Tanzania has a goat population of about 24.8 million most of which belong to the Small East African breed distributed in almost all agro-ecological zones. The different goat populations and the production system in which they are raised are not well characterized depriving animal breeders useful information in designing and running improvement and conservation programs. Therefore, the study was conducted in all agro-ecological zones in Tanzania to characterize the indigenous goats and the production system in which they are raised. Data on animals were collected from 688 randomly selected adult female goats and for production system description; 220 households were interviewed. Analysis of variance and discriminant analysis were used on quantitative data, while frequency analysis was used on qualitative data. Income generation and meat production were the primary goat rearing objectives. More than 55% of respondents grazed their animals freely in communal lands where natural pasture was the chief feed resource. Mating was mainly uncontrolled with apron and castration being used by goat keepers as mating control methods. Common diseases were contagious caprine pleural pneumonia and helminthiasis. Feed shortage, prevalence of diseases, and water scarcity were the major goat production constraints. There were morphological variations between and within these goat populations, and based on quantitative data, the goats were categorized into two groups. High twinning was observed in Ujiji and Lindi goats and low for Sukuma. The dominant coat color was plain white in Pare, Gogo, Maasai, and Tanga. Other coat color patterns were mixed black and white for Sukuma, reddish-brown for Lindi, black and reddish-brown for Ujiji, and white and reddish-brown for Pwani and Maasai. High within population variation is observed which is important as it can be used as a basis for genetic improvement through selection. Tanzania has a goat population of 24.8 million NBS  most of Efforts to improve goat production and productivity in the country have been made using three approaches  and who spoke Swahili  and where necessary the questions were translated to the language of the respondents. Information on household socioeconomic characteristics, socio-cultural importance of goats, management practices, breeding system, unique adaptive character, goat feeding and watering, production constraints, and other related issues were collected using semi-structured questionnaires. Secondary information such as temperature, precipitation, agroecology, and livestock and livestock population demography of the study areas was accessed from district and ward extension offices from published and unpublished secondary data sources.n = 73), Lindi (n = 54), Maasai (n = 82), Newala (n = 54), Pare (68), Pwani (55), Fipa (54), Songwe (54), Sukuma (69), Tanga (54), and Ujiji (71). To avoid the genetic similarity of goats, up to 3 animals per household (based on the number of goats) were used for both qualitative and quantitative trait recording. For each goat, five quantitative traits were measured, i.e., body weight (BW), chest girth (CG), height at wither (HW), body length (BL), and rump height (RH). Body weight in kg was measured using a Salter hanging spring-type scale . The linear measurements were taken using a measuring tape  after making the animal stand squarely on even ground and recorded in centimeters. Qualitative traits such as coat color pattern, coat color type, horn presence, horn shape, horn orientation, ear orientation, facial (head) profile, wattles presence, and beard presence were recorded.Based on breed morphological characteristics descriptor list of FAO  for morpQuantitative data were analyzed using Statistical Analysis System Version 9.2 SAS , whereasThe following fixed-effect models were used to analyze morphological body measurements.where.Yij = observed quantitative measurement of trait of interest.μ = population mean.Bi = ith goat population effect .εij = random error associated with quantitative body measurements .The quantitative variables were subjected to discriminant (DISCRIM) and canonical discriminant analysis (CANDISC) procedure of SAS to ascertain the existence of population-level phenotypic differences among the goat populations. Multivariate discriminant analysis was conducted using quantitative traits to determine the percentage assignment of each individual to their respective populations, to distinguish significant discriminating power of different traits and to obtain distances between populations. Hierarchical cluster analysis was performed using quantitative variables, and dendrogram was constructed based on Euclidean distance between goat populations using unweighted pair-group method to group the goat populations into their morphological similarity.Analysis of multiple response questions on the purpose of keeping goats is presented in Table Information was sought on different aspects of management of their animals such as feed resources and feeding practices, sources of water, and housing Table . Kraal oAcross all the study areas, the most prevalent diseases Table  were gasAnalysis of multiple response questions on the constraints to goat production by goat keepers in all areas is presented in Fig. The percentages of occurrence of qualitative traits of indigenous goats of Tanzania are presented in Table p < 0.05) the heaviest weighing above 32 kg and Sukuma goats the lowest weighing 24 kg, while other goat populations fell in between. Similarly, for other body dimensions, Songwe goats occupied the first position in body weight profile, while Sukuma occupied the lowest in all traits except for HW and HR in which Ujiji goats had the lowest value (Fig. Results for body measurements of the different goat populations are presented in Table The hierarchical cluster analysis generated a phylogenetic tree Fig.  that cluThe Mahalanobis distances between the pairs of goat populations are presented in Table Incidence of multiple births and average number of kids at kidding which were the two parameters used to assess the reproductive performance of the goats is reported in Fig. This study is the first attempt to characterize the Tanzanian indigenous goats sampled from all major agro-ecological zones where they are raised and therefore representing all the presumed goat populations in the country. Previous efforts to characterize the indigenous goats in Tanzania have been concentrating on few populations or agro-ecological zones. For a sustainable breeding program, knowledge on purpose of keeping goats is essential (Van Arendonk Management aspects including feeding, watering, and housing are determined by the production system which is influenced by the agro-ecological conditions of the particular area. Majority of the indigenous goats in Tanzania are raised under traditional extensive production system which is characterized by seasonal shortage of feeds and water. Additionally, majority of indigenous goat keepers are resource poor farmers who reside in marginal rural areas with limited supply of inputs where indigenous animals are adapted and therefore predominant. Under such production conditions, only the observed management practices of free grazing with minimal supplementation using locally available feed resources would be feasible. The findings in this study are consistent with study by Chenyambuga and Lekule  who repoIt can be noted that in areas like Mtwara, Pwani, Tanga, Rukwa, and Songwe where mixed crop livestock is the dominant production system, the proportion of farmers who practiced tethering along with free grazing was relatively higher. This was due to shortage of grazing lands especially during wet season when most of the land is taken for growing crops leaving no or little land available for heading and free grazing. Also, it is common during the rainy season for most of the family members to be working on their farm plots and therefore farmers with few animals tether their animals close to their farm plots or their homesteads or leave them indoors and bring them feed when returning from field work.The observed housing systems across the study areas do not offer protection of animals against predation, theft, and weather extremes which could lead to low productivity of the animals. Poor housing of animals has been observed in many smallholder systems in the tropics (Gwaze et al, Controlled mating is one of the best livestock breeding management practice for improvement of animal productivity to be achieved. Controlled mating is important for genetic improvement as it enables farmers to avoid indiscriminate crossbreeding and inbreeding. Also controlled mating enables farmers to plan for their animals to kid at a time when there is sufficient amount of feeds typically after the rain season. Low level of mating control is caused by several factors including poor land tenure system in which individual land ownership is not encouraged and communal grazing and sharing of watering points is common, typical of extensive production system which is the most predominant in Tanzania. Castration, though not very common in most parts, was the most widely used method among the farmers who reported to practice controlled mating. Apart from controlled mating, improving the quality of meat through fattening and reducing bad smell from bucks to get better price in markets were another motivation for castration. Separation of bucks could work better in controlling mating, but under small-scale farming systems, this could be hard and expensive to have few separate groups of bucks. Considering the low practice of castration and culling against old animals especially bucks, the use of breeding bucks from within the flock as observed among the interviewed farmers represents a high risk of inbreeding of which they were probably not aware.In order to develop sustainable strategies for control of small ruminant diseases, there is a need to determine the most important diseases affecting the animals in different areas (Shija et al Goat production in communal areas is faced with many constraints which may differ with areas, countries, regions, or geographical locations Kosgey . The majDescription of the animal phenotypic features in terms of body measurements is important in making taxonomic, behavioral, and ecological comparisons within and between animal populations and explaining intraspecific variation in morphology over broad environmental gradients (Mittelbach et al., Variations observed in body weight and body dimension among the indigenous goat populations may be due to isolation-by-distance, historical and geological factors, physical barriers, and ecological factors through morphological adaptation to local conditions (Mekuriaw et al., Significant variations were observed in terms of qualitative traits of the goats across the study areas. In the present study, the common colors were plain white, black, and reddish brown and mixture of black and white, black and reddish brown, white and reddish brown and black, and white and reddish brown. The findings are consistent with observations of Mason and Maule , who repHigh percentages of correctly assigned individuals for Ujiji, Tanga, and Newala goats are an indication of more uniformity and homogeneity of these populations which might have been caused by reproductive isolation and good production conditions. Ujiji goats are found in Kigoma region which is located in the north-western part of the country bordering DRC and historically has not experienced as much interaction with pastoralists from other regions compared with many other parts of the country due to its peripheral location. Similarly, Newala goats native to Mtwara region are located in the southern-eastern border with Mozambique which until recently had limited movement of pastoralists from other parts of the country into the region due to prevalence of cattle trypanosomosis. Tanga goats from Tanga region found in the Eastern part of the country close to the Indian Ocean has sub-humid weather and with good rainfall which affect the quality and quantity of pasture forage.On the contrary, the low classification rate of Gogo, Maasai, Pwani, and Fipa goats indicates the heterogeneity of the population due to intermixing with different populations because of geographical closeness and interactions between goat keepers or similarity of production conditions. Consistent with the discriminant analysis, canonical discriminant analysis revealed that inter-population distance was small and insignificant for most of the pairs of goat populations reflecting their geographical distance and possibility of intermixing due to pastoral migrations. Even where the goat populations are not geographically close, like the case of Maasai and Fipa, the populations might be in the same “migration route” which bring the animals in contact. Pastoral and agro-pastoral communities like Sukuma, Maasai, Barabaig, Kurya, and Taturu were reported to be migrating with livestock in different parts of the country (Tenga et al, Animals producing twins or triplet contribute more than 1.5 times towards meat production than the animals producing single offspring at birth Khosa, . TwinninGenerally, the indigenous goats in Tanzania are heterogeneous and have very small between population variations and large within population variations. The 11 goat populations can be clustered into two major groups based on body weight and body dimensions with Ujiji and Sukuma occupying one cluster and other cluster comprising of all other populations with minor clusters between them. Notable distinction has been observed in terms of twinning with Ujiji and Lindi goats showing high ability. The large variation observed especially within populations, with regard to body weight and body dimension, and between populations with regard to reproductive performance, is important as it can be used as a basis for genetic improvement through selection and/or crossbreeding.


Osteoarthritis (OA) is the most common form of arthritis in adults that affects more than 500 million people globally . The burThere are no disease-modifying OA drugs (DMOADs) approved for the treatment of OA that can arrest, slow, or reverse the progression of structural damage of the joint . Over thThe US Food and Drug Administration (FDA)–National Institutes of Health (NIH) defines biomarker as a defined characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or biological responses to an exposure or intervention, including therapeutic interventions. Biomarkers may include molecular , histologic, radiographic, or physiologic characteristics .Categories of biomarkers include:Susceptibility/risk biomarker;Diagnostic biomarker;Monitoring biomarker;Prognostic biomarker;Predictive biomarker;Pharmacodynamic/response biomarker;Safety biomarker.Over the last decade and a half, advances have been made in the evaluation and qualification of OA-specific biomarkers . As a reThere have been tremendous advances in research on various biomarkers, including imaging, biochemical, and molecular biomarkers, as potential markers to predict the incidence and progression of OA . The proRadiographically (X-ray) defined Joint Space Narrowing (JSN) is currently the only recommended imaging endpoint by both the US FDA and European Agency for the Evaluation of Medicinal Products (EMEA) guidance documents for clinical trials of DMOADs . HoweverThe biochemical molecules present in urine, synovial fluid, and blood as a result of the pathophysiological process indicate dynamic and measurable changes in the joint tissues reflecting joint remodelling and disease progression . Unlike Curcuma longa extract in knee OA patients with ultrasonography-defined effusion–synovitis , and the ZAP2 trial assessed the effects of intravenous zoledronic acid in knee OA patients with subchondral bone marrow lesions (BML) detected by MRI  [Biomarkers are now increasingly used to characterize and subgroup (endotypes and phenotypes) patients with OA according to the BIPEDS classification. However, the results from these studies are not consistent in showing a sensitive marker that can predict joint pain, symptomatic OA, radiographic OA, or total joint replacement. However, clinical research in OA is focusing on exploring a personalized medicine approach using biomarkers—matching the right treatment with the right patient—to find an optimal management strategy to improve joint pain and change the disease trajectory . Consideenotype) ,30. Simienotype) .In addition to the use as an outcome measure in clinical trials and as a measure to phenotype OA, biomarkers are essential as an outcome measure in population-based epidemiological studies . Further


Airborne particulate matter (PM) pollution, as a leading environmental health risk, causes millions of premature deaths globally every year. Lower respiratory infection (LRI) is a sensitive response to short-term exposure to outdoor PM pollution. The airborne transmission of etiological agents of LRI, as an important pathway for infection and morbidity, bridges the public health issues of air quality and pathogen infectivity, virulence, resistance, and others. Enormous efforts are underway to identify common pathogens and substances that are etiological agents for LRI and to understand the underlying toxicological and clinical basis of health effects by identifying mechanistic pathways. Seasonal variations and geographical disparities in the survival and infectivity of LRI pathogens are unsolved mysteries. Weather conditions in geographical areas may have a key effect, but also potentially connect LRI with short-term increases in ambient air PM pollution. Statistical associations show that short-term elevations in fine and coarse PM lead to increases in respiratory infections, but the causative agents could be chemical or microbiological and be present individually or in mixtures, and the interactions between chemical and microbiological agents remain undefined. Further investigations on high-resolution monitoring of airborne pathogens in relation to PM pollution for an integrated exposure–response assessment and mechanistic study are warranted. Improving our understanding of the spatiotemporal features of pathogenic bioaerosols and air pollutants and translating scientific evidence into effective policies is vital to reducing the health risks and devastating death toll from PM pollution. More than 90% of the world’s population now live in areas that exceed the WHO’s Air Quality Guideline. According to recent estimates by the WHO, air PM pollution, as a leading environmental health risk, causes 4.2 million premature deaths globally every year  and fine particulate matter   includes infections of the lungs and alveoli (pneumonia) and the airways (bronchitis and bronchiolitis) Fig. , which a By what mechanisms do the causative agents of LRI work to pose a risk to the public? How do seasonal/weather influences shape the spatiotemporal features of LRI? Do the connection and interplay between chemical and microbiological agents in PMs lead to an increase in LRI?Despite the scattered understanding of air pollution, pathogenic bioaerosols, and lower respiratory infection in different disciplines, critical barriers are yet to be broken at the biogeochemistry–health interface geochemistry. With the above critical barriers in mind, we aim to provide holistic perspectives on the research needs to disentangle the interplay between airborne PM pollution, pathogenic bioaerosols, and LRI.Streptococcus pneumoniae. Atypical pneumoniae are caused by such agents as Haemophilus influenzae, Legionella pneumophila, Moraxella catarrhalis, Mycobacterium tuberculosis, Mycoplasma pneumoniae, etc. Fungi, such as Aspergillus sp. and Blastomyces sp., are less common causes but important in immunocompromised people. Out of concern for critical public health issues, studies on the bacterial and fungal agents of LRI are being devoted not only to determining causative pathogen phenotypes, but are also focusing on the important aspects of virulence and resistance. For instance, studies have recently demonstrated that ambient PM2.5 serves as a pathway for the transmission of antibiotic resistance genes  and other microbial allergens and pathogens in respirable ambient PM during the well-known winter haze events in Beijing , they form complex mixtures of PM and have a profound impact on human health. In contrast to extensive physicochemical characterizations, the understanding of the microbiological dimension of such inhalable cocktails is still in its infancy  by direct contact with infected individuals; (2) by contact with contaminated objects ; and (3) by inhalation of pathogen-laden droplets of various sizes. The contribution of each mode to the overall transmission of pathogens is not clearly known. Respiratory transmission depends upon the origin of droplets and airborne infections. Speaking and normal breathing all produce droplets of airborne microorganisms, while coughing and sneezing lead to the more forceful expulsion of greater amounts of infectious particles. While coughing may produce several hundred particles, a sneeze can generate up to 40,000 droplets of respirable size, ranging between 0.5 and 12 μm in diameter  has been reported to be greatest at high levels of relative humidity, but airborne gram-negative bacteria  are reported to not survive well at increased levels of relative humidity, while some airborne gram-positive bacteria ) survive poorly at intermediate levels of relative humidity. Seasonal variations in airborne fungal and spore concentrations associated with common environmental settings, including ambient temperature, relative humidity, precipitation, and wind speed, have also been suggested in many studies  are distinguished from bacteria (between 1 and 10 µm) in size distribution, the geographically disparate abundance of antibiotic resistance genes in these fractions would result in geographical differences in inhalation and deposition in human lungs  and mixture-toxicity experiments and modeling also found that transition metals  and PAHs  accounted for up to 40% of the oxidative stress in the human lung cells exposed to PMIn addition to PM chemical–microbial compositions and toxicity, combined field and laboratory studies of the transmission of respiratory viruses in the community to resolve influenza transmission mechanisms, including at the animal–human interface, have been designed and implemented. For example, a transmission chamber that separates virus-laden particles in the air by size has been established to study airborne particles that mediate influenza transmission in ferrets  to the current situation , the association between LRI and PM appears to persist. Globally, the elevated hazard ratio of LRI in response to PMThe seasonal dynamics of airborne pathogens associated with geographical-specific PM profiles taking climatic features and pollution gradients into consideration, remain largely unknown. This knowledge is a pre-requisite for the mapping of exposures to airborne pathogens in relation to air PM pollution for an integrated exposure–response and public health assessment. Understanding such mechanisms requires a seamless connection between the source–pathway–receptor continuum at the environmental end and the hazard–exposure–disease continuum at the health end  on the abundance of active pathogens and the combined effects of the chemical and microbiological agents.Recent decades have seen the development of state-of-the-art technologies in biogeochemistry and bioinformatics. These robust analytical tools, e.g., next-generation sequencing  (Behjati & Tarpey, The prior research spans the environmental, epidemiological, and medical aspects of the infection–pathogen–pollution link, which has prompted us to cross research fields in search of answers to the more crystallized scientific question: whether ambient respirable particles in certain environmental settings at peak seasons contain high enough concentrations of active LRI pathogens, and hence enhance the mechanistic link between LRI encounters and air PM pollution? Current research strengths call for an interdisciplinary research work to achieve a more comprehensive understanding of the environmental aspects of the LRI causative pathogens that connect the ambient air environment and human exposure events prior to the development of disease. Therefore, the environmental aspects of respiratory pathogens should be integrated into the complex link between respiratory infectious diseases and ambient PM pollution, so that the appropriate control measures can be formulated to best ensure the health of the public.


Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD. I live with pain every day, if I don't take those pills every day my arm goes numb, gets useless.” and “I found out about 35 years ago that I had diabetes. I've lost a lot of my eyesight, I developed cataracts from the diabetes. I'm in the last stages of kidney disease.” These stories motivate our goals of health promotion for and with current and future generations of AI people.Type 2 diabetes (T2D) represents a critical health inequity in many American Indian (AI) communities where rates are more than double the overall US population , includiDoubly motivating are the roots of injustice underlying the T2D epidemic. Stress has been considered an etiological agent of T2D for centuries  and compThere is thus a critical need to address the fundamental causes , 17 of aOur community/university team has worked to create, enhance, and evaluate a multi-generational preventive intervention for AI families within diverse tribal communities called Together on Diabetes and later Together Overcoming Diabetes (TOD). Our approach emphasizes lessons learned in prior T2D prevention and treatment programs and expands the approach to include family-centered, home-based holistic health promotion, community-specific targets for health promotion and risk, and addressing common barriers to care. A major tenet of the development, piloting, and ongoing trials for TOD is that Indigenous community perspectives and co-creation of preventive interventions are necessary for program effectiveness, acceptability, and sustainability. Indeed, authentic community engagement through orientations such as community-based participatory research (CBPR) are essential for ethically addressing health priorities within any community; such approaches also align with the sovereign right of Tribal Nations to govern and oversee any research that takes place within its territories .process and content of TOD curriculum creation and evaluation.Another tenet of our approach is that Indigenous Peoples have long centered cultural ways and the reclamation of traditional values and teachings as critical components of health promotion , 25. YetAs noted, our team's approach to public health intervention development and evaluation is rooted in community-researcher relationships and collaboration. Stage 1) involves an invitation from a community to address an issue of concern. Stage 2 prioritizes the identification of community and/or culturally relevant risk/protective factors related to the health outcome and/or formative work to identify issues relevant to the feasibility and/or acceptability of a proposed intervention. This is often accomplished through “basic” (vs. applied) or formative research techniques. Stage 3 considers a range of possibilities for intervention development or adaptation such as those outlined by Okamoto et al. , including T2D.In 1980, a Johns Hopkins pediatrician, Dr. Mathuram Santosham, began work with the White Mountain Apache Tribe (WMAT) to address an outbreak of diarrheal disease in babies. Following this, he moved his family to the Fort Apache reservation where he lived and worked for over 5 years. Here, he worked with WMAT and later, the Navajo Nation to identify and address disparities in infectious disease among Native children. In 1991, he founded the Johns Hopkins University (JHU) Center for American Indian Health (CAIH) with a mission to In the late 2000s, Navajo and Apache communities identified T2D as an urgent issue and began to work with CAIH to identify strategies to address this concern. In Fall of 2011, CAIH researchers applied for and received funding to develop, implement and evaluate a program to address T2D with 1 Apache and 3 Navajo communities. The funding was flexible, providing the team the opportunity to adapt existing or develop new intervention content and structure, determine the target population for the intervention, and identify the most appropriate study design.The TOD_SW team initially included an On-site Manager at the Albuquerque Hub of CAIH; local study teams comprised of 3–4 local Native staff at each of the 4 communities; Community Advisory Boards (CAB) from the 4 participating communities; a Cross Site Steering Committee (CSSC); and a Curriculum Specialist, Evaluator, Program Manager, and PI based in CAIH administrative offices in Baltimore, MD. We also consulted with a Harvard-based pediatrician with nutrition expertise, a diabetes expert from Indian Health Services (IHS) and various other experts across the partnering communities and the US. CABs at each site were created to guide program development and implementation. Each CAB consisted of 8–12 members and included health educators, teachers, law enforcement representatives, medical providers, behavioral health specialists, traditional practitioners/elders, parents, youth and community members from the study sites. The CSSC was comprised of pediatricians, nurse practitioners, diabetes consultants and educators, mental health providers, IHS clinic leaders, community-based program leads, diabetes focused program leads, cultural consultants, a traditional practitioner, elders, wellness center coordinators, and CAIH study staff from the four study sites. Many CSSC members also joined their local CABs. All study staff who worked on the TOD_SW study were hired as full-time employees of JHU. All community staff were Native; most were from the community in which they worked.Initial TOD_SW formative work took place over a period of 9 months, during which we aimed to build a culturally appropriate program that fit the unique needs of the four communities and adequately addressed existing gaps in T2D prevention and management. The CSSC met four times in the first 6 months of the project (2012) and annually thereafter; meetings were held in person, began with a prayer followed by lunch and a sharing of knowledge. Meetings ended with a closing prayer. At the first meeting included presentation from site representatives that include information about: (1) T2D prevalence and incidence data from their site/service unit, (2) T2D programming in their community, (3) perceived gaps and opportunities in T2D prevention, management and treatment, and (4) perceived diabetes risk and protective factors; the urgent need for programming for youth with diabetes or pre-diabetes emerged as a need across sites. Additional gaps included those at the service level  and at the program/community level . Identified opportunities included enthusiasm of local partners, robust network of diabetes programming for adults, and traditional Native medicine programs at many of the participating sites.Respect: CAB meetings ensured TOD was designed and implemented with respect for Navajo/Apache culture and communities. Responsibility: a wide range of community members were engaged consistently in order to develop and sustain meaningful relationships and foster a shared responsibility/commitment toward community wellness. Further, the impact of the TOD program was discussed at final CAB meetings. Relevance: CABs provided information about changing needs of the community and identified potential activities that could be implemented at community level. Reciprocity: CAB meetings engaged Native and non-Native community members and had a primary goal of shared learning. Resources exchanged at these meetings were also mutually beneficial. Community partners helped each other because we all had a shared goal of community wellness.CABs met quarterly throughout the duration of the study. CAB meetings incorporated the Indigenous holistic framework  as folloEarly in the study the CSSC proposed roundtables with youth and parents in the four communities to better understand how to address T2D through team-identified gaps and opportunities. Roundtable guides were developed with CABs and Baltimore team members. The guides focused on healthy and unhealthy behaviors and knowledge and attitudes about physical, mental, spiritual and emotional health. Participating youth were also asked about their role models and who/what influences their behaviors. A total of 12 roundtables were completed with youth ages 10–19 years and nine with adult parents. Roundtables were facilitated by trained Navajo or Apache study staff who took notes which were reviewed and compiled to inform TOD. Roundtables were not recorded. Key takeaways were: (1) youth did not think holistically about the food they ate, (2) parents wanted to be involved in programming, as they had limited knowledge of healthy eating/exercise and wanted to support their children's lifestyle changes, (3) there were few activities available for families, and (4) youth needed additional support related to life skills . A theme across roundtables was that parents play a key role in youth diets, physical activity, and mental health. Thus, TOD would be delivered to youth alongside their parents or trusted adults, named “Support Persons (SPs),” with a family/multi-generational, holistic health emphasis. A family focus also aligns with Navajo and Apache cultural norms, which are common across many Indigenous groups –37.Diabetes Prevention Program (DPP) which has a rich evidence base for reducing incidence of diabetes among at-risk adults  Che parents , was und parents . UltimatInformation from the CSSCs, CABs, and roundtables was coupled with knowledge from local study staff and scientific experts in order for a Curriculum Specialist and Study Manager (Curriculum Team) to draft a basic outline of 12 intervention lessons. The outline was reviewed and revised with CSSC members, the CAB, local staff, and content experts . Feedback was minimal and included specific suggestions for incorporating local knowledge. The Curriculum Team then created first lesson drafts by reviewing activities/content in programs described in Stage 2 for possible integration or adaption into TOD, and adding original content for topics that addressed community needs and assets. Content was also informed by findings in the scientific literature. The Curriculum Team reviewed draft lessons with the local study team. In some instances, the local team was asked to come up with additional ideas for lesson activities, which were incorporated into next drafts. These lessons were then reviewed by CAB and CSSC members; using their feedback, the Curriculum Team revised drafts and finalized/refined content in collaboration with local study team and/or CAB members and/or content experts . It was determined that cultural elements that were not