The development and pilot testing of a rapid assessment tool to improve local public health system capacity in Australia

<p>Abstract</p> <p>Background</p> <p>To operate effectively the public health system requires infrastructure and the capacity to act. Public health's ability to attract funding for infrastructure and capacity development would be enhanced if it was able to demonstrate what level of capacity was required to ensure a high performing system. Australia's public health activities are undertaken within a complex organizational framework that involves three levels of government and a diverse range of other organizations. The question of appropriate levels of infrastructure and capacity is critical at each level. Comparatively little is known about infrastructure and capacity at the local level.</p> <p>Methods</p> <p>In-depth interviews were conducted with senior managers in two Australian states with different frameworks for health administration. They were asked to reflect on the critical components of infrastructure and capacity required at the local level. The interviews were analyzed to identify the major themes. Workshops with public health experts explored this data further. The information generated was used to develop a tool, designed to be used by groups of organizations within discrete geographical locations to assess local public health capacity.</p> <p>Results</p> <p>Local actors in these two different systems pointed to similar areas for inclusion for the development of an instrument to map public health capacity at the local level. The tool asks respondents to consider resources, programs and the cultural environment within their organization. It also asks about the policy environment - recognizing that the broader environment within which organizations operate impacts on their capacity to act. Pilot testing of the tool pointed to some of the challenges involved in such an exercise, particularly if the tool were to be adopted as policy.</p> <p>Conclusion</p> <p>This research indicates that it is possible to develop a tool for the systematic assessment of public health capacity at the local level. Piloting the tool revealed some concerns amongst participants, particularly about how the tool would be used. However there was also recognition that the areas covered by the tool were those considered relevant.</p

Dispersion as an Important Step in the Candida albicans Biofilm Developmental Cycle

Biofilms are dynamic microbial communities in which transitions between planktonic and sessile modes of growth occur interchangeably in response to different environmental cues. In the last decade, early events associated with C. albicans biofilm formation have received considerable attention. However, very little is known about C. albicans biofilm dispersion or the mechanisms and signals that trigger it. This is important because it is precisely C. albicans cells dispersed from biofilms that are the main culprits associated with candidemia and establishment of disseminated invasive disease, two of the gravest forms of candidiasis. Using a simple flow biofilm model recently developed by our group, we have performed initial investigations into the phenomenon of C. albicans biofilm dispersion, as well as the phenotypic characteristics associated with dispersed cells. Our results indicate that C. albicans biofilm dispersion is dependent on growing conditions, including carbon source and pH of the media used for biofilm development. C. albicans dispersed cells are mostly in the yeast form and display distinct phenotypic properties compared to their planktonic counterparts, including enhanced adherence, filamentation, biofilm formation and, perhaps most importantly, increased pathogenicity in a murine model of hematogenously disseminated candidiasis, thus indicating that dispersed cells are armed with a complete arsenal of “virulence factors” important for seeding and establishing new foci of infection. In addition, utilizing genetically engineered strains of C. albicans (tetO-UME6 and tetO-PES1) we demonstrate that C. albicans biofilm dispersion can be regulated by manipulating levels of expression of these key genes, further supporting the evidence for a strong link between biofilms and morphogenetic conversions at different stages of the C. albicans biofilm developmental cycle. Overall, our results offer novel and important insight into the phenomenon of C. albicans biofilm dispersion, a key part of the biofilm developmental cycle, and provide the basis for its more detailed analysis