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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. [ABSTRACT FROM AUTHOR]

Formative evaluation of multimedia programs can prevent costly and time-consuming revisions and result in more effective programs. Yet systematic formative evaluation is seldom conducted. This paper reviews the basic principles of formative evaluation and describes how we applied those principles to the formative evaluation of a multimedia program for patients about the side effects of cancer treatment. It discusses the challenges of developing multimedia programs for patients and provides guidance to other health professionals interested in developing programs on other topics. [ABSTRACT FROM AUTHOR]

This article shows that higher ethnolinguistic diversity is associated with a greater risk of social tensions and conflict, which, in turn, is a dispersion force lowering urbanization and the incentives to move to big cities. We construct a worldwide dataset at a fine-grained level on urban settlement patterns and ethnolinguistic population composition. For 3,540 provinces of 170 countries, we find that increased ethnolinguistic fractionalization and polarization are associated with lower urbanization and an increased role for secondary cities relative to the primate city of a province. These striking associations are quantitatively important and robust to various changes in variables and specifications. We find that democratic institutions affect the impact of ethnolinguistic diversity on urbanization patterns., Competing Interests: The authors declare no competing interest.

This paper documents strong but differentiated links between climate and urbanization in large panels of districts and cities in Sub-Saharan Africa, which has dried substantially in the past fifty years. The key dimension of heterogeneity is whether cities are likely to have manufacturing for export outside their regions, as opposed to being exclusively market towns providing local services to agricultural hinterlands. In regions where cities are likely to be manufacturing centers (25% of our sample), drier conditions increase urbanization and total urban incomes. There, urban migration provides an "escape" from negative agricultural moisture shocks. However, in the remaining market towns (75% of our sample), cities just service agriculture. Reduced farm incomes from negative shocks reduce demand for urban services and derived demand for urban labor. There, drying has little impact on urbanization or total urban incomes. Lack of structural transformation in Africa inhibits a better response to climate change.

The literature views many African cities as dysfunctional with a hodgepodge of land uses and poor "connectivity." One driver of inefficient land uses is construction decisions for highly durable buildings made under weak institutions. In a novel approach, we model the dynamics of urban land use with both formal and slum dwellings and ongoing urban redevelopment to higher building heights in the formal sector as a city grows. We analyze the evolution of Nairobi using a unique high-spatial resolution data set. The analysis suggests insufficient building volume through most of the city and large slum areas with low housing volumes near the center, where corrupted institutions deter conversion to formal sector usage., (Copyright © 2016, American Association for the Advancement of Science.)

Objective: To determine the prevalence of chronic pain, its causes, severity, management, impact on sleep, mood and activity levels, and general practitioner (GP) and patient satisfaction with pain management., Design: A subset of 197 GPs and 5,793 patients from the BEACH program, a continuous, national cross-sectional survey of Australian general practice., Results: The prevalence of chronic pain was 19.2% (95% confidence interval: 17.4-21.0) (N = 1,113). The most commonly reported causal conditions were osteoarthritis (48.1%) and back problems (29.4%). For pain severity (using Von Korff's pain grades), 25.2% were at Grade I (lowest); 37.1% were at Grade II; 28.3% at Grade III; and 9.4% at Grade IV (highest). Medication was used for pain management by 86.1% of patients, and one third also used nonpharmacological managements. One third of patients were taking opioids, most commonly those at the highest pain severity grades. On "Live Better with Pain Log" scale, the impact of pain was similar across activity (mean = 4.0), sleep (mean = 4.8), and mood (mean = 4.8). On a scale of 1 (highest) to 5 (lowest), GPs' satisfaction (mean = 2.5) was highly correlated (r = 0.7) with patients' satisfaction (mean = 2.6) with pain management., Conclusions: Chronic pain impairs patient quality of life, and is a public health burden. This study provides a national overview of the prevalence, causes, severity, management and impact of chronic pain in Australian general practice patients, and the parity between GP and patient satisfaction with pain management., (Wiley Periodicals, Inc.)

