Western organizational change capacity theory and its application to public health organizations in China: A multiple case analysis.

As health reform becomes a crucial task for both Chinese and United States government, public health organizations are required to adopt changes based on reform policy. Organizational Change Capacity theory is a Western theory that indicates the capacities that organizations should possess when pursuing successful organizational change. This study seeks to understand the applicability of this theory to Chinese public health organizations by contrasting organizations that have achieved success or remained challenged in implementing organizational change to optimize health reform. The research questions are: Is the Organizational Change Capacity theory applicable in Chinese public health organizations? How should it be modified to best fit Chinese public health organizations? Seventy-two participants from 12 public health organizations in Beijing and Xi'an were recruited for interviews and follow-up questionnaires that asked for experiences during their organizational changes. During the analysis, a new Chinese Organizational Change Capacity theory with nine main themes emerged. This new framework provides a guideline for Chinese public health organizations to evaluate their change capacity, and offers a theoretical foundation for researchers to design interventions that increase these organizations' capacity in achieving successful change.

Using the interactive systems framework to support a quality improvement approach to dissemination of evidence-based strategies to promote early detection of breast cancer: planning a comprehensive dynamic trial.

Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance. Although CDT may offer distinct advantages over static designs, organizing the many necessary roles and activities is a significant challenge. In this article, we discuss use of the Interactive Systems Framework for Dissemination and Implementation to systematically implement a CDT. Specifically, we describe "Bronx ACCESS", a program designed to disseminate evidence-based strategies to promote adherence to mammography guidelines. In Bronx ACCESS, the Intervention Delivery System will elicit information needed to adapt strategies to specific settings and circumstances. The Intervention Synthesis and Translation System will use this information to test changes to strategies through "embedded experiments". The Intervention Support System will build local capacities found to be necessary for intervention institutionalization. Simulation modeling will be used to integrate findings across systems. Results will inform on-going policy debate about interventions needed to promote population-level screening. More generally, this project is intended to advance understanding of research paradigms necessary to study dissemination.

Empowerment evaluation for violence prevention public health programs.

The formative evaluation consultation and systems technique (FORECAST) approach to evaluating complex community programs is described as an empowerment evaluation strategy. First, empowerment evaluation is defined and contrasted with more-traditional approaches, such as experimental and quasi-experimental designs. Then FORECAST is described, illustrating how it was applied in four community projects. One of the projects is used to demonstrate the application of FORECAST evaluation in programs addressing the prevention of first-time male perpetration of sexual violence.

The 6-step model for community empowerment: revisited in public housing communities for low-income senior citizens.

The 6-step community empowerment model was replicated in communities with different geographical, racial, and age backgrounds from the original application. Resident groups of Blue Ribbon Health Panels (BRHPs) in federally funded senior housing in Pennsylvania followed the 6 steps to identify community health issues, to develop strategies to address priority issues, and to implement the strategies in collaboration with partner agencies. The 6-step model served as an operationalization strategy of community empowerment by facilitating quick accomplishments of communities' desired outcomes, legitimizing and motivating BRHP efforts. Community capacities to actively participate and collaborate influenced the model's progress in this replication study, as did partner agencies' capacities to adhere to the community-based participatory and collaborative orientation of the project. Community capacity development and partnership facilitation would be important for a community empowerment project, as well as consistent and clear communication among everyone involved in the process.

A construct for building the capacity of community-based initiatives in racial and ethnic communities: a qualitative cross-case analysis.

This article reports on a qualitative cross-case study that compares patterns of implementation across community-based public health initiatives resulting in a construct for building the capacity of such initiatives in racial and ethnic communities. By specifying which capacities provide optimum leverage, community initiatives may increase precision in developing intervention strategies that focus on those pivotal capacities that are necessary for producing desired outcomes. First, community capacity is defined and briefly contrasted with social capital. Then the research method is described from which the capacity construct is derived. The study reveals several capacities of community-based initiatives that are crucial in distinguishing highly successful initiatives from those that had greater difficulty in realizing their goals. Leadership was the most important capacity that distinguished highly and less successful initiatives. Organizing capacity, or the propensity to provide structure, operational procedures, oversight, and activity formation were also critical in leveraging community action and desired outcomes. The study concludes that developing high levels of community capacity where it can produce the most strategic advantage is a promising pathway for mitigating antagonistic social factors.

