Lp mean estimates for an operator preserving inequalities between polynomials

If $P(z)$ be a polynomial of degree at most $n$ which does not vanish in $|z| < 1$, it was recently formulated by Shah and Liman \cite[\textit{Integral estimates for the family of $B$-operators, Operators and Matrices,} \textbf{5}(2011), 79 - 87]{wl} that for every $R\geq 1$, $p\geq 1$, $$\left\|B[P\circ\sigma](z)\right\|_p \leq\frac{R^{n}|\Lambda_n|+|\lambda_{0}|}{\left\|1+z\right\|_p}\left\|P(z)\right\|_p,$$ where $B$ is a $\mathcal{B}_{n}$-operator with parameters $\lambda_{0}, \lambda_{1}, \lambda_{2}$ in the sense of Rahman \cite{qir}, $\sigma(z)=Rz$ and $\Lambda_n=\lambda_{0}+\lambda_{1}\frac{n^{2}}{2} +\lambda_{2}\frac{n^{3}(n-1)}{8}$. Unfortunately the proof of this result is not correct. In this paper, we present a more general sharp $L_p$-inequalities for $\mathcal{B}_{n}$-operators which not only provide a correct proof of the above inequality as a special case but also extend them for $0 \leq p <1$ as well.Comment: 16 Page

Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction?

Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications

The Resilient Local Health Department: Surviving the 2008 Economic Crisis

Research Objective: The purpose of this study was to identify potential modifiable factors that can protect local health departments from job losses and budget cuts during periods of economic stress. Study Design: This was a retrospective cohort study which used data from census surveys of local health departments (LHDs) which were conducted in 2005 and 2010 by the National Association of County and City Health Officials. The 2005 survey data served as the source of independent variables, which were grouped around domains of organization, revenue, and services. The outcome of interest - resiliency of the LHD - represented financial resiliency for maintaining budgets in the face of the recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. Control variables included several measures known to influence both LHD performance and health outcomes, including jurisdictional population, poverty, race, education, age distribution, and health insurance status. An ordered logistic regression was used to model the dependent variable with three attributes - resilient, variously resilient, and non-resilient - with independent and control variables as described above. Population Studied: Data from 987 local health departments comprised the final dataset for analysis. Principal Findings: LHDs above the 95% confidence interval for the mean observed-to-predicted expenditures per capita ratio for 2010 (n=338) were defined as resilient; those within the 95% confidence interval (n=85) were defined as variously resilient; and LHDs below the 95% confidence interval (n=564) were defined as non-resilient. In the final ordered logistic regression model, there were significant differences across the three categories of resiliency for presence of a board of health and a board of health without hire/fire authority; percentage of revenues from Medicaid, Medicare, and federal pass-through funding; number of services categorized as screening, treatment, and population services; and community characteristics including percentage of African-Americans, percentage of the population greater than 65 years, and the percentage of uninsured persons. Marginal effects estimates from the ordered logit model indicate that an agency\u27s probability of being resilient increased by 9% for agencies governed by a board of health, compared to agencies without a board (p Conclusion: Local health departments which successfully weathered the economic recession of 2008 were more likely to have had a board of health (but without the authority to hire/fire), have a greater diversity of funding sources (relative to local sources only), and provide a larger number of treatment and population services compared to LHDs which experienced significant losses in funding by 2010. Implications for Policy, Delivery or Practice: Since advocacy for LHDs (through a board of health), revenue mix, and array of services may all be modifiable and adaptable characteristics, the findings suggest possible means for LHDs to attain resiliency in the face of future economic crises

The Resilient Local Health Department: Surviving the 2008 Economic Crisis

The purpose of this study was to identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress. This was a retrospective cohort study based on the 2005 and 2010 surveys of LHDs conducted by the National Association of County and City Health Officials. The outcome of interest – resiliency of the LHD – represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010. LHDs which successfully weathered the economic recession of 2008 represented smaller populations and were better resourced in 2005, were less likely to have had a board of health with the authority to hire/fire, and were less likely to be dependent on local resources compared to LHDs which experienced significant losses in funding by 2010. These results varied by size of the jurisdictional population

Interoperability of Information Systems Managed and Used by the Local Health Departments

Background: In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs). Objectives: To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability. Data and Methods: This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received (50% response rate). Qualitative data were used from a key informant interview study of LHD informatics staff from across the United States. Qualitative data were independently coded by 2 researchers and analyzed thematically. Survey data were cleaned, bivariate comparisons were conducted, and a multivariable logistic regression was run to characterize factors associated with interoperability. Results: For 30% of LHDs, no systems were interoperable, and 38% of LHD respondents indicated some of the systems were interoperable. Significant determinants of interoperability included LHDs having leadership support (adjusted odds ratio [AOR] = 3.54), control of information technology budget allocation (AOR = 2.48), control of data systems (AOR = 2.31), having a strategic plan for information systems (AOR = 1.92), and existence of business process analysis and redesign (AOR = 1.49). Conclusion: Interoperability of all systems may be an informatics goal, but only a small proportion of LHDs reported having interoperable systems, pointing to a substantial need among LHDs nationwide

Urgent Challenges for Local Public Health Informatics

This editorial highlights the urgent challenges for local public health informatics and provides solutions to face these challenges

Teacher Effectiveness and Digital Competence of High School Teachers in Shopian District, Jammu and Kashmir

Effectiveness of teaching is essential condition, to make learning more meaningful, clear and fruitful to a student. Through the present study an attempt has been made by the investigator to study the Teaching Effectiveness and digital competence of High School Teachers in the Shopian District of Jammu and Kashmir. Two scales were adopted and applied in the study namely (i) Teacher Effectiveness Scale (KTES) developed by the investigator (2021) and (ii) the Digital Competence scale developed by Ramakrishna (2017) for collection of the required data. The sample for the study was 330 (190 Male and 140 Female) High school teachers including contractual teachers. Stratified random sampling technique is used in this study. To make the statistical analysis descriptive method has been used by the investigator in the present study. The study reveals that Teacher Effectiveness of female teachers was found to be significantly higher as compared to the male teachers. Also, Teachers having higher levels of Digital Competence were found to be more effective than those having low levels of Digital Competence

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health

Background and Objectives: Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. Design: Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. Results: In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees\u27 intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one\u27s supervisor. Conclusions: Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. Implications: Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries

Characteristics of Local Health Departments Associated with Their Implementation of Electronic Health Records and Other Informatics System

Background: Information technology and information systems (IT/IS) play a critical role in the daily operation of local health departments (LHDs). Assessing LHDs’ informatics capacities is important, especially within the context of broader, system-level health reform efforts. Research Objective: This study assesses a nationally representative sample of LHDs’ level of adoption of information systems, technology, and the factors associated with adoption/implementation. Specifically, five areas of public health informatics were examined: electronic health records (EHRs), health information exchange (HIE), immunization registry (IR), electronic disease reporting system (EDRS), and electronic lab reporting (ELR). Data Sets and Sources: Data from NACCHO’s 2013 National Profile of LHDs was used. Descriptive statistics and multinomial logistic regression were performed for the five implementation-oriented outcome variables of interest, with three levels of implementation. Independent variables included infrastructural capacity, financial capacity, and other characteristics theoretically associated with informatics capacity. Study Design: This study uses a cross-sectional survey research design. Principal Findings: Thirteen percent of LHDs had implemented HIEs. About 22 % had implemented EHRs, 47% ELR, 72.2% EDRS, and 82% had implemented Immunization Registry. Significant determinants of health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, having health information system specialists on staff, having larger population size, having decentralized governance system, having one and more local boards of health, and having top executive with greater number of years in the job. Conclusions: The capacity of LHDs to use real-time, local data and information is critical. Many LHDs do not have this capacity. This may be due to lack of specialized staff, availability of data systems, or a host of other political or organizational constraints. This is especially the case for smaller jurisdictions. Cross-jurisdictional sharing or regionalization of some informatics and surveillance functions may be a reasonable approach to address these shortfalls. Implications for Public Health Practice and Policy: A combination of investment in public health informatics infrastructure, additional training of new informatics staff and existing epidemiologists, and better integration with healthcare systems is needed to augment LHD informatics capacity and ensure governmental public health can meet the information needs of the 21st century

Advances and development in transdermal drug delivery system-A review

It is one of the best pharmaceutical dosage forms for those patients, they cannot take medicaments orally. Transdermal drug delivery system (TDDS) established itself as an integral part of novel drug delivery systems (NDDS). On the application of Transdermal patches, the delivery of the drug across dermis gives the systemic effect. TDDS is costly alternative to conventional formulation. It is also important due to its unique advantage. Controlled absorption, more uniform plasma levels, improved bioavailability, reduced side effects, painless and simple application and flexibility of terminating drug administration by simply removing the patch from the skin are some of the potential advantages of transdermal drug delivery. Development of controlled release transdermal dosage form is a complex process involving extensive efforts. This review article describes the methods of preparation of different types of transdermal patches. In addition, the various methods of evaluation of transdermal dosage form and Advance Development in TDDS have also been reviewed