This paper studies the urban land market in China in 2003-2007. In China, all urban land is owned by the state. Leasehold use rights for land for (re)development are sold by city governments and are a key source of city revenue. Leasehold sales are viewed as a major venue for corruption, prompting a number of reforms over the years. Reforms now require all leasehold rights be sold at public auction. There are two main types of auction: regular English auction and an unusual type which we call a "two stage auction". The latter type of auction seems more subject to corruption, and to side deals between potential bidders and the auctioneer. Absent corruption, theory suggests that two stage auctions would most likely maximize sales revenue for properties which are likely to have relatively few bidders, or are "cold", which would suggest negative selection on property unobservables into such auctions. However, if such auctions are more corruptible, that could involve positive selection as city officials divert hotter properties to a more corruptible auction form. The paper finds that, overall, sales prices are lower for two stage auctions, and there is strong evidence of positive selection. The price difference is explained primarily by the fact that two stage auctions typically have just one bidder, or no competition despite the vibrant land market in Chinese cities.

GDP growth is often measured poorly for countries and rarely measured at all for cities or subnational regions. We propose a readily available proxy: satellite data on lights at night. We develop a statistical framework that uses lights growth to augment existing income growth measures, under the assumption that measurement error in using observed light as an indicator of income is uncorrelated with measurement error in national income accounts. For countries with good national income accounts data, information on growth of lights is of marginal value in estimating the true growth rate of income, while for countries with the worst national income accounts, the optimal estimate of true income growth is a composite with roughly equal weights. Among poor-data countries, our new estimate of average annual growth differs by as much as 3 percentage points from official data. Lights data also allow for measurement of income growth in sub- and supranational regions. As an application, we examine growth in Sub Saharan African regions over the last 17 years. We find that real incomes in non-coastal areas have grown faster by 1/3 of an annual percentage point than coastal areas; non-malarial areas have grown faster than malarial ones by 1/3 to 2/3 annual percent points; and primate city regions have grown no faster than hinterland areas. Such applications point toward a research program in which "empirical growth" need no longer be synonymous with "national income accounts."

Localities in developed countries often enact regulations to deter low-income households from moving in. In developing countries, such restrictions lead to the emergence of informal housing sectors. To deter low-income migrants, localities in developing countries withhold public services to the informal housing sector. Using a large sample of Brazilian localities, we examine migration and exclusion, focusing on the public provision of water to small houses where low-income migrants are likely to live. Withholding water connections reduces the locality growth rate, particularly of low-education households. In terms of service provision, during dictatorship in Brazil, we find evidence of strategic exclusion, where localities appear to withhold services to deter in-migration. We also find evidence of strategic interactions among localities within metro areas in their setting of service levels: if one locality provides more services to migrant households, other localities respond by withholding service.

Indonesia has a tradition of corruption among local officials who harass and collect bribes from firms. This paper examines whether corruption is affected by a change in institutions introducing local democratization and by party composition of local assemblies. Democratization occurred in 1999 and decentralization in 2001. We have firm-level data for 2001 and 2004. The 2001 data benchmark corruption at the time of decentralization, but for a limited sample of districts. We find that corruption declines between 2001 and 2004 overall, but much less [more] so in districts with more secular [Islamic] party representatives in district assemblies. For a larger sample of districts, correspondingly, we find that corruption in 2004 is more in districts which voted more in favor of secular party representatives in the first elections in 1999. We argue that the effects seem to be causal, over above any effects of changing religiosity and economic circumstances across districts.

This paper examines city formation in a country whose urban population is growing steadily over time, with new cities required to accommodate this growth. In contrast to most of the literature there is immobility of housing and urban infrastructure, and investment in these assets is taken on the basis of forward-looking behavior. In the presence of these fixed assets cities form sequentially, without the population swings in existing cities that arise in current models, but with swings in house rents. Equilibrium city size, absent government, may be larger or smaller than is efficient, depending on how urban externalities vary with population. Efficient formation of cities with internalization of externalities involves local government intervention and borrowing to finance development. The paper explores the institutions required for successful local government intervention.

Objectives: To estimate prevalence of selected diagnosed chronic diseases among patients attending general practice, in the general practice patient population, and in the Australian population, and to compare population estimates with those of the National Health Survey (NHS)., Design, Setting and Participants: In late 2005, 305 general practitioners each provided data for about 30 consecutive patients (total, 9156) as part of the BEACH (Bettering the Evaluation And Care of Health) program, a continuous national study of general practice activity. GPs used their knowledge of the patient, patient self-report, and medical records as sources., Main Outcome Measures: Crude prevalence of each listed condition currently under management among surveyed patients, and adjusted prevalence for the general practice patient population, and the national population., Results: 39.6% of respondents had none of the listed conditions diagnosed; 30.0% had a cardiovascular problem (uncomplicated hypertension, 17.6%; ischaemic heart disease, 9.5%); 24.8% had a psychological problem (depression, 14.2%; anxiety, 10.7%); 22.8% had arthritis, mostly osteoarthritis (20.0%); 10.7% had asthma; and 8.3% had diabetes, mostly type 2 (7.2%). Adjustment to the population attending general practice resulted in lower estimates for cardiovascular disease, arthritis and diabetes but had little effect on prevalence of asthma and psychological problems. After adjusting for non-attenders, about one in five people in the population had a cardiovascular problem, a similar proportion had a psychological problem, 14.8% had arthritis, and about 10% had asthma, hyperlipidaemia and gastro-oesophageal reflux disease. Estimates were similar to NHS results for any arthritis, asthma, and malignant neoplasms; higher for any cardiovascular problem; far higher for specific cardiovascular diseases, cerebrovascular disease and hyperlipidaemia; and almost twice the NHS estimate for psychological problems (particularly depression and anxiety). Estimates for type 1 diabetes aligned with NHS results, but were far higher for "all diabetes" and type 2 diabetes., Conclusions: This study offers an alternative, perhaps more accurate, approach to measurement of disease prevalence than the NHS approach, which relies on respondent self-report alone. It provides valid prevalence estimates with the help of GPs at a fraction of the cost of the NHS. This study could be repeated annually to augment other data sources and better define existing health needs in the population.

The Virtual Terrorism Response Academy is a reusable virtual learning environment to prepare emergency responders to deal with high-risk, low-frequency events in general, terrorist attacks in particular. The principal learning strategy is a traditional one: apprenticeship. Trainees enter the Academy and travel through its halls, selecting different learning experiences under the guidance of instructors who are simultaneously master practitioners and master trainers. The mentors are real individuals who have been videotaped according to courseware designs; they are subsequently available at any time or location via broadband Internet or CD-ROM. The Academy features a Simulation Area where trainees are briefed on a given scenario, select appropriate resources (e.g., protective equipment and hazmat instruments), then enter a 3-dimensional space where they must deal with various situations. Simulations are done under the guidance of a master trainer who functions as a coach, asking questions, pointing out things, explaining his reasoning at various points in the simulation. This is followed by a debriefing and discussion of lessons that could be learned from the simulation and the trainee's decisions.

The advent of the Global War on Terrorism (GWOT) underscored the need to improve the U.S. disaster response paradigm. Existing systems involve numerous agencies spread across disparate functional and geographic jurisdictions. The current architecture remains vulnerable to sophisticated terrorist strikes. To address these vulnerabilities, we must continuously adapt and improve our Homeland Security architecture. Virtual Reality (VR) technologies will help model those changes and integrate technologies. This paper provides a broad overview of the strategic threats, together with a detailed examination of how specific VR technologies could be used to ensure successful disaster responses.

Purpose/objectives: To obtain detailed information about the preferences of patients with cancer and their need for information about side effects of cancer treatment to design an interactive multimedia educational program., Design: Qualitative., Setting: Regional rural academic medical center., Sample: 51 patients and 14 spouses of patients who either currently were undergoing or recently had completed chemotherapy or radiation therapy for cancer., Methods: Focus groups., Main Research Variables: Information needs and common and distressing symptoms., Findings: Patients wanted information about the process of getting treatment, specific side effects that might occur, and the impact of treatment on their lives. Patients sought information from a variety of sources, but many found that other patients were the most helpful source. Although most patients wanted as much information as possible so they would be prepared for whatever happened, some patients preferred to avoid information about possible side effects. Several obstacles related to information were reported, including access to providers, communication difficulties with providers, informational overload, and problems with retention., Conclusions: Several aspects regarding information needs confirmed previous findings, and new aspects were illuminated. This led to a conclusion that multimedia technology offered many advantages to meet these informational needs., Implications for Nursing: New approaches to patient education that will meet the needs of patients as well as clinicians and educators need to be developed.

