Navigating tensions in climate change-related planned relocation.

The planned relocation of communities away from areas of climate-related risk has emerged as a critical strategy to adapt to the impacts of climate change. Empirical examples from around the world show, however, that such relocations often lead to poor outcomes for affected communities. To address this challenge, and contribute to developing guidelines for just and sustainable relocation processes, this paper calls attention to three fundamental tensions in planned relocation processes: (1) conceptualizations of risk and habitability; (2) community consultation and ownership; and (3) siloed policy frameworks and funding mechanisms. Drawing on the collective experience of 29 researchers, policymakers and practitioners from around the world working on planned relocations in the context of a changing climate, we provide strategies for collectively and collaboratively acknowledging and navigating these tensions among actors at all levels, to foster more equitable and sustainable relocation processes and outcomes.

Public health communication professional development opportunities and alignment with core competencies: an environmental scan and content analysis. / Offres de perfectionnement professionnel en communication en santé publique et correspondance avec les compétences essentielles : analyse contextuelle et analyse de contenu.

INTRODUCTION: Communication is vital for effective and precise public health practice. The limited formal educational opportunities in health communication render professional development opportunities especially important. Competencies for public health communication describe the integrated knowledge, values, skills and behaviours required for practitioner and organizational performance. Many countries consider communication a core public health competency and use communication competencies in workforce planning and development. METHODS: We conducted an environmental scan and content analysis to determine the availability of public health communication professional development opportunities in Canada and the extent to which they support communication-related core competencies. Three relevant competency frameworks were used to assess the degree to which professional development offerings supported communication competency development. RESULTS: Overall, 45 professional development offerings were included: 16 "formalized offerings" (training opportunities such as courses, webinars, certificate programs) and 29 "materials and tools" (resources such as toolkits, guidebooks). The formalized offerings addressed 25% to 100% of the communication competencies, and the materials and tools addressed 67% to 100%. Addressing misinformation and disinformation, using current technology and communicating with diverse populations are areas in need of improved professional development. CONCLUSION: There is a significant gap in public health communication formalized offerings in Canada and many of the materials and tools are outdated. Public health communication professional development offerings lack coordination and do not provide comprehensive coverage across the communication competencies, limiting their utility to strengthen the public health workforce. More, and more comprehensive, professional development offerings are needed.

Discovery of N-X anomeric amides as electrophilic halogenation reagents.

Electrophilic halogenation is a widely used tool employed by medicinal chemists to either pre-functionalize molecules for further diversity or incorporate a halogen atom into drugs or drug-like compounds to solve metabolic problems or modulate off-target effects. Current methods to increase the power of halogenation rely on either the invention of new reagents or activating commercially available reagents with various additives such as Lewis or Brønsted acids, Lewis bases and hydrogen-bonding activators. There is a high demand for new reagents that can halogenate otherwise unreactive compounds under mild conditions. Here we report the invention of a class of halogenating reagents based on anomeric amides, taking advantage of the energy stored in the pyramidalized nitrogen of N-X anomeric amides as a driving force. These robust halogenating methods are compatible with a variety of functional groups and heterocycles, as exemplified on over 50 compounds (including 13 gram-scale examples and 1 flow chemistry scale-up).

Adapting and Evaluating a Theory-Driven, Non-Pharmacological Intervention to Self-Manage Pain.

BACKGROUND: The existing literature has limited detail on theory-driven interventions, particularly in pain studies. We adapted Bandura's self-efficacy framework toward a theory-driven, non-pharmacological intervention using auricular point acupressure (APA) and evaluated participants' perceptions of this intervention on their pain self-management. APA is a non-invasive modality based on auricular acupuncture principles. METHODS: We mapped our study intervention components according to Bandura's key sources of self-efficacy (performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal) to facilitate the self-management of pain. Through a qualitative study design, we conducted virtual interviews at one and three months after a 4-week APA intervention among 23 participants using purposive sampling to describe their experiences in managing their pain based on our theory-driven APA intervention. RESULTS: Using thematic analyses, we found four themes: the enhanced self-management of pain, improved pain outcomes, the feasibility of technology, and the sustainability of APA. CONCLUSIONS: Describing how interventions are mapped according to the elements of theoretical frameworks can help to guide intervention development, advance science and knowledge development, and promote the implementation of interventions. As such, using Bandura's self-efficacy theory as a foundation for the APA intervention, APA was found to be feasible and sustainable, improving self-management, pain intensity, and pain-related outcomes. Participants provided recommendations for the further improvement of this theory-driven intervention.

