What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments.

OBJECTIVE: Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans). DESIGN: This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021. MAIN OUTCOME MEASURES: Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme. RESULTS: The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18). CONCLUSION: While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.

A Strategy for Strengthening: Implementation of the Capabilities Opportunities Assessment Tool for the Public Health Workforce.

CONTEXT: Strengthening the national public health infrastructure is crucial to ensure provision of necessary public health services in all jurisdictions. Public health agencies and their governing bodies need an evidence-based understanding of workforces' capabilities to operationalize this effort. PROGRAM: The Capabilities Opportunities Assessment Tool for the Public Health Workforce (COAT-PH) is an assessment of workforce foundational capabilities (FCs), based on the Foundational Public Health Services (FPHS) framework. The COAT-PH provides data on employees' capabilities to health departments to help them improve and operationalize the FPHS. IMPLEMENTATION: This article describes the development and pilot testing of the COAT-PH in a convenience sample of 8 health departments in Texas of various sizes and accreditation statuses. Participating leadership teams were provided easily interpretable reports to deliver clear evidence of division and organization-level workforce capability gaps and strengths. Follow-up semistructured interviews were conducted with leaders to capture insights into the tool and the usefulness of the findings. EVALUATION: Eighty-eight percent of pilot health departments reported successfully appraising employee capability deficits, and 83% of small and medium health departments successfully assessed division or organizational FC strengths and gaps. All participating departments identified ways they could use their findings in future improvement efforts. Instrument psychometrics included the Cronbach α of internal reliability using a small test-retest sample (n = 6) of 0.956. Item test-retest reliability using Cohen's κ revealed 89% of items demonstrated at least slight reliability and 43% demonstrated moderate to substantial reliability. Content validity was established through review by 15 subject matter experts in the field of public health. DISCUSSION: To provide the FPHS, health department leadership teams need a strong, prepared workforce and an effective method to demonstrate employee capabilities and provide evidence of health department workforce strengths and gaps to their governing bodies in the form of data that are clear and easy to understand. Early results demonstrated the usefulness of the COAT-PH in this effort.

Engaging Leadership Competencies Through Population Health Policy Advocacy: A Review of the Evidence.

The purpose of this article is to identify the gaps in prelicensure nursing curriculum regarding the teaching and learning of policy advocacy and the necessary nursing leadership competencies that are significant in addressing social determinants of health at an upstream, policy level and to discuss how current prelicensure nursing curricula integrates and applies concepts of population health, policy advocacy, and nursing leadership competencies. The authors performed a conceptual review of the literature, analyzing the current, evidence-based scholarship on the topic in an effort to categorize and describe relevant concepts and outline a relationship between them, by combining the concept terms nursing leadership, policy advocacy, population health policy, nursing education, and social determinants of health. The conceptual review identified gaps in nursing education regarding the preparation of nursing graduates for leadership engagement at the policy level, which presents opportunities for future research and exploration. This article shares the thematic gaps, major findings, and recommendations that resulted. Continued effort should be invested into the development of more robust discussions and curriculum related to population health advocacy and the impact on population health in baccalaureate nursing educational programming.

Evidence synthesis evaluating body weight gain among people treating HIV with antiretroviral therapy - a systematic literature review and network meta-analysis.

Background: This systematic review aimed to compare body weight gain associated outcomes over time between dolutegravir (DTG)-based antiretroviral (ART) regimens to other ART regimens, to compare tenofovir alafenamide (TAF)-based regimens, and to evaluate the associated prognostic factors. Methods: Systematic searches of MEDLINE, Embase, and CENTRAL for RCTs and observational studies comparing ART regimens were conducted on 13 September 2021. Outcomes of interest included: change in body weight, body mass index (BMI), waist circumference; and risk of hyperglycaemia and diabetes. Network meta-analyses were conducted at 12, 24, 48, 96 and 144 weeks using two networks differentiated by 3rd agents and backbone agents. Findings: The review identified 113 publications reporting on 73 studies. DTG-based regimens led to statistically higher weight gains than efavirenz-based regimens at all time points (mean difference: 1·99 kg at 96 weeks; 95% credible interval: 0·85-3·09) and was higher over time than low-dose efavirenz-, elvitegravir-, and rilpivirine-based regimens. They were comparable to raltegravir-, bictegravir- and atazanavir-based regimens. For backbones, TAF led to higher weight gain relative to tenofovir disoproxil fumarate (TDF), abacavir, and zidovudine. Prognostic factor analysis showed both low CD4 cell count and high HIV RNA viral load at baseline were consistently associated with higher weight gain, while sex was an effect modifier to African origins. Interpretation: DTG-based regimens lead to larger average weight gains than some other ART regimens and TAF leads to larger average weight gains than all other backbone antiretrovirals. Further research is needed to better understand long-term outcomes and their relationship to other metabolic outcomes. Funding: The WHO Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

Students, Stress, and the Pandemic: An Occupational Health Perspective for Nursing Education.