1. We investigated whether an individual duckling's (Anas platyrhynchos domesticus) attributes were associated with its response to an approaching human when it was a member of one of three flocks of 12. 2. Each individual was scored according to its response to (i) an approaching human when alone and feeding, (ii) a taxidermist's model fox when alone and feeding, and (iii) an approaching human when alone in a 9 m annulus, and its nearest neighbour distance in the home pen, competitiveness for food in a series of paired encounters, running ability and physical characteristics. 3. Each flock was herded around a 7 m diameter annulus in separate trials by a human walking at 0.5ms(-1). The distance maintained by each duckling from the human, and hence its relative flock position, was calculated. 4. Individual flight distance maintained from an approaching human when alone in an annulus was the attribute that predicted distance maintained from an approaching human when part of a flock. 5. Some ducklings had reduced average distances from an approaching human when they were in a flock compared to when they were tested alone, and inter-individual variation in distance from the human was greatly reduced when birds were part of a flock.

1. Small flocks of ducks (Anasplatyrhynchos domesticus) were exposed to two stimuli, a small mobile vehicle and a walking human, to investigate their flight responses. 2. Experiment 1. Flocks were herded around an annular arena by each stimulus at 0.5 ms(-1) and the flight distance between the stimulus and the centre of the flock, and individual positions within the flock were recorded every 10 s. Flocks maintained a significantly longer distance from the human (6.0 m) than the vehicle (5.1 m) and usually did not maintain visual contact with either stimulus. Significant consistency in individual positions within the flock was found within and between trials. 3. Experiment 2. Flocks were exposed to each stimulus which approached them as they were feeding in a circular arena. The latencies for cessation and resumption of feeding were recorded and the paths followed by the flocks described. Ducks showed a significantly shorter latency to cease feeding in response to the human (4.9 s) compared with the vehicle (6.9 s). 4. Domestic ducks apparently perceive an approaching human as a greater threat than a small vehicle. The findings are discussed in relation to the development of herding robots.

There are increasing opportunities for robots to work amongst animals in agricultural systems. One potential application is in herding animals prior to catching or transportation. An effective herding robot must be able to interrupt ongoing animal behaviour without causing panic or flight reactions. The extent to which different approaching stimuli interrupted the feeding behaviour of pairs of domestic ducklings was examined to assess their suitability as herding stimuli. Experiment 1 assessed the responses of ducklings to an approaching human (the most likely current herding stimulus), a vertical cylinder (a stimulus with the minimum features of a simple robot) and a model fox (simulating the more natural features of a predator). Interruption of feeding was greatest in response to the human and least to the cylinder. Experiment 2 found no significant difference in the extent to which feeding was interrupted when facial appearance and head orientation of the model fox were manipulated. Experiment 3 examined whether biologically realistic features of the model fox affected duckling response. At a distance of 7 m, photographs of the model fox interrupted feeding behaviour as much as the model itself. However, at a distance of 1 m, the model fox caused significantly more feeding interruption than an intact photograph. A fragmented photograph caused the least interruption of feeding behaviour.

This article discusses the application of technology to promote more comprehensive clinical education in the biopsychosocial aspects of primary care. Comprehensive refers to the inclusion, in addition to scientific and technical knowledge, of knowledge that is less easily characterized, quantified, and taught: empathy, intuition, the demonstration of artistry. Clinical education will be increasingly facilitated by the proliferation of computers capable of displaying combinations of text, graphics, video, and sound; broadband networks capable of delivering these multiple media to the home or office; and new methods for using these technologies for education and training. However, current models for technology-based learning are limiting, lagging behind the rapid technological evolution driving our entry into the Information Age. Some recent educational models (Schon's reflection-in-action and reflective practicums [1], Boisot's E-space [2], Kolb's learning cycle [3]) provide for a more comprehensive and complete view of health professional education. This article describes these models in depth and proposes a new model for technology-based clinical training, the "Virtual Practicum," based on them. The Virtual Practicum is illustrated with a new interactive CD-ROM program, dealing with primary care of patients with HIV/AIDS. The concepts presented here are generally useful in thinking about clinical education, regardless of the means used.

