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Transitions from pediatric to adult care by young adults with chronic conditions are fraught with challenges. Poor transitions lead to discontinuities of care that are avoidable with better communication between providers. We tested whether exposure to providers with sustained patient-sharing relationships resulted in fewer emergent admissions of young adults with congenital heart disease (CHD). Care transitions are particularly important for young adults with CHD. Though it is not possible to avoid planned admissions for scheduled procedures, emergency admissions are avoidable with proper care. We tested whether several different patient-sharing relationship measures influenced emergent admissions and found that compared with less severe CHD patients, those with severe CHD experienced a 4 to 10 percentage point decline in emergent admissions given a 5 percentage point increase in practice-level patient-sharing relationships. These results are consistent with our hypothesis that patient sharing improves communication and continuity of care across providers, especially for severe CHD patients.

This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.

Objective To assess the structure, content, quality, and quantity of partnerships that developed in response to a national cardiovascular health initiative, Million Hearts. Design This study used a social network analysis (SNA) approach to assess the Million Hearts initiative network partnerships and identify potential implications for policy and practice. Setting/participants The Million Hearts network comprised a core group of federal and private sector partners that participate in Million Hearts activities and align with initiative priorities. To bound the network for the SNA, we used a list of 58 organizations (74% response rate) from a previously completed qualitative analysis of Million Hearts partnerships. Main outcome measures We used the online PARTNER (Program to Analyze Record and Track Networks to Enhance Relationships-www.partnertool.net) survey to collect data on individual organizational characteristics and relational questions that asked organizations to identify and describe their relationships with other partners in the network. Key SNA measures include network density, centralizations, value, and trust. Results Our analyses show a network that is decentralized, has strong perceptions of trust and value among its members, and strong agreement on intended outcomes. Interestingly, partners report a desire and ability to contribute resources to Million Hearts; however, the perceptions between partners are that resources are not being contributed at the level they potentially could be. The majority of partners reported that being in the network helped them achieve their goals related to cardiovascular disease prevention. The largest barrier to successful activities within the network was cited as lack of targeted funding and staff to support participation in the network. Conclusions The Million Hearts network described in this article is unique in its membership at the national level, agreement on outcomes, its powerful information-sharing abilities that require few resources, and its decentralized structure. We identified strategies that could be implemented to strengthen the network and its activities. By examining a national-level public-private partnership formed to address a public health issue, we can identify ways to strengthen the network and provide a framework for developing other initiatives.

Introduction Neurosurgical guidelines recommend maintaining mean arterial pressure (MAP) between 85 and 90 mm Hg following acute spinal cord injury (SCI). In our hospital, SCI patients receive orders for MAP targeting for 72 hours following admission, but it is unclear how often the patient's MAP meets the target and whether or not this affects outcome. We hypothesized that the proportion of MAP measurements ≥85 mm Hg would be associated with neurologic recovery. Methods Spinal cord injury patients with blunt mechanism of injury admitted between 2014 and 2019 were identified from the registry of a level 1 trauma center. Proportion of MAP values ≥85 mm Hg was calculated for each patient. Neurologic improvement, as measured by positive change in American Spinal Injury Association (ASIA) impairment scale by ≥1 level from admission to discharge was evaluated with respect to proportion of elevated MAP values. Results A total of 136 SCI patients were evaluated. Average proportion of elevated MAP values was 75%. Admission ASIA grades were as follows: A, 30 (22.1%); B, 20 (14.7%); C, 28 (20.6%); and D, 58 (42.6%). One hundred six patients (77.9%) required vasopressors to elevate MAP (ASIA A, 86.7%; B, 95.0%; C, 92.9%; D, 60.3%). Forty patients (29.4%) were observed to have improvement in ASIA grade by discharge (admission ASIA A, 15%; B, 33%; C, 40%; D, 13%). The proportion of elevated MAP values was higher for patients with neurologic improvement (0.81 ± 0.15 vs. 0.72 ± 0.25, p = 0.014). Multivariate modeling demonstrated a significant association between proportion of elevated MAP values and neurologic improvement (p = 0.028). An interaction revealed this association to be moderated by vasopressor dose (p = 0.032). Conclusion The proportion of MAP measurements ≥85 mm Hg was determined to be an independent predictor of neurologic improvement. Increased vigilance regarding MAP maintenance above 85 mm Hg is warranted to optimize neurologic recovery following SCI. Level of evidence Therapeutic/care management, level IV.

ObjectiveTo summarize ways that networks of community-based organizations (CBO), in partnership with public health departments, contribute to community recovery from disaster.MethodsThe study was conducted using an online survey administered one and 2 years after Hurricane Sandy to the partnership networks of 369 CBO and the New York Department of Health and Mental Hygiene. The survey assessed the structure and durability of networks, how they were influenced by storm damage, and whether more connected networks were associated with better recovery outcomes.ResultsDuring response and recovery, CBOs provide an array of critical public health services often outside their usual scope. New CBO partnerships were formed to support recovery, particularly in severely impacted areas. CBOs that were more connected to other CBOs and were part of a long-term recovery committee reported greater impacts on the community; however, a partnership with the local health department was not associated with recovery impacts.ConclusionCBO partners are flexible in their scope of services, and CBO partnerships often emerge in areas with the greatest storm damage, and subsequently the greatest community needs. National policies will advance if they account for the dynamic and emergent nature of these partnerships and their contributions, and clarify the role of government partners. (Disaster Med Public Health Preparedness. 2018;12:635–643)

This article details the development and implementation of the Federal Emergency Management Agency (FEMA) Corps program, a federal interagency partnership. While many federal agencies partner through fee-for-service arrangements and contracts, few contemporary examples of interagency program creation and implementation are available. This article develops an interagency collaboration framework by drawing from the collaboration literature, as well as literature on institutions, to examine the development of this unique partnership. This research draws on key informant interviews and content analysis of documentation, including the interagency agreement (IAA), historical records, memos, meeting minutes, and participant observations. Findings suggest that even in formal IAAs, a strong history of informal institutional collaboration may be an important antecedent of forming and implementing collaborative arrangements. Similarly, the presence of a champion may play an important role in cultivating and developing both informal and formal institutions that create an opportunity to collaborate. Finally, the rules-in-use and the rules-in-form may vary at different levels of management. As the federal government increasingly employs interagency partnerships, this article provides lessons for developing relationships, identifying and understanding roles, crossing organizational boundaries, and merging both agency cultures and administrative processes.

Given the complexity of today’s social and political dilemmas, a common method of program and policy implementation is surfacing in the form of interorganizational, cross-sector goal-directed netwo...

Community resilience has grown in importance in national disaster response and recovery efforts. However, measurement of community resilience, particularly the content and quality of relationships aimed at improving resilience, is lacking. To address this gap, we used a social network survey to measure the number, type, and quality of relationships among organizations participating in 16 coalitions brought together to address community resilience in the Los Angeles Community Disaster Resilience project. These coalitions were randomized to one of two approaches (community resilience or preparedness). Resilience coalitions received training and support to develop these partnerships and implement new activities. Both coalition types received expert facilitation by a public health nurse or community educator. We also measured the activities each coalition engaged in and the extent to which partners participated in these activities at two time points. We found that the community resilience coalitions were initially larger and had lower trust among members than the preparedness communities. Over time, these trust differences dissipated. While both coalitions grew, the resilience community coalitions maintained their size difference throughout the project. We also found differences in the types of activities implemented by the resilience communities; these differences were directly related to the trainings provided. This information is useful to organizations seeking guidance on expanding the network of community-based organizations that participate in community resilience activities.

Objectives. We evaluated organization- and network-level factors that influence organizations’ perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change. Methods. In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success. Results. A total of 53 of 59 “whole networks” met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%–100%). Occupying a leadership position (P Conclusions. Organizations’ perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.

Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.

Interorganizational networks are a common collaborative approach to tackle complex issues such as public health, national security, education, and poverty. While there is a consensus that networks are a viable approach to these issues, it is unclear what factors lead to effective collaborative performance. One issue for assessing performance is the lack of sufficient evaluation/assessment methods and, subsequently, of empirical data. Applying a conceptual model based in the literature, this study examines characteristics of network members and their perceptions of success in order to ascertain the degree to which members’ agreement on outcomes varies among networks and the characteristics of members of networks that report greater levels of success or of disagreement about success. This study contributes to the collaborative performance literature by analyzing an unprecedentedly large N (n = 98) dataset of interorganizational (whole) networks to test empirically the conceptual model. The results ...

Objectives. We explored to what extent “silos” (preferential partnering) persist in interorganizational boundaries despite advances in working across boundaries. We focused on organizational homophily and resulting silo effects within networks that might both facilitate and impede success in public health collaboratives (PHCs). Methods. We analyzed data from 162 PHCs with a series of exponential random graph models to determine the influence of uniform and differential homophily among organizations and to identify the propensity for partnerships with similar organizations. Results. The results demonstrated a low presence (8%) of uniform homophily among networks, whereas a greater number (30%) of PHCs contained varying levels of differential homophily by 1 or more types of organization. We noted that the higher frequency among law enforcement, nonprofits, and public health organizations demonstrated a partner preference with similar organizations. Conclusions. Although we identified only a modest occurrence of partner preference in PHCs, overall success in efforts to work across boundaries might be problematic when public health members (often leaders of PHCs) exhibit the tendency to form silos.

The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services have implemented Million Hearts (MH), an initiative to coordinate efforts across the United States to promote cardiovascular health. This report examines the partnerships developed in MH, defines the practices and approaches to cardiovascular disease prevention that occurred as a result of the program, and provides suggestions for future MH activities.

The Million Hearts initiative has been successful at the national level in bringing stakeholders together to address cardiovascular disease, but the network could be enhanced and the level of membership commitment and activity could be strengthened.

Interorganizational collaboration is an essential function of public health agencies. These partnerships form social networks that involve diverse types of partners and varying levels of interaction. Such collaborations are widely accepted and encouraged, yet very little comparative research exists on how public health partnerships develop and evolve, specifically in terms of how subsequent network structures are linked to outcomes. A systems science approach, that is, one that considers the interdependencies and nested features of networks, provides the appropriate methods to examine the complex nature of these networks. Applying Mays and Scutchfields's categorization of "structural signatures" (breadth, density, and centralization), this research examines how network structure influences the outcomes of public health collaboratives. Secondary data from the Program to Analyze, Record, and Track Networks to Enhance Relationships (www.partnertool.net) data set are analyzed. This data set consists of dyadic (N = 12,355), organizational (N = 2,486), and whole network (N = 99) data from public health collaborations around the United States. Network data are used to calculate structural signatures and weighted least squares regression is used to examine how network structures can predict selected intermediary outcomes (resource contributions, overall value and trust rankings, and outcomes) in public health collaboratives. Our findings suggest that network structure may have an influence on collaborative-related outcomes. The structural signature that had the most significant relationship to outcomes was density, with higher density indicating more positive outcomes. Also significant was the finding that more breadth creates new challenges such as difficulty in reaching consensus and creating ties with other members. However, assumptions that these structural components lead to improved outcomes for public health collaboratives may be slightly premature. Implications of these findings for research and practice are discussed.