appropriate to be incorporated into the curriculum would be delivered orally by family health coaches during lessons. Penultimate drafts were reviewed and feedback collected from in-person CAB meetings, the CSSC, and local study staff prior to finalization.The resulting TOD_SW program curriculum is summarized in The program addressed multiple levels of influence  using: (1) youth curriculum (details below); (2) support person curriculum , (3) engagement with local healthcare providers , (4) community connections and events , and (5) optional social support visits from FHCs. The youth curriculum included an intervention phase and a maintenance phase. The intervention phase included 12 lessons, each lasting about 45–60 min, delivered biweekly during the first 6-months of enrollment. All lessons were delivered in the home to the youth, and support persons were encouraged to attend. The 12 intervention lessons focused on balance and moderation and provided enrolled youth with knowledge and skills regarding nutrition, physical activity, diabetes, and life skills such as positive thinking, problem solving, support networks and communication. All lessons included the incorporation of Motivational Interviewing to help youth make and reach realistic healthy living goals based on information youth had learned, and a check in time to follow up on previous goals . Lesson Many of the community-driven targets within TOD curriculum are paralleled by existing or emerging scientific evidence. For example, TOD emphasizes balance and holistic wellness. This includes balancing energy in (food) with energy out , overall wellness across physical, spiritual, emotional and mental health. Holistic health considerations are also critical to T2D outcomes. For example, those living with T2D are more likely than people without diabetes to experience depression, which in turn is associated with a variety of consequences such as increased rates of hospitalization and health care spending, activity impairment, comorbidities, and heightened mortality –47. SimiAs noted previously, the home-based, family-focused nature of TOD recognizes the centrality of family in many AI communities. Home-based delivery also addresses community-cited transportation issues that diminish access to care. For example, prior research shows that AIs report transportation barriers to healthcare twice as often as Whites (39% vs. 18%) and transportation was a contributor to intervention dropout in the AI DPP , 50. OurPast research suggests that cultural and communication differences between AI patients and non-AI providers may compromise T2D care, and AI adults have reported feeling inadequately supported in T2D management –55. LossImplementation and evaluation of TOD included hiring and training FHCs to deliver the curriculum and conduct evaluation work. Training focused on curriculum delivery, study protocols, and special topics (often hosted by Native organizations), including motivational interviewing, facilitation skills, cultural teachings, diabetes knowledge, and Native nutrition. Follow-up trainings were conducted based on needs of FHCs identified through feedback on anonymous surveys and through regular check-in calls with all study team members.The CSSC and Baltimore-based team members collaborated to identify TOD_SW evaluation methods. Because there were no other services or programs for youth with T2D and because TOD was a new program, we felt it was unethical and premature to conduct a randomized controlled trial to assess program efficacy. Thus, we designed a pilot pre/post evaluation study to assess program impact and acceptability.Evaluation outcomes were selected by reviewing scientific literature and measures previously used in CAIH behavioral intervention studies, from which we created a matrix of potential measures  to guide discussion at CAB and CSSC meetings. Community-based team members suggested inclusion of resiliency and medical home measures. We piloted measures with ~20 youth and their caregivers. Based on feedback, we made edits to the language of existing measures to improve face validity and comprehension , 57.N = 256 youth ages 10–19 years and N = 226 adult support persons enrolled in the study. Baseline data was collected from all youth enrollees. A total of 217 (84.8%) youth completed the 12-month evaluation. Youth completed an average of 9.35 lessons, with 73.4% of youth completing >8 lessons. A total of 21 FHCs across the four tribal community sites delivered 3,118 lessons and 1,149 evaluations during the project period. Sites also hosted regular community-based wellness activities . Over 30 outreach activities and 10 diabetes support services were conducted at community sites during the project period.A total of Throughout implementation, the Baltimore and Albuquerque teams met weekly with each site team to discuss case load, identify barriers to implementation and generally talk through what was and was not working in relation to the TOD program. The Baltimore and Albuquerque teams also led a cross-site teleconference meeting with all four sites once a month. This meeting was a time for sites to share successes and challenges. During these calls, we identified and made minor edits to the curriculum  and to the evaluation outcomes  .n = 35) experienced a significant decline in BMI , is currently being implemented. The TOD program has also been implemented in Native communities in California. This stage also interacts with Stage 5  as we implement the TOD program in the Great Lakes region.The foundational work of the TOD_SW team resulted in a promising multigenerational home-based diabetes preventive intervention developed by and for Indigenous Peoples. Below, we describe a next-generation iteration of TOD development and evaluation using In June 2019, a team of Ojibwe community and JHU-based researchers working in the midwestern US received funding to adapt, implement, and evaluate the TOD program through a wait-list RCT (TOD_GL). The team had already completed two observational studies focused on Ojibwe experiences with a) mental health and diabetes (Mino Giizhigad study), and b) stress and diabetes ; additional background information for these studies has been published previously , 61. In Community Research Council was adopted to replace Advisory Boards to acknowledge the substantial and active contributions of the CRCs in the project that goes far beyond advising. CRCs include representatives from participating communities who have diabetes or have family members with diabetes, work at local clinics, and/or are Elders, nurses, diabetes educators, fitness coaches, and representatives of tribal governments.The TOD_GL team includes JHU researchers at the CAIH Great Lakes Hub offices in Minnesota and Community Research Councils (CRCs) from five participating Ojibwe reservation communities. Each CRC is comprised of four to eight individuals who act as equal partners with academic researchers in every stage of program adaption, implementation, and evaluation . The terThe GL team's prior research on mental health, stress, and T2D generated foundational basic/observational knowledge that informed TOD adaptation processes. In particular, our team generated scientific evidence that aligned with stress process models of disease , 64 to sAdditional formative work for the GL team included CRC-led community feasts and forums, listening sessions, brief surveys, and group discussions at all 5 tribal sites prior to applying for funding for the TOD_GL trial. These activities generated preliminary community-based data to suggest that residents across the five tribes were interested in the content of the program, found it matched gaps in terms of their needs/their community needs, and that they gave high rankings of perceived effectiveness and willingness to participate in the program.Together Overcoming Diabetes in English. The resulting TOD_GL intervention includes 14 core lessons, six maintenance lessons, and four optional social support visits. Following TOD_SW, the intervention is delivered to adult-youth dyads in their homes by local FHCs. The TOD_GL curriculum is rooted in the lessons, structure, and foundational successes of TOD_SW. The process of adapting curriculum was iterative and centered Ojibwe community and cultural perspectives in alignment with Okomoto et al.'s  descriptThe process of adapting and refining TOD_GL curriculum involved deep reviews and demonstrations of draft lessons by/with community/university teams, advisement by elders, and reviews and consultations with outside experts and medical clinic staff in each community. This process varied based on the objectives of specific lessons. For example, lessons 1 and 2 focus on understanding the biomedical mechanisms of diabetes and its management and thus were shared with local clinic staff early in our adaptation process. Staff reviewers included diabetes educators, nurses, administrators, physicians, and fitness coaches who gave us feedback on the medical accuracy and alignment of lessons with local clinical protocols. As another example, five nutrition lessons were reviewed by CRCs during a full day in-person meeting. Team members reviewed each lesson in small groups and provided feedback on necessary cultural adaptions and general improvements. Refinements included further integration of traditional Ojibwe foods and processing techniques, inclusion of the role and importance of traditional foods in Ojibwe spiritual and social traditions, and strengthening the focus on the interconnectedness of people with nature .A respected Ojibwe Elder Lee Obizaan Staples provided Ojibwemowin (Ojibwe language) words and phrases relevant to each lesson and cultural teachings on topics such as traditional cultural practices, dealing with stress, and taking care of oneself. The critical need for Ojibwemowin throughout the curriculum has been reinforced by FHCs, who set aside weekly meeting time for language lessons and practice time. The TOD_GL team also included and cited a variety of regionally relevant content from published and online materials from Indigenous-serving organizations, activists, chefs, and authors. All curricular revisions were facilitated by a project coordinator and drafted in collaboration with the JHU Curriculum Team, most of whom had worked on TOD_SW. University and community members reviewed and provided input on all lessons after adaptations and revisions were completed prior to pilot sessions.N = 15 participants). Pilot families included one adult and at least