Evaluating Application of Knowledge and Skills: The Use of Consensus Expert Review to Assess Conference Abstracts of Field Epidemiology Training Participants

Background: Often evaluations of training programs are limited — with many focusing on the aspects that are easy to measure (e.g., reaction of trainees) without addressing the important outcomes of training, such as how trainees applied their new knowledge, skills, and attitudes. Numerous evaluations fail to measure training’s effect on job performance because few effective methods are available to do so. Particularly difficult is the problem of evaluating multisite training programs that vary considerably in structure and implementation from one site to another. Purpose: NA Setting: NA  Intervention: NA Research Design: We devised a method of a consensus expert review to evaluate the quality of conference abstracts submitted by participants in Field Epidemiology Training Programs – an approach that can provide useful information on how well trainees apply knowledge and skills gained in training, complementing data obtained from other sources and methods. This method is practical, minimally intrusive, and resource-efficient, and it may prove useful for evaluation practice in diverse fields that require training. Data Collection and Analysis: NA Findings: NA

Involuntary mental health treatment in the era of the United Nations Convention on the Rights of Persons with Disabilities

The introduction of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) and General Comment 1 on Article 12 (GC1) has generated considerable debate regarding the assertion that people with psychosocial disabilities (disabilities arising from mental health conditions) always possess decision-making capacity. While there is debate over the feasibility and acceptability of supported decision-making, stakeholders interviewed for this study suggested that coercive treatment is heavily overutilized and that there needs to be more dialogue between holders of divergent positions. There are a number of important unresolved questions relating to more complex cases and to whether the right guaranteed by the CRPD is absolute and immediate or subject to limitations. Ensuring participation of all key stakeholders is essential to realizing the pluralistic vision of the CRPD, as is research focusing on implementation of supported decision-making regimes, particularly in low- and middle-income countries. Training on the provisions of the CRPD is also needed to ensure implementation, and addressing stigmatized beliefs among policy makers about the decision-making and cognitive abilities of mental healthcare users (MHCUs) is critical.S1 Text. Methods.S1 Table. Sampling summary.http://www.plosmedicine.orgam2019Centre for Human Right

Rumor Surveillance and Avian Influenza H5N1

We describe the enhanced rumor surveillance during the avian influenza H5N1 outbreak in 2004. The World Health Organization’s Western Pacific Regional Office identified 40 rumors; 9 were verified to be true. Rumor surveillance informed immediate public health action and prevented unnecessary and costly responses

Monitoring travellers from Ebola-affected countries in New South Wales, Australia: what is the impact on travellers?

Background Amidst an Ebola virus disease (EVD) epidemic of unprecedented magnitude in west Africa, concerns about the risk of importing EVD led to the introduction of programs for the screening and monitoring of travellers in a number of countries, including Australia. Emerging reports indicate that these programs are feasible to implement, however rigorous evaluations are not yet available. We aimed to evaluate the program of screening and monitoring travellers in New South Wales. Methods We conducted a mixed methods study to evaluate the program of screening and monitoring travellers in New South Wales. We extracted quantitative data from the Notifiable Conditions Information Management System database and obtained qualitative data from two separate surveys of public health staff and arrivals, conducted by phone. Results Between 1 October 2014 and 13 April 2015, public health staff assessed a total of 122 out of 123 travellers. Six people (5%) developed symptoms compatible with EVD and required further assessment. None developed EVD. Aid workers required lower levels of support compared to other travellers. Many travellers experienced stigmatisation. Public health staff were successful in supporting travellers to recognise and manage symptoms. Conclusion We recommend that programs for monitoring travellers should be tailored to the needs of different populations and include specific strategies to remediate stigmatisation.JC was completing a placement as part of the Masters of Philosophy in Applied Epidemiology, Australian National University

A novel public health threat – high lead solder instainless steel rainwater tanks in Tasmania

OBJECTIVE: We identified two water tanks in Tasmania with water lead concentrations exceeding the Australian Drinking Water Guidelines (ADWG) limit; they had been constructed with stainless steel and high-lead solder from a single manufacturer. An investigation was initiated to identify all tanks constructed by this manufacturer and prevent further exposure to contaminated water. METHODS: To identify water tanks we used sales accounts, blood and water lead results from laboratories, and media. We analysed blood and water lead concentration results from laboratories and conducted a nested cohort study of blood lead concentrations in children aged <18 years. RESULTS: We identifed 144 tanks constructed from stainless steel and high lead solder. Median water lead concentrations were significantly higher in the stainless steel tanks (121µg/L) than in the galvanised tanks (1µg/L). Blood lead concentrations ranged from 1 to 26µg/dL (median 5µg/dL); of these, 77% (n=50) were below the then-recommended health-related concentration of 10µg/dL. Concentrations in the 15 people (23%) above this limit ranged from 10-26µg/dL, with a median of 14µg/dL. The median blood lead concentration in the nested cohort of children was initially 8.5µg/dL, dropping to 4.5µg/dL after follow-up. CONCLUSIONS: Lead concentrations in the water tanks constructed from stainless steel and high-lead solder were up to 200 times above the recommended ADWG limits. Implications for public health: This investigation highlights the public health risk posed by use of non-compliant materials in constructing water tanks

