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Context: State health officials (SHOs), the executive and administrative leaders of state public health, play a key role in policy development, must be versed in the relevant/current evidence, and provide expertise about health issues to the legislature and the governor., Objective: To provide an empirical examination of SHO backgrounds and qualifications over time., Design, Setting, and Participants: Cross-sectional survey of current/former SHOs., Main Outcome Measures: State health official educational backgrounds; public health experience; previous employment setting., Results: Two-thirds of respondents (64.6%) reported having a medical degree, approximately half (48.3%) a formal public health degree, and almost one-quarter (21.8%) a management degree. The majority had governmental public health experience at some prior point in their career (70.0%). Almost two-thirds worked in governmental public health immediately before becoming an SHO. The proportion that was female increased significantly by decade from 5.6% in the 1970s/80s to 46.4% in the 2010s (P = .02)., Conclusions: The main finding from this study shows that more than two-thirds of SHOs have had governmental public health experience at some point in their career. This is not a new trend as there were no statistical differences in public health experience by decade. More than half of the SHOs were appointed to the role directly from governmental public health, indicating that their public health experience is timely and likely germane to their appointment as SHO. Findings also indicate improvements in gender diversity among one of the most influential leadership roles in governmental public health whereas significant changes in racial and ethnic diversity were not identified. Women are increasingly being appointed as SHOs, indicating increasing gender diversity in this influential position. Given that governmental public health employees are predominantly women, there is still room for gender equity improvements in executive leadership roles. This is coupled with the need for further racial and ethnic diversity improvements as well.

State health officials (SHOs) lead state governmental public health agencies, playing an important role in their states. However, little comprehensive research has examined SHOs or characteristics of these leaders, limiting evidence about ways to improve SHO selection and subsequent performance. This brief describes the methods of the SHO-CASE study focused on current and former SHOs in state public health agencies. Methods used include qualitative components that informed the development of survey questions, survey administration, and survey response. A total of 147 SHOs responded to the SHO survey representing every state and Washington, District of Columbia. The SHO-CASE study survey database represents the most comprehensive database of its kind regarding a range of attributes of current and former SHOs. These data can be used to explore factors contributing to SHO success including valuable insights into effectively working with the states' elected officials.

Background: Blomia tropicalis, a dust mite commonly found in subtropical and tropical environments, is the fourth most common mite in the United States. Thirty-eight percent of 167 consecutive subjects evaluated for allergic respiratory symptoms in the Tampa Bay area had positive skin test responses to B. tropicalis., Methods: Nasal challenges were performed in 19 subjects with allergic rhinitis; 12 had positive skin test responses to B. tropicalis (group I), and seven had negative skin test responses to B. tropicalis but positive skin test responses to Dermatophagoides pteronyssinus and D. farinae (group II). Subjects were challenged with a normal saline control solution and increasing concentrations of a 1 mg/ml in-house extract of B. tropicalis (1:125,000 vol/vol, 1:25,000 vol/vol, 1:5000 vol/vol, 1:1000 vol/vol, and 1:200 vol/vol). Inspiratory nasal airway resistance (was measured every 5 minutes for 15 minutes by posterior rhinomanometry at 50 Pa after each nasal challenge., Results: Nasal challenge response was considered positive and stopped when the mean inspiratory nasal airway resistance was greater than twice the mean inspiratory nasal airway resistance after the normal saline challenge. Ten of 12 (83%) subjects in group I and none of seven (0%) subjects in group II had positive nasal challenge responses to B. tropicalis (p = 0.0024)., Conclusion: B. tropicalis is allergenic and should be considered as a cause of allergic rhinitis when evaluating a patient who lives in an area where it is endemic.

This study evaluated the prevalence of positive percutaneous skin test results to Blomia tropicalis, Dermatophagoides pteronyssinus, and D. farinae in 167 consecutive persons (61 males, 106 females; mean age, 38.7 years; range, 14 to 75 years) with asthma or rhinitis, or both, in Tampa, Fla. Forty-nine had asthma with or without rhinitis, and 118 had rhinitis alone. RAST and RAST inhibition analysis of all three mite species were performed by using pooled patient sera. Prepared extracts of B. tropicalis and standardized D. pteronyssinus and D. farinae (1:50 wt/vol) were used for percutaneous skin tests. One hundred twelve subjects (67%) had a positive result to at least one mite species; 38%, 62%, and 60% reacted to B. tropicalis, D. pteronyssinus, and D. farinae, respectively. Positive skin test results to both D. pteronyssinus and D. farinae occurred in 96 subjects (57%); 56 of these subjects (58%) were also positive to B. tropicalis. Positive skin test results to B. tropicalis, D. pteronyssinus, or D. farinae alone occurred in four (2%), five (3%), and four (2%), respectively. RAST and RAST inhibition data indicate that B. tropicalis contains unique allergens. The high rate of skin test reactivity to B. tropicalis extracts, and its unique allergenic composition, warrants its use in the diagnosis and treatment of allergic disorders in Tampa.

Southern bayberry, distributed throughout the southeastern United States, is the source of the fifth most common windborne tree pollen in Tampa, Fla. Fifteen percent of 400 consecutive subjects evaluated for allergic respiratory symptoms in the Tampa Bay area had positive skin tests to bayberry pollen extract. Bayberry pollen extract was obtained commercially and used to perform 25 nasal and 22 bronchial challenges on 45 subjects. Twelve of 13 (92%) study subjects with allergic rhinitis and positive skin tests to bayberry pollen extract and two of 12 (17%) control subjects with negative skin tests had positive nasal challenges (p = 0.0001). Four of seven (57%) study subjects with extrinsic asthma and positive skin tests to bayberry pollen extract and none of the 15 (0%) control subjects with negative skin tests had positive bronchial challenges (p = 0.001). Sera from 30 subjects who underwent 31 challenges were assayed for bayberry pollen extract-specific IgE by plate radioimmunoassay. Specific IgE antibodies were present in the sera of 8 of 13 (62%) subjects with positive challenges and absent in 15 of 18 (83%) subjects with negative challenges (p = 0.01). Intradermal skin tests with bayberry pollen extract were more predictive of provocation challenge results than plate radioimmunoassay (positive predictive value of 80%, 95% CI 62% to 98%; versus 73%, 95% CI 47% to 99%). Bayberry pollen extract is allergenic, and the Southern bayberry tree fulfills Thommen's criteria defining aeroallergen-producing plants.

We report a case of a 20-year-old woman who presented with a 3-year history of a stable cystic nodule on the scalp. Light microscopy of the excised nodule demonstrated a malignant small round cell undifferentiated neoplasm. Immunohistochemical studies suggested a neural crest origin, while ultrastructural examination revealed characteristics of schwannian differentiation. Both of these special techniques were essential in establishing the diagnosis of a malignant epithelioid schwannoma of superficial tissue (neurotropic melanoma, desmoplastic melanoma). We discuss the differential diagnoses and describe the immunohistochemical and ultrastructural characteristics of this tumor. This case illustrates the difficulty of diagnosing this rare malignant tumor, which masqueraded as a benign-appearing scalp lesion.