Domains of Excellence: A CDC Framework for Developing High-Quality, Impact-Driven Public Health Science Publications.

CONTEXT: The Centers for Disease Control and Prevention (CDC) has a long history of using high-quality science to drive public health action that has improved the health, safety, and well-being of people in the United States and globally. To ensure scientific quality, manuscripts authored by CDC staff are required to undergo an internal review and approval process known as clearance. During 2022, CDC launched a scientific clearance transformation initiative to improve the efficiency of the clearance process while ensuring scientific quality. PROGRAM: As part of the scientific clearance transformation initiative, a group of senior scientists across CDC developed a framework called the Domains of Excellence for High-Quality Publications (DOE framework). The framework includes 7 areas ("domains") that authors can consider for developing high-quality and impactful scientific manuscripts: Clarity, Scientific Rigor, Public Health Relevance, Policy Content, Ethical Standards, Collaboration, and Health Equity. Each domain includes multiple quality elements, highlighting specific key considerations within. IMPLEMENTATION: CDC scientists are expected to use the DOE framework when conceptualizing, developing, revising, and reviewing scientific products to support collaboration and to ensure the quality and impact of their scientific manuscripts. DISCUSSION: The DOE framework sets expectations for a consistent standard for scientific manuscripts across CDC and promotes collaboration among authors, partners, and other subject matter experts. Many aspects have broad applicability to the public health field at large and might be relevant for others developing high-quality manuscripts in public health science. The framework can serve as a useful reference document for CDC authors and others in the public health community as they prepare scientific manuscripts for publication and dissemination.

Correlation of tangible quality parameters of vegetable-based transformer fluids.

Due to the inherent environmental footprint of petroleum derived transformer fluids, the power industry is gradually exploring the potential of vegetable oils as alternatives. The impetus comes mostly from vegetable oils renewability and their inherent biodegradability. However, the major drawback in the use of vegetable oils as dielectric fluids is their lower oxidative stability and higher kinematic viscosity compared to mineral oils. The results obtained clearly demonstrate the correlation between spectroscopic data induction time, kinematic viscosity, acid value, and peroxide value. Quantitatively, the absorption frequencies of functional groups in vegetable oil transformer fluids that can be correlated to the mentioned quality parameters show noticeable changes with aging/oxidative degradation. The study also demonstrates the utility of integrating spectroscopic data to understand trends in induction time and kinematic viscosity of oil samples heated under transformer service conditions.

The Differential Impact of Reopening States With and Without COVID-19 Face Mask Mandates on County-Level Consumer Spending.

OBJECTIVES: By the end of 2020, 38 states and the District of Columbia had issued requirements that people wear face masks when in public settings to counter SARS-CoV-2 transmission. To examine the role face mask mandates played in economic recovery, we analyzed the interactive effect of having a state face mask mandate in place on county-level consumer spending after state reopening, adjusting for county rates of new COVID-19 cases and deaths, time trends, and county-specific effects. METHODS: We collected county-specific data from state executive orders, consumer spending data from the Opportunity Insights Economic Tracker, and COVID-19 case and death data from the Centers for Disease Control and Prevention COVID-19 tracker. Using an event study approach, we compared county-level changes in consumer spending before and after state-issued closure orders were lifted and assessed the interactive effect of state-issued face mask mandates. RESULTS: The lifting of state-issued closures was associated with an average increase in consumer spending across all counties studied within 1 month. However, the increase was 1.2-1.7 percentage points higher in counties with a state face mask mandate in place than in counties without a state face mask mandate. CONCLUSIONS: In addition to their public health benefits, face mask mandates may have assisted economic recovery during the COVID-19 pandemic, suggesting they are a strong public health strategy for policy makers to consider now and for potential future pandemics arising from airborne viruses.

COVID-19 Trends Among Persons Aged 0-24 Years - United States, March 1-December 12, 2020.

Coronavirus disease 2019 (COVID-19) case and electronic laboratory data reported to CDC were analyzed to describe demographic characteristics, underlying health conditions, and clinical outcomes, as well as trends in laboratory-confirmed COVID-19 incidence and testing volume among U.S. children, adolescents, and young adults (persons aged 0-24 years). This analysis provides a critical update and expansion of previously published data, to include trends after fall school reopenings, and adds preschool-aged children (0-4 years) and college-aged young adults (18-24 years) (1). Among children, adolescents, and young adults, weekly incidence (cases per 100,000 persons) increased with age and was highest during the final week of the review period (the week of December 6) among all age groups. Time trends in weekly reported incidence for children and adolescents aged 0-17 years tracked consistently with trends observed among adults since June, with both incidence and positive test results tending to increase since September after summer declines. Reported incidence and positive test results among children aged 0-10 years were consistently lower than those in older age groups. To reduce community transmission, which will support schools in operating more safely for in-person learning, communities and schools should fully implement and strictly adhere to recommended mitigation strategies, especially universal and proper masking, to reduce COVID-19 incidence.

