Using Distance Learning to Address the Preparedness Needs of the Public Health Practitioner Community

In an effort to respond to the unmet needs of public health professionals for training related to bioterrorism, emergency response and disaster preparedness, the Public Health Leadership Program (PHLP) and the North Carolina Center for Public Health Preparedness (NCCPHP) are developing a new course to be taught in the Spring of 2004 at the University of North Carolina School of Public Health. Introduction to Public Health Preparedness will be based on the Public Health Preparedness Core Capacities for Threats and Emergencies and the Core Emergency Preparedness Competencies for All Public Health Workers. The course responds to needs identified in assessments of state and local level public health professionals in North Carolina, as well as the recommendations of national groups such as the Institute of Medicine's recent report, Who Will Keep the Public Healthy? This paper describes the background for why this course was developed and summarizes the process for developing the course. It also describes the modules of the course, with appendices including a complete syllabus, as well as sample assessments, case studies and evaluations. In order to meet the needs of public health professionals as efficiently and effectively as possible, this course will take advantage of the existing resources of a leading academic center for public health and a center for public health preparedness practice center. Using distance-learning technology and case study based discussion forums, this course will provide accessible and relevant training through a partnership that will fulfill both the School of Public Health and the Preparedness Center's responsibility to assure that appropriate, quality education and training are available to the current and future public health workforce (IOM, 2003). This course will strive to meet the training needs of the public health workforce as required to apply their current skills in the context of bioterrorism, disasters and emergencies and to develop the new skills in leadership, strategic planning, communication and teamwork necessary to provide an effective response to emerging threats.Master of Public Healt

Management of radiation dermatitis in patients receiving cetuximab and radiotherapy for locally advanced squamous cell carcinoma of the head and neck: proposals for a revised grading system and consensus management guidelines

Background: Radiation dermatitis developing in patients receiving cetuximab concomitantly with radiotherapy for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) is now recognized to have different pathophysiological and clinical characteristics to the radiation dermatitis associated with radiotherapy or concomitant chemotherapy and radiotherapy. Current grading tools were not designed to grade this type of radiation dermatitis; their use may lead to misclassification of reactions and inappropriate management strategies, potentially compromising cancer treatment. Patients and methods: An advisory board of seven leading European specialists (three medical oncologists, three radiation oncologists and a dermatologist) with extensive experience of the use of cetuximab plus radiotherapy produced consensus guidelines for the grading and management of radiation dermatitis in patients receiving cetuximab plus radiotherapy. Results: Modifications to the current, commonly used National Cancer Institute—Common Terminology Criteria for Adverse Events version 4.3 for grading radiation dermatitis were proposed. Updated management guidelines, building on previously published guidelines from 2008, were also proposed. Conclusions: The proposed revisions to the grading system and updated management guidelines described here represent important developments toward the more appropriate grading and effective management of radiation dermatitis in patients receiving cetuximab plus radiotherapy for LA SCCH

The Inducible CXCR3 Ligands Control Plasmacytoid Dendritic Cell Responsiveness to the Constitutive Chemokine Stromal Cell–derived Factor 1 (SDF-1)/CXCL12

The recruitment of selected dendritic cell (DC) subtypes conditions the class of the immune response. Here we show that the migration of human plasmacytoid DCs (pDCs), the blood natural interferon α–producing cells, is induced upon the collective action of inducible and constitutive chemokines. Despite expression of very high levels of CXCR3, pDCs do not respond efficiently to CXCR3 ligands. However, they migrate in response to the constitutive chemokine stromal cell–derived factor 1 (SDF-1)/CXCL12 and CXCR3 ligands synergize with SDF-1/CXCL12 to induce pDC migration. This synergy reflects a sensitizing effect of CXCR3 ligands, which, independently of a gradient and chemoattraction, decrease by 20–50-fold the threshold of sensitivity to SDF-1/CXCL12. Thus, the ability of the constitutive chemokine SDF-1/CXCL12 to induce pDC recruitment might be controlled by CXCR3 ligands released during inflammation such as in virus infection. SDF-1/CXCL12 and the CXCR3 ligands Mig/CXCL9 and ITAC/CXCL1 display adjacent expression both in secondary lymphoid organs and in inflamed epithelium from virus-induced pathologic lesions. Because pDCs express both the lymph node homing molecule l-selectin and the cutaneous homing molecule cutaneous lymphocyte antigen, the cooperation between inducible CXCR3 ligands and constitutive SDF-1/CXCL12 may regulate recruitment of pDCs either in lymph nodes or at peripheral sites of inflammation

Plasmacytoid predendritic cells initiate psoriasis through interferon-α production

Psoriasis is one of the most common T cell–mediated autoimmune diseases in humans. Although a role for the innate immune system in driving the autoimmune T cell cascade has been proposed, its nature remains elusive. We show that plasmacytoid predendritic cells (PDCs), the natural interferon (IFN)-α–producing cells, infiltrate the skin of psoriatic patients and become activated to produce IFN-α early during disease formation. In a xenograft model of human psoriasis, we demonstrate that blocking IFN-α signaling or inhibiting the ability of PDCs to produce IFN-α prevented the T cell–dependent development of psoriasis. Furthermore, IFN-α reconstitution experiments demonstrated that PDC-derived IFN-α is essential to drive the development of psoriasis in vivo. These findings uncover a novel innate immune pathway for triggering a common human autoimmune disease and suggest that PDCs and PDC-derived IFN-α represent potential early targets for the treatment of psoriasis