BACKGROUND: Nursing students have high risk factors for stress, and the coronavirus disease 2019 pandemic underscored weaknesses in mitigating nursing student stress and supporting well-being. Occupational health uses proven frameworks and perspectives for understanding and mitigating health risks, and promoting worker wellness. Nurse educators can draw from this knowledge to implement system-level changes in support of a safe and healthy learning environment. METHOD: This article describes the use of an occupational health strategy to create healthier educational environments. RESULTS: Applying occupational health concepts to nursing education supports honest appraisal of mental health dangers to students, offers keys to managing student health risks, and provides effective approaches for communicating risks with mitigation tactics. CONCLUSION: An occupational health and safety perspective creates a lens through which nursing stress resulting from the pandemic can be viewed and managed creatively using a holistic approach to mitigate harm from stress in the nursing educational setting. [J Nurs Educ. 2021;60(12):674-679.].

Facilitating health professional education research development; an action research approach.

BACKGROUND: Educational research and scholarship can advance teaching knowledge and practices. In the Westmead health precinct, Australia, education research has occurred in isolated pockets, with little professional development support. We developed a course to introduce the practice of educational research to multidisciplinary health professional educators in 2019. OBJECTIVE: We explored how we, as multidisciplinary teacher educators, could enable educators to undertake education research while improving our practice. METHODS: The course was developed based on Social Development Theory and applied to peer teaching to develop our teacher education capacity. Using action research, we worked together and with learners through repeated planning, observing, reflecting and engaging. We conducted facilitator/learner pre-/post-course and post-workshop surveys, and mid-course facilitator focus group. Data were analysed through theoretical thematic analysis using Guba and Lincoln's evaluation framework and Social Development Theory. RESULTS: Facilitators expected the course would enable novice participants to initiate research. Facilitators and learners reported course content, structure and approach were relevant, accessible and effective; however, limited times and irregular attendance challenged knowledge and skills development, and individual research engagement. Mid-course improvements increased time for application to authentic, collaborative research activities. Facilitators enhanced their teaching through jointly developing the course, reflection and responding to feedback. CONCLUSIONS: Through peer teaching, reflection and discussion, we collaboratively created, then improved, a health professional education research course, and developed our capacity as teacher educators. Our need to overcome challenges forced us to reconsider and adjust our approach. Action research benefits learners and teachers by improving teaching practice through a dynamic, cyclical, responsive approach.

Network meta-analysis of liraglutide versus dipeptidyl peptidase-4 inhibitors for the treatment of type 2 diabetes in Japanese patients.

AIMS: To determine the comparative efficacy and safety of liraglutide and dipeptidyl peptidase-4 (DPP-4) inhibitors as antidiabetics for Japanese patients with uncontrolled type 2 diabetes (T2DM). METHODS AND MATERIALS: We searched for randomized controlled trials (RCTs) evaluating outcomes among Japanese adults with uncontrolled T2DM and including liraglutide or DPP-4 inhibitors up to August 2016. We extracted data on trial and patient characteristics, and the following outcomes: HbA1c, weight, patients meeting HbA1c <7%, patients experiencing hypoglycemic events, microalbuminuria, estimated glomerular filtration rate (eGFR) and creatinine. We synthesized data using network meta-analyses (NMA) using a Bayesian framework. Continuous outcomes were modeled using normal likelihoods and an identity link, while dichotomous outcomes were modeled using a binomial likelihood and a logit link. RESULTS: The systematic literature review yielded 39 publications pertaining to 38 trials. A total of 27 trials (5032 patients) reported change in HbA1c at 12 weeks and at 24 weeks 9 trials (2091 patients). All treatments showed statistically significant reductions in HbA1c relative to placebo at 12 and 24 weeks. Liraglutide 0.9 mg was statistically superior to all DPP-4 interventions (vildagliptin, sitagliptin, linagliptin, alogliptin, teneligliptin, trelagliptin and omarigliptin) at 12 weeks and 24 weeks among those reporting. Treatments were not statistically differentiable with respect to weight change and risk of hypoglycemia. Finally, no comparisons of eGFR and microalbuminuria were conducted, as this data was reported in too few trials to conduct analyses. LIMITATIONS: Some important outcomes were limited by poor reporting (eGFR and microalbuminuria) or low event rates (hypoglycemia). The follow-up time was relatively short. Clinically, the 24 week time point is more important as it demonstrates more sustained results. CONCLUSIONS: Our research suggests that liraglutide 0.9 mg offers a more efficacious treatment option for T2DM than the DPP-4 inhibitors among adult Japanese patients and that it is a viable option for this population.

U.S. Food and Drug Administration approval: panitumumab for epidermal growth factor receptor-expressing metastatic colorectal carcinoma with progression following fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy regimens.