An Analysis of the Massachusetts Healthcare Law.

Healthcare in the United States has been one topic of the debates and discussion in the country for many years. The challenge for affordable, accessible, and quality healthcare for most Americans has been on the agenda of federal and state legislatures. There is probably no other state that has drawn as much individual attention regarding this challenge as the state of Massachusetts. While researching the topic for this article, it was discovered that financial and political perspectives on the success or failure of the healthcare model in Massachusetts vary depending on the aspect of the system being discussed. In this article the authors give a brief history and description of the Massachusetts Healthcare Law, explanation of how the law is financed, identification of the targeted populations in Massachusetts for which the law provides coverage, demonstration of the actual benefit coverage provided by the law, and review of the impact of the law on healthcare providers such as physicians and hospitals. In addition, there are explanations about the impact of the law on health insurance companies, discussion of changes in healthcare premiums, explanation of costs to the state for the new program, reviews of the impact on the health of the insured, and finally, projections on the changes that healthcare facilities will need to make to maintain fiscal viability as a result of this program.

Converting ICD-9 to ICD-10.

Implementing the International Classification of Diseases, Ninth Revision (ICD-9) to International Classification of Diseases, Tenth Revision (ICD-10) conversion on October 1, 2015, in the United States has been a long-term goal. While most countries in the world converted more than 10 years ago, the United States was still using ICD-9. Many countries in the world have a single-payer healthcare system, while there are thousands of different healthcare organizations (providers and payers) that presently exist in the United States. With so many different software platforms for healthcare providers and payers, the conversion had become that much more complicated and capital intensive for all healthcare organizations in the country. A few of the present delay reasons to the ICD-10 conversion in past years were the concurrent timelines for meeting meaningful use requirements for the electronic health record, testing with external payers and upgrades from vendors which added complexities and extra costs. The authors examine the reasoning behind the conversion as well as the delays, before making the conversion on October 1, 2015, and review the question regarding whether the government's decision to push the date back a year would have been helpful.

The influence of race on end-of-life choices following a counselor-based palliative consultation.

Black Americans are more likely than whites to choose aggressive medical care at the end of life. We present a retrospective cohort study of 2843 patients who received a counselor-based palliative care consultation at a large US southeastern hospital. Before the palliative consultation, 72.8% of the patients had no restrictions in care, and only 4.6% had chosen care and comfort only (CCO). After the consult, these choices dramatically changed, with only 17.5% remaining full code and 43.3% choosing CCO. Both before and after palliative consultation, blacks chose more aggressive medical care than whites, but racial differences diminished after the counselor-based consultation. Both African American and white patients and families receiving a counselor-based palliative consultation in the hospital make profound changes in their preferences for life-sustaining treatments.

Ultrasonic real-time in-die monitoring of the tablet compaction process-a proof of concept study.

The mechanical properties of a drug tablet can affect its performance (e.g., dissolution profile and its physical robustness. An ultrasonic system for real-time in-die tablet mechanical property monitoring during compaction has been demonstrated. The reported set-up is a proof of concept compaction monitoring system which includes an ultrasonic transducer mounted inside the upper punch of the compaction apparatus. This upper punch is utilized to acquire ultrasonic pressure wave phase velocity waveforms and extract the time-of-flight of pressure waves travelling within the compact at a number of compaction force levels during compaction. The reflection coefficients for the waves reflecting from punch tip-powder bed interface are extracted from the acquired waveforms. The reflection coefficient decreases with an increase in compaction force, indicating solidification. The data acquisition methods give an average apparent Young's moduli in the range of 8-20 GPa extracted during the compaction and release/decompression phases in real-time. A monitoring system employing such methods is capable of determining material properties and the integrity of the tablet during compaction. As compared to the millisecond time-scale dwell time of a typical commercial compaction press, the micro-second pulse duration and ToF of an acoustic pulse are sufficiently fast for real-time monitoring.

The use and role of open source software applications in public and not-for-profit hospitals in the United States.

BACKGROUND: The potential cost savings and customizability of open source software (OSS) may be particularly attractive for hospitals. However, numerous health-care-specific OSS applications exist, the adoption of OSS health information technology (HIT) applications is not widespread in the United States. PURPOSE: This disconnect between the availability of promising software and low adoption raises the basic question: If OSS HIT is so advantageous, why are more health care organizations not using it? METHODOLOGY: We interviewed the chief information officer, or equivalent position, at 17 not-for-profit and public hospitals across the United States. Through targeted recruitment, our sample included nine hospitals using OSS HIT and eight hospitals not using OSS HIT. The open-ended interview questions were guided by domains included in the fit-viability theory, an organizational-level innovation adoption framework, and those suggested by a review of the literature. Transcripts were analyzed using an inductive and comparative approach, which involved an open coding for relevant themes. FINDINGS: Interviews described the state of OSS use in hospitals. Specifically, general OSS applications were widely used by IT professionals. In addition, hospitals using OSS HIT still relied heavily on vendor support. In terms of why decisions arose to use OSS HIT, several hospitals using OSS HIT noted the cost advantages. In contrast, hospitals avoiding OSS HIT were clear, OSS as a class did not fit with clinical work and posed too much risk. PRACTICE IMPLICATIONS: Perceptions of OSS HIT ranged from enthusiastic embracement to resigned adoption, to refusal, to abandonment. Some organizations were achieving success with their OSS HIT choices, but they still relied on vendors for significant support. The decision to adopt OSS HIT was not uniform but contingent upon views of the risk posed by the technology, economic factors, and the hospital's existing capabilities.

The effects of aging on the attentional demands of walking toward and stepping up onto a curb.

Community ambulation requires the capacity to alter gait in response to obstacles within the path of travel that appear at a known location. Acquiring information from the environment to safely negotiate a curb may increase the cognitive demands of walking. The purpose of this study was to examine the attentional demands of walking toward and stepping up onto a curb in young, middle-age and older adults. Single and dual-task voice reaction time (VRT) was measured in community-dwelling young (n = 24), middle-age (n = 24), and older adults (n = 24) across 5 conditions: sitting in a chair, standing, level walking, and walking toward and while stepping up onto a curb. A 3 (group) by 5 (task condition) ANOVA was used to examine VRT. The interaction of group with task revealed statistically significant within group increases in VRT when comparing either sitting and/or standing to walking on a level surface and walking toward the curb and stepping up onto the curb. When compared to the other groups, older adults had significantly longer VRT for all walking tasks. Stepping onto the curb significantly increased the attentional requirements of walking for all of the groups when compared to level walking. The pattern of statistically significant between group and within group differences during the walking tasks indicate the effects of a curb located at a predictable place in the environment on attentional allocation.

Acoustic assessment of mean grain size in pharmaceutical compacts.

An ultrasonic non-destructive technique for the microstructure length-scale characterization of solid dosage pharmaceutical tablets is presented. The technique is based on the relationship between the attenuation of longitudinal ultrasonic elastic waves and the size of micro-structural features in the tablet material. In the reported experiments, the ultrasonic attenuation in microcrystalline cellulose (MCC)-lactose monohydrate (LMH) blended pharmaceutical compacts is measured by means of two pitch-catch experiments. The frequency dependent attenuation coefficient for the MCC-LMH compacts is then related to the mean grain diameter for each compact. For verification purposes, the mean grain diameter of the compacts was also established using micro-scale X-ray computerized tomography (MicroXCT). The mean grain diameters established by both routines agree well, and support the efficacy of the ultrasonic attenuation technique. The microstructure of a pharmaceutical compact (i.e., grain sizes and micro-feature size distribution) has been shown to have a profound effect on its mechanical properties, namely hardness, porosity, and mass density distribution, and in turn, can critically impact the dissolution profile and structural integrity of a compact. The ultrasonic technique presented provides a non-destructive and rapid method for determining the mean grain diameter size for powder compacts, thus providing a more timely and cost-effective method, compared to traditional techniques, of characterizing a compact's internal microstructure.

Real-time in-die compaction monitoring of dry-coated tablets.

The practicability of a pulse-echo ultrasonic approach developed for the real-time quality monitoring of dry-coated tablets in the tablet press during compaction is evaluated. The punch-tablet interface (i.e., steel-tablet) is the boundary condition that dictates the viability of acoustic in-die compaction monitoring. The current study utilizes compacted tablets with a simulated punch-tablet interface to achieve the required waveform detectability levels needed for in-die compaction monitoring. The geometric and mechanical properties of a dry-coated tablet are crucial to its structural functions and therapeutic effectiveness, therefore they are monitored especially when the control of dissolution rates of their active ingredients are critically important. Acquired pulse-echo ultrasonic waveforms in the tablet could provide the time-of-flight information needed to determine the thickness, elasticity and/or integrity of the relevant layer, and bonding quality between layers depending on the given parameters. Since the amplitudes of the reflected waves are extremely low due to the high acoustic impedance mismatches of tablet materials and die/punch materials, signal processing techniques are required to extract the wave arrival times. In current study, it is demonstrated that the reflection of an ultrasonic pulse generated by a transducer embedded in a die or a punch from the coat-core interface can be acquired by the same transducer.

Sticker shock: an exploration of supply charge capture outcomes.

Do you find supply item charge stickers in shocking places in nursing units? Capturing supply item charges to increase net revenue or achieve break-even are based on efficiency. To determine practical efficiency for a hospital in supply charge capture, the authors examined the quantity of supply charge capture items, volume, and relative size of the hospital in 10 hospitals in the midwestern and southeastern United States. What differences in supply charge capture information can determine if a hospital can break even? Results show that hospital size and number of supply charge capture items to manage are important factors.

Factors that influence the clinical decision making of novice and experienced physical therapists.

BACKGROUND: The depth and breadth of prior experience informs clinical decision making in novice and experienced physical therapist clinicians. OBJECTIVES: The aims of this research were to identify differences in clinical decision-making abilities and processes between novice and experienced physical therapist clinicians and to develop a model of the factors that influence clinical decision making. DESIGN: Qualitative research methods and grounded theory were used to gain insight into the factors and experiences that inform clinical decision making. METHODS: Three participant pairs (each pair consisted of 1 novice physical therapist and 1 experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries from each participant provided the basis for within- and across-case analyses. The credibility of the results was established through checking of the case summaries by the participants, presentation of low-inference data, and triangulation across multiple data sources and within and across participant groups. RESULTS: The factors that influenced clinical decision making were categorized as informative or directive. Novice participants relied more on informative factors, whereas experienced participants were more likely to rely on directive factors. An intermediate effect beyond novice practice was observed. CONCLUSIONS: The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities for students and novice learners with the aim of facilitating the development of skills and abilities consistent with expert clinical decision making.

Real healthcare reform: focus on primary care access.

Primary care coverage for the uninsured is the first necessary step to reform and can be more cost effective and tolerable than a major system reform. By providing foundational care to the uninsured, more care resources are targeted to those that most need the services, while providing benefits such as increased productivity and reduced inappropriate emergency department utilization. The authors aimed to design a primary care coverage system in the United States for the uninsured using established reimbursement, budgeting, and compliance methods. Providing four primary care visits for acute care, four associated ancillary and four fulfilled pharmaceutical-treatment prescriptions, and one preventive primary care visit per year for nearly 48,000,000 uninsured would cost $36 per month for every working American and legal alien resident. Theoretical and empirical literature was reviewed and the authors applied practical knowledge based on their experience in healthcare systems to develop the Access America Program.

Drive alive: teen seat belt survey program.

OBJECTIVE: To increase teen seat belt use among drivers at a rural high school by implementing the Drive Alive Pilot Program (DAPP), a theory-driven intervention built on highway safety best practices. METHODS: The first component of the program was 20 observational teen seat belt surveys conducted by volunteer students in a high school parking lot over a 38-month period before and after the month-long intervention. The survey results were published in the newspaper. The second component was the use of incentives, such as gift cards, to promote teen seat belt use. The third component involved disincentives, such as increased police patrol and school policies. The fourth component was a programmatic intervention that focused on education and media coverage of the DAPP program. RESULTS: Eleven pre-intervention surveys and nine post-intervention surveys were conducted before and after the intervention. The pre- and post-intervention seat belt usage showed significant differences (p<0.0001). The average pre-intervention seat belt usage rate was 51.2%, while the average post-intervention rate was 74.5%. This represents a percentage point increase of 23.3 in seat belt use after the DAPP intervention. CONCLUSION: Based on seat belt observational surveys, the DAPP was effective in increasing seat belt use among rural high school teenagers. Utilizing a theory-based program that builds on existing best practices can increase the observed seat belt usage among rural high school students.

Novice and experienced physical therapist clinicians: a comparison of how reflection is used to inform the clinical decision-making process.

BACKGROUND: Prior experience informs clinical decision making and shapes how reflection is used by novice and experienced physical therapist clinicians. OBJECTIVES: The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists. DESIGN: Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making. METHODS: Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups. RESULTS: Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed. CONCLUSIONS: The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners.