US CENTERS FOR DISEASE CONTROL AND PREVENTION EXPERIENCE IN THE JOINT EXTERNAL EVALUATION PROCESS-RADIATION EMERGENCIES TECHNICAL AREA.

In 2015-16, the US Department of Health and Human Services led 23 US Government (USG) agencies including the Centers for Disease Control and Prevention (CDC), and more than 120 subject matter experts in conducting an in-depth review of the US core public health capacities and evaluation of the country's compliance with the International Health Regulations using the Joint External Evaluation (JEE) methodology. This two-part process began with a detailed 'self-assessment' followed by a comprehensive independent, external evaluation conducted by 15 foreign assessors. In the Radiation Emergencies Technical Area, on a scale from 1-lowest to 5-highest, the assessors concurred with the USG self-assessed score of 3 in both of the relevant indicators. The report identified five priority actions recommended to improve the USG capacity to handle large-scale radiation emergencies. CDC is working to implement a post-JEE roadmap to address these priority actions in partnership with national and international partners.

A public health perspective on the U.S. response to the Fukushima radiological emergency.

On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness.

Federal interagency communication strategies for addressing radiation emergencies and other public health crises.

Federal agencies have a variety of roles and responsibilities related to communicating with the public before, during, and after a radiological emergency. To better understand the various efforts currently underway, the Radiation Studies Branch of the Centers for Disease Control and Prevention convened a roundtable of representatives from federal agencies with responsibility for communicating with the public about radiation emergencies. Roundtable participants shared valuable information about efforts underway to develop information and messages for a variety of audiences and agreed that continued interagency coordination and dialogue about communication before, during, and after an event are needed. The group suggested several strategies for future collaborative efforts and indicated a desire to continue working together to develop and assess messages for radiological emergency preparedness and response. The group also recommended that more work be done to determine whether messages need to be packaged or tailored for specific special populations and suggested that more research be conducted to answer questions about specific audience/cultural needs around communicating radiation risks. Since this roundtable, attendees have continued to work together to develop and test messages for the public.

Educating medical staff about responding to a radiological or nuclear emergency.

A growing body of audience research reveals medical personnel in hospitals are unprepared for a large-scale radiological emergency such as a terrorist event involving radioactive or nuclear materials. Also, medical personnel in hospitals lack a basic understanding of radiation principles, as well as diagnostic and treatment guidelines for radiation exposure. Clinicians have indicated that they lack sufficient training on radiological emergency preparedness; they are potentially unwilling to treat patients if those patients are perceived to be radiologically contaminated; and they have major concerns about public panic and overloading of clinical systems. In response to these findings, the Centers for Disease Control and Prevention (CDC) has developed a tool kit for use by hospital medical personnel who may be called on to respond to unintentional or intentional mass-casualty radiological and nuclear events. This tool kit includes clinician fact sheets, a clinician pocket guide, a digital video disc (DVD) of just-in-time basic skills training, a CD-ROM training on mass-casualty management, and a satellite broadcast dealing with medical management of radiological events. CDC training information emphasizes the key role that medical health physicists can play in the education and support of emergency department activities following a radiological or nuclear mass-casualty event.

Credentials and skills required for hospital food and nutrition department directors.

The perceptions of hospital administrators, food and nutrition department directors, and management dietetic educators were compared with respect to the credentials and administrative skills required for a director of a food and nutrition department in a hospital with 300 beds or more. Questionnaires were mailed to the director of food and nutrition services and the vice president of hospital operations at 132 hospitals in five midwestern states. Fifty-six questionnaires were mailed to all educators on the 1986 to 1988 membership list of the Foodservice Systems Management Education Council. Response rates of directors, administrators, and educators were 68%, 53%, and 82%, respectively. The questionnaire consisted of three parts. Part one addressed credentials required; part two required participants to rank 14 skill categories in order of importance; and part three focused on facility descriptors and credentials of participating administrators and directors. Findings of the survey indicate that the minimum qualifications for department directors were registered dietitian status, at least a bachelor's degree in food and nutrition, and work experience in foodservice systems management. Although administrators ranked foodservice management skills higher than nutrition skills, they ranked nutrition skills significantly (p less than .001) higher than did directors or educators. These findings may guide career development of practitioners who aspire to department director positions.

On the nature of immobilized tris(carboxymethyl)ethylenediamine.

Immobilized tris(carboxymethyl)ethylenediamine (TED) (also known as ethylenediamine-N,N,N'-triacetic acid) serves as a stationary phase for fractionation of proteins and the preparation of metal-free proteins by immobilized metal-ion affinity chromatography. The Cu(II) complex of commercially available immobilized TED has been characterized by elemental, electrochemical and spectroscopic techniques. There is a large discrepancy between the theoretical capacity determined from the nitrogen content and the experimental capacities determined by atomic-absorption spectroscopy and anodic stripping voltammetry (ASV), indicating that a substantial portion of the immobilized ligand is not binding Cu(II). In addition, the titration of immobilized TED with Cu(II), monitored by ASV, suggests that more than one ligand is involved in binding Cu(II). A comparison of the EPR spectrum for immobilized Cu(II)-TED with spectra for various model complexes shows that the major immobilized ligand is ethylenediamine-N,N'-diacetic acid (EDDA) with immobilized TED present only as a minor component. The complexation constant for Cu(II) is close to the value for Cu(II)-EDDA in solution. The formation of EDDA is consistent with the method for synthesizing immobilized TED.