one youth aged 10–16 years. All pilots were conducted in late 2020 and facilitated virtually to align with COVID-19 safety protocols put in place by JHU and tribal agencies. Pilots lasted between 30 and 90 min and involved a JHU team member completing a verbal consent process before guiding participants through 1–2 individual lessons. After completion of the lesson, JHU staff asked families a series of questions soliciting feedback on sections that were confusing, hard to follow, whether or not cultural teachings or language flowed or was appropriate to the lesson, if anything important was missing. Families received a $50 gift card for participating in pilot sessions.Our focus at Stage 4 was to ensure basic acceptability and comprehension of the revised TOD curriculum. All lessons were piloted with Indigenous families from each of the participating communities  with a randomized block design by reservation community to evaluate program effectiveness. We chose a wait-list design (as opposed to a classic RCT where the control group foregoes treatment) in alignment with cultural and community goals of sharing, inclusion, and equitable distribution of benefits. Primary and secondary outcomes for the trial are HbA1c and lipids (adult participants); and BMI/zBMI, depressive symptoms, physical activity, nutrition, and coping resources and responses  (adult and youth participants). We anticipate families will continue enrolling in the trial through summer, 2022, and we will gather evaluation data at baseline, 3, 6, 12, 18, and 24-month intervals. In addition, we plan to complete a participatory evaluation activity called ripple effects mapping with families and community members across sites twice throughout the duration of the study.A mission of the CAIH and a goal of our teams is to partner with Indigenous communities to improve health and well-being. As such, we are strategic about prioritizing dissemination of eventual findings and lessons learned along the way using techniques that move beyond conventional academic publications. In addition to empirical manuscripts, our team produces and presents Technical Reports to partnering Tribal Governing Boards/Councils and reservation-based health and human service workers and grant writers. We create public webpages, use social media, and have a project YouTube channel to share information about the project and eventual results. If TOD is found effective through this research, our CBPR design will expedite program uptake and integration with existing services within communities and our attention to dissemination possibilities will promote sharing with other Tribal and Urban Indian groups and organizations.The TOD_GL team is following the lead of the SW experience: curriculum refinement continues as FHCs provide feedback on lessons “live,” as they are learned and rolled out within their own communities. For example, Lesson 13 is being adapted to provide more content for those who get their groceries via food assistance programs. FHCs recognized that the current version of the lesson was geared toward those who were able to shop for their groceries and therefore have control over what foods are available in their homes. In addition, the curricular adaptations made for TOD_GL have been shared back to SW teams, who in turn are working to implement these changes within their own communities.The TOD program has been developed, evaluated, and iteratively refined across multiple Tribal communities over the span of a decade. While we have taken distinctive paths through the stages of intervention development and evaluation displayed in The need for such flexibility is of course made more challenging in the context of sponsor/funder, institutional, and local pressures to address urgent issues within what can sometimes be stringent milestone metrics and budget constraints. As others have argued, there is need for expansion of markers of “success” in health equity research to include partnership synergy, infrastructure development, resource sharing, and sustainability efforts via flexible timelines and funding structures , 68. FurThere are also distinctions between the two iterations of TOD worthy of attention. While Stage 7 is important for flexibility and applicability of the program over time and across groups, this can also make comparability across distinct iterations of a curriculum difficult. For instance, we do not know if the addition of content around historical trauma, stress, and coping in TOD_GL will activate unique mechanisms for health promotion or change compared to the SW iteration. In addition, the complexities navigating five distinct clinical systems, dozens of diabetes healthcare providers, and practical constraints of COVID-19 mean that TOD_GL FHCs are not as connected to local healthcare providers or systems as was done in the SW. Despite these differences, both iterations of the program share a similar structure and target common “active ingredients” for health improvement . Furthermore, our stage-based process of program development and implementation is potentially useful across community contexts, including in non-Indigenous communities.A number of questions and areas for future exploration remain. We found that 62% of TOD_SW lessons were attended by at least one family member in the household who was not officially enrolled in the study. This finding suggests to us that inclusion beyond target dyads may allow for more deliberate family systems changes. Additional studies are needed to better understand the role of the family and extended family engagement on the efficacy of TOD. Sustainability of the program within Tribal or urban Indian or non-Native community settings beyond grant funding periods is not fully determined . Perhaps most importantly, major efficacy questions remain to be answered with regards to the impact of TOD on diabetes outcomes for Native families. Some of these questions can be empirically answered in planned and ongoing trials.We also recognize the need for humility in our work. TOD as a single program does little to address structural or environmental determinants of health, many of which are rooted in historically anchored traumas and policies that translate into tangible issues in modern times . As one The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.MW created an initial model and outline for this manuscript and led a collaborative writing process. RC drafted significant sections of the manuscript and helped with final edits. All remaining authors contributed equally to the work by assisting with literature reviews, writing sections of the manuscript, and providing comments on final drafts.Research reported in this article was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (DK091250), the Shakopee Mdewakanton Sioux Community, and by the Bristol Meyers Squibb Foundation.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Reproduction in canids has been characterized by having some peculiar aspects, such as the extended reproductive cycle and ovulation of immature oocytes. However, progress toward the understanding of mechanisms underlying these unique features has been very slow, which, in turn, limits our ability to control or enhance reproduction and to develop clinical tools to diagnose reproductive disorders. The Special Issue assembles research and review articles focusing on various aspects of canine reproduction, including reproductive diversity, semiochemical communication, mechanisms regulating oocyte maturation, germ cell development, reproductive disorders, pregnancy, and influence of anesthetic drugs on ovarian blood flow.(i). Reproductive diversity: The canine family comprises a wide variety of species, some of which are listed as endangered by the International Union for Conservation of Nature. Reproduction is fundamental in animal conservation programs, and in this regard, the knowledge of different reproductive characteristics is fundamental to apply the various strategies to ensure the genetic and demographic sustainability of a population . A revie(ii). Semiochemical communication: Similar to other species, male canids distinguish the reproductive status of conspecific females based on odor . A study(iii). In vitro oocyte maturation: One of the most intriguing characteristics of canine reproduction is the ovulation of immature oocytes that require an additional 48–72 h within the oviduct to acquire fertilizing and developmental abilities . To date(iv). Germ cell development: Primordial germ cells are specialized cells that give rise to gametes (sperm and eggs). A review paper presented in this Special Issue summarizes the latest findings on germ cell development, the methods available for obtaining germ cells in vitro, and their potential applications in canid species. (v). Reproductive disorders: New advances in disorders associated with reproduction were addressed in this Special Issue. Canine Brucellosis is a worldwide zoonosis, causing reproductive failures such as infertility and stillbirths . The gen(vi). Pregnancy. Canine pregnancy is characterized by many specific features, three articles in this issue deal with different aspects of gestation and neonatal conditions. These include (i) a study describing fetal parameters associated with the length of gestation and their use as predictors of delivery time in the dog; (ii) maternal cardiovascular function assessment during pregnancy in Great Danes and the impact of the gestational stage on diastolic and systolic parameters; and (iii) a clinical evaluation of Apgar scores and umbilical cord blood gas analysis obtained from clamped umbilical cords of newborn pups delivered by the cesarean section.(vii). Ovariohysterectomy. Excessive bleeding is the major complication during the ovariohysterectomy procedure. A study compared the ovarian artery flow velocity by a Doppler ultrasound before and after sedation with two alpha-2 agonists: medetomidine and dexmedetomidine. The authors found that the two anesthetic drugs decrease blood flow velocities in the ovarian artery, and thus, could be a useful option in ovariohysterectomy surgeries to reduce the risk of hemorrhages. Over the past few years, progress has been made toward a better understanding of mechanisms regulating canine reproduction, especially the aspect of gamete maturation and development. Further, studies have integrated molecular and imaging technologies to generate knowledge about disease progression and to develop diagnostic tools for reproductive disorders in domestic dogs.