When a disaster affects a community, dissipated (and ad hoc) social relationships often result, leading to new questions about how to identify and study social networks. Disasters have the ability to disorganize an entire social infrastructure, turning what is known about the way people relate, the way organizations behave, and the system of social and resource support into new questions that, if understood, could greatly impact people’s abilities to deal with the consequences of disasters. These networks arise on different scales, from the individual to the community level, so researchers exploring network dynamics need to draw on a range of methodologies. To explore the impact of a disaster on social networks at all levels, innovative research designs and methodological tools that account for the unique social structures and their accompanying dynamics are required. What follows is a representation of a methodological framework for designing disaster network studies. That framework is followed by attention to units of analysis, levels of analysis, types of network links, approaches to analysis, network dynamics, and the main challenges faced in research on disaster networks. Specific types of questions that can be answered using a network analysis approach are identified throughout this chapter.

Community networks that include nonprofit, public, and private organizations have formed around many health issues, such as chronic disease management and healthy living and eating. Despite the increases in the numbers of and funding for cross-sector networks, and the growing literature about them, there are limited data and methods that can be used to assess their effectiveness and analyze their designs. We addressed this gap in knowledge by analyzing the characteristics of 260 cross-sector community health networks that collectively consisted of 7,816 organizations during the period 2008-15. We found that nonprofit organizations were more prevalent than private firms or government agencies in these networks. Traditional types of partners in community health networks such as hospitals, community health centers, and public health agencies were the most trusted and valued by other members of their networks. However, nontraditional partners, such as employer or business groups and colleges or universities, reported contributing relatively high numbers of resources to their networks. Further evidence is needed to inform collaborative management processes and policies as a mechanism for building what the Robert Wood Johnson Foundation describes as a culture of health.

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest.

In this paper, we explore the effects of various teaching methodologies on the social interactions reported by university students in the School of Public Affairs at the University of Colorado Denver. Specifically, we will answer the question: How do different teaching methodologies affect the formation of network ties among students in a university classroom? We implement a novel research design, in which we operationalize the impact of alternative teaching methodologies on social interactions, specifically the number and quality of dyadic relationships between students in university classrooms. We find that online classes tend to have fewer, but more frequent interactions among students, more diversity among interactions, and greater likelihood that students perceive other students as influential to their learning. In primarily lecture classes, students reported fewer connections, but similar to online students’ interactions, the interactions were frequent and influential. We conclude that teaching in a...

Objectives. We explored and analyzed how findings from public affairs research can inform public health research and practice, specifically in the area of interorganizational collaboration, one of the most promising practice-based approaches in the public health field. Methods. We conducted a systematic review of the public affairs literature by following a grounded theory approach. We coded 151 articles for demographics and empirical findings (n = 258). Results. Three primary findings stand out in the public affairs literature: network structure affects governance, management strategies exist for administrators, and collaboration can be linked to outcomes. These findings are linked to priorities in public health practice. Conclusions. Overall, we found that public affairs has a long and rich history of research in collaborations that offers unique organizational theory and management tools to public health practitioners.

Current approaches to addressing the problems families face when navigating complex service systems on behalf of their children rely largely on state or nationally driven efforts around the development of systems of care (SOCs). However, operationalizing meaningful family involvement within SOCs remains a challenge, with little attention paid to the role of personal social support networks (PSSNs). Specifically, risk factors related to the variations in the social connectedness of family social support networks are difficult to identify, assess, and track over time. This paper summarizes families’ descriptions of their PSSNs and describes the development of a social network analysis tool, the Person-Centered Network App (PCNA), used to measure and monitor the social connectedness of families of children with special health care and developmental needs. Twenty-nine families participated in the project and completed social network surveys, identifying a total of 38 unique types of support partners and 230 partnerships (dyadic relationships). Families identified a range of formal and informal members including primary care providers, medical specialists, family, friends, faith-based organizations, insurance providers, nurses, community organizations, early interventionists, school resources, other families, online support groups, and public resources, rating 61 percent of them as “very important.” Informal network members (e.g., family, friends) provided emotional and day-to-day support. Primary care providers, medical specialists, and public resources provided health care services while early intervention and medical specialists provided therapies. PSSNs were characterized by high levels of trust but low levels of coordination. These findings inform providers and case workers that families can readily describe their social connectedness in ways that may affect health care access and utilization. Understanding how PSSNs function in the lives of families of children with complex health care needs provides opportunities for improving systems of care (e.g., medical homes) and ultimately, enhancing health and developmental outcomes.

“Can state–society synergy be created in the short run, or does it require historically deep institutional and normative foundations?” In other words, what role can an outside party—such as a government or state actor—play in constructing social capital when it is not a permanent fixture of the existing interrelationships within a community? Taking a network perspective, this exploratory research examines community-level social capital outcomes of a government-led intervention. Operationalized as social networks, social capital is measured as an increase to the strength of weak ties and reduction in redundancy among exchange relationships. Findings suggest that state–society synergy has the potential to increase bridging social capital in communities. In addition, communities with higher levels of cohesion and connectivity pre-intervention results in greater increases to social capital, and although trust plays a crucial role in development of social capital, the influence organizations are perceived to have does not.

The XeCl excimer laser (308 nm) was used for depositing p-type SrCu 2 O 2 (SCO) films by pulsed-laser deposition (PLD) from undoped and Ba-doped (6%) SCO targets. The SCO films were deposited at 300 °C on glass and p-type Si substrates, while the oxygen pressure was kept constant at 5 x 10 -2 Pa and their properties were investigated just after deposition and after annealing at 330 °C in forming gas. The films were amorphous just after deposition but became stoichiometric SrCu 2 O 2 polycrystalline after annealing and very resistive. The Ba-doped SCO films showed lower transmittance than the undoped ones but for both films the transmittance increased to around 70-80% in the NIR-IR spectrum. The optical energy gap was found to be around 3.24 eV after annealing. SCO films deposited on p-Si exhibited rectifying properties, behaving like p - -SCO/p-Si heterojunctions and their I-V and C-V characteristics were examined with temperature. An explanation of the diode behaviour is attempted based on materials properties and heterodiode characteristics.

e15622Background: National guidelines (NCCN 2016) recommend profiling for microsatellite instability (MSI) and mismatch repair (MMR) for all patients (pts) with colon cancer. Evaluations may identi...

Scholars have explored the idea of the determinants of the size of the nonprofit sector as a linear relationship between supply of resources and the demand for nonprofit services. This in turn has fueled debate about whether there are too many nonprofits for available resources. In this article, we propose that the scarcity (or abundance) of resources does not inherently determine the limits of a community's nonprofit “carrying capacity”. Rather, network exchanges between nonprofits and other organizations may exhibit positive synergistic effects that are associated with diverse outcomes. We therefore propose a model of nonprofit carrying capacity that shifts the discussion to the ability of a community to support network exchanges among independent agents.

To document the numbers and types of interorganizational partnerships within the national patient safety domain, changes over time in these networks, and their potential for disseminating patient safety knowledge and practices.Self-reported information gathered from representatives of national-level organizations active in promoting patient safety.Social network analysis was used to examine the structure and composition of partnership networks and changes between 2004 and 2006.Two rounds of structured telephone interviews (n=35 organizations in 2004 and 55 in 2006).Patient safety partnerships expanded between 2004 and 2006. The average number of partnerships per interviewed organization increased 40 percent and activities per reported partnership increased over 50 percent. Partnerships increased in all activity domains, particularly dissemination and tools development. Fragmentation of the overall partnership network decreased and potential for information flow increased. Yet network centralization increased, suggesting vulnerability to partnership failure if key participants disengage.Growth in partnerships signifies growing strength in the capacity to disseminate and implement patient safety advancements in the U.S. health care system. The centrality of AHRQ in these networks of partnerships bodes well for its leadership role in disseminating information, tools, and practices generated by patient safety research projects.

