A framework for centering racial equity throughout the administrative data life cycle.

INTRODUCTION: Data integration by local and state governments is undertaken for the public good to support the interconnected needs of families and communities. Though data infrastructure is a powerful tool to support equity-oriented reforms, racial equity is rarely centered or prioritized as a core goal for data integration. This raises fundamental concerns, as integrated data increasingly provide the raw materials for evaluation, research, and risk modeling. Generally, institutions have not adequately examined and acknowledged structural bias in their history, or the ways in which data reflect systemic racial inequities in the development and administration of policies and programs. Meanwhile, civic data users and the public are rarely consulted in the development and use of data systems. OBJECTIVES: This paper presents a framework and site-based examples of "Work in Action" that were collaboratively generated by a civic data stakeholder workgroup from across the U.S. in 2019-2020. METHODS: Purposive sampling was used to curate a diverse 15-person workgroup that used participatory action research and public deliberation to co-create a framework of best practices. RESULTS: This framework aims to support agencies seeking to acknowledge and compensate for the harms and bias baked into data and practice. It is organized across six stages of the administrative data life cycle-planning, data collection, data access, use of algorithms/statistical tools, analysis, and reporting and dissemination. For each stage, the framework includes positive and problematic practices for centering racial equity, with site-based examples of "Work in Action" from across the U.S. Using this framework, the workgroup then developed a Toolkit for Centering Racial Equity Throughout Data Integration, a resource that has been broadly disseminated across the U.S. CONCLUSIONS: Findings indicate that centering racial equity within data integration efforts is not a binary outcome, but rather a series of small steps towards more equitable practice. There are countless ways to center racial equity across the data life cycle, and this framework provides concrete strategies for organizations to begin to grow that work in practice.

Designing an Interactive Field Epidemiology Case Study Training for Public Health Practitioners.

Globally, public health practitioners are called upon to respond quickly and capably to mitigate a variety of immediate and incipient threats to the health of their communities, which often requires additional training in new or updated methodologies or epidemiologic phenomena. Competing public health priorities and limited training resources can present challenges in developed and developing countries alike. Training provided to front-line public health workers by ministries of health, donors and/or partner organizations should be delivered in a way that is effective, adaptable to local conditions and culture, and should be an experience perceived as a job benefit. In this review, we share methods for interactive case-study training methodologies, including the use of problem-based scenarios, role-play activities, and other small-group focused efforts that encourage the learner to discuss and synthesize the concepts taught. We have fine-tuned these methods through years of carrying out training of all levels of public health practitioners in dozens of countries worldwide.

Disease intervention specialists as a resource in a public health emergency.

With the current shortage of qualified staff at state and local public health departments, a flexible public health workforce could fill critical gaps in staffing. Disease intervention specialists (DISs) are public health outreach workers who are responsible for finding and counseling people with sexually transmitted diseases and their contacts. DIS skills and job duties parallel those that would be needed to respond quickly and efficiently to urgent public health problems, including bioterrorism. Including DISs in public health preparedness planning could be a practical way of providing surge capacity for departments of public health. In many states, DISs are already being used for functions that fall outside their traditional duties. However, planning and DIS training are essential for effective utilization of DIS skills in a public health emergency. North Carolina has included DISs in their bioterrorism response plans and currently deploys them on an as-needed basis for nonroutine activities.

Knowledge and practice of foodborne disease clinical specimen testing and reporting in North Carolina, 2004.

BACKGROUND: Detection of foodborne disease outbreaks relies on health care practitioners (HCPs), infection control practitioners (ICPs), and clinical laboratorians to report notifiable diseases to state or local health departments. METHODS: To examine knowledge and practices about notifiable foodborne disease reporting among HCPs and ICPs in western North Carolina and among clinical laboratorians statewide, participants responded to a self-administered questionnaire about foodborne pathogen testing and reporting, referencing Campylobacter, shiga-toxin producing Escherichia coli, and other organisms. RESULTS: Three hundred seventy-two of 1442 health care providers participated in this survey. Of 372 study participants, fewer than 20% knew that both the clinician and the laboratorian were legally responsible for reporting the study pathogens. Most laboratorians identified the ICP (57%) as responsible for reporting. There was a lack of understanding about which infections and test results were reportable. LIMITATIONS: The response rate was very low, particularly among HCPs; participants may have been biased towards those with a particular interest in foodborne disease or surveillance. This descriptive study cannot be used to determine rates of reporting among the medical community. CONCLUSIONS: Although not legally obliged to report, ICPs were found to play a significant role in disease reporting. Dissemination of surveillance information and training through the established network of North Carolina ICPs may be ideal for improving foodborne disease surveillance in this state.

Spatial gene expression in the T-stage mouse metanephros.

The E11.5 mouse metanephros is comprised of a T-stage ureteric epithelial tubule sub-divided into tip and trunk cells surrounded by metanephric mesenchyme (MM). Tip cells are induced to undergo branching morphogenesis by the MM. In contrast, signals within the mesenchyme surrounding the trunk prevent ectopic branching of this region. In order to identify novel genes involved in the molecular regulation of branching morphogenesis we compared the gene expression profiles of isolated tip, trunk and MM cells using Compugen mouse long oligo microarrays. We identified genes enriched in the tip epithelium, sim-1, Arg2, Tacstd1, Crlf-1 and BMP7; genes enriched in the trunk epithelium, Innp1, Itm2b, Mkrn1, SPARC, Emu2 and Gsta3 and genes spatially restricted to the mesenchyme surrounding the trunk, CSPG2 and CV-2, with overlapping and complimentary expression to BMP4, respectively. This study has identified genes spatially expressed in regions of the developing kidney involved in branching morphogenesis, nephrogenesis and the development of the collecting duct system, calyces, renal pelvis and ureter.

