Association of State Laws and Healthcare Workers' Influenza Vaccination Rates.

State laws are being used to increase healthcare worker (HCW) influenza vaccine uptake. Approximately 40% of states have enacted such laws but their effectiveness has been infrequently studied. Data sources for this study were the 2000-2011 U.S. National Health Interview Survey Adult Sample File and a summary of U.S. state HCW influenza vaccination laws. Hierarchical linear modeling was used for two time periods: 1) 2000-2005 (before enactment of many state laws) and 2) 2006-2011 (a time of increased enactment of state HCW influenza vaccination legislation). During 2000-2005, two states had HCW influenza vaccination laws and HCW influenza vaccination rates averaged 22.5%. In 2006-2011, 19 states had such laws and vaccination rates averaged 50.9% (p < 0.001). The likelihood of HCW vaccination increased with the scope and breadth, measured by a law score. Although laws varied widely in scope and applicability, states with HCW influenza vaccination laws reported higher HCW vaccination rates.

Hospital policies, state laws, and healthcare worker influenza vaccination rates.

This study used hierarchical linear modeling to determine the relative contribution of hospital policies and state laws to healthcare worker (HCW) influenza vaccination rates. Hospital mandates with consequences for noncompliance and race were associated with 3%-12% increases in HCW vaccination; state laws were not significantly related to vaccination rates.

School closure as an influenza mitigation strategy: how variations in legal authority and plan criteria can alter the impact.

BACKGROUND: States' pandemic influenza plans and school closure statutes are intended to guide state and local officials, but most faced a great deal of uncertainty during the 2009 influenza H1N1 epidemic. Questions remained about whether, when, and for how long to close schools and about which agencies and officials had legal authority over school closures. METHODS: This study began with analysis of states' school-closure statutes and pandemic influenza plans to identify the variations among them. An agent-based model of one state was used to represent as constants a population's demographics, commuting patterns, work and school attendance, and community mixing patterns while repeated simulations explored the effects of variations in school closure authority, duration, closure thresholds, and reopening criteria. RESULTS: The results show no basis on which to justify statewide rather than school-specific or community-specific authority for school closures. Nor do these simulations offer evidence to require school closures promptly at the earliest stage of an epidemic. More important are criteria based on monitoring of local case incidence and on authority to sustain closure periods sufficiently to achieve epidemic mitigation. CONCLUSIONS: This agent-based simulation suggests several ways to improve statutes and influenza plans. First, school closure should remain available to state and local authorities as an influenza mitigation strategy. Second, influenza plans need not necessarily specify the threshold for school closures but should clearly define provisions for early and ongoing local monitoring. Finally, school closure authority may be exercised at the statewide or local level, so long as decisions are informed by monitoring incidence in local communities and schools.

Preparedness for pandemics: does variation among states affect the nation as a whole?

OBJECTIVE: Since states' public health systems differ as to pandemic preparedness, this study explored whether such heterogeneity among states could affect the nation's overall influenza rate. DESIGN: The Centers for Disease Control and Prevention produced a uniform set of scores on a 100-point scale from its 2008 national evaluation of state preparedness to distribute materiel from the Strategic National Stockpile (SNS). This study used these SNS scores to represent each state's relative preparedness to distribute influenza vaccine in a timely manner and assumed that "optimal" vaccine distribution would reach at least 35% of the state's population within 4 weeks. The scores were used to determine the timing of vaccine distribution for each state: each 10-point decrement of score below 90 added an additional delay increment to the distribution time. SETTING AND PARTICIPANTS: A large-scale agent-based computational model simulated an influenza pandemic in the US population. In this synthetic population each individual or agent had an assigned household, age, workplace or school destination, daily commute, and domestic intercity air travel patterns. MAIN OUTCOME MEASURES: Simulations compared influenza case rates both nationally and at the state level under 3 scenarios: no vaccine distribution (baseline), optimal vaccine distribution in all states, and vaccine distribution time modified according to state-specific SNS score. RESULTS: Between optimal and SNS-modified scenarios, attack rates rose not only in low-scoring states but also in high-scoring states, demonstrating an interstate spread of infections. Influenza rates were sensitive to variation of the SNS-modified scenario (delay increments of 1 day versus 5 days), but the interstate effect remained. CONCLUSIONS: The effectiveness of a response activity such as vaccine distribution could benefit from national standards and preparedness funding allocated in part to minimize interstate disparities.

State courts and public health: building partnerships to enhance preparedness.

Laws and regulations can facilitate or impede emergency preparedness and response activities. State legislators, judges, and lawyers play critically important roles in creating and interpreting laws that affect the ability of public health practitioners and their partners to effectively respond to emergencies. In an age when political unrest, global travel, and emerging biological threats can combine to create social and economic havoc worldwide, it is critical that those responsible for upholding the rule of law during emergencies understand the law and its implications. In 2003, the University of Pittsburgh Center for Public Health Preparedness (UP-CPHP) created a Preparedness Law and Policy Program to advance legal preparedness for public health emergencies across Pennsylvania and the nation. To achieve this goal, UP-CPHP has partnered with local, state, and national organizations. In the course of these activities, Pennsylvania judges, the Administrative Office of Pennsylvania Courts, UP-CPHP, and the Centers for Disease Control and Prevention's Public Health Law Program have developed a strong and enduring collaborative relationship that has put the Pennsylvania judiciary in a better position today to plan for and respond to a public health crisis than it has been at any other point in its history. The tools and resources developed through this collaboration can readily be adapted to assist other jurisdictions nationwide in their efforts to ensure that their judicial systems are similarly prepared.

Species-specific SSR alleles for studies of hybrid cattails (Typha latifolia x T. angustifolia; Typhaceae) in North America.

PREMISE: Studies of hybridizing species are facilitated by the availability of species-specific molecular markers for identifying early- and later-generation hybrids. Cattails are a dominant feature of wetland communities, and a better understanding of the prevalence of hybrids is needed to assess the ecological and evolutionary effects of hybridization. Hybridization between Typha angustifolia and T. latifolia produce long-lived clones, known as Typha ×glauca, which are considered to be invasive. Although morphological variation in cattails makes it difficult to recognize early- and later-generation hybrids, several dominant, species-specific RAPD markers are available. Our goal was to find codominant, species-specific markers with greater polymorphism than RAPDs, to identify later-generation hybrids more efficiently. • METHODS: We screened nine SSR (simple sequence repeat) loci that were described from populations in Ukraine, and we surveyed 31 cattail populations from the upper Midwest and eastern USA. • KEY RESULTS: Seven SSR loci distinguished the parent taxa and were consistent with known species-specific RAPD markers, allowing easier detection of backcrossing. We used linear discriminant analysis to show that F(1) hybrid phenotypes were intermediate between the parent taxa, while those of backcrossed plants overlapped with the hybrids and their parents. Log(leaf length/leaf width), spike gap length, spike length, and stem diameter explained much of the variation among groups. • CONCLUSIONS: We provide the first documentation of backcrossed plants in hybridizing cattail populations in Michigan. The diagnostic SSR loci we identified should be extremely useful for examining the evolutionary and ecology interactions of hybridizing cattails in North America.

When divergent life histories hybridize: insights into adaptive life-history traits in an annual weed.

*Colonizing weed populations face novel selective environments, which may drive rapid shifts in life history. These shifts may be amplified when colonists are hybrids of species with divergent life histories. Selection on such phenotypically diverse hybrids may create highly fecund weeds. We measured the phenotypic variation, strength of natural selection and evolutionary response of hybrid and nonhybrid weeds. *We created F(1) hybrids of wild radish, an early flowering, small-stemmed weed, and its late-flowering, large-stemmed, crop relative (Raphanus spp.). Replicate wild and hybrid populations were established in an agricultural landscape in Michigan, USA. The consequences of three generations of natural selection were measured in a common garden experiment. *Hybrid populations experienced strong selection for larger, earlier flowering plants whereas selection was relatively weak on wild populations. Large plant size evolved two to three times faster in the hybrid populations than in wild populations, yet hybrid populations did not evolve earlier flowering. Strong selection on size and phenotypic correlations between age at reproduction and size may have limited the response of flowering phenology. *Our findings demonstrate hybridization between species with divergent life histories may catalyse the rapid evolution of certain adaptive, weedy traits while tradeoffs limit the evolution of others.

Rapid evolution in crop-weed hybrids under artificial selection for divergent life histories.

When species hybridize, offspring typically exhibit reduced fitness and maladapted phenotypes. This situation has biosafety implications regarding the unintended spread of novel transgenes, and risk assessments of crop-wild hybrids often assume that poorly adapted hybrid progeny will not evolve adaptive phenotypes. We explored the evolutionary potential of early generation hybrids using nontransgenic wild and cultivated radish (Raphanus raphanistrum, Raphanus sativus) as a model system. We imposed four generations of selection for two weedy traits - early flowering or large size - and measured responses in a common garden in Michigan, USA. Under selection for early flowering, hybrids evolved to flower as early as wild lineages, which changed little. These early-flowering hybrids also recovered wild-type pollen fertility, suggesting a genetic correlation that could accelerate the loss of crop traits when a short life cycle is advantageous. Under selection for large size at reproduction, hybrids evolved longer leaves faster than wild lineages, a potentially advantageous phenotype under longer growing seasons. Although early generation hybrid offspring have reduced fitness, our findings provide novel support for rapid adaptation in crop-wild hybrid populations. Biosafety risk assessment programs should consider the possibility of rapid evolution of weedy traits from early generations of seemingly unfit crop-wild hybrids.

Assessing bioterrorism and disaster preparedness training needs for school nurses.

Meeting the complex needs of a school system and all its members in the event of a bioterrorism (BT) disaster demands a competent workforce. School nurses are in position to be key contributors to planning for and responding to potential BT and disaster events. As part of a state preparedness leadership institute, the BT and disaster preparedness needs of school nurses in a three-county area were assessed and the nurses' preferred method to meet those needs was determined. Using competencies derived from publications by the Centers for Disease Control and Prevention and National Association of School Nurses, a survey was created and mailed to school nurses (N = 125) in public and private k-12 schools. Eighty surveys were returned (64% response rate). Responses were analyzed according to BT and emergency preparedness competencies and skills required for the phases of emergency management: mitigation, preparedness, response, and recovery. Low confidence in preparedness capabilities across almost all categories was reported. High training need was identified across almost all competencies, with 63 percent to 70 percent requesting additional education related to emergency response, infectious disease, hazardous materials, and diagnostic criteria. Although two-thirds report having Internet access in their school office, traditional classroom instruction was overwhelmingly preferred (74%) for training.