Modernizing public health communication competencies in Canada: A survey of the Canadian public health workforce.

OBJECTIVES: Since the publication of the Core Competencies for Public Health in Canada in 2008, the public health and communication landscape has changed dramatically. Digital media and infodemics have shifted how practitioners must communicate and respond to health information. The age of the current competency framework, which is relied on for workforce development, alongside emerging public health challenges, have prompted calls for modernized competency statements. This study aims to (i) measure self-reported communication competence in the public health workforce, (ii) measure agreement with new communication competency statements, (iii) identify variation in agreement between sub-groups of professionals, and (iv) explore current and needed communication training. METHODS: Using a mixed-methods online survey, a sample of 378 participants in various Canadian public health roles and regions were asked to rate their current communication competence and agreement with a modernized, evidence-based draft communication competency framework. The survey was distributed in both official languages through partner organizations and social media. Descriptive statistics were performed to assess agreement and variation was analyzed in relation to public health roles and experience. RESULTS: While most participants self-reported communication competence, specific areas were rated lower. All 21 proposed competency statements received high agreement with some variation observed between expertise and experience levels. Demand for communication training is high. CONCLUSION: Strong agreement with statements indicates support for a modernized communication competency framework among sampled professionals. Research to gather more evidence surrounding the communication demands of the public health workforce and observed variation in strong agreement for the proposed statements is underway.

RéSUMé: OBJECTIFS: Depuis la publication des Compétences essentielles en santé publique au Canada en 2008, le paysage de la santé publique et des communications a radicalement changé. Les médias numériques et l'infodémie ont fait évoluer les façons dont les praticiennes et les praticiens doivent communiquer les informations sur la santé et y réagir. L'âge du cadre de compétences actuel et son importance pour le développement de la main-d'œuvre, en plus des problèmes de santé publique émergents, suscitent des appels à moderniser les énoncés de compétences. Notre étude vise à : i) mesurer la compétence en communication autodéclarée dans la main-d'œuvre en santé publique, ii) mesurer l'accord avec de nouveaux énoncés de compétences en communication, iii) déterminer si les sous-groupes professionnels diffèrent dans leurs niveaux d'accord et iv) explorer la formation en communication actuelle et celle qui serait nécessaire. MéTHODE: À l'aide d'un sondage en ligne à méthodes mixtes, nous avons demandé à un échantillon de 378 personnes exerçant divers rôles en santé publique dans diverses régions du Canada d'évaluer leur compétence en communication actuelle et leur accord avec un projet de cadre de compétence en communication modernisé, fondé sur les données probantes. Le sondage a été diffusé dans les deux langues officielles par des organismes partenaires et dans les médias sociaux. Nous avons effectué une analyse statistique descriptive pour évaluer le niveau d'accord, et nous avons analysé les écarts par rapport aux rôles et à l'expérience en santé publique. RéSULTATS: La plupart des personnes participantes se sont dites compétentes en communication, mais certains aspects ont obtenu des notes plus faibles. Les 21 énoncés de compétences proposés ont été bien acceptés, avec quelques écarts observés entre le savoir-faire et les niveaux d'expérience. La demande de formation en communication est élevée. CONCLUSION: L'accord général avec les énoncés est signe de l'appui à un cadre de compétence en communication modernisé chez le personnel professionnel de notre échantillon. Une étude est en cours pour réunir d'autres éléments probants sur les demandes de la main-d'œuvre en santé publique en matière de communication et sur les écarts observés dans l'accord général avec les énoncés proposés.

Divalent Titanium via Reductive N-C Coupling of a TiIV Nitrido with π-Acids.

The nitrido-ate complex [(PN)2Ti(N){µ2-K(OEt2)}]2 (1) (PN-=(N-(2-PiPr2-4-methylphenyl)-2,4,6-Me3C6H2) reductively couples CO and isocyanides in the presence of DME or cryptand (Kryptofix222), to form rare, five-coordinate TiII complexes having a linear cumulene motif, [K(L)][(PN)2Ti(NCE)] (E=O, L=Kryptofix222, (2); E=NAd, L=3 DME, (3); E=NtBu, L=3 DME, (4); E=NAd, L=Kryptofix222, (5)). Oxidation of 2-5 with [Fc][OTf] afforded an isostructural TiIII center containing a neutral cumulene, [(PN)2Ti(NCE)] (E=O, (6); E=NAd (7), NtBu (8)) and characterization by CW X-band EPR spectroscopy, revealed unpaired electron to be metal centric. Moreover, 1e- reduction of 6 and 7 in the presence of Kryptofix222cleanly reformed corresponding discrete TiII complexes 2 and 5, which were further characterized by solution magnetization measurements and high-frequency and -field EPR (HFEPR) spectroscopy. Furthermore, oxidation of 7 with [Fc*][B(C6F5)4] resulted in a ligand disproportionated TiIV complex having transoid carbodiimides, [(PN)2Ti(NCNAd)2] (9). Comparison of spectroscopic, structural, and computational data for the divalent, trivalent, and tetravalent systems, including their 15N enriched isotopomers demonstrate these cumulenes to decrease in order of backbonding as TiII→TiIII→TiIV and increasing order of π-donation as TiII→TiIII→TiIV, thus displaying more covalency in TiIII species. Lastly, we show a synthetic cycle whereby complex 1 can deliver an N-atom to CO and CNAd.

Information about life expectancy related to obesity is most important to cat owners when deciding whether to act on a veterinarian's weight loss recommendation.

OBJECTIVE: To determine the relative importance of information communicated to cat owners during veterinarian-client obesity-related conversations. SAMPLE: Cat owner participants recruited via snowball sampling. METHODS: A cross-sectional online questionnaire was distributed to cat owners who owned cats of any weight status. A discrete choice experiment design was used to determine the relative importance of obesity-related attributes to cat owners when receiving information from a veterinarian. RESULTS: A total of 1,095 questionnaires were analyzed. Participating cat owners resided primarily in Canada and the US. Impact on life expectancy was the most important attribute that would encourage participants to pursue weight management for a cat with obesity (relative importance, 32.66%), followed by change to cost of food (20.40%), future quality of life (20.38%), future mobility (14.40%), and risk of developing diabetes (12.15%). CLINICAL RELEVANCE: Findings suggest that cat owners consider the impact on life expectancy to be most important when considering whether to follow a veterinarian's recommendation for their cat to lose weight. When veterinary professionals are communicating about obesity in practice, there is the potential to increase owner engagement in weight management efforts for cats by emphasizing the obesity-related information owners prefer to receive.

Impact on life expectancy was the most important information to clients when considering whether to take action for an overweight or obese dog.

OBJECTIVE: To determine dog owner preferences for information communicated during veterinarian-client obesity-related conversations within companion animal practice. SAMPLE: Dog owners recruited using snowball sampling. METHODS: A cross-sectional online questionnaire was distributed to dog owners. A discrete choice experiment was used to determine the relative importance, to participating dog owners, of information about selected weight-related attributes that would encourage them to pursue weight management for a dog when diagnosed as overweight by a veterinarian. RESULTS: A total of 1,108 surveys were analyzed, with most participating dog owners residing in Canada. The most important weight-related attribute was life expectancy (relative importance, 28.56%), followed by the timeline for developing arthritis (19.24%), future quality of life (18.91%), change to cost of food (18.90%), and future mobility (14.34%). CLINICAL RELEVANCE: Results suggest that dog owners may consider information relating to an extension of their dog's life as the most important aspect of an obesity-related veterinary recommendation. By integrating dog owner preferences into discussions between clients and veterinary professionals about obesity, there is the potential to encourage more clients to engage in weight management efforts for their overweight or obese dog.

Anhydrous and Stereoretentive Fluoride-Enhanced Suzuki-Miyaura Coupling of Immunomodulatory Imide Drug Derivatives.

Immunomodulatory imide drugs form the core of many pharmaceutically relevant structures, but Csp2-Csp2 bond formation via metal-catalyzed cross coupling is difficult due to the sensitivity of the glutarimide ring ubiquitous in these structures. We report that replacement of the traditional alkali base with a fluoride source enhances a previously challenging Suzuki-Miyaura coupling on glutarimide-containing compounds with trifluoroborates. These enabling conditions are reactive enough to generate these derivatives in high yields but mild enough to preserve both the glutarimide and its sensitive stereocenter. Experimental and computational data suggest a mechanistically distinct process of π-coordination of the trifluoroborate enabled by these conditions.

Retention, adherence, and acceptability testing of a digital health intervention in a 3-group randomized controlled trial for chronic musculoskeletal pain.

OBJECTIVES: Evaluate a digital health intervention using Auricular Point Acupressure (APA) for chronic musculoskeletal pain in terms of participant retention, adherence, acceptability, and satisfaction. Chronic musculoskeletal pain is a global concern and there are persistent challenges in pain management. Despite the value of digital health interventions, these interventions need to be fully evaluated for feasibility. METHODS: We conducted a 3-group, longitudinal, randomized controlled trial (RCT). After Institutional Review Board approval, we posted recruitment flyers in a university, healthcare clinics, and community settings. Participants were randomized into an in-person + app group (n = 8), virtual + app group (n = 7), and a wait-list, education-enhanced control group (n = 8), evaluating our outcomes using standard feasibility measures. The 4-week intervention consisted of virtual sessions, telecommunications, and our APA app, followed by a 3-month follow-up. RESULTS: Data from 22 participants were subsequently analyzed (95.7%). All app participants adhered to the study protocol and used APA at the minimum recommended frequency and duration. The virtual + app group used APA more during the intervention and follow-up periods. All app participants found the intervention to be acceptable and at least 80% overall were satisfied with APA at the 3-month follow-up. There were no adverse events reported. CONCLUSIONS: Our digital health intervention was found to be acceptable and sustainable; participants adhered to and were satisfied with the intervention providing support for a larger RCT. CLINICAL TRIAL: #: NCT05020470.

Developing competencies in public health: a scoping review of the literature on developing competency frameworks and student and workforce development.

Effective and precise public health practice relies on a skilled and interdisciplinary workforce equipped with integrated knowledge, values, skills, and behaviors as defined by competency frameworks. Competency frameworks inform academic and professional development training, support performance evaluation, and identify professional development needs. The aim of this research was to systematically identify and examine trends in the extent, nature, and range of the literature related to developing competencies in public health. This includes developing public health competency frameworks, and how competencies are developed and maintained in students and practitioners. We used a scoping review methodology to systematically identify and report on trends in the literature. Two independent reviewers conducted title and abstract and full-text screening to assess the literature for relevance. Articles were included if they were original primary research or gray literature and published in English. No date or geographic restrictions were applied. Articles were included if they focused on developing competency statements or frameworks for public health and/or training public health students or practitioners to develop competencies. The review encompassed a range of methods and target populations, with an emphasis on building competencies through student and professional development. Foundational competency development was a primary focus, and we found a gap in discipline-specific competency research, especially within developing discipline-specific competency statements and frameworks. Several evidence-based practices for competency development were highlighted, including the importance of governance and resources to oversee competency framework development and implementation, and workforce planning. Experiential learning and competency-based training were commonly identified as best practices for building competencies. A comprehensive understanding of public health competency development-through developing and incorporating foundational and discipline-specific competencies, mapping student and practitioner training to competency frameworks, and incorporating best practices-will enable public health to create skills and an adaptable workforce capable of addressing complex public health issues.

Effectiveness of Bivalent mRNA COVID-19 Vaccines in Preventing SARS-CoV-2 Infection in Children and Adolescents Aged 5 to 17 Years.

Importance: Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited. Objective: To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents. Design, Setting, and Participants: Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms. Exposure: Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records. Main Outcome and Measures: Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence. Results: Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose. Conclusion and Relevance: The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.

Relationship between extreme precipitation and acute gastrointestinal illness in Toronto, Ontario, 2012-2022.

Extreme precipitation events are occurring more intensely in Canada. This can contaminate water sources with enteric pathogens, potentially increasing the risk of acute gastrointestinal illness. This study aimed to investigate the relationship between extreme precipitation and emergency department (ED) visits for acute gastrointestinal illness in Toronto from 2012 to 2022. Distributed lag non-linear models were constructed on ED visit counts with a Quasi Poisson distribution. Extreme precipitation was modelled as a 21-day lag variable, with a linear relationship assumed at levels ≧95th percentile. Separate models were also conducted on season-specific data sets. Daily precipitation and gastrointestinal illness ED visits ranged between 0 to 126 mm, and 12 to 180 visits respectively. Overall, a 10-mm increase in precipitation >95th percentile had no significant relationship with the risk of ED visits. However, stratification by seasons revealed significant relationships during spring (lags 1-19, peak at lag 14 RR = 1.04; 95% CI: 1.03, 1.06); the overall cumulative effect across the 21-day lag was also significant (RR = 1.94; 95% CI: 1.47, 2.57). Extreme precipitation has a seasonal effect on gastrointestinal health outcomes in Toronto city, suggesting varying levels of enteric pathogen exposures through drinking water or other environmental pathway during different seasons.

What do veterinary professionals and clients want? Using discrete choice methods in veterinary research to determine preferences.

Discrete choice methods (DCMs) are a suite of research techniques for identifying individual preferences using choice information. Widely utilized by other fields yet rarely employed in veterinary research, DCMs have tremendous potential to improve veterinary healthcare by understanding and incorporating owner and veterinary professionals' (encompassing veterinarians, veterinary clinicians, technicians, receptionists, attendants, etc) preferences to optimize the care continuum. DCMs have several advantages over other stated preference methods, such as ranking and ratings, including improved data quality and actionability. However, they are not a panacea, and limitations that may affect DCMs' application to the veterinary field are outlined alongside realistic mitigation strategies. The information provided aims to increase awareness of DCMs and their utility in veterinary research and encourage greater uptake as a more robust method for measuring preferences.

Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study.

OBJECTIVES: Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. METHODS: The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. RESULTS: A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. CONCLUSION: The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.

Redirecting antibody responses from egg-adapted epitopes following repeat vaccination with recombinant or cell culture-based versus egg-based influenza vaccines.