The aim of this study was to provide insights learned from disaster research response (DR2) efforts following Hurricane Harvey in 2017 to launch DR2 activities following the Intercontinental Terminals Company (ITC) fire in Deer Park, Texas, in 2019.A multidisciplinary group of academic, community, and government partners launched a myriad of DR2 activities.The DR2 response to Hurricane Harvey focused on enhancing environmental health literacy around clean-up efforts, measuring environmental contaminants in soil and water in impacted neighborhoods, and launching studies to evaluate the health impact of the disaster. The lessons learned after Harvey enabled rapid DR2 activities following the ITC fire, including air monitoring and administering surveys and in-depth interviews with affected residents.Embedding DR2 activities at academic institutions can enable rapid deployment of lessons learned from one disaster to enhance the response to subsequent disasters, even when those disasters are different. Our experience demonstrates the importance of academic institutions working with governmental and community partners to support timely disaster response efforts. Efforts enabled by such experience include providing health and safety training and consistent and reliable messaging, collecting time-sensitive and critical data in the wake of the event, and launching research to understand health impacts and improve resiliency. In August 2017, Hurricane Harvey was the wettest tropical cyclone to impact the United States with over 50 inches of rain and record-breaking catastrophic flooding along the Gulf Coast. More than 30,000 residents were affected and over 200,000 homes destroyed at an estimated cost of $130 billion.2 In this study, we describe our action-to-research disaster response to Hurricane Harvey and the ITC fire and provide lessons about how academic institutions can use their resources and infrastructure to partner with community groups and governmental agencies to improve disaster resiliency.In response to Hurricane Harvey, the Southwest Center for Occupational and Environmental Health (SWCOEH) at The University of Texas Health Science Center at Houston  teamed with academic, community, and governmental partners to launch disaster research response (DR2) activities and address environmental health concerns in affected communities. These DR2 studies laid the groundwork for a response to an industrial fire 18 mo later at the Intercontinental Terminals Company (ITC), a storage facility for petroleum liquids and gases in Deer Park, Texas, a suburb of Houston.All activities were approved by UTHealth’s Committee for the Protection of Human Subjects and the Institutional Review Boards (IRBs) at participating institutions.3 to identify neighborhoods for environmental sampling that were most affected by the storm as well as participated in community events to deliver in-person trainings on cleanup safety. Led by BCM colleagues, we assisted in developing and launching the Houston Hurricane Harvey Health (Houston 3H) DR2 study to evaluate the impacts of the storm on mental and physical health.4 Participants completed self-administered questionnaires about demographics, flood-related exposures, and health outcomes; provided nasal, oral, and fecal samples for microbiome analyses; and wore silicone wristbands as passive personal samplers to assess exposure to over 1500 chemicals.Following Hurricane Harvey’s historic landfall, an Incident Command structure was put in place. The UTHealth Harvey response team secured funding and coordinated activities with external partners, including colleagues at Baylor College of Medicine (BCM), Harvard T.H. Chan School of Public Health, Houston Health Department (HHD) and Environmental Defense Fund (EDF). Our disaster response actions included environmental monitoring, distributing safety kits, providing training on proper cleanup of flooded homes and businesses, gathering oral histories, developing an informational website, and hosting worker safety seminars. We reached out to religious leaders and community partners of an ongoing community-engaged research project5 Also, approximately 60 public health officials, faculty, staff, and students and nonprofit organization  members participated in sponsored disaster response training events. Within 3 months of Harvey’s landfall, 201 soil samples and 38 water samples were collected from Houston-area neighborhoods and analyzed for 24 metals. RESCUE real-time air sensors were installed in 12 homes (10 flooded homes with on-going remediation and 2 nonflooded homes) for a 6-month period. Over 100 oral histories were gathered from Muslim leaders who opened their mosques to non-Muslim flood victims; social workers at Texas Children’s Hospital in Houston who worked or volunteered during the storm; Cajun Navy volunteers; entrepreneurs in Dallas who made T-shirts to raise funds for Harvey victims; first responders and emergency response coordinators; and mothers and teachers from schools in Houston’s low-income neighborhoods. Also, within 30 days of the storm making landfall, 208 participants were enrolled in the Houston 3H study from 4 sites across Harris County.4In total, 71 volunteers were trained to conduct environmental monitoring and provide health and safety education to residents and workers involved in cleanup of flooded homes and businesses. We attended 19 community events and presented in-person, bilingual safety training sessions where we distributed approximately 1200 safety kits. Six months later, we re-contacted over 80 individuals who had received the safety training and assessed their health, the status of remediation efforts, and the effectiveness of the training.Learnings from these immediate post-Harvey activities included experience with publicly available resources  protocols) available within the DR2 community; development of protocols for recruiting, training, and scheduling student volunteers; and development of adaptable in-house field training materials, disaster protocols, and environmental/biological monitoring procedures. These efforts also increased the familiarity of IRB with the rapid approval needed in a disaster setting and established multi-directional avenues for communication with community members and other stakeholders.2.5) and total volatile organic compounds (TVOCs) while the fire was burning. Experts trained student volunteers on sampling procedures and code of conduct in the field by modifying the protocols developed during Hurricane Harvey DR2 efforts.Drawing on these lessons from our multi-faceted response to Hurricane Harvey, and the partnerships established as a result of those efforts , we quic2 Furthermore, the Harvey study protocols served as preplanned and in-house templates that were adapted for developing recruitment strategies, informed consents, health questionnaires, and in-depth interview probes. Faculty and trained student volunteers conducted health surveys and in-depth interviews. They also installed RESCUE air sensors, which were being stored in-house following Hurricane Harvey, for monitoring of ambient air PM2.5 and TVOCs at resident homes over 6 weeks. Furthermore, we co-located passive samplers for analysis of 31 VOCs. Prior decisions about reporting back results to study participants in the Houston 3H study facilitated plans for reporting individualized results of residential concentrations of the monitored air pollutants. Drawing on enriched collaborations following Hurricane Harvey, we assisted EDF and HHD in installing 20 Clarity solar-powered and weatherproof real-time air sensors to monitor PM2.5 and nitrogen oxides outdoors at schools, homes, and fire departments to establish an air quality surveillance network in Deer Park and surrounding areas.Based on our experience gaining rapid approval for Hurricane Harvey activities, our IRB was better positioned to provide expedited approval for a DR2 study in response to the ITC fire, the Deer Park Chemical Fire (DeeP Fire) study.In the face of these two disasters that affected the Texas Gulf Coast, we were able to apply what we learned from one disaster to the second to mobilize volunteers quickly, tap into our infrastructure, and work with colleagues to address community needs and launch DR2 activities. While the SWCOEH had a commitment to, and long-standing history of, research, outreach, and service, particularly among vulnerable populations and workers, other partners new to DR2 activities gained valuable experience during Harvey applicable in other disaster settings, including the ITC fire. Responding to Hurricane Harvey required protocols with a much shorter response time and “boot-strapping” activities with more limited resources than previous efforts. However, what was learned in this process—even though the disasters were quite different—provided a strong foundation for our response to the ITC fire 18 months later.6 having in-house environmental sampling equipment, and developing IRB disaster research protocols that could be tailored for different types of emergencies. For example, we were able to respond more quickly and deploy an air monitoring team in the field within 48 hr of the ITC fire. Furthermore, we launched a DR2 study by implementing protocols that we developed following Hurricane Harvey . Key to our response to both disasters was working with an interdisciplinary team of academics as well as partners from the government and the community to enable meaningful science.7 Moving forward, there is also need for continued support of DR2 toolkits currently available and support from academic institutions to facilitate response efforts to disasters in the future.Preplanning (that we had not done before Hurricane Harvey) facilitated identification of local expertise and capabilities, within and across institutions, which enabled a more effective response to the ITC fire. Such preplanning requires drawing on the DR2 experience, resources, and mechanisms already available,The use of student volunteers is recognized as a valuable resource in communities facing disasters. By providing on-the-ground training, students have an opportunity for service learning through experiential education rooted in action in the community. One strategy we used following Harvey was to tap into an ongoing course by developing a project focused on collecting oral histories from individuals impacted by the storm or involved in response or recovery efforts. Furthermore, we trained student volunteers in environmental sampling and survey administration following both disasters. Having already completed human subjects training facilitated and accelerated their participation in these activities. However, a challenge was working with students in providing training and scheduling field visits, the former of which focused on emphasizing commitment and responsibilities and the latter of which required frequent email exchanges to stay abreast of changing schedules. Establishing on-going coursework or training on disaster response in college curricula would increase student capacity when disasters occur.8 Subsequently, Collins et al.9 applied this framework to post-Harvey Houston and found that households of color and low socioeconomic status (SES) experienced more extensive flooding than non-Hispanic whites and higher SES households. Recognizing cultural differences in working with low income and diverse ethnic/racial communities , we prepared our safety information, videos, and questionnaires in Spanish as well as English. However, we faced difficulty in identifying enough bilingual field team members during both disasters who could assist in communicating with Spanish-speaking individuals. This could be partially remediated in the future in strengthening partnerships with community partners that have staff fluent in Spanish. Houston’s diverse population speaks 145 languages,11 so expanding to other languages beyond English and Spanish is also important.Following Hurricane Katrina, the inequitable distribution of Hurricane-related flooding effects was framed for the first time within the context of environmental justice.12 In working with local public health officials following Harvey, we developed an informational webpage with HHD, and we communicated our real-time air monitoring results to the Harris County Public Health, which also engaged in assessing community air quality during and after the ITC fire. We later participated in a workgroup convened by Harris County Public Health that led to a commitment of over $11 million to expand staffing and resources to improve the county’s response to disasters.13Many of our initial activities in response to Harvey and the ITC fire were driven by our commitment to serve neighborhoods in need. In distributing cleanup safety kits to residents and workers, we hoped that they would make the connection between environmental exposures and health and promote changes in behavior to remediate flooded homes and businesses. In the DR2 studies that we conducted, most participants were interested in receiving their individual results, which created additional opportunities for informal learning about environmental health.if Houston will experience another disaster but rather when. Hence, we expect the data we collected post-Harvey and post-ITC fire will provide valuable baseline information when the next disaster hits.Unfortunately, a major challenge that we and others face in addressing health effects related to environmental exposures following catastrophic events is not having collected baseline exposure data before a disaster. As shown in Response, recovery, and research efforts have laid the groundwork for improving our capacity for timely and efficient response to disasters. Challenges ahead include sustaining collaborations with partners and enhancing infrastructure that will facilitate future DR2 efforts. It is incumbent upon academic institutions to work together locally and nationally, and with public health agencies and other governmental and community partners, to support time-critical outreach, education, training, and research to address the needs of communities impacted by disasters.