Billing and payment of commercial and Medicaid health plan adult vaccination claims in Michigan since the Affordable Care Act.

BACKGROUND: Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims. METHODS: We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types. We compared commercial and Medicaid payment rates to Medicare payment rates and examined patient cost sharing. RESULTS: Pharmacy-submitted claims for adult vaccine doses were almost always paid (commercial 98.5%; Medicaid 100%). As the physician office accounted for the clear majority (79% commercial; 69% Medicaid) of medical (non-pharmacy) vaccination services, we limited further analyses of both commercial and Medicaid medical claims to the physician office setting. In the physician office setting, rates of payment were high with commercial rates of payment (97.9%) greater than Medicaid rates (91.6%). Reasons for non-payment varied, but generally related to the complexity of adult vaccine recommendations (patient diagnosis does not match recommendations) or insurance coverage (complex contracts, multiple insurance payers). Vaccine administration services were also generally paid. Commercial health plan payments were greater for both vaccine dose and vaccine administration than Medicare payments; Medicaid paid a higher amount for the vaccine dose, but less for vaccine administration than Medicare. Patients generally had very low (commercial) or no (Medicaid) cost-sharing for vaccination. CONCLUSIONS: Adult vaccine dose claims were usually paid. Medicaid generally had higher rates of non-payment than commercial insurance.

Recovery, purification, and cloning of high-molecular-weight DNA from soil microorganisms.

We describe here an improved method for isolating, purifying, and cloning DNA from diverse soil microbiota. Soil microorganisms were extracted from soils and embedded and lysed within an agarose plug. Nucleases that copurified with the metagenomic DNA were removed by incubating plugs with a high-salt and -formamide solution. This method was used to construct large-insert soil metagenomic libraries.

Use of surface plasmon resonance imaging to study viral RNA: protein interactions.

Surface plasmon resonance imaging (SPRi) is an emerging microarray technology that is label-free, rapid and extremely flexible. Here the capabilities of SPRi are demonstrated in results of proof-of-concept experiments detailing a method for studying viral genomic RNA:protein interactions in array format. The principal RNA is the well-characterized origin of assembly (OAS) containing region of Tobacco mosaic virus (TMV) RNA, whereas the principal protein is the primary subunit for TMV virion assembly, the 20S capsid protein aggregate. DNA probes complementary to TMV and non-TMV RNA fragments were covalently attached to a thin gold layer deposited on glass. These DNA probes were used to discreetly capture in vitro transcribed TMV and Red clover necrotic mosaic virus (RCNMV) RNA2 (used as a negative control for the subsequent protein binding). The 4S TMV capsid protein monomers were isolated from TMV particles purified from infected plants of Nicotiana tabacum L. and were induced to form 20S stacked disc aggregates. These 20S stacked disc aggregates were then injected onto the array containing the RNA fragments captured by the DNA probes immobilized on the microarray surface. The discrete and preferential binding of the 20S stacked disc aggregates to the array locations containing the TMV OAS RNA sequence was observed. The results demonstrate that SPRi can be used to monitor binding of large RNA molecules to immobilized DNA capture probes which can then be used to monitor the subsequent binding of complex protein structures to the RNA molecules in a single real-time, label-free microarray experiment. The results further demonstrate that SPRi can distinguish between RNA species that have or do not have an origin of assembly sequence specific for a particular viral capsid protein or protein complex. The broader implications of these results in virology research are found in other systems where the research goals include characterizing the specificity and kinetics of viral or host protein or protein complex interactions with viral nucleic acids.

Development of scales measuring the capacity of community-based initiatives.

This article describes the development of two measures for the capacity of local public health initiatives. Data obtained from a qualitative study of eight community-based initiatives served as the basis for the development of a survey instrument. It was administered to a national sample of both leaders and nonleaders of 291 such initiatives. Because survey results for leaders and nonleaders differed, results could not be combined into a single data set for analysis. Results for each data set were analyzed by employing exploratory principal components and factor analyses. A 44-item, six-factor scale resulted for leaders and a 38-item, five-factor scale resulted for nonleaders. The high degree of overlap (22 items) between the two scales resulted in a combined 60-item instrument that can be administered to both leaders and nonleaders but analyzed separately.

