Conceptualizing Trust and Distrust as Alternative Stable States: Lessons from the Flint Water Crisis.

Despite the universally recognized importance of fostering trust and avoiding distrust in governance relationships, there remains considerable debate on core questions like the relation between (dis)trust and the evaluations of the characteristics that make a governance agent appear (un)worthy of trust. In particular, it remains unclear whether levels of (dis)trust simply follow levels of (dis)trustworthiness-such that building trust is primarily a question of increasing evidence of trustworthiness and avoiding evidence of distrustworthiness, or if their dynamics are more complicated. The current paper adds novel theory for thinking about the management of trust and distrust in the governance context through the application of principles borrowed from resilience theory. Specifically, we argue that trust and distrust exist as distinct, self-reinforcing (i.e., stable) states separated by a threshold. We then theorize as to the nature of the self-reinforcing processes and use qualitative data collected from and inductively coded in collaboration with Flint residents as part of a participatory process to look for evidence of our argument in a well-documented governance failure. We conclude by explaining how this novel perspective allows for clearer insight into the experience of this and other communities and speculate as to how it may help to better position governance actors to respond to future crises.

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Primary and secondary syphilis in the metropolitan area of Nashville and Davidson County, Tennessee: 1996 to 1998 epidemic described.

BACKGROUND: Metropolitan Nashville, Tennessee experienced a syphilis epidemic from 1996 to 1998. GOAL: This study describes the syphilis epidemic during this period. DESIGN: Descriptive analyses of syphilis surveillance data (1988-1998) were performed, with emphasis on the current epidemic (1996-1998), and were stratified by age, gender, race, and census tracts. RESULTS: Five features were observed regarding the 1996 to 1998 syphilis epidemic: (1) males and females were almost equally affected, with a delay in diagnosis in female patients; (2) the 30-39-year age group was most affected; (3) the 15-19-year age group had the highest percentage increase in incidence; (4) African Americans were the most affected population subgroup; and (5) downtown Nashville and the surrounding areas were most affected. CONCLUSION: Although talk of eradicating syphilis has surfaced nationally, Nashville has continually faced syphilis as a public health problem. During each of the past 3 years (1996-1998), the incidence of syphilis in this community has reached epidemic proportions.

Strategies for suppression, containment, and eradication of resurgent tuberculosis.

This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis. Some ethnic minority communities are at greatest risk because of the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome, poverty and malnutrition, congregate living situations, aberrant lifestyles, illegal immigration, and underemployment among these populations. Proposed strategies include the education of the population at risk as well as health care providers to permit the optimization of preventive, diagnostic, and therapeutic technologies. Also necessary is the development of effective, safe, newer medications to enhance patient compliance and decrease drug resistance. Strategic planning embraces national socioeconomic policy to permit adequate resources to combat poverty and malnutrition, to rebuild the infrastructure of the public health system, and to improve access to health care among rural and urban dwellers. It is concluded that these efforts must continue to ensure the eradication of tuberculosis.

Peripheral nerve regeneration through silicone chambers in streptozocin-induced diabetic rats.

The silicone chamber model was used to evaluate peripheral nerve regeneration (PNR) in streptozocin (STZ)-induced diabetic rats. Diabetic and control animals underwent sciatic nerve transection and silicone chamber implantation establishing gaps of various lengths between the transected nerve ends. In animals with 5 and 10 mm gaps, diabetes was induced in experimental rats 1 week before surgery, and the animals were sacrificed 3 weeks after surgery. In animals with 8 mm gaps, diabetes induction occurred 3 days after surgery, and they were sacrificed after 7 weeks. Diabetic rats with 10 mm gaps demonstrated an impaired ability to form bridging cables, the initial step of regeneration through chambers. Morphometric studies of bridging cables between transected nerve ends demonstrated a significant reduction in the mean endoneurial area in diabetic animals with 5 and 8 mm gaps compared to controls. The number of regenerated myelinated axons in the chamber was significantly decreased in diabetic rats with 8 and 10 mm gaps. The mean myelinated fiber area in the regenerated cables of the diabetic group was significantly decreased with 5 mm gaps and significantly increased with 8 mm gaps compared to controls. Size-frequency histograms of regenerated myelinated fiber areas suggest a delay in the maturation of small caliber axons. Schwann cell migration across 5 mm gaps was examined with S-100 immunohistochemistry. The total distance of Schwann cell migration into cables from both proximal and distal ends was significantly reduced in diabetic animals. Characterization of PNR across gaps through silicone chambers in diabetic rats showed impairment in multiple aspects of the regenerative process, including cable formation, Schwann cell migration, and axonal regeneration.

The influence of fibronectin and laminin during Schwann cell migration and peripheral nerve regeneration through silicon chambers.

The ability of extracellular proteins to influence the regenerative process was examined in Sprague-Dawley rats. Silicon chambers, filled with sterile saline solutions of cytochrome-c, fibronectin, laminin, a combination of fibronectin and laminin, or nerve growth factor were surgically implanted between the severed ends of sciatic nerves to form gaps of 18 mm. Four months later, the various groups were examined to determine the success of regeneration. The incidence of cable formation that bridged the gap was similar in all groups. The group of animals that had implants containing the combination of fibronectin/laminin had increased numbers of myelinated axons in the regenerated segment within the chamber and in the distal sciatic tributary nerves. Horseradish peroxidase labelling demonstrated that increased numbers of sensory and motor neurons in the fibronectin/laminin group had regenerated axons across the gap into the distal tributaries of the sciatic nerve. The effect of the various agents on non-neuronal cells was measured by immunohistochemical staining with S-100 antibodies to determine the effects on Schwann cell migration. Silicon chambers, filled with sterile saline solutions of fibronectin, laminin, fibronectin/laminin, nerve growth factor, or cytochrome-c, were surgically implanted to form 5 mm gaps between severed sciatic nerve ends. Ten days later, Schwann cell migration into the bridging cables was examined in each group. Analysis revealed a greater influx of Schwann cells migrating into the regenerating segments in the fibronectin, the laminin, and the combination fibronectin/laminin groups compared to the control group (cytochrome-c).

Improving the quality of healthcare delivery to homeless tuberculosis patients: a new approach.

"Doing things the same old way" can lead to complacency and eventually to a breakdown in the healthcare system. Such is the case with the deadly disease tuberculosis (TB). While TB was thought to be a disease of the past, the United States is experiencing an alarming rise in the incidence of the disease, especially among those least likely to get help or to stick with a treatment program. This article explores a more creative approach for reaching out to treat homeless people who have TB.