Leishmania species and transmitted to humans by sandflies, are among such diseases. Leishmania and other Trypanosomatidae display some peculiar features, which make them a complex system to study. Leishmaniasis chemotherapy is limited due to high toxicity of available drugs, long-term treatment protocols, and occurrence of drug resistant parasite strains. Systems biology studies the interactions and behavior of complex biological processes and may improve knowledge of Leishmania drug resistance. System-level studies to understand Leishmania biology have been challenging mainly because of its unusual molecular features. Networks integrating the biochemical and biological pathways involved in drug resistance have been reported in literature. Antioxidant defense enzymes have been identified as potential drug targets against leishmaniasis. These and other biomarkers might be studied from the perspective of systems biology and systems parasitology opening new frontiers for drug development and treatment of leishmaniasis and other diseases. Our main goals include: 1) Summarize current advances in Leishmania research focused on chemotherapy and drug resistance. 2) Share our viewpoint on the application of systems biology to Leishmania studies. 3) Provide insights and directions for future investigation.Neglected Tropical Diseases include a broad range of pathogens, hosts, and vectors, which represent evolving complex systems. Leishmaniasis, caused by different  Leishmania is a complex biological system in itself. In the lack of an effective vaccine, human treatment relies on chemotherapy since the early 1920’s. Drug resistance of parasite strains adds a layer of complexity to this public health issue. Systems biology, which access interactions and behavior of complex biological processes, may improve knowledge of Leishmania drug resistance. Leishmania systems biology discussed in the present work.Leishmania and leishmaniasis; Leishmaniasis treatment; Chemotherapy and antioxidant defense enzymes; Systems biology: concepts and applications; Leishmania systems biology; and Conclusions and future directions.Here we present our perspective by providing a viewpoint on some specific areas of investigation as well as current advances and future directions. For this purpose, this article is organized into the following topics: Leishmania (Trypanosomatidae), which are transmitted to humans by infected female phlebotomine sandflies (Phlebotominae).Leishmaniasis are among such diseases currently affecting 12 million people worldwide and presenting an incidence of 0.7-1.0 million new cases annually from nearly 100 endemic countries . LeishmaLeishmania and other Trypanosomatidae such as their kinetoplast, mitochondrial DNA editing (Leishmania species present a remarkable degree of conservation in gene content and architecture (synteny) according to their evolutionary divergence , infectious agent , drugs (e.g. pharmacodynamics/pharmacokinetics), chemotherapeutic protocol, etc. .Leishmania drug resistance threatens the prevention and treatment of infections. Literature shows that the mechanism of drug resistance in Leishmania involves different metabolic pathways including several molecular markers. However, little is known about the biochemical mechanisms underlying drug resistance in field isolates of this parasite. System biology approaches are very important to elucidate drug resistance mechanisms and identify new molecular markers and targets for drug development against leishmaniasis.Nevertheless, isolate’s drug resistance status is the first indication for therapeutic choice. via the inhibition of glycolysis and fatty acid oxidation  have been used as the first-line treatment in many countries . Their mxidation , changinxidation , DNA fraxidation .V) has been reported in Bihar (India), where more than 60% of patients with visceral leishmaniasis (VL) are unresponsive to this drug  transporters have been involved in SbV resistance. PGP/MRPA (ABCC3) was the first one described to be responsible for clinical resistance to SbV in L. donovani (V resistance in L. donovani include decreased drug uptake through inactivation of the aquaglyceroporin (AQP1) transporter -resistant (R) susceptible (S) L. braziliensis lines identified several potential candidates for biochemical or signaling networks associated with the antimony resistance in this parasite  and L. infantum (LiWTS and LiSbR) showed that 71.4% of protein spots with differential abundance identified were different between both species  is a phosphatidylcholine analogue initially developed as an antineoplastic drug shown to be very effective for the VL treatment in India . This iso assays . MT and/o assays .in vitro showed a decreased drug accumulation , and error measurement  are also relevant.Because of the complexity of biological systems, it is important to understand the interactions among genotype, phenotype, and environment. Systems biology addresses such aspects by applying quantitative measurement, mathematical modeling, and interdisciplinary studies including ecology and evolutionary biology .By using a system biology approach, a large number of non-linear molecular interactions can be explored, such as post-transcriptional or post-translational modifications, metabolic effects, and protein recruitment dynamics in different cellular compartments. The idea is to go beyond the simplistic model of gene role determination and its phenotypic effect .Efforts of drug repositioning and development of new drugs require systems biology approaches to understand the genetic basis of diseases including leishmaniasis. An essential aspect of systems biology in drug discovery is the identification of potential drug targets considering the presence of multiple genes and proteins involved . In paraLeishmania  in which systems biology would play a crucial role, we highlight the issue of drug resistance in reatment .Leishmania and other taxa. Here we provide an overview of some components of a systems biology study aiming at identifying molecular targets for drug design and development in Leishmania . All authors contributed to the article and approved the submitted version.This work was supported by the FIOCRUZ Innovation Promotion Program , Institut Pasteur/FIOCRUZ (SM: no grant number), Minas Gerais Research Funding Foundation , and National Council for Scientific and Technological Development . Graduate student fellowships were provided by the Higher Education Improvement Coordination  and FIOCRUZ Vice-Presidency of Education, Information and Communication .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The emergence and transmission of zoonotic diseases are driven by complex interactions between health, environmental, and socio-political systems. Human movement is considered a significant and increasing factor in these processes, yet forced migration remains an understudied area of zoonotic research–due in part to the complexity of conducting interdisciplinary research in these settings.We conducted a systematic review to identify and analyze theoretical frameworks and approaches used to study linkages between forced migration and zoonotic diseases.We searched within eight electronic databases: ProQuest, SCOPUS, Web of Science, PubMed, PLoSOne, Science Direct, JSTOR, and Google Scholar, to identify a) research articles focusing on zoonoses considering forced migrants in their study populations, and b) forced migration literature which engaged with zoonotic disease. Both authors conducted a full-text review, evaluating the quality of literature reviews and primary data using the Critical Appraisal Skills Programme (CASP) model, while theoretical papers were evaluated for quality using a theory synthesis adapted from Bonell et al. (2013). Qualitative data were synthesized thematically according to the method suggested by Noblit and Hare (1988).Analyses of the 23 included articles showed the increasing use of interdisciplinary frameworks and approaches over time, the majority of which stemmed from political ecology. Approaches such as EcoHealth and One Health were increasingly popular, but were more often linked to program implementation and development than broader contextual research. The majority of research failed to acknowledge the heterogeneity of migrant populations, lacked contextual depth, and insufficient acknowledgments of migrant agency in responding to zoonotic threats.Addressing the emergence and spread of zoonoses in forced migration contexts requires more careful consideration and use of interdisciplinary research to integrate the contributions of social and natural science approaches. Robust interdisciplinary theoretical frameworks are an important step for better understanding the complex health, environment, and socio-political drivers of zoonotic diseases in forced migration. Lessons can be learned from the application of these approaches in other hard-to-reach or seldom-heard populations. Zoonotic diseases represent a growing threat to public health , with ovAcross disciplines, scholars are increasingly recognising the importance of engaging with forced migrants as a distinct population. At the end of 2019, there were an estimated 79.5 million forced migrants, including 20.4 million refugees, 45.7 million internally displaced persons (IDPs), and 4.2 million asylum seekers . LMIS beThe inherent relational complexities of forced migration and zoonotic diseases require a nuanced understanding of social, biological, and ecological factors which have not been adequately studied to date . TraditiEngaging with the multi-layered and intersecting drivers of zoonotic disease in forced migration contexts presents significant challenges for researchers. Evaluating the quality and utility of existing approaches used to study these complex dynamics is a vital first step in expanding our understanding of this understudied area. Our systematic literature review contributes to this emerging knowledge base by answering the research question: how have theoretical frameworks and approaches been utilized to study the role of forced migration in zoonotic disease dynamics?We designed a systematic literature review to identify, collate, and