Patients often want considerable information about their conditions, and enhanced patient participation might reduce unwanted practice variation and improve medical decisions. The authors assessed how men with benign prostatic hyperplasia reacted to an education program designed to facilitate participation in decisionmaking, and how strongly ratings of their symptom state and the prospect of complications predicted their treatment choice. A prospective cohort study was conducted in three hospital-based urology practices: two in prepaid group practices, and one Veterans Administration clinic. Four hundred twenty-one men with symptomatic benign prostatic hyperplasia without prior prostatectomy or benign prostatic hyperplasia complications were enrolled, and 373 provided usable ratings. Subjects participated in an interactive videodisc-based shared decisionmaking program about benign prostatic hyperplasia and its treatment options, prostatectomy, and "watchful waiting." They rated the length, clarity, balance, and value of the program and were followed for 3 months to determine if they underwent surgery. Patients rated the program as generally clear, informative, and balanced. Across all three sites, 77% of patients were very positive and 16% were generally positive about the program's usefulness in making a treatment decision. Logistic models predicting choice of surgical treatment documented the independent importance of negative ratings of the current symptom state (odds ratio 7.0, 95% confidence interval 2.9-16.6), as well as the prospect of postoperative sexual dysfunction (odds ratio 0.20, 95% confidence interval 0.08-0.48) in decisionmaking. Patients rated the Shared Decisionmaking Program very positively and made decisions consistent with their assessed preferences. These results suggest that patients can be helped to participate in treatment decisions, and support a randomized trial of the Shared Decisionmaking Program.

An apparatus has been constructed and tested at pressures to 200 ATA which meets the basic requirements for intracellular microelectrode work. Standard microelectrodes, unaffected by pressure in this range, were used with lobster axon and frog sartorius fibers and action potentials have been recorded at pressure up to 151 ATA. The chamber itself has a simple roll-in door and a modular design that recommends it as a highly convenient multipurpose vessel for work at moderately high pressures.

The squid giant synapse, which permits intracellular electrical measurements in a single, excitatory synapse, was exposed to helium pressures up to 204 atm. By stimulating presynaptically and recording postsynaptically with an intracellular electrode it was found that pressure alters, but does not prevent, synaptic transmission of action potentials. Synaptically transmitted action potentials are prolonged in the same way as in the directly stimulated axon. However, slowing of the excitatory postsynaptic potential and marked increases in synaptic fatigue were observed at pressures as low as 35 atm. These changes may contribute to high pressure nervous effects by interfering with information transfer within the nervous system.

Attention to the quality of information in design of a medical information system is fundamental to the success of that system. This point is made using WWI and WWII combat casualty statistics. While the analyses presented are legitimate, serious problems of interpretation arise from the operational definitions used in gathering and analyzing these data. The impact of this is illustrated in a hypothetical battle, a model emphasizing the introduction of biases resulting from an apparent inattention to operational definitions on the part of combat care managers in WWII. The paper concludes with some broad recommendations.

Training military physicians in trauma management is a dilemma in peacetime, since there are few opportunities to gain clinical experience within the military care system. This program provides experience in clinical decision making through case simulation. Five cases, of increasing difficulty, are presented in a single videodisc side. The program is implemented on a system based on the IBM PC, and is written in the C programming language. The program emphasizes clinical realism by providing many clinical options at each decision point, and by audiovisually depicting combat clinical care in very realistic ways. The user interface is flexible and, though complex, is easy to use; it is supported by a narrated, on-line tutorial.

The belief that tachycardia is an early and reliable indicator of shock has recently been challenged. We examined 144 battlefield casualties with penetrating intraperitoneal injury to determine whether patients in shock presented with pulse rates that were significantly more rapid than those in patients not in shock. No differences in mean pulse rates were found when using objective operational definitions of shock. In contrast, the only pulse rate difference was noted when shock was defined on the basis of the surgeon's subjective clinical impression and this was attributed to selection bias. The absence of a tachycardic response in battlefield casualties with penetrating abdominal wounds cannot be taken as an indication that serious injury and significant intraperitoneal bleeding have not occurred. Caution should be exercised when using this parameter as a guide for therapeutic interventions, and further study is indicated to determine whether a similar pattern is seen in civilian practice.