Support for the “democratization of the policy sciences” has led to the development of a number of frameworks and theories to enhance the normative, multidisciplinary approach to policy analysis. However, this approach has been challenged for failing to produce the objective empirical and normative standards implied by its scientific aspirations. One consideration that has been advanced under a variety of rubrics is “participatory policy analysis.” This is a methodological proposal that expands the range of actors/stakeholders involved in the making and execution of public policy in a discursive or deliberative mode. While much of the research on policy networks is focused on the management and coordination of such networks (i.e., collaborative management), there is little attention on analysis of networks as a participatory policy analytical approach. We propose a theory of “collaborative policy networks” that examines not only the stakeholder composition of a group or the partnerships between any two stakeholders but also the way these stakeholders are embedded in various degrees of institutionalized structure and the discursive tendencies of exchange among them that leads to policy initiative, implementation, evaluation, and possibly termination. Collaborative policy networks are characterized by discursive properties, specifically reciprocity, representation, equality, participatory decision making, and collaborative leadership. We suggest that the results of such research can identify structural signatures of collaborative policy networks that serve as “stamps” of the common nature of such networks that, if fostered, can inform and improve the attempt of networks of partners to achieve policy goals.

Dynamic social networks, a key concept in modern social science research, are beginning to play a major role in understanding the ways in which individuals and communities respond to disasters. The authors of this paper review the relevant theory and research regarding how crises cause change in social networks, and how those changes may or may not facilitate recovery, as a function of the kinds of changes that occur. It applies the In/Out/Seeker/Provider (IOSP) framework to identify categories in which we might study disasters and the impact both on the networks and the impacts to the networks. This paper details options for applying social network analysis to research of both pre- and post-disaster settings and concludes by framing a research agenda for the future study of the dynamics of network change following a disaster.

A major challenge facing state and local public health agencies is how to partner with other organizations, agencies, and groups to collaboratively address goals in population health while effectively maximizing resource sharing of the partners involved. Today's public health efforts require multiagency partnerships between both governmental and nongovernmental sectors to achieve this mission. However, the frequent reconfiguration of partnerships among government and nongovernmental agencies has left many public health managers struggling to find ways to both develop public health collaboratives and evaluate their success. In this article, we use network theory and social network analysis to outline the core dimensions of connectivity used to measure progress in public health collaboratives. Connectivity is defined as the measured interactions between partners in a collaborative such as the amount and quality of interactions and how these relationships might change over time. We also articulate how these measures fit into the overall process of measuring progress in public health collaboratives and end the article with suggestions for future research and development.

Thin films of ZnO:Al (AZO) and pure ZnO have been grown by pulsed laser deposition (PLD) at a wide temperature range (200–500 °C) and at different partial oxygen pressures (5 × 10− 5–5 × 10− 2 mbar). The films have been characterized structurally, optically and electrically. It is observed that the presence of aluminum in the ZnO films results in an enlargement of the optical band gap (~ 3.8 eV) while the transmittance is increased in comparison to pure ZnO films, to approximately 85%. Furthermore, in the AZO films occurs a lowering of the resistivity to the order of magnitude of 10− 4 Ωcm. Finally, a sharp emission excitonic peak centered at 353.5 nm was observed for the highly conductive (3.3 × 10− 4 Ωcm) ZnO:Al films.

Background: Collaboration among partners in a health system of care (SOC) has many benefits. In large and complex systems, the role of public health, mental health, and primary care play critical roles in the provision of care. How these systems vary across urban and rural settings is understudied. Understanding of perceived roles and ongoing collaboration across these sectors in urban and rural communities is needed. Methods: We assessed geographic and sector of care differences among members of a SOC providing care to CHSNC. In this study, dyadic data (n=698) from a 2013 statewide SOC for CSHCN were analyzed to explore the relationships between sectors (mental health, public health and primary care) and geographic settings (urban, rural, mixed). Results: The majority of partnerships were reported among urban partners (n=484), followed by mixed (n=136) and rural (n=78). Significant variation was found in frequency (p

ObjectiveThe purpose of this article was to describe how the Hospital Preparedness Program