comparatively analyze qualifying literature on zoonoses in forced migration to explore the theoretical and methodological foundations used in these articles. The original protocol for this study is registered with the Open Science Framework, DOI 10.17605/OSF.IO/E9JUF. The study follows the statements on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA); the PRISMA flow chart is given in Eight electronic databases were interrogated in June 2020: ProQuest, SCOPUS, Web of Science, PubMed, PLoSOne, Science Direct, JStor, and Google Scholar, using the search terms zoono* AND . Search terms were developed from wider analyses of zoonotic research, forced migration literature, expert suggestion, and informed by AT and DBs experience. No limit was placed on publication dates.Primary inclusion criteria were:peer reviewed articles published in English after 1975Publication of central focus on zoonotic diseaseA specific inclusion of one or more forced migrant populationsThe explicit use of theoretical frameworks or approaches at any stage of the study.The Citations were downloaded and manually screened for duplicates by the authors (AT and DB). Both authors independently reviewed the complete shortlist of articles using the inclusion criteria above. External experts were consulted individually by AT and DB where either author was uncertain. Disagreements between the authors were resolved by consensus through discussion. The quality of literature reviews and primary data studies were verified using the standardized Critical Appraisal Skills Program (CASP)  approachpopulation characterization and theory and practice.The synthesis was informed by an inductive qualitative comparative review to identify emergent key themes across the texts in line with the methodologies detailed by Noblit and Hare  and AtkiThe systematic review identified 2,153 articles; removal of duplicates left 2,067 articles. Titles and abstract screening excluded a further 2,004 articles, leaving 63 articles for full-text analysis see . Twenty-The majority of included publications were theoretical contributions (n = 10), with a limited number of literature reviews (n = 5) and commentary pieces (n = 3). The remaining articles combined meeting reports (n = 2), a lecture (n = 1), prevalence survey (n = 1), and response plan (n = 1).We conducted an inductive qualitative comparative analysis of the articles in line with the methodology described by Noblit and Hare . Six secHuman displacement is driven by a range of complex factors. Within the reviewed literature we identified five typologies of displacement and eight causes, detailed in Geographically, most publications focused on LMIS populations; 9 from a generalized global view and 11 from a geographically-bounded perspective, including regional (e.g. sub-Saharan or Mediterranean) and country-specific foci (e.g. Turkey or Uganda); details of geographical foci are provided in Geographical considerations are central to understanding zoonoses in forced migration. Vulnerabilities of forced migrant populations are rooted in historical and political contexts; drawing on case studies in Africa, Kalipeni and Oppong  argue thwell-managed migration could provide an adaptive response that reduces the adverse health impacts of climate change” [The specific contribution of forced migration to zoonotic risks were less well explored. Multiple authors argued that resettlement programs and refugee migration may act as vectors for endemic disease into naive populations, citing increased disease risk through environmental and socioeconomic change such as poverty and health inequality , 46, 47. change” , p.549.The second theme identified tensions between research framed as more abstract theoretical enquiry, and more empirical, holistic approaches informed by a combination of theoretical precedent and contextual understandings. Adherence to structured theory during research remains a contested subject across disciplines, with views ranging from ‘there is nothing so practical as a good theory’ , p.18 toDisciplines and theoretical frameworks. Kalipeni and Oppong [d Oppong  explicitThemes of environmental change can be found in many of the included studies. Writing two years later, Mayer  again usParallel to macro-political landscapes of inequalities and health, many studies in this review structured their research so as to present empirical case studies which explored the influence of national and international health systems on disease pathways. Spatial diffusion theory used by Bouma and Rowland  characteAs noted earlier, social justice was discussed by both Pedersen  and SingApproaches for research and implementation. When evaluating zoonoses in forced migration, it is important to understand the often opaque relationship between theoretical and applied approaches used by researchers. For example, political ecology is often characterized as a theoretical approach, whereas frameworks including One Health and EcoHealth resist easy definition, variously employed as theory, methodology, and a policy devices [ devices –tools fo devices , or b) t devices . In this devices , 40, and devices . These s devices  and Ebol devices , to more devices . In thisSchistosomiasis.EcoHealth approaches in forced migration research emerged almost in parallel with One Health. EcoHealth shares much common ground with One Health, providing systems-based ways of thinking around zoonoses, disease emergence, and pandemic threats . EcoHealmigratory may often have more in common with settled indigenous groups in border zones than the wider national population. This underlines the importance of understanding political and social context when framing zoonotic disease risks in migrant populations, in particular the unique institutional landscape in which many refugees exist [Despite covering over three decades of work, the articles considered in the review consistently display a number of shortcomings. Most articles treated forced migrants as exemplar populations, proxies for exposure to specific and isolated risks, without acknowledgments or consideration of the inherent complexity and diversity of these populations. Multiple studies reviewed here chose to link human mobility to endemic and non-endemic disease exposure, reducing forced migrants to vectors for the movement of non-endemic disease into study populations. We argue that the reality for forced migrants is significantly more complex. Classifying populations as forced migrants for instance overlooks the fact that many within these communities may have been settled for many years ; indeed es exist .In addition to internal diversity and contextual detail, all studies considered in this review failed to consider migrant-led responses to zoonotic disease. Many articles cited poor sanitation and ineffective health systems, yet forced migrants have in the past adapted their surroundings through local water supply innovations , and devOur review does give cause for hope. The subjective shift from the political ecological approaches of the 1990s and early 2000s, towards a more Public Health-based understanding in the last decade suggests a movement towards a more holistic, interdisciplinary treatment of complexity. These approaches are arguably better positioned to map the nonlinear nature of zoonoses which are driven by a variety of social, political, historical, economic, environmental, and biological factors. Advances in One Health and EcoHealth approaches have arguably outpaced wider understandings of the role of human migration on infectious disease, but we are optimistic that increasing attention offers the chance to bring these domains together. Despite this optimism, the centering of Public Health in forced migration zoonotic research should prompt critical reflection, informed by current debates on neocolonial aspects of international aid and development programming. Public Health has the ability to generate highly techno- and ethnocentric narratives which, rather than engaging local communities in healthcare, can serve to obfuscate indigenous knowledge systems and further disadvantage the most vulnerable. Considerations of social justice can be found across articles include in the review , 32, 49;There are several limitations to this review. Only English language articles were included, limiting our engagement with indigenous scholarship. Secondly, it is possible that ethnographic studies exist that engage with zoonotic diseases using locally-defined terms which would not have been detected by the search protocol. This review only considered peer reviewed articles, making publication biases likely and selecting against internal reports from development organizations. Given the focus of this review was primarily theoretical, it reports and evaluations which did not explicitly employ theoretical or analytical frameworks will have been excluded.The results of this review indicate that research on zoonotic diseases in forced migration increasingly employs interdisciplinary approaches to consider holistically social, environmental, and biological complexity. These approaches acknowledge linkages between human, animal, and environmental health through the integration of disciplines and participation of local stakeholders and interlocutors. Many of these approaches build on political ecological approaches to address macro-level disease risks, but often overlook the complexity and diversity of forced migrant populations. Studies continue to characterize movement as a major determinant for disease and health outcomes, despite a lack of evidence for doing so. Disease vulnerabilities depend on a multitude of internal and external factors which must be better researched and contextualized; further work is required to build theoretical frameworks able to address the societal and biological processes of forced migration across time and space.S1 Fig(TIF)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 TableTheoretical quality review.(DOCX)Click here for additional data file.S4 TableTypologies and causes of displacement.(DOCX)Click here for additional data file.S5 TableGeographical focus and distribution of studies.(DOCX)Click here for additional data file.