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Community health workers (CHWs), or promotores de salud, have long played a role in health promotion, but the COVID-19 pandemic has brought renewed attention to the functions, sustainability, and financing of CHW models. ¡Andale! ¿Que Esperas? was a 12-month (June 2021-May 2022) campaign that expanded the CHW workforce to increase COVID-19 vaccination rates in structurally vulnerable, Latinx communities across California. This mixed-methods evaluation aims to elucidate (1) the role of CHWs in COVID-19 response, recovery, and rebuilding and (2) the importance, needs, and perils of CHW models in the COVID-19 era and beyond. CHWs facilitated 159,074 vaccinations and vaccine appointments by countering mis/disinformation, addressing mental health and social needs, building digital competencies, and meeting people where they are, all of which expanded access and instilled confidence in the COVID-19 vaccine. CHWs' success in engaging the community lies in their shared lived experience as well as their accessibility and recognition in the community, enabling their role in both immediate response and long-term recovery. Funding instability imperils the advances made by CHWs, and efforts are needed to institutionalize the CHW workforce with sustainable funding models. While Medicaid reimbursement models exist in some states, these models are often limited to healthcare services, overlooking a critical function of the CHW model: building community resilience and mobilizing the community for social change.

Data sharing between local health departments and health care systems is challenging during public health crises. In early 2021, the supply of COVID-19 vaccine was limited, vaccine appointments were difficult to schedule, and state health departments were using a phased approach to determine who was eligible to get the vaccine.Multiple local health departments and health care systems with the capacity for mobile and pop-up vaccine clinics came together in Columbus and Franklin County, Ohio, with a common objective to coordinate where, when, and how to set up mobile/pop-up COVID-19 vaccine clinics. To support this objective, the Equity Mapping Tool, which is a set of integrated tools, workflows, and processes, was developed, implemented, and deployed in partnership with an academic institution.The Equity Mapping Tool was designed after a rapid community engagement phase. Our analytical approaches were informed by community engagement activities, and we translated the Equity Mapping Tool for stakeholders, who typically do not share timely and granular data, to build capacity for data-enabled decision making.We discuss our observations related to the sustainability of the Equity Mapping Tool, lessons learned for public health scientists/practitioners, and future directions for extending the Equity Mapping Tool to other jurisdictions and public health crises.

Background: Dengue fever is a vector-borne infectious tropical disease caused by the dengue virus, the most common arthropod-borne infection in humans. According to WHO, the best strategy to avoid dengue endemic is to educate people about the disease and preventative measures? Despite the efforts to avoid the dengue virus, the newest national survey statistics show that dengue fever is still on the increase among the population. The major goal of this study was to examine university students' knowledge of dengue and preventative measures, as well as to determine the relationship between awareness of dengue and drivers of knowledge of dengue infection in Government College University Faisalabad students. Aim: The aim of this review is to highlight Dengue fever (break-borne fever). Materials and methods: This was a survey review article. This research work was conducted at Government College University, Faisalabad. And this research work was conducted in three months (Between February 2020 and April 2020). A cross-sectional study investigation was carried out. A total of 500 students were interviewed, with pre-tested questioners being used. Results: A cross-sectional investigation was carried out. A total of 500 students were interviewed, with pre-tested questioners being used. The sampling was done in a convenient manner. In Government College University Faisalabad, several medical terminologies were put in plain English, and interviewers were trained for data collecting. The research was carried out at Government College University in Faisalabad. The course of study was also thought to have an influence on Dengue fever knowledge. SPSS was used to examine the findings of this investigation. The total score range was 25. The participants (26.4%) showed scores from a range of 10 or below 10 which means they had poor knowledge about dengue awareness. While the participants (45.4%) showed scores from a range of 11 to 18 which means they had fair knowledge about dengue awareness. The participants (28.2%) s showed scores ranging from 19 to 25 which means they had good knowledge about dengue fever awareness. Conclusion: Of this study is that knowledge is poor between the study respondents while the majority of persons had clear understanding of fever, headache, joint pain as general signs and symptoms of dengue viral fever. However, a huge proportion exhibited vague opinions of other different signs and symptoms involving muscular pain and skin rashes. Only rare of them knew that dengue viral fever is caused by mosquito bites, and was conscious that the mosquito causing dengue breeds in artificially collected water.

