First Steps: A Pilot Preparedness Program for Public Health Nurses

Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in New York City and other recent incidents demonstrate how important public health is as a frontline defense against emerging infections, bioterrorism, and other unexpected emergencies. A well-prepared public health workforce is more critical than ever. The challenges are particularly great in urban areas, which traditionally serve as ports of entry, may be appealing targets to terrorists, and have large and diverse populations with complex health risk factors. To better prepare the public health workforce to carry out routine functions effectively and fulfill the additional roles required in emergencies, a national network of "Centers for Public Health Preparedness" has been established by the Centers for Disease Control and Prevention (CDC). The network currently includes seven academic Centers funded through a cooperative agreement with the Association of Schools of Public Health (ASPH). Goals include the development of competency-based public health practice courses primarily designed to utilize distance-learning technology (such as World Wide Web-based instruction) that can be implemented locally and replicated nationally. The Center for Public Health Preparedness at the Mailman School of Public Health, Columbia University, is working toward these goals in partnership with the New York City Department of Health (NYC DOH)

First Steps: A Pilot Preparedness Program for Public Health Nurses

Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in New York City and other recent incidents demonstrate how important public health is as a frontline defense against emerging infections, bioterrorism, and other unexpected emergencies. A well-prepared public health workforce is more critical than ever. The challenges are particularly great in urban areas, which traditionally serve as ports of entry, may be appealing targets to terrorists, and have large and diverse populations with complex health risk factors. To better prepare the public health workforce to carry out routine functions effectively and fulfill the additional roles required in emergencies, a national network of "Centers for Public Health Preparedness" has been established by the Centers for Disease Control and Prevention (CDC). The network currently includes seven academic Centers funded through a cooperative agreement with the Association of Schools of Public Health (ASPH). Goals include the development of competency-based public health practice courses primarily designed to utilize distance-learning technology (such as World Wide Web-based instruction) that can be implemented locally and replicated nationally. The Center for Public Health Preparedness at the Mailman School of Public Health, Columbia University, is working toward these goals in partnership with the New York City Department of Health (NYC DOH)

Toward standardized, comparable public health systems data: a taxonomic description of essential public health work

The objective of this study is to identify taxonomy of task, knowledge and resources for documenting the work performed in local health departments (LHDs). Secondary data were collected from documents describing public health practice produced by organizations representing the public health community. A multi-step consensus-based method was used that included literature review, data extraction, expert opinion, focus group review and pilot testing. Terms and concepts were manually extracted from documents, consolidated, and evaluated for scope and sufficiency by researchers. An expert panel determined suitability of terms and a hierarchy for classifying them. This work was validated by practitioners and results pilot tested in 2 LHDs. The finalized taxonomy was applied to compare a national sample of 11 LHDs. Data were obtained from 1064 of 1267 (84%) of employees. Frequencies of tasks, knowledge, and resources constitute a profile of public health work. About 70% of ! the correlations between LHD pairs on tasks and knowledge were high (> 0.7) suggesting between department commonalities. On resources only 16% of correlations between LHD pairs were high, suggesting a source of performance variability. A taxonomy of public health work serves as a tool for comparative research and a framework for further development

The Influence of Management and Environment on Local Health Department Organizational Structure and Adaptation: A Longitudinal Network Analysis

Objective: The nation's 2862 local health departments (LHDs) are the primary means for assuring public health services for all populations. The objective of this study is to assess the effect of organizational network analysis on management decisions in LHDs and to demonstrate the technique's ability to detect organizational adaptation over time. Design and Setting: We conducted a longitudinal network analysis in a full-service LHD with 113 employees serving about 187 000 persons. Network survey data were collected from employees at 3 times: months 0, 8, and 34. At time 1 the initial analysis was presented to LHD managers as an intervention with information on evidence-based management strategies to address the findings. At times 2 and 3 interviews documented managers' decision making and events in the task environment. Results: Response rates for the 3 network analyses were 90%, 97%, and 83%. Postintervention (time 2) results showed beneficial changes in network measures of communication and integration. Screening and case identification increased for chlamydia and for gonorrhea. Outbreak mitigation was accelerated by cross-divisional teaming. Network measurements at time 3 showed LHD adaptation to H1N1 and budget constraints with increased centralization. Task redundancy increased dramatically after National Incident Management System training. Conclusions: Organizational network analysis supports LHD management with empirical evidence that can be translated into strategic decisions about communication, allocation of resources, and addressing knowledge gaps. Specific population health outcomes were traced directly to management decisions based on network evidence. The technique can help managers improve how LHDs function as organizations and contribute to our understanding of public health systems

A System Dynamics Evaluation Model: Implementation of Health Information Exchange for Public Health Reporting

The objective of this study is to evaluate complex dynamics involved in implementing electronic health information exchange for public health reporting at a state health department, and to identify policy implications to inform similar implementations. Qualitative data were collected over eight months from seven experts at NYS DOH who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation also was collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. Validation of the diagrams was done iteratively by individual experts followed by group review online, and through confirmatory review of documents a! nd artifacts. Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thought about complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal HITECH legislatio

Are We Ready for Mass Fatality Incidents? Preparedness of the US Mass Fatality Infrastructure

Objective To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks. Methods In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure. Results A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated “not at all.” Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place. Conclusions The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI

Patterns of Interaction Among Local Public Health Officials and the Adoption of Recommended Practices

The network that local health officials use to communicate about professional issues contains two groups of LHDs that are influential for either their ability to spread information or to innovate. Both groups are more likely to conduct community health assessments and develop health improvement plans. Since these activities are fundamental aspects of accreditation and health reform, the findings may present an early indication that these initiatives are having an effect on the public health system

Preliminary Findings from an Interventional Study using Network Analysis to Support Management in Local Health Departments in Florida

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. We attributed this increase in hierarchical communication to preparations for a statewide accreditation initiative. When QI initiatives are undertaken globally within a state, managers and leaders need to be alert for possible impact on autonomous decision-making of professionals at the point of service which could affect service delivery

A Role for Non-Covalent SUMO Interaction Motifs in Pc2/CBX4 E3 Activity

Background: Modification of proteins by the small ubiquitin like modifier (SUMO) is an essential process in mammalian cells. SUMO is covalently attached to lysines in target proteins via an enzymatic cascade which consists of E1 and E2, SUMO activating and conjugating enzymes. There is also a variable requirement for non-enzymatic E3 adapter like proteins, which can increase the efficiency and specificity of the sumoylation process. In addition to covalent attachment of SUMO to target proteins, specific non-covalent SUMO interaction motifs (SIMs) that are generally short hydrophobic peptide motifs have been identified. Methodology/Principal Findings: Intriguingly, consensus SIMs are present in most SUMO E3s, including the polycomb protein, Pc2/Cbx4. However, a role for SIMs in SUMO E3 activity remains to be shown. We show that Pc2 contains two functional SIMs, both of which contribute to full E3 activity in mammalian cells, and are also required for sumoylation of Pc2 itself. Pc2 forms distinct sub-nuclear foci, termed polycomb bodies, and can recruit partner proteins, such as the corepressor CtBP. We demonstrate that mutation of the SIMs in Pc2 prevents Pc2-dependent CtBP sumoylation, and decreases enrichment of SUMO1 and SUMO2 at polycomb foci. Furthermore, mutational analysis of both SUMO1 and SUMO2 reveals that the SIM-interacting residues of both SUMO isoforms are required for Pc2-mediated sumoylation and localization to polycomb foci

Impact of Laws Aimed at Healthcare-Associated Infection Reduction: A Qualitative Study

Background: Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. Objective: The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. Methods: A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. Results: Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. Conclusions: While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed