Voices on diversity: Making the scientific community more inclusive.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. In this piece, they discuss ways to make science more inclusive-from key points they wish their colleagues understood to actions those in the scientific community can take. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on diversity: recruiting underrepresented scientists.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. In this piece, they discuss strategies to recruit underrepresented minority students to universities and careers in science. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on diversity: support systems that work.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. In this segment, we asked about support systems-the types of support that are most helpful (and less helpful), how to find a supportive network, and how institutions can better support underrepresented scientists. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on diversity: confronting racial bias.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. Here, they discuss the impact of racial bias and share strategies for addressing it. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on Diversity: Creating a Sense of Belonging.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists. Here they tell us about behaviors that can lead underrepresented scientists to feel that they do not belong and what the scientific community can do to provide better support. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on Diversity: Combating Racial Inequality to Increase Diversity.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists in a series of questions and answers. Here, they discuss ways that the scientific community can combat racial inequality and increase diversity. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on Diversity: Overcoming Barriers to Pursuing a Career in Science.

As part of our commitment to amplifying the voices of underrepresented scientists, we are publishing the insights and experiences of a panel of underrepresented scientists in a series of questions and answers. Here, they tell us about barriers they faced in pursuing a scientific career. These are the personal opinions of the authors and may not reflect the views of their institutions.

Voices on Diversity: Multiple Paths to Becoming a Scientist.

As part of our commitment to amplifying the voices of underrepresented scientists, we will be publishing the insights and experiences of a panel of underrepresented scientists. To kick off this series, they introduce themselves, tell us what sparked their interest in science, and describe their scientific journeys. These are the personal opinions of the authors and may not reflect the views of their institutions.

Language matters for biodiversity.

Language is central to the way people learn about the natural world. A salient concern of the biodiversity conservation arena has been to understand how language can be employed by scientists to communicate knowledge to nonexpert audiences and build ecological literacy. The use of analogy and narrative by scientists are prominent techniques. In this article, we consider how these two modes of language-based reasoning extend into ordinary conversational language use by the public, specifically when articulating everyday understanding and experiences of biodiversity. Drawing on a process of public engagement in a UK woodland environment, a typological framework based on principles of analogical and narrative reasoning is developed to characterize the precise character of processes of everyday biodiversity sense making. The implications of the framework are discussed in the context of future biodiversity research, particularly its participatory and educational dimensions.

Staffing Up and Sustaining the Public Health Workforce.

OBJECTIVES: Estimate the number of full-time equivalents (FTEs) needed to fully implement Foundational Public Health Services (FPHS) at the state and local levels in the United States. METHODS: Current and full implementation cost estimation data from 168 local health departments (LHDs), as well as data from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, were utilized to estimate current and "full implementation" staffing modes to estimate the workforce gap. RESULTS: The US state and local governmental public health workforce needs at least 80 000 additional FTEs to deliver core FPHS in a post-COVID-19 landscape. LHDs require approximately 54 000 more FTEs, and states health agency central offices require approximately 26 000 more. CONCLUSIONS: Governmental public health needs tens of thousands of more FTEs, on top of replacements for those leaving or retiring, to fully implement core FPHS. IMPLICATIONS FOR POLICY AND PRACTICE: Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.

Can biodiverse streetscapes mitigate the effects of noise and air pollution on human wellbeing?

Most of the global population are urban, with inhabitants exposed to raised levels of pollution. Pollutants negatively impact human wellbeing, and can alter the structure and diversity of ecosystems. Contrastingly, urban biodiversity can positively contribute to human wellbeing. We know little, however, about whether the negative impacts of pollution on wellbeing could be lessened for householders living on more biodiverse streets, as the complex interlinkages between pollution, biodiversity and wellbeing have rarely been examined. Here, we used structural equation modelling to simultaneously test whether biodiversity (actual and perceived) mediates the relationship between traffic-related pollution (noise, dB; nitrogen dioxide, NO2) or air pollution (PM2.5) and wellbeing (mental wellbeing, happiness). In summer 2019, we conducted questionnaires and biodiversity surveys, and collected noise and air pollution data, from households (n = 282) across the streetscapes of Leeds, UK. Biodiversity (actual or perceived) showed no mediating effects. However, increased flowering plant richness was positively associated with mental wellbeing. Traffic-related pollution negatively affected pollinator and flowering plant richness, but not wellbeing. This could be because householders are not exposed to high levels of noise or NO2 because they do not maintain front gardens on noisier streets. There was no measurable effect of air pollution on biodiversity or wellbeing. These findings shed light on the complex mechanisms through which biodiversity could improve human wellbeing. Enhancing the diversity of plant species in streetscapes would have a positive effect on wellbeing, further emphasising the important role that biodiverse urban streetscapes play in improving the liveability of cities.

Radiologic evaluation of fracture healing.

While assessment of fracture healing is a common task for both orthopedic surgeons and radiologists, it remains challenging due to a lack of consensus on imaging and clinical criteria as well as the lack of a true gold standard. Further complicating this evaluation are the wide variations between patients, specific fracture sites, and fracture patterns. Research into the mechanical properties of bone and the process of bone healing has helped to guide the evaluation of fracture union. Development of standardized scoring systems and identification of specific radiologic signs have further clarified the radiologist's role in this process. This article reviews these scoring systems and signs with regard to the biomechanical basis of fracture healing. We present the utility and limitations of current techniques used to assess fracture union as well as newer methods and potential future directions for this field.

Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence.

PURPOSE: The purpose of this study was to determine the incidence and predictors of incontinence-associated dermatitis (IAD) in nursing home residents. METHODS: Records of a cohort of 10,713 elderly (≥65 years) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed up for IAD development. Potential multilevel predictors of IAD were identified in 4 national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression. RESULTS: The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits. CONCLUSION: Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A WOC nurse offers expertise in these interventions and can educate staff about IAD predictors, which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits.

Inflammatory Bowel Disease: Epidemiology, Evaluation, Treatment, and Health Maintenance.

The incidence and prevalence of inflammatory bowel disease are rising. Crohn's disease and ulcerative colitis each have distinct features. Treatments are changing rapidly, and there are many new drugs in the pipeline. Health maintenance also plays a key role in the care of this patient population.

Pan-cancer transcriptome analysis reveals long noncoding RNAs with conserved function.

A growing number of gene-centric studies have highlighted the emerging significance of lncRNAs in cancer. However, these studies primarily focus on a single cancer type. Therefore, we conducted a pan-cancer analysis of lncRNAs comparing tumor and matched normal expression levels using RNA-Seq data from ∼ 3,000 patients in 8 solid tumor types. While the majority of differentially expressed lncRNAs display tissue-specific expression we discovered 229 lncRNAs with outlier or differential expression across multiple cancers, which we refer to as 'onco-lncRNAs'. Due to their consistent altered expression, we hypothesize that these onco-lncRNAs may have conserved oncogenic and tumor suppressive functions across cancers. To address this, we associated the onco-lncRNAs in biological processes based on their co-expressed protein coding genes. To validate our predictions, we experimentally confirmed cell growth dependence of 2 novel oncogenic lncRNAs, onco-lncRNA-3 and onco-lncRNA-12, and a previously identified lncRNA CCAT1. Overall, we discovered lncRNAs that may have broad oncogenic and tumor suppressor roles that could significantly advance our understanding of cancer lncRNA biology.

Creating quality improvement culture in public health agencies.

OBJECTIVES: We conducted case studies of 10 agencies that participated in early quality improvement efforts. METHODS: The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. RESULTS: Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. CONCLUSIONS: Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

CDC/NACCHO Accreditation Support Initiative: advancing readiness for local and tribal health department accreditation.

CONTEXT: Health departments have various unique needs that must be addressed in preparing for national accreditation. These needs require time and resources, shortages that many health departments face. OBJECTIVE: The Accreditation Support Initiative's goal was to test the assumption that even small amounts of dedicated funding can help health departments make important progress in their readiness to apply for and achieve accreditation. DESIGN: Participating sites' scopes of work were unique to the needs of each site and based on the proposed activities outlined in their applications. Deliverables and various sources of data were collected from sites throughout the project period (December 2011-May 2012). SETTING/PARTICIPANTS: Awardees included 1 tribal and 12 local health departments, as well as 5 organizations supporting the readiness of local and tribal health departments. RESULTS: Sites dedicated their funding toward staff time, accreditation fees, completion of documentation, and other accreditation readiness needs and produced a number of deliverables and example documents. All sites indicated that they made accreditation readiness gains that would not have occurred without this funding. CONCLUSIONS: Preliminary evaluation data from the first year of the Accreditation Support Initiative indicate that flexible funding arrangements may be an effective way to increase health departments' accreditation readiness.

A study of incentives to support and promote public health accreditation.

CONTEXT: Accreditation of public health agencies through the Public Health Accreditation Board is voluntary. Incentives that encourage agencies to apply for accreditation have been suggested as important factors in facilitating participation by state and local agencies. OBJECTIVE: The project describes both current and potential incentives that are available at the federal, state, and local levels. DESIGN: Thirty-nine key informants from local, state, tribal, federal, and academic settings were interviewed from March through May 2012. Through open-ended interviews, respondents were asked about incentives that were currently in use in their settings and incentives they thought would help encourage participation in Public Health Accreditation Board accreditation. RESULTS: Incentives currently in use by public health agencies based on interviews include (1) financial support, (2) legal mandates, (3) technical assistance, (4) peer support workgroups, and (5) state agencies serving as role models by seeking accreditation themselves. Key informants noted that state agencies are playing valuable and diverse roles in providing incentives for accreditation within their own states. Key informants also identified the Centers for Disease Control and Prevention and other players, such as private foundations, public health institutes, national and state associations, and academia as providing both technical and financial assistance to support accreditation efforts. CONCLUSIONS: State, tribal, local, and federal agencies, as well as related organizations can play an important role by providing incentives to move agencies toward accreditation.

Guiding the way to public health improvement: exploring the connections between The Community Guide's Evidence-Based Interventions and health department accreditation standards.

CONTEXT: Recent years have seen rising interest in initiatives that focus on public health improvement. This includes support for accreditation of public health departments-administered by the Public Health Accreditation Board (PHAB)-and increasing expectations that health departments should use evidence-based programs, services, and policies (interventions) such as those described in The Guide to Community Preventive Services (The Community Guide). OBJECTIVE: This project was initiated to explore the potential connections between Community Guide interventions and PHAB domains, standards, and measures. DESIGN: The project team focused on developing a Crosswalk tool to assist health departments in identifying evidence-based interventions from The Community Guide whose implementation could help document conformity with PHAB domains, standards, and measures. All Community Preventive Services Task Force-recommended interventions were reviewed to determine whether they reflect the intent and requirements of the PHAB standards and measures. MAIN OUTCOME MEASURES: Three types of connections were defined through which Community Guide interventions could be relevant to the required documentation for a PHAB measure. All instances of these connections were identified and included in the Crosswalk. RESULTS: The Crosswalk tool consists of 2 tables. The first table cross-references individual PHAB domains, standards, and measures with interventions from The Community Guide that could help provide documentation for accreditation. The second table can help accreditation preparation staff to engage with program staff. It is searchable by Community Guide topic, identifying the PHAB measures that relate to each Community Guide intervention within that topic. The type, location, and extent of connections between Community Guide interventions and PHAB domains, standards, and measures are presented and discussed. CONCLUSIONS: Tools such as the Crosswalk can be instrumental in advancing the use of evidence-based interventions in public health practice.