PURPOSE: To describe the Food and Drug Administration review and marketing approval considerations for panitumumab (Vectibix) for the third-line treatment of patients with epidermal growth factor receptor-expressing metastatic colorectal carcinoma. EXPERIMENTAL DESIGN: Food and Drug Administration reviewed a single, open-label, multicenter trial in which 463 patients with epidermal growth factor receptor-expressing metastatic colorectal cancer who had progressed on or following treatment with a regimen containing a fluoropyrimidine, oxaliplatin, and irinotecan were randomized (1:1) to receive best supportive care (BSC) with or without panitumumab (6 mg/kg every other week) administered until disease progression or intolerable toxicity. Progression and response were confirmed by an independent review committee masked to treatment assignment. At progression, patients in the BSC-alone arm were eligible to receive panitumumab. RESULTS: Although median progression-free survival (PFS) was similar in both treatment arms ( approximately 8 weeks), the mean PFS was approximately 50% longer among patients receiving panitumumab than among those receiving BSC alone (96 versus 60 days, respectively) and the objective response rate in patients receiving panitumumab was 8%. However, no difference in overall survival was shown between the two study arms. CONCLUSIONS: Panitumumab received accelerated approval based on improvement in PFS and an independently confirmed response rate of 8%, similar to that observed with other active agents at this advanced stage of disease. Confirmation of clinical benefit will be required for full approval.

Stigmatomyces from New Zealand and New Caledonia: new records, new species and two new host families.

Seven new records and three new species of Stigmatomyces (S. australis, S. baeopteri and S. clasiopellae), a genus of Laboulbeniales associated only with Diptera, are described from New Zealand and New Caledonia. Two new host families for Laboulbeniales are recorded, and a dichotomous key to Stigmatomyces species in New Zealand and New Caledonia is presented.

New species and records of Laboulbeniales from the subantarctic islands of New Zealand.

Until now Rhachomyces kenodactyli Balazuc & W. Rossi has been the only species of Laboulbeniales known to occur on Coleoptera in the Bounty, Antipodes, Auckland, Campbell and Snares Islands, which lie 48° to 35° S. Four new species (Diphymyces depressus, Diphymyces leschenii, Laboulbenia subantarctica and Laboulbenia loxomeri) and five new records for the subantarctic (Cucujomyces phycophilus, Diphymyces penicillifer, Laboulbenia sp. 1, Rhachomyces sp. 1 and Teratomyces sp. 1) are reported, increasing the known number of taxa tenfold. An expanded geographic range for Rhachomyces kenodactyli is reported. A relatively high percentage (12%) of known beetle species in the subantarctic serve as hosts for Laboulbeniales. This host utilization rate is higher than that in tropical and north temperate regions. The high proportion of intertidal coleopteran taxa in the subantarctic fauna probably accounts for the greater number of host species utilized. Fungi on intertidal beetles (Omaliinae [Staphylinidae], Oopterus [Carabidae] and Kenodactylus audouini [Carabidae]) are known from many host individuals and collections, while those on terrestrial species are known from few, and in some cases, a single collection or host. The sporadic occurrence of some species encountered increases the likelihood that a few species of Laboulbeniales on Coleoptera probably remain undiscovered in the region.

Cyanide bystander effect of the linamarase/linamarin killer-suicide gene therapy system.

BACKGROUND: The killer-suicide system linamarase/linamarin (lis/lin) uses the plant gene linamarase (beta-glucosidase) to convert the cyanogenic glucoside substrate, linamarin, into glucose and cyanide. We have studied the bystander effect associated with this new system mediated by the production of the cyanide ion that diffuses freely across membranes. METHODS: Immunofluorescent staining of cells treated with an anti-linamarase antibody allowed us to localize the enzyme within the cells. Flow cytometry was used to determine the sensitivity of different mixtures of cells, C6lis and C6gfp (green), to linamarin as a percentage of cell survival. RESULTS: We demonstrate here that rat glioblastoma C6 cells carrying the linamarase gene (lis), mixed with naive C6 cells and exposed to linamarin, induce generalized cell death. Cells expressing lis efficiently export linamarase, whereas linamarin enters cells poorly by endocytosis; as a result most of the cyanide is produced outside the cells. The study was facilitated by the presence of the green fluorescent protein (gfp) gene in the bystander population. As few as 10% C6lis-positive cells are sufficient to eliminate the entire cell culture in 96 h. CONCLUSIONS: This bystander mechanism does not preferentially kill toxic metabolite producer cells compared with bystander cells, thus allowing production of sufficient cyanide to cause tumor regression. In this report we confirm the potential of the lis/lin gene therapy system as a powerful tool to eliminate tumors in vivo.

The taxonomic status of Corethromyces bicolor from New Zealand, as inferred from morphological, developmental, and molecular studies.

Due to the absence of antheridial characters in collected material the precise placement of Corethromyces bicolor has remained troublesome up until now. Recent re-examination of receptacular and appendage characters present in the holotype led to its transfer to the genus Mimeomyces. Fresh collections of this fungus have provided the opportunity to re-assess its taxonomic position. Based on a combination of morphological and molecular characters, this species is re-instated within the genus Corethromyces.