Differential gene expression in the developing mouse ureter.

In many instances, kidney dysgenesis results as a secondary consequence to defects in the development of the ureter. Through the use of mouse genetics a number of genes associated with such malformations have been identified, however, the cause of many other abnormalities remain unknown. In order to identify novel genes involved in ureter development we compared gene expression in embryonic day (E) 12.5, E15.5 and postnatal day (P) 75 ureters using the Compugen mouse long oligo microarrays. A total of 248 genes were dynamically upregulated and 208 downregulated between E12.5 and P75. At E12.5, when the mouse ureter is comprised of a simple cuboidal epithelium surrounded by ureteric mesenchyme, genes previously reported to be expressed in the ureteric mesenchyme, foxC1 and foxC2 were upregulated. By E15.5 the epithelial layer develops into urothelium, impermeable to urine, and smooth muscle develops for the peristaltic movement of urine towards the bladder. The development of these two cell types coincided with the upregulation of UPIIIa, RAB27b and PPARgamma reported to be expressed in the urothelium, and several muscle genes, Acta1, Tnnt2, Myocd, and Tpm2. In situ hybridization identified several novel genes with spatial expression within the smooth muscle, Acta1; ureteric mesenchyme and smooth muscle, Thbs2 and Col5a2; and urothelium, Kcnj8 and Adh1. This study marks the first known report defining global gene expression of the developing mouse ureter and will provide insight into the molecular mechanisms underlying kidney and lower urinary tract malformations.

pfmdr1 genotyping and in vivo mefloquine resistance on the Thai-Myanmar border.

Molecular markers have been proposed as a method of monitoring malaria drug resistance and could potentially be used to prolong the life span of antimalarial drugs. Single nucleotide polymorphisms (SNPs) in the Plasmodium falciparum gene pfmdr1 and increased gene copy number have been associated with in vitro drug resistance but have not been well studied in vivo. In a prospective cohort study of malaria patients receiving mefloquine treatment on the Thai-Myanmar border, there was no significant association between either pfmdr1 SNPs or in vitro drug sensitivity and mefloquine resistance in vivo. Increased pfmdr1 gene copy number was significantly associated with recrudescence (relative risk 2.30, 95% CI 1.27-4.15). pfmdr1 gene copy number may be a useful surveillance tool for mefloquine-resistant falciparum malaria in Thailand.

Practices around acute diarrheal illness diagnosis, counseling, and reporting: laboratory and health-care practitioners in North Carolina, 2004.

OBJECTIVES: To describe foodborne disease surveillance in North Carolina, particularly diagnosis, counseling, and reporting of diagnoses from health-care practitioners (HCPs) and reporting of positive laboratory results from clinical diagnostic laboratories. MATERIALS: A survey was administered on knowledge of diagnostic testing and reporting practices for foodborne disease among HCPs in western North Carolina. We also queried laboratories statewide about foodborne disease testing and reporting practices. RESULTS: HCPs in specialties likely to diagnose acute diarrheal illness (ADI) participated (319/1442, 22% response rate). Only 66% of HCPs were comfortable with their knowledge of foodborne illness, and 68% were comfortable diagnosing and treating foodborne illnesses. In the past 30 days, 29% of HCPs did not request a stool culture from their ADI patients. We estimate that, overall, 8% of ADI patients who sought care in this region have a diagnosis that is reported to the health department (HD). The laboratory response rate was 39% (42/108), and 70% gave timely foodborne diagnosis reports to the HD. In this cross-sectional study, causes of reporting behavior could not be explored. In addition, HCPs survey response rates were low. CONCLUSIONS: Many HCPs were not comfortable with their knowledge and did not adequately provide counseling on prevention of foodborne illnesses. HCPs in western North Carolina may benefit from provider training on foodborne illness counseling and reporting. Improvements in communication between laboratories, HCPs, and HDs may increase HCP confidence in diagnosing foodborne illnesses and increase counseling of patients on prevention. Increased requests for testing of stool specimens by HCPs could substantially impact foodborne disease reporting in North Carolina.

Socioeconomics drive urban plant diversity.

Spatial variation in plant diversity has been attributed to heterogeneity in resource availability for many ecosystems. However, urbanization has resulted in entire landscapes that are now occupied by plant communities wholly created by humans, in which diversity may reflect social, economic, and cultural influences in addition to those recognized by traditional ecological theory. Here we use data from a probability-based survey to explore the variation in plant diversity across a large metropolitan area using spatial statistical analyses that incorporate biotic, abiotic, and human variables. Our prediction for the city was that land use, along with distance from urban center, would replace the dominantly geomorphic controls on spatial variation in plant diversity in the surrounding undeveloped Sonoran desert. However, in addition to elevation and current and former land use, family income and housing age best explained the observed variation in plant diversity across the city. We conclude that a functional relationship, which we term the "luxury effect," may link human resource abundance (wealth) and plant diversity in urban ecosystems. This connection may be influenced by education, institutional control, and culture, and merits further study.