A Novel Approach for Workforce Surveillance at the US Department of Health and Human Services.

BACKGROUND: Expert groups have recommended ongoing monitoring of the public health workforce to determine its ability to execute designated objectives. Resource- and time-intensive surveys have been a primary data source to monitor the workforce. We evaluated an administrative data source containing US Department of Health and Human Services (HHS) aggregate federal civil service workforce-related data to determine its potential as a workforce surveillance system for this component of the workforce. METHODS: We accessed FedScope, a publicly available online database containing federal administrative civilian HHS personnel data. Using established guidelines for evaluating surveillance systems and identified workforce characteristics, we evaluated FedScope attributes for workforce surveillance purposes. RESULTS: We determined FedScope to be a simple, highly accepted, flexible, stable, and timely system to support analyses of federal civil service workforce-related data. Data can be easily accessed, analyzed, and monitored for changes across years and draw conclusions about the workforce. FedScope data can be used to calculate demographics (eg, sex, race or ethnicity, age group, and education level), employment characteristics (ie, supervisory status, work schedule, and appointment type), retirement projections, and characterize the federal workforce into standard occupational categories. CONCLUSIONS: This study indicates that an administrative data source containing HHS personnel data can function as a workforce surveillance system valuable to researchers, public health leaders, and decision makers interested in the federal civil service public health workforce. Using administrative data for workforce development is a model that can be applicable to federal and nonfederal public health agencies and ultimately support improvements in public health.

Within-session spacing improves delayed recall in children.

Multiple retrievals of a memory over a spaced manner improve long-term memory performance in infants, children, younger and older adults; however, few studies have examined spacing effects with young school-age children. To expand the understanding of the spacing benefit in children, the current study presented weakly associated English word-pairs to children aged 7-11 and cued their recall two times immediately (massed), after a delay of 5 or 10 items (spaced) or not at all (control). After this encoding session with or without two retrievals, participants were tested two times for memory of all word-pairs: immediately and 30 minutes after the encoding session. Multiple retrievals significantly improved memory on the tests. However, words repeated in a spaced design were remembered at higher rates than those that were massed, while gap size between repetitions (5 or 10) did not differentially impact performance. The data show that a within-session spacing strategy can benefit children's ability to remember word-pairs after 30 minutes. Thus, asking students to recall what they have learned within a lesson is a technique that can be used in a classroom to improve long-term recall.

Long-term memory, sleep, and the spacing effect.

Many studies have shown that memory is enhanced when study sessions are spaced apart rather than massed. This spacing effect has been shown to have a lasting benefit to long-term memory when the study phase session follows the encoding session by 24 hours. Using a spacing paradigm we examined the impact of sleep and spacing gaps on long-term declarative memory for Swahili-English word pairs by including four spacing delay gaps (massed, 12 hours same-day, 12 hours overnight, and 24 hours). Results showed that a 12-hour spacing gap that includes sleep promotes long-term memory retention similar to the 24-hour gap. The findings support the importance of sleep to the long-term benefit of the spacing effect.

The new global health.

Global health reflects the realities of globalization, including worldwide dissemination of infectious and noninfectious public health risks. Global health architecture is complex and better coordination is needed between multiple organizations. Three overlapping themes determine global health action and prioritization: development, security, and public health. These themes play out against a background of demographic change, socioeconomic development, and urbanization. Infectious diseases remain critical factors, but are no longer the major cause of global illness and death. Traditional indicators of public health, such as maternal and infant mortality rates no longer describe the health status of whole societies; this change highlights the need for investment in vital registration and disease-specific reporting. Noncommunicable diseases, injuries, and mental health will require greater attention from the world in the future. The new global health requires broader engagement by health organizations and all countries for the objectives of health equity, access, and coverage as priorities beyond the Millennium Development Goals are set.

Shifting students toward testing: impact of instruction and context on self-regulated learning.

Much of the learning that college students engage in today occurs in unsupervised settings, making effective self-regulated learning techniques of particular importance. We examined the impact of task difficulty and supervision on whether participants would follow written instructions to use repeated testing over restudying. In Study 1, we found that when supervised, instructions to test resulted in changes in the self-regulated learning behaviors such that participants tested more often than they studied, relative to participants who were unsupervised during learning. This was true regardless of the task difficulty. In Study 2, we showed that failure to shift study strategies in unsupervised learning was likely due to participants avoidance of testing rather than failure to read the instructions at all. Participants who tested more frequently remembered more words later regardless of supervision or whether or not they received instructions to test, replicating the well-established testing effect (e.g., Dunlosky et al. in Psychol Sci Public Interest 14:4-58, 2013. http://doi.org/10.1177/1529100612453266 ). In sum, there was a benefit to testing, but instructing participants to test only increased their choice to test when they were supervised. We conclude that supervision has an impact on whether participants follow instructions to test.

Leveraging Rapid Response Activities to Build Public Health Capacity: Development of the Opioid Rapid Response Team Model.

As part of the federal response to the opioid crisis, the Opioid Rapid Response Team project (2018-2019) was created to provide rapid short-term assistance to requesting US jurisdictions responding to an acute opioid-related event. The project used an approach that maximized overall value by leveraging existing federal resources and harnessing opportunities to meet project-specific objectives while also enhancing general response capacity at the federal, state, and local levels. This tandem capacity building for both opioid rapid response and general response focused on systems and operations, workforce readiness, technical assistance, and partnerships. In this article, we demonstrate the ancillary value that issue-specific response activities can contribute to broader public health response capacity.

The spacing effect in older and younger adults: does context matter?

Age-related memory change has been a topic of much investigation in recent years, including spacing benefits and reliance on contextual cues. We manipulated the spacing schedule and the context of learning and observed the effects on long-term recall ability in healthy older and younger adults. After learning Swahili-English word pairs, half practiced immediately (massed) and half practiced 24 h later (spaced) either in the same room or a different room (context) from the initial session. A final recall test 10 days after the practice session occurred in the same room as the first session. Participants in the spaced condition remembered more than those in the massed condition 10 days later. Younger adults remembered more word pairs than older adult participants. Context change eliminated the spacing benefit for both age groups.

Improved program activities are associated with decreasing tuberculosis incidence in the United States.

OBJECTIVE: This study was conducted to determine whether improvements in tuberculosis (TB) program activities correlate with incident TB cases. METHODS: National TB surveillance data and program data from patients with pulmonary and laryngeal TB and their contacts were collected. These data were analyzed using regression models to assess the association between changes in incident TB cases and indicators of program performance (a time series of percent changes in program indices). RESULTS: A total of 1,361,113 contacts exposed to 150,668 TB patients were identified through contact investigations. From 1987 to 1992 (the period of TB resurgence and antedating increased funding), there was a decline in several measures used by TB programs for outcomes of contact investigations. From 1993 to 1998 (the period after increases in TB funds), there was an observable improvement in the program indices. Four program indices for contacts and two for TB cases (directly observed therapy and completion of therapy) were statistically associated (p < or = .01) with the decline in TB incident cases. CONCLUSIONS: These analyses suggest that expanded TB program activities resulted in the reduction in national TB cases and underscore the importance of treatment completion for TB disease and latent TB infection. Based on these results, we propose that further improvements in these activities will accelerate the decline of TB in the United States.

Aminoglycoside toxicity: daily versus thrice-weekly dosing for treatment of mycobacterial diseases.

Aminoglycoside use is limited by ototoxicity and nephrotoxicity. This study compared the incidences of toxicities associated with 2 recommended dosing regimens. Eighty-seven patients with tuberculosis or nontuberculous mycobacterial infections were prospectively randomized by drug to receive 15 mg/kg per day or 25 mg/kg 3 times per week of intravenous streptomycin, kanamycin, or amikacin. Doses were adjusted to achieve target serum concentrations. The size of the dosage and the frequency of administration were not associated with the incidences of ototoxicity (hearing loss determined by audiogram), vestibular toxicity (determined by the findings of a physical examination), or nephrotoxicity (determined by elevated serum creatinine levels). Risk of ototoxicity (found in 32 [37%] of the patients) was associated with older age and with a larger cumulative dose received. Vestibular toxicity (found in 8 [9%] of the patients) usually resolved, and nephrotoxicity (found in 13 [15%] of the patients) was mild and reversible in all cases. Subjective changes in hearing or balance did not correlate with objective findings. Streptomycin, kanamycin, and amikacin can be administered either daily or 3 times weekly without affecting the likelihood of toxicity.

Treatment for latent TB in correctional facilities: a challenge for TB elimination.

BACKGROUND: To eliminate tuberculosis (TB) in the United States, more information is needed on how to gain access to difficult-to-reach, high-risk populations to evaluate people who would benefit from treatment for latent TB infection (LTBI). METHODS: A field study was conducted of people at risk for co-infection with TB and the human immunodeficiency virus (HIV) and to demonstrate that treating LTBI in inmates is feasible. Inmates were tested for LTBI using the Mantoux tuberculin skin test (TST). Outcomes measured were skin test results and the start and completion of treatment for LTBI. RESULTS: In 49 correctional facilities in 12 states, 198102 inmates had a skin test read. The mean skin test positivity rate among inmates was 17.0%. Of those who had a known HIV test result, 14.5% tested HIV positive. Inmates with a positive TST were 4.2 times more likely than those with a negative TST to be HIV infected (95% confidence interval [CI]=3.9-4.4). Therapy for LTBI was completed in 55.9% of patients started on treatment. Patients who were HIV positive and started on a 12-month treatment regimen were less likely than HIV-negative patients (40.0% vs 68.1%, respectively) to complete treatment (odds ratio [OR]=0.24, 95% CI=0.20-0.28). Patients treated in jails were less likely than those treated in prisons (33.6% vs 57.7%, respectively) to complete treatment (OR=0.29, 95% CI=0.26-0.32). CONCLUSIONS: Correctional facilities offer a venue for identifying and treating high-risk individuals for LTBI. However, completing treatment is more problematic in jails than in prisons.

Diminished but not forgotten: effects of aging on magnitude of spacing effect benefits.

OBJECTIVES: Age-related changes in memory performance are common in paired associate episodic memory tasks, although the deficit can be ameliorated with distributed practice. Benefits of learning episode spacing in older adults have been shown in single-session studies with spaced presentations of items followed by a test. This study examined the magnitude of the spacing effect benefit in older adults relative to younger adults when given a multiday spacing effect paradigm. METHOD: We examined the impact of spacing gap (~15min vs. 24hr) in younger (N = 51, Mage = 19 years, SD = 0.6) and older (N = 54, Mage = 65 years, SD = 8.8) adults with a 10-day retention interval. RESULTS: Spacing of learning episodes benefited both younger and older adults. There was an age-related difference in the magnitude of this benefit that has not been observed in earlier studies. DISCUSSION: These results suggest that spacing benefited the long-term memory of older adults, however the effect was diminished and qualitatively different from that of younger adults.

Influence of attended repetition trials on negative priming in younger and older adults.

A lengthened response time when a distractor becomes a target, called negative priming, is an undisputed phenomenon in selective attention, yet just what the underlying mechanism responsible for negative priming is has not been resolved. In this study, the proportion of attended repetition trials was manipulated in order to test the predictions of three theories that have been proposed for explaining spatial negative priming: distractor suppression (e.g., Tipper, 1985), episodic memory retrieval (e.g., Neill, Valdes, & Terry, 1995), and novelty bias (e.g., Milliken, Tipper, Houghton, & Lupiáñez, 2000). The results supported the proposal that a novelty bias, which is flexible and can be overridden, is the primary mechanism responsible for priming in spatial tasks. Memory retrieval obscured the novelty bias for target processing, was more selective in older adults, and did not affect distractor processing. Novelty bias and distractor suppression may share the same inhibitory attentional mechanism.