Recent COVID-19-related federal legislation has resulted in time-limited increases in Mental Health Block Grant (MHBG) set-aside dollars for coordinated specialty care (CSC) throughout the United States. The state of Ohio has opted to apply these funds to establish a learning health network of Ohio CSC teams, promote efforts to expand access to CSC, and quantify the operating costs and rates of reimbursement from private and public payers for these CSC teams. These efforts may provide other states with a model through which they can apply increased MHBG funds to support the success of their own CSC programs.

Phalsa (Grewia asiatica L.) belongs to family Malvaceae is a delicious fruit with wide range of therapeutic benefits. The current research work was planned to develop cream cheese using frozen and dehydrated (F & D) phalsa. The developed product quality and acceptability was subjected to sensory evaluation followed by various analysis to check the microbial activity of frozen & dehydrated phalsa-based product. The microbial count was 18cfu/mL in frozen phalsa-based product while 14cfu/mL in dehydrated phalsabased cream cheese. On comparison it is concluded based on results that dehydrated phalsa-based product was proved to be most effective as compared to frozen phalsa-based product.

Aedes aegypti (Linnaeus, 1762) is a major vector responsible for dengue transmission. Insecticides are being used as the most effective tool to control vector populations in Lahore, Pakistan. Control of Ae. aegypti is threatened by the development of resistance against insecticides. The current status of insecticide resistance was evaluated against pyrethroids (deltamethrin, cypermethrin, and lambda-cyhalothrin) in different populations of Lahore (Model Town, Mishri Shah, Sadar Cantt, Walton, and Valencia). The susceptibility of the larval and adult populations was tested following the standard WHO guidelines. Moderate to high levels of resistance were found against pyrethroids in the larval (RR50: 3.6–27.2 and RR90: 5–90) and adult populations (percentage mortality < 98%). Biochemical assays revealed a statistically significant increase in the enzyme level in all field populations compared to the laboratory strain. The value of esterase was one-fold higher, monooxygenase was 3.9- to 4.7-fold higher, and glutathione S-transferases was 1.9- to 2.6-fold higher in field populations compared to the laboratory strain. These results depict the presence of resistance against deltamethrin, cypermethrin, and lambda-cyhalothrin in field populations of Lahore mediated by metabolic enzymes i.e. esterases, monooxygenases, and glutathione S-transferase.

Objectives We describe the prevalence and correlates of nonuse of preferred contraceptive method among women 18-44 years of age in Ohio using contraception. Study Design The population-representative Ohio Survey of Women had 2529 participants in 2018–2019, with a response rate of 33.5%. We examined prevalence of preferred method nonuse, reasons for nonuse, and satisfaction with current method among current contraception users (n = 1390). We evaluated associations between demographic and healthcare factors and preferred method nonuse. Results About 25% of women reported not using their preferred contraceptive method. The most common barrier to obtaining preferred method was affordability (13%). Those not using their preferred method identified long-acting methods (49%), oral contraception (33%), or condoms (21%) as their preferred methods. The proportion using their preferred method was highest among intrauterine device (IUD) users (86%) and lowest among emergency contraception users (64%). About 16% of women using permanent contraception reported it was not their preferred method. Having the lowest socioeconomic status (versus highest) (prevalence ratio [PR]: 1.47, 95% CI: 1.11–1.96), Hispanic ethnicity (versus non-Hispanic white) (PR: 1.83, 95% CI: 1.15–2.90), reporting poor provider satisfaction related to contraceptive care (PR: 2.33, 95% CI: 1.02–5.29), and not having a yearly women's checkup (PR: 1.31, 95% CI: 1.01–1.68) were significantly associated with nonuse of preferred method. Compared to preferred-method nonusers, higher proportions of preferred-method users reported consistent contraceptive use (89% vs. 73%, p Conclusions Affordability and poor provider satisfaction related to contraceptive care were associated with nonuse of preferred contraceptive method. Those using their preferred method reported more consistent use. Implications Cost is an important barrier for women in obtaining their preferred contraceptive methods. Low quality birth control care may also be a barrier to preferred-method use. Removal of cost barriers and improvement in contraceptive counseling strategies may increase access to preferred contraceptive methods.

Background: Obesity poses significant challenges to healthcare globally, particularly through its bi-directional relationship with co-morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods: A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings: Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity-related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion: Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi-faceted actions on major outcomes.

This research study analyzes Putin's leadership and its efforts for Russianresurgence as a great power. In its desire to achieve its great power statusback; Russia has formed a more assertive foreign policy. Hence, it deemednecessary for Russian policy makers to re-Sovietize its former republics togain its desired objectives. Ukraine appears to be an important state for thecontemporary grand strategy of the Russian Federation. The annexation ofCrimea in 2014, have certain key drivers, such as the large ethnic Russianpopulation with the real grievances that had created instability, which madeRussia step in and intervene. Putin desired to enhance Russia’s internationalstature and deterring Western involvement in its sphere of influence. Russia'sforeign policy goals under Putin have been formulated upon the militaryadventures of the country, especially in its near abroad to engage the postSoviet periphery in geo-economic and geo-political ties with the RussianFederation. Putin seems determined to achieve a central position for Russiaby using his political ideology and leadership as a source of his vertical powerto affluence in the new geostrategic and economic pole of Eurasia. This studyhighlights Putin's keen interest in the former republic of Ukraine that holds avital position that escalated after annexing Crimea while consideringUkraine's importance in the geopolitics of Eurasia simultaneously.

Racism is a principal determinant of health inequity, but recent events have galvanized local and state leaders across Ohio to declare racism a public health emergency. In addition to the renewed call to racial justice, sustained progress will require ongoing measurement to determine which anti-racist efforts are working, and why. In this review, we present existing measures categorized by 3 dimensions of racism that interact and build off of one another: (1) systemic racism, considering the health effects of policies in housing, voting, criminal legal system, economic opportunity, and health care; (2) interpersonal racism, and measures of provider bias and cultural competency; (3) internalized racism, measured as allostatic stress and heightened vigilance in distinct contexts. After identifying knowledge gaps, we developed a racism measurement framework that more comprehensively depicts the disparities caused by racism within Ohio and can be used to monitor and evaluate the effectiveness of anti-racist efforts implemented across the state. As such, this framework provides not only a call for action against racism in Ohio, but an opportunity for organizations to measure the extent to which efforts have intervened on supposedly entrenched pathways to health inequities and disparities caused by racism.

Cervical cancer is the second most common cancer among women in the Philippines. Human papillomavirus (HPV) vaccination provides protection from the most common cancer-causing HPV types. This analysis used a proportionate outcomes model to estimate the potential cost-effectiveness of four different HPV vaccine products-Cervarix™, Cecolin®, GARDASIL®, and GARDASIL®9-for routine HPV vaccination of 10 cohorts of 9-year-old girls from the government and societal perspectives. Model parameters included cervical cancer burden, healthcare and program costs, vaccine efficacy with and without potential cross-protection, and vaccination coverage. Univariate and probabilistic sensitivity analyses evaluated the impact of uncertainty on model results. Compared to no vaccination, HPV programs with Cecolin®, Cervarix™, and GARDASIL® are projected to be cost-effective at US$1,210, US$1,300, and US$2,043 per DALY averted, respectively, from the government perspective, and at US$173, US$263, and US$1,006 per DALY averted, respectively, from the societal perspective when cross-protection was considered. When direct comparisons were made across vaccines, GARDASIL® was dominated by Cervarix™ and Cecolin®. In a scenario where cross-protection was not considered, results were similar except that Cervarix™ and GARDASIL® were both dominated by Cecolin®. GARDASIL®9 was not cost-effective under any of the modeled scenarios.

The primary focus of this research is to understand Russian hybrid warfare as a tool of Russian Foreign policy in contemporary Syria. Although hybrid warfare is not new, however Russian focus on hybrid warfare appears to signal a reorientation of its foreign policy, most visibly in Syria. Russian resurgence has caused a stir in the international community, particularly after the 'colour revolution' in Georgia in 2008. The threat seems to have grown with the Crimean Annexation of 2014 and the alleged Russian role in the U.S presidential election 2016. Russian hybrid warfare became noticeable in the Middle East, specifically in Syria after the infamous 'Arab Spring' 2011. The use of controlled warfare tactics in countering the enemy, aiding the proxies, and public opinion formation (misinformation); working aside from the governmental presentation has accelerated the international concern, as the legal uncertainties in the international law, leaves room for use of hybrid means. Consolidation of Bashar Al Assad regime, aided by Russian intervention, on the pretext of 'fighting terrorism' in 2015, also highlighted Russian resurgence in the Middle East. This research would primarily study the prospects of understanding hybrid warfare as the significant emerging generation of warfare in contemporary times, understanding the nature of Russian hybrid warfare, its implication in the Middle East and in particular on Syria. The Paper will in particular look at Maskirovka - the military strategy employed by Russia, which explains its hybrid tactics and aims particularly in Syria.