Engaging partners to initiate evaluation efforts: tactics used and lessons learned from the prevention research centers program.

BACKGROUND: The Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRC) Program underwent a 2-year evaluation planning project using a participatory process that allowed perspectives from the national community of PRC partners to be expressed and reflected in a national logic model. CONTEXT: The PRC Program recognized the challenge in developing a feasible, useable, and relevant evaluation process for a large, diverse program. To address the challenge, participatory and utilization-focused evaluation models were used. METHODS: Four tactics guided the evaluation planning process: 1) assessing stakeholders' communication needs and existing communication mechanisms and infrastructure; 2) using existing mechanisms and establishing others as needed to inform, educate, and request feedback; 3) listening to and using feedback received; and 4) obtaining adequate resources and building flexibility into the project plan to support multifaceted mechanisms for data collection. CONSEQUENCES: Participatory methods resulted in buy-in from stakeholders and the development of a national logic model. Benefits included CDC's use of the logic model for program planning and development of a national evaluation protocol and increased expectations among PRC partners for involvement. Challenges included the time, effort, and investment of program resources required for the participatory approach and the identification of whom to engage and when to engage them for feedback on project decisions. INTERPRETATION: By using a participatory and utilization-focused model, program partners positively influenced how CDC developed an evaluation plan. The tactics we used can guide the involvement of program stakeholders and help with decisions on appropriate methods and approaches for engaging partners.

A construct for building the capacity of community-based initiatives in racial and ethnic communities: a qualitative cross-case analysis.

OBJECTIVE: This article reports on a qualitative study that contrasts implementation patterns across community-based public health initiatives, resulting in a construct for building the capacity of such initiatives in racial and ethnic communities. By specifying which capacities provide optimum leverage, community initiatives may increase precision in developing intervention strategies that are pivotal in producing desired outcomes. METHOD: Cross-case comparisons were made on the basis of intensive interviews with key initiative leaders. RESULTS: Several capacities distinguish highly successful initiatives from those that had greater difficulty in realizing their goals. Leadership was the most important distinguishing capacity. Organizing capacity, or the propensity to provide structure, operational procedures, oversight, and activity formation, was also critical in leveraging community action and desired outcomes. CONCLUSION: The study concludes that developing high levels of community capacity where it can produce the most strategic advantage is a promising pathway for mitigating antagonistic social factors.

The public health role in the primary prevention of diabetes: recommendations from the chronic disease directors' project.

AIM: The article reports on the recommendations from the Diabetes Primary Prevention Project that was initiated and funded by the Division of Diabetes Translation, Centers for Disease Control and Prevention, and developed by the National Association of Chronic Disease Directors. METHOD: Essential components of statewide programs are delineated for effective interventions for diabetes primary prevention. The recommendations were derived from a structured process that is detailed on the basis of a cross-comparison of state-level diabetes prevention initiatives in six states where such programs were most developed. RESULTS: The recommendations focus on state-level partnerships, statewide program planning, required resources, policies, benchmarks for progress, and data collection. CONCLUSION: Illustrations are provided regarding how the project influenced the six participating states in further developing their programs for the primary prevention of diabetes.

Patients with Complex Chronic Diseases: perspectives on supporting self-management.

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed.

Identification and characterization of the gene encoding the Acidobacterium capsulatum major sigma factor.

Acidobacterium capsulatum is an acid-tolerant, encapsulated, Gram-negative member of the ubiquitous, but poorly understood Acidobacteria phylum. Little is known about the genetics and regulatory mechanisms of A. capsulatum. To begin to address this gap, we identified the gene encoding the A. capsulatum major sigma factor, rpoD, which encodes a 597-amino acid protein with a predicted sequence highly similar to the major sigma factors of Solibacter usitatus Ellin6076 and Geobacter sulfurreducens PCA. Purified hexahistidine-tagged RpoD migrates at approximately 70 kDa under SDS-PAGE conditions, which is consistent with the predicted MW of 69.2 kDa, and the gene product is immunoreactive with monoclonal antibodies specific for either bacterial RpoD proteins or the N-terminal histidine tag. A. capsulatum RpoD restored normal growth to E. coli strain CAG20153 under conditions that prevent expression of the endogenous rpoD. These results indicate we have cloned the gene encoding the A. capsulatum major sigma factor and the gene product is active in E. coli.

Relationship between primary care physician financial risk and member emergency department use in a commercial HMO population.

OBJECTIVE: To demonstrate whether, despite factors beyond the control of primary care physicians (PCPs), health maintenance organization (HMO) members under the care of PCPs with greater financial risk for the cost of emergency care have lower rates of emergency department use. STUDY DESIGN: Cohort study using calendar year 2000 administrative data on 217 298 commercial members enrolled in a nonprofit statewide HMO (Blue Care Network of Michigan) under the care of non-staff-model PCPs with varying levels of financial risk for emergency care. METHODS: Ordinary least squares (OLS) and binary logistic regression models were developed to assess the influence of PCP financial risk, net effects of member and PCP demographics, and emergency care accessibility on use of emergency treat-and-release services by members. RESULTS: OLS results indicated emergency use was lower by 33 visits per 1000 (P < .001) and 51 visits per 1000 (P < .001) for members with PCPs who had medium and high financial risk, respectively, compared with members whose PCPs had low financial risk for emergency care. Emergency care availability, member copayment and demographics, and the number of all Blue Care Network members assigned to the PCP also were significant predictors of emergency use. CONCLUSIONS: PCPs do have the ability to influence their patients' emergency department use if financially motivated to do so. Ensuring that the PCP has a large enough number of patients under a specific contractual arrangement also is an important component of the success of an associated financial incentive.

Molecular characterization of four rice genes encoding ethylene-responsive transcriptional factors and their expressions in response to biotic and abiotic stress.

We isolated and identified four rice genes, OsBIERF1 to OsBIERF4 (Oryza sativa benzothiadiazole (BTH)-induced ethylene responsive transcriptional factors (ERF)) and analyzed their expressions in rice disease resistance response and under various abiotic stress conditions. The OsBIERF1-4 proteins contain conserved ERF domains, but are categorized into different classes of the previously characterized ERF proteins based on their structural organizations. OsBIERF3 and OsBIERF2 belong to Classes I and II, respectively; while OsBIRERF1 and OsBIERF4 are members of Class IV. OsBIERF3 could bind specifically to the GCC box sequence and was targeted to nucleus when transiently expressed in onion epidermis cells. Expression of OsBIERF1, OsBIERF3 and OsBIERF4 was induced by treatments with BTH and salicylic acid, chemical inducers capable of inducing disease resistance response in rice. In the BTH-treated rice seedlings, expression of OsBIERF1, OsBIERF3 and OsBIERF4 was further induced by infection with Magnaporthe grisea, the rice blast fungus, as compared with those in water-treated seedlings. OsBIERF1 and OsBIERF3 were activated in an incompatible interaction but not in compatible interaction between rice and M. grisea. Moreover, OsBIERF1, OsBIERF3 and OsBIERF4 were also up-regulated by salt, cold, drought and wounding. These results suggest that OsBIERF proteins may participate in different signaling pathways that mediate disease resistance response and stress responses to abiotic factors.

The Impact of Commercial Health Plan Prior Authorization Programs on the Utilization of Services for Low Back Pain.

STUDY DESIGN: An observational study. OBJECTIVE: The aim of this study was to evaluate the impact of a health plan's prior authorization (PA) programs for low back pain (LBP) in a non-Medicare population by assessing changes in pre-surgical nonoperative care; lumbar fusion trends; and overall back surgery rates compared with another health plan with a similar program and national benchmarks. The PA programs require mandatory physiatrist consultation before surgical evaluation, with subsequent additional LBP surgery PA. SUMMARY OF BACKGROUND DATA: LBP is prevalent and concern exists that spinal fusion is overutilized for LBP. METHODS: Annual rates of lumbar fusion trended over 6 years, and analysis of changes in standardized costs for LBP-related services among a 501-member subset who underwent lumbar fusion before and after program implementations, during the period January 1, 2008, through December 31, 2013, among commercial members aged 18 and 65 years enrolled in a health maintenance organization with commercial membership averaging >500,000 annually. RESULTS: After initiation of the physiatrist PA in December 2010, lumbar fusions decreased from 76.27/100,000 in 2010 to 62.63/100,000 in 2011 with subsequent increases to 64.24/100,000 and 73.84/100,000 in years 2012 and 2013. For members who had lumbar fusion, per-member, pre-surgical costs increased by $2,233 with the physiatrist PA and an additional $1,370 with implementation of the LBP surgery PA (March 2013). Spinal injections and inpatient admissions were the greatest contributors to the overall increase in costs. The physiatrist and LBP surgery PA programs were also associated with lengthening of LBP episodes ending in surgery by 309 and 198 days. CONCLUSION: Mandatory referral to a physiatrist before surgical evaluation did not result in persistent reduction in lumbar fusions. Instead, these programs were associated with the unintended consequence of increased costs from more nonoperative care for only a transitory change in the lumbar fusion rate, likely from delays due to the introduction of both PA programs. LEVEL OF EVIDENCE: 3.

Cloning and identification of the promoter of the tobacco Sar8.2b gene, a gene involved in systemic acquired resistance.

Expression of the Sar8.2 gene family is induced by salicylic acid (SA) in tobacco during induction of systemic acquired resistance. Expression of Sar8.2b, one member of this 12-member family, was detected as early as 12 h after treatment with SA and was maximal 36 h after SA treatment. In NahG transgenic tobacco plants, benzothiadiazole and dichloroisonicotinic acid induced expression of Sar8.2b but SA did not, suggesting that expression of the Sar8.2b gene is SA-dependent. Several putative cis-acting elements were found in the Sar8.2b gene promoter region, including an as-1 element and GT-1 and Dof binding sequences. We constructed a series of progressive deletion mutations in the Sar8.2b promoter region linked to the beta-glucuronidase (GUS) coding region and analyzed GUS activities by stable expression in transformants of Arabidopsis thaliana. Deletions between -728 and -927 bp or between -351 and -197 bp of the promoter region resulted in a significant reduction in GUS activity induced by SA treatment as shown in stable transformants of A. thaliana. The -197 bp fragment of the promoter region was found to confer a relatively low level of GUS activity induced by SA treatment in stable expression of transformants in A. thaliana. The results suggest that 927 bp of the Sar8.2b gene promoter confers full promoter activity and that cis-acting elements required for high-level SA-inducible expression of the Sar8.2b gene may exist within the regions -728 to -927 bp and -197 to -351 bp.

A qualitative evaluation of the National Centers of Excellence in Women's Health Program.

A qualitative evaluation was conducted at 15 nationally designated Centers of Excellence in Women's Health (CoEs) that were funded by the U.S. Department of Health and Human Services' (DHHS) Office on Women's Health at the time of data collection. The evaluation focused on organizational issues including: 1) the impact of CoE designation on the recipient institutions; 2) the greatest strengths and challenges affecting the CoEs and their core components of research, clinical care, professional education, leadership, and community outreach; and 3) whether the core components developed an interface and coordinated with one another as intended according to the DHHS national model. A total of 91 individuals were interviewed for the evaluation. The study indicates that the national designation served to legitimize and expand the scope of women's health within the recipient institutions. The CoEs enhanced collaboration among researchers and practitioners, and were able to leverage additional resources. The core components largely were successful at interfacing in accordance with the national model. Notwithstanding these successes, the CoEs remain susceptible to failure if they do not gain additional support for the concept of women's health within the recipient institutions, and will not remain durable without additional and stable funding sources.

Collaborative community empowerment: an illustration of a six-step process.

This article illustrates a method used in a community empowerment project where community members and university facilitators collaborated to increase the capacity of the community. The method may have practical uses in collaborations with community groups. The six-step process enabled the community groups to accomplish their short-term community goals: developing effective after-school programs and resolving problems of damaged homes and blighted properties in a relatively short time and continuing on their collaborative work. Having a social ecological model as a conceptual framework was helpful for the community to assess their status and develop action plans. Consistent community meetings, open communication, focused community leadership, community networking, and collaboration of community organizations and a university were the factors that reinforced the empowerment process. Challenges such as maximizing limited resources and generating more participation from the community need to be resolved while the reinforcing factors are cultivated.