Mental health, human rights, and legal capacity

In September, 2021, our edited volume Mental Health, Human Rights and Legal Capacity was published. The book takes an interdisciplinary approach to engage with evolving debates related to legal capacity in the field of mental health care, documenting perspectives from legal scholars, practitioners, policy makers, advocates, and people with lived experience of mental health conditions from diverse regions worldwide. The volume is intended to stimulate a conversation. Its objective is to document good practices while also recognising that there remain considerable barriers to the implementation of non-coercive models of mental health support, as required by the 2006 UN Convention on the Rights of Persons with Disabilities (CRPD). Ultimately, our aim is to illustrate that ending coercion in mental health care is both necessary and possible, and that supported decision making in community-based mental health settings is the way of the future.http://www.thelancet.com/psychiatryhj2023Centre for Human Right

Internationally Distributed Frozen Oyster Meat Causing Multiple Outbreaks of Norovirus Infection in Australia.

Background. Between November 2003 and January 2004, outbreaks of norovirus in 3 Australian jurisdictions involving 83 cases of illness were associated with imported oyster meat. Methods. Cohort studies were conducted in 2 jurisdictions to identify relative risks of illness for the consumption of oysters. A case series was conducted in the third jurisdiction. Results. The cohort studies conducted in the first 2 jurisdictions identified relative risks of illness of 17 (95% confidence interval, 5-51) and 35 (95% confidence interval, 5-243), respectively, for the consumption of oysters. Multiple strains of norovirus were detected in fecal specimens from 8 of 14 patients and in 1 of the 3 batches of implicated oyster meat using seminested reverse-transcriptase polymerase chain reaction methods. Traceback investigations revealed that all oyster meat was harvested from the same estuary system in Japan within the same month. Conclusions. These outbreaks demonstrate the potential of foodborne disease to spread internationally and the need for national and international collaboration to investigate such outbreaks. Foodborne illness related to norovirus is underestimated because of underreporting of human cases and challenges in laboratory detection of viruses in foods, both of which can delay public health action

T cell derived HIV-1 is present in the CSF in the face of suppressive antiretroviral therapy.

HIV cerebrospinal fluid (CSF) escape, where HIV is suppressed in blood but detectable in CSF, occurs when HIV persists in the CNS despite antiretroviral therapy (ART). To determine the virus producing cell type and whether lowered CSF ART levels are responsible for CSF escape, we collected blood and CSF from 156 neurosymptomatic participants from Durban, South Africa. We observed that 28% of participants with an undetectable HIV blood viral load showed CSF escape. We detected host cell surface markers on the HIV envelope to determine the cellular source of HIV in participants on the first line regimen of efavirenz, emtricitabine, and tenofovir. We confirmed CD26 as a marker which could differentiate between T cells and macrophages and microglia, and quantified CD26 levels on the virion surface, comparing the result to virus from in vitro infected T cells or macrophages. The measured CD26 level was consistent with the presence of T cell produced virus. We found no significant differences in ART concentrations between CSF escape and fully suppressed individuals in CSF or blood, and did not observe a clear association with drug resistance mutations in CSF virus which would allow HIV to replicate. Hence, CSF HIV in the face of ART may at least partly originate in CD4+ T cell populations

Viscoelastic properties of bovine articular cartilage attached to subchondral bone at high frequencies

<p>Abstract</p> <p>Background</p> <p>Articular cartilage is a viscoelastic material, but its exact behaviour under the full range of physiological loading frequencies is unknown. The objective of this study was to measure the viscoelastic properties of bovine articular cartilage at loading frequencies of up to 92 Hz.</p> <p>Methods</p> <p>Intact tibial plateau cartilage, attached to subchondral bone, was investigated by dynamic mechanical analysis (DMA). A sinusoidally varying compressive force of between 16 N and 36 N, at frequencies from 1 Hz to 92 Hz, was applied to the cartilage surface by a flat indenter. The storage modulus, loss modulus and phase angle (between the applied force and the deformation induced) were determined.</p> <p>Results</p> <p>The storage modulus, <it>E'</it>, increased with increasing frequency, but at higher frequencies it tended towards a constant value. Its dependence on frequency, <it>f</it>, could be represented by, <it>E' </it>= <it>Alog</it>_{<it>e </it>}(<it>f</it>) + <it>B </it>where <it>A </it>= 2.5 ± 0.6 MPa and <it>B </it>= 50.1 ± 12.5 MPa (mean ± standard error). The values of the loss modulus (4.8 ± 1.0 MPa mean ± standard deviation) were much less than the values of storage modulus and showed no dependence on frequency. The phase angle was found to be non-zero for all frequencies tested (4.9 ± 0.6°).</p> <p>Conclusion</p> <p>Articular cartilage is viscoelastic throughout the full range of frequencies investigated. The behaviour has implications for mechanical damage to articular cartilage and the onset of osteoarthritis. Storage modulus increases with frequency, until the plateau region is reached, and has a higher value than loss modulus. Furthermore, loss modulus does not increase with loading frequency. This means that more energy is stored by the tissue than is dissipated and that this effect is greater at higher frequencies. The main mechanism for this excess energy to be dissipated is by the formation of cracks.</p