INTRODUCTION: The disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response METHODS: We used tracking sheets to identify 1,436 unique participants (aged 5-86) enrolled in Latino Health Access's Emotional Wellness program, of whom 346 enrolled in the pre-COVID-19 period (March 2019-February 2020) and 1,090 in the COVID-19 period (March-June 2020) Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson chi2 tests Regression models were developed to compare factors associated with referrals in the pre-COVID-19 and COVID-19 periods RESULTS: During the pandemic, service volume (P < 001) and participant volume (P < 001) increased significantly compared with the prepandemic period Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic Nonreferred services, such as peer support, increased during the pandemic period Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income CONCLUSION: An effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities This study presents a model of how to integrate both factors by leveraging promotor-led programs

IntroductionIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive and irreversible lung disease. Licensed treatment options for IPF are pirfenidone and nintedanib. The aim of this study was to assess the impact of antifibrotic therapy in patients with IPF with preserved lung function based upon a forced vital capacity (FVC) above 80%.MethodThis is a retrospective single-centre cohort study, performed as part of a service evaluation, between January 2007 and September 2018. Patient demographic, treatment and lung function profiles were collected using electronic patient records. A linear mixed model and Kaplan–Meier estimator were utilised to assess changes in FVC and survival over 36 months.ResultsA total of 161 patients were included in this study. Mean age was 72 ± 4. Twenty-four (14.9%) received pirfenidone, 86 (53.4%) received nintedanib and 18 (11.2%) received both antifibrotics provided by a compassionate use program (CUP), as the National Institute of Heath and Clinical excellence (NICE) criteria for antifibrotics in the UK is restricted to an FVC 50–80%. Thirty-three (20.5%) patients did not receive treatment. Patients without antifibrotic therapy had a statistically higher baseline FVC compared to other groups: 3.55 l (100%) vs 2.85 l (89.7%) pirfenidone (p = 0.012), vs 2.99 l (93.5%) nintedanib (p = 0.04) and 3.10 l (92.7%) (p = 0.07) for both antifibrotics. FVC decline over 1 year was similar in groups receiving pirfenidone, nintedanib or no treatment [3.72% (158.1 ml) untreated vs 2.77% (139 ml) pirfenidone vs 2.96% (131 ml) nintedanib]; however, it was significantly greater in patients who received both antifibrotics [6.36% (233 ml), p = 0.01]. Use of antifibrotics was associated with a higher median survival post diagnosis; 3.5, 3 and 3.75 years respectively in pirfenidone, nintedanib and both antifibrotic cohorts, compared to the untreated cohort (2.5 years).ConclusionOne in five untreated patients with an average FVC of 100% die within a median of 2.5 years. Antifibrotic therapy was associated with a higher median survival of 3–3.75 years despite treatment groups having lower baseline lung function.

Altered DNA repair capacity may affect an individual's susceptibility to cancers due to compromised genomic integrity. This study was designed to elucidate the association of selected polymorphisms in DNA repair genes with urothelial bladder carcinoma (UBC). OGG1 rs1052133 and rs2304277, XRCC1 rs1799782 and rs25487, XRCC3 rs861539, XPC rs2228001, and XPD rs13181 were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 200 UBC cases and 200 controls. We found association of OGG1 rs2304277 [odds ratio (OR)GG = 3.55, 95% confidence interval (CI) = 1.79-7.06] and XPC rs2228001 (ORAC = 2.38, 95% CI = 1.43-3.94) with UBC. In stratified analysis with respect to smoking status, OGG1 rs2304277 and XPC rs2228001 exhibited increased risk in smokers [(rs2304277 ORGG = 4.96, 95% CI = 1.51-16.30) (rs2228001 ORAC = 2.19, 95% CI = 1.02-4.72)] as well as nonsmokers [(rs2304277 ORGG = 2.95, 95% CI = 1.26-6.90) (rs2228001 ORAC = 2.57, 95% CI = 1.31-5.04)]. These polymorphisms were also associated with both low-grade [(rs2304277 ORGG = 3.73, 95% CI = 1.72-8.09) (rs2228001 ORAC = 2.18, 95% CI = 1.21-3.92)] and high-grade tumors [(rs2304277 ORGG = 3.45, 95% CI = 1.52-7.80) (rs2228001 ORAC = 2.81, 95% CI = 1.48-5.33)] as well as with non-muscle-invasive bladder cancer [(rs2304277 ORGG = 4.03, 95% CI = 1.87-8.67) (rs2228001 ORAC = 2.14, 95% CI = 1.20-3.81)] and muscle-invasive bladder cancer [(rs2304277 ORGG = 3.06, 95%CI = 1.31-7.13) (rs2228001 ORAC = 2.95, 95%CI = 1.51-5.75)]. This is the first study on DNA repair gene polymorphisms and UBC in the Pakistani population. It identifies OGG1 rs2304277 and replicates XPC rs2228001 as significant modulators of UBC susceptibility.

The aims of this study were to 1) examine pharyngoesophageal and cardiorespiratory responses to provoking pharyngeal stimuli, and 2) to determine potential contributory factors impacting heart rate (HR) changes to provide insight into cardiorespiratory events occurring in preterm infants. Forty-eight neonates (19 females and 29 males, born at 27.7 ± 0.5 wk; mean ± SE) pending discharge on full oral feeds were studied at 38.7 ± 0.2 wk postmenstrual age using concurrent pharyngoesophageal manometry, electrocardiography, respiratory inductance plethysmography, and nasal airflow thermistor. Pharyngoesophageal and cardiorespiratory responses (prevalence, latency, and duration) were quantified upon abrupt pharyngeal water stimuli (0.1, 0.3, and 0.5 ml in triplicate). Mixed linear models and generalized estimating equations were used for comparisons between HR changes. Contributory factors included stimulus characteristics and subject characteristics. Of 338 pharyngeal stimuli administered, HR increased in 23 (7%), decreased in 108 (32%), and remained stable in 207 (61%) neonates. HR decrease resulted in repetitive swallowing, increased respiratory-rhythm disturbance, and decreased esophageal propagation rates (all, P < 0.05). HR responses were related to stimulus volume, stimulus flow rate, and extreme prematurity (all, P < 0.05). In preterm infants, HR remains stable in a majority of pharyngeal provocations. HR decrease, due to pharyngeal stimulation, is related to aberrant pharyngoesophageal motility and respiratory dysregulation and is magnified by prematurity. We infer that the observed aberrant responses across digestive, respiratory, and cardiovascular systems are related to maladaptive maturation of the parasympathetic nervous system. These aberrant responses may provide diagnostic clues for risk stratification of infants with troublesome cardiorespiratory events and swallowing difficulty.NEW & NOTEWORTHY Cardiorespiratory rhythms concurrent with pharyngeal, upper esophageal sphincter, and esophageal body responses were examined upon pharyngeal provocation in preterm-born infants who were studied at full-term maturation. Decreased heart rate (HR) was associated with extreme preterm birth and stimulus flow/volume. With HR decrease responses, aerodigestive reflex abnormalities were present, characterized by prolonged respiratory rhythm disturbance, repetitive multiple swallowing, and poor esophageal propagation. Promoting esophageal peristalsis may be a potential therapeutic target.

Objective To test whether symptom generation in infants is related to the severity of gastroesophageal reflux disease (GERD) symptoms as determined by the Acid Reflux Index (ARI), stimulus media, and stimulus volume during provocative esophageal manometry. Study design Symptomatic neonates (n = 74) born at a median of 28.9 weeks gestation (range, 23.4-39.4 weeks) were studied at a median of 41.0 weeks (range, 34.6-48.0 weeks) postmenstrual age using 24-hour pH-impedance methods to determine ARI severity, followed by provocative esophageal manometry with graded mid-esophageal infusions (0.1-5.0 mL) of air, water, and apple juice. Peristaltic reflexes and symptom characteristics were compared among ARI severity categories using linear mixed models and generalized estimating equations. Results The effects of 2635 separate esophageal stimuli on reflexes and symptoms were analyzed. Peristaltic reflexes occurred in 1880 infusions (71%), and physical, cardiorespiratory, sensory symptoms were seen in 439 infusions (17%). Symptom prevalence did not differ across the ARI severity categories (ARI 7, 16%; P = 1.0). Symptom and peristaltic responses increased with incremental stimulus volumes (all media, P Conclusions Symptoms and peristaltic reflexes are manifestations of the recruitment of several neurosensory and neuromotor pathways evoked by mid-esophageal infusions. ARI severity grade plays no role in symptom generation, indicating that GERD should not be diagnosed and severity should not be assigned based on symptoms alone. An increase in symptom occurrence was noted with increasing stimulus volumes, which provided increased activation of receptors, afferents, and efferents in evoking peristaltic clearance reflexes.

A fuzzy soft set is a mapping from parameter set to the fuzzy subsets of universe. Fuzzy soft set theory provides a parameterized point of view for uncertainty modeling and soft computing model. In this research article, we apply the concept of fuzzy soft sets to graphs. We present the concept of fuzzy soft graphs, various methods of their construction, and investigate some of their related properties. We discuss certain types of irregular fuzzy soft graphs. We also describe applications of fuzzy soft graphs in social network and road network.

BACKGROUND A common osmolality threshold for feedings is to stay

BACKGROUND: In adults, distal baseline impedance (BI) is a determinant of esophageal mucosal integrity with values 2000Ω). Regression analysis was used to identify potential contributing factors of BI. RESULTS: In BI2000Ω), and 2) positive symptom correlations were noted with bolus (73%) and acid events (55%). Significant predictors of BI included chronological age, acid reflux index, and BPD diagnosis (all P2000Ω likely involves little or no inflammation because acid exposure is minimal. Combination of SAP, pH-impedance metrics and BI along with clarification of dysmotility mechanisms provides the rationale for personalized anti-reflux therapies as needed.

BACKGROUND Pharyngeal contractility is critical for safe bolus propulsion. Pharyngeal contractile vigor can be measured by Pharyngeal Contractile Integral (PhCI): product of mean pharyngeal contractile amplitude, length, and duration. We characterized PhCI in neonates and examined the hypothesis that PhCI differs with mode of stimulation. METHODS Nineteen neonates born at 38.6(34-41) weeks gestation were evaluated at 42.9 (40.4-44.0) weeks postmenstrual age using high resolution manometry (HRM). PhCI was calculated using: a) Conventional, and b) Automated Swallow Detection algorithm (ASDA) methods. Contractility metrics of all pharyngeal regions were examined using mixed statistical models during spontaneous and adaptive state (pharyngeal and oral stimulus) swallowing. RESULTS PhCI of oral stimuli swallows were distinct from pharyngeal stimuli and spontaneous swallows (P

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health.

OBJECTIVE This study reports the use of exploratory factor analysis to describe essential skills and knowledge for an important segment of the domestic public health workforce-Centers for Disease Control and Prevention (CDC) project officers-using an evidence-based approach to competency development and validation. DESIGN A multicomponent survey was conducted. Exploratory factor analysis was used to examine the underlying domains and relationships between competency domains and key behaviors. The Cronbach α coefficient determined the reliability of the overall scale and identified factors. SETTING AND PARTICIPANTS All domestic (US state, tribe, local, and territorial) grantees who received funding from the CDC during fiscal year 2011 to implement nonresearch prevention or intervention programs were invited to participate in a Web-based questionnaire. MAIN OUTCOME MEASURE(S) A total of 34 key behaviors representing knowledge, skills, and abilities, grouped in 7 domains-communication, grant administration and management, public health applied science and knowledge, program planning and development, program management, program monitoring and improvement, and organizational consultation-were examined. RESULTS There were 795 responses (58% response rate). A total of 6 factors were identified with loadings of 0.40 or more for all 34 behavioral items. The Cronbach α coefficient was 0.95 overall and ranged between 0.73 and 0.91 for the factors. CONCLUSIONS This study provides empirical evidence for the construct validity of 6 competencies and 34 key behaviors important for CDC project officers and serves as an important first step to evidence-driven workforce development efforts in public health.

Objective: Most people with severe mental illness do not use evidence-based smoking cessation treatments. Ethnic and racial identification among people with severe mental illness may add complexity to their participation in smoking cessation interventions. The purpose of this qualitative study was to explore smoking and smoking cessation attitudes, beliefs, and behaviors among three race/ethnicity groups of smokers with severe mental illness. Methods: Researchers inquired into day-to-day smoking activities and quit attempts in six focus groups with 36 randomly selected African American, Latino, and White smokers with severe mental illness. Transcripts were reviewed to identify prominent themes, and first-person perspectives were selected to provide a description of smoking norms, motivation to quit, and sources of quit information. Results: Participants of all three race/ethnicity groups reported that multiple facets of their lives contributed to smoking initiation and maintenance, including the belief th...

This column describes a best practice for dissemination and implementation used by the Johnson & Johnson-Dartmouth Program: a national learning collaborative among community mental health programs on supported employment. In this two-tiered learning collaborative, researchers meet regularly with mental health and vocational rehabilitation leaders in 12 states and the District of Columbia, and state leaders oversee more than 130 individual programs in their respective states. Participants share educational programs, implementation and intervention strategies, practice experiences, outcome data, and research projects. The national learning collaborative facilitates implementation, dissemination, standardization, and sustainability of supported employment. (Psychiatric Services 62:704–706, 2011)