Repeat vaccination with egg-based influenza vaccines could preferentially boost antibodies targeting the egg-adapted epitopes and reduce immunogenicity to circulating viruses. In this randomized trial (Clinicaltrials.gov: NCT03722589), sera pre- and post-vaccination with quadrivalent inactivated egg-based (IIV4), cell culture-based (ccIIV4), and recombinant (RIV4) influenza vaccines were collected from healthcare personnel (18-64 years) in 2018-19 (N = 723) and 2019-20 (N = 684) influenza seasons. We performed an exploratory analysis. Vaccine egg-adapted changes had the most impact on A(H3N2) immunogenicity. In year 1, RIV4 induced higher neutralizing and total HA head binding antibodies to cell- A(H3N2) virus than ccIIV4 and IIV4. In year 2, among the 7 repeat vaccination arms (IIV4-IIV4, IIV4-ccIIV4, IIV4-RIV4, RIV4-ccIIV4, RIV4-RIV4, ccIIV4-ccIIV4 and ccIIV4-RIV4), repeat vaccination with either RIV4 or ccIIV4 further improved antibody responses to circulating viruses with decreased neutralizing antibody egg/cell ratio. RIV4 also had higher post-vaccination A(H1N1)pdm09 and A(H3N2) HA stalk antibodies in year 1, but there was no significant difference in HA stalk antibody fold rise among vaccine groups in either year 1 or year 2. Multiple seasons of non-egg-based vaccination may be needed to redirect antibody responses from immune memory to egg-adapted epitopes and re-focus the immune responses towards epitopes on the circulating viruses to improve vaccine effectiveness.

Performance of established disease severity scores in predicting severe outcomes among adults hospitalized with influenza-FluSurv-NET, 2017-2018.

Background: Influenza is a substantial cause of annual morbidity and mortality; however, correctly identifying those patients at increased risk for severe disease is often challenging. Several severity indices have been developed; however, these scores have not been validated for use in patients with influenza. We evaluated the discrimination of three clinical disease severity scores in predicting severe influenza-associated outcomes. Methods: We used data from the Influenza Hospitalization Surveillance Network to assess outcomes of patients hospitalized with influenza in the United States during the 2017-2018 influenza season. We computed patient scores at admission for three widely used disease severity scores: CURB-65, Quick Sepsis-Related Organ Failure Assessment (qSOFA), and the Pneumonia Severity Index (PSI). We then grouped patients with severe outcomes into four severity tiers, ranging from ICU admission to death, and calculated receiver operating characteristic (ROC) curves for each severity index in predicting these tiers of severe outcomes. Results: Among 8252 patients included in this study, we found that all tested severity scores had higher discrimination for more severe outcomes, including death, and poorer discrimination for less severe outcomes, such as ICU admission. We observed the highest discrimination for PSI against in-hospital mortality, at 0.78. Conclusions: We observed low to moderate discrimination of all three scores in predicting severe outcomes among adults hospitalized with influenza. Given the substantial annual burden of influenza disease in the United States, identifying a prediction index for severe outcomes in adults requiring hospitalization with influenza would be beneficial for patient triage and clinical decision-making.

Developing public health competency statements and frameworks: a scoping review and thematic analysis of approaches.

Competencies ensure public health students and professionals have the necessary knowledge, skills, values, and behaviours to do their jobs effectively. Public health is a dynamic and complex field requiring robust competency statements and frameworks that are regularly renewed. Many countries have public health competencies, but there has been no evidence synthesis on how these are developed. Our research aim was to synthesize the extent and nature of the literature on approaches and best practices for competencies statement and framework development in the context of public health, including identifying the relevant literature on approaches for developing competency statements and frameworks for public health students and professionals using a scoping review; and, synthesizing and describing approaches and best practices for developing public health competency statements and frameworks using a thematic analysis of the literature identified by the scoping review. We conducted a scoping review and thematic analysis of the academic and grey literature to synthesize and describe approaches and best practices for developing public health competency statements and frameworks. A systematic search of six databases uncovered 13 articles for inclusion. To scope the literature, articles were assessed for characteristics including study aim, design, methods, key results, gaps, and future research recommendations. Most included articles were peer-reviewed journal articles, used qualitative or mixed method design, and were focused on general, rather than specialist, public health practitioners. Thematic analysis resulted in the generation of six analytical themes that describe the multi-method approaches utilized in developing competency statements and frameworks including literature reviews, expert consultation, and consensus-building. There was variability in the transparency of competency framework development, with challenges balancing foundational and discipline-specific competencies. Governance, and intersectoral and interdisciplinary competency, are needed to address complex public health issues. Understanding approaches and best practices for competency statement and framework development will support future evidence-informed iterations of public health competencies.