peer-reviewed journals and relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42018110505.

A systematic review of strategies for reducing missed opportunities for vaccination.

BACKGROUND: Missed opportunities for vaccination (MOVs) occur when persons eligible for vaccination visit a health facility and do not get the vaccines they need. We conducted a systematic review to assess effects of interventions for reducing MOVs. METHODS: We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in April 2017. Three authors independently screened search outputs, reviewed potentially eligible papers, assessed risk of bias, and extracted data; resolving disagreements by consensus. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. RESULTS: Six studies (five trials and one cohort study) met our inclusion criteria, all conducted in the United States of America. All six studies had various limitations and were classified as having a high risk of bias. We found moderate certainty evidence that the following interventions probably improve vaccination coverage: patient education (RR 1.92, 95% CI 1.38-2.68), patient tracking using community health workers (RR 1.18, 95% CI 1.11-1.25), and patient tracking and provider prompts (RR 1.24, 95% CI 1.18-1.31). In addition, we found low certainty evidence that concurrent interventions targeting health-facility (education, prompts, and audit and feedback) and family settings (phone calls) may increase vaccination coverage (RR 1.25, 95% CI 1.08-1.46). CONCLUSIONS: The currently available evidence suggests that patient education, patient tracking, outreach sessions, and provider prompts reduce missed opportunities for vaccination and improve vaccination coverage. Rigorous studies are required to confirm these findings and increase the certainty of the current evidence base. WHO is currently coordinating efforts to generate such evidence, especially from low-income and middle-income countries, and it is likely that the data will be available in the next few years.

Effectiveness of brief alcohol interventions in primary care populations.

BACKGROUND: Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES: To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS: We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS: We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.

The importance of survey content: testing for the context dependency of the New Ecological Paradigm Scale.

Using a regression-based analysis of a survey of U.S. households, we demonstrate that both environmental concern, as measured by the New Ecological Paradigm (NEP) Scale, and facets of environmental concern, as measured by three NEP factors, are influenced by survey context. Survey respondents were presented with detailed information about two to four threatened and endangered marine species in the United States, including the Endangered Species Act listing status of the species and threats to the survival of the species. All else being equal, measures of environmental concern are influenced by both which species were included in the survey and by the concern expressed about these species. As such, measures of environmental concern are found to be context dependent since they are correlated with the species included in each survey. We also demonstrate that NEP-based measures of environmental concern are affected by socio-demographic variables, opinions about government spending, and environmental knowledge. Given the wide, multi-disciplinary use of the NEP Scale, it is important for researchers to recognize that NEP-based measures of environmental concern may be sensitive to information included in surveys.

Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.

BACKGROUND: The high levels of healthcare worker shortage is recognised as a severe impediment to increasing patients' access to antiretroviral therapy. This is particularly of concern where the burden of disease is greatest and the access to trained doctors is limited.This review aims to better inform HIV care programmes that are currently underway, and those planned, by assessing if task-shifting care from doctors to non-doctors provides both high quality and safe care for all patients requiring antiretroviral treatment. OBJECTIVES: To evaluate the quality of initiation and maintenance of HIV/AIDS care in models that task shift care from doctors to non-doctors. SEARCH METHODS: We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress) from 1 January 1996 to 28 March 2014, with major HIV/AIDS conferences searched 23 May 2014. We had also contacted relevant organizations and researchers. Key words included MeSH terms and free-text terms relevant to 'task shifting', 'skill mix', 'integration of tasks', 'service delivery' and 'health services accessibility'. SELECTION CRITERIA: We included controlled trials (randomised or non-randomised), controlled-before and after studies, and cohort studies (prospective or retrospective) comparing doctor-led antiretroviral therapy delivery to delivery that included another cadre of health worker other than a doctor, for initiating treatment, continuing treatment, or both, in HIV infected patients. DATA COLLECTION AND ANALYSIS: Two authors independently screened titles, abstracts and descriptor terms of the results of the electronic search and applied our eligibility criteria using a standardized eligibility form to full texts of potentially eligible or uncertain abstracts. Two reviewers independently extracted data on standardized data extraction forms. Where possible, data were pooled using random effects meta-analysis. We assessed evidence quality with GRADE methodology. MAIN RESULTS: Ten studies met our inclusion criteria, all of which were conducted in Africa. Of these four were randomised controlled trials while the remaining six were cohort studies.From the trial data, when nurses initiated and provided follow-up HIV therapy, there was high quality evidence of no difference in death at one year, unadjusted risk ratio was 0.96 (95% CI 0.82 to 1.12), one trial, cluster adjusted n = 2770. There was moderate quality evidence of lower rates of losses to follow-up at one year, relative risk of 0.73 (95% CI 0.55 to 0.97). From the cohort data, there was low quality evidence that there may be an increased risk of death in the task shifting group, relative risk 1.23 (95% CI 1.14 to 1.33, two cohorts, n = 39 160) and very low quality data reporting no difference in patients lost to follow-up between groups, relative risk 0.30 (95% CI 0.05 to 1.94).From the trial data, when doctors initiated therapy and nurses provided follow-up, there was moderate quality evidence that there is probably no difference in death compared with doctor-led care at one year, relative risk of 0.89 (95% CI 0.59 to 1.32), two trials, cluster adjusted n = 4332. There was moderate quality evidence that there is probably no difference in the numbers of patients lost to follow-up at one year, relative risk 1.27 (95% CI 0.92 to 1.77), P = 0.15. From the cohort data, there is very low quality data that death at one year may be lower in the task shifting group, relative risk 0.19 (95% CI 0.05 to 0.78), one cohort, n = 2772, and very low quality evidence that loss to follow-up was reduced, relative risk 0.34 (95% CI 0.18 to 0.66).From the trial data, for maintenance therapy delivered in the community there was moderate quality evidence that there is probably no difference in mortality when doctors deliver care in the hospital or specially trained field workers provide home-based maintenance care and antiretroviral therapy at one year, relative risk 1.0 (95% CI 0.62 to 1.62), 1 trial, cluster adjusted n = 559. There is moderate quality evidence from this trial that losses to follow-up are probably no different at one year, relative risk 0.52 (0.12 to 2.3), P = 0.39. The cohort studies did not report on one year follow-up for these outcomes.Across the studies that reported on virological and immunological outcomes, there was no clear evidence of difference whether a doctor or nurse or clinical officer delivered therapy. Three studies report on costs to patients, indicating a reduction in travel costs to treatment facilities where task shifting was occurring closer to patients homes. There is conflicting evidence regarding the relative cost to the health system, as implementation of the strategy may increase costs. The two studies reporting the patient and staff perceptions of the quality of care, report good acceptability of the service by patients, and general acceptance by doctors of the shifting of roles. One trial reported on the time to initiation of antiretroviral therapy, finding no clear evidence of a difference between groups. The same trial reports on new diagnosis of tuberculosis which favours nurse initiation of HIV care for increasing the numbers of diagnoses of tuberculosis made. AUTHORS' CONCLUSIONS: Our review found moderate quality evidence that shifting responsibility from doctors to adequately trained and supported nurses or community health workers for managing HIV patients probably does not decrease the quality of care and, in the case of nurse initiated care, may decrease the numbers of patients lost to follow-up.

Are environmental attitudes influenced by survey context? An investigation of the context dependency of the New Ecological Paradigm (NEP) Scale.

General environmental attitudes are often measured with questions added to surveys about specific environmental or non-environmental issues. Using results from a large-scale national survey on the protection of threatened and endangered marine species, we examine whether the context of the survey in which New Ecological Paradigm (NEP) Scale items are asked influence measured environmental concern. In this application the role that specific threatened or endangered species play in affecting responses to NEP Scale items is explored using a combination of non-parametric and parametric approaches. The results in this case suggest that context does influence stated general environmental attitudes, though the effects of context differ across NEP items.

Bibliometric and content analysis of the Cochrane Complementary Medicine Field specialized register of controlled trials.

BACKGROUND: The identification of eligible controlled trials for systematic reviews of complementary and alternative medicine (CAM) interventions can be difficult. To increase access to these difficult to locate trials, the Cochrane Collaboration Complementary Medicine Field (CAM Field) has established a specialized register of citations of CAM controlled trials. The objective of this study is to describe the sources and characteristics of citations included in the CAM Field specialized register. METHODS: Between 2006 and 2011, regular searches for citations of CAM trials in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) were supplemented with contributions of controlled trial citations from international collaborators. The specialized register was 'frozen' for analysis in 2011, and frequencies were calculated for publication date, language, journal, presence in MEDLINE, type of intervention, and type of medical condition. RESULTS: The CAM Field specialized register increased in size from under 5,000 controlled trial citations in 2006 to 44,840 citations in 2011. Most citations (60%) were from 2000 or later, and the majority (71%) were reported in English; the next most common language was Chinese (23%). The journals with the greatest number of citations were CAM journals published in Chinese and non-CAM nutrition journals published in English. More than one-third of register citations (36%) were not indexed in MEDLINE. The most common CAM intervention type in the register was non-vitamin, non-mineral dietary supplements (e.g., glucosamine, fish oil) (34%), followed by Chinese herbal medicines (e.g., Astragalus membranaceus, Schisandra chinensis) (27%). CONCLUSIONS: The availability of the CAM Field specialized register presents both opportunities and challenges for CAM systematic reviewers. While the register provides access to thousands of difficult to locate trial citations, many of these trials are of low quality and may overestimate treatment effects. When including these trials in systematic reviews, adequate analysis of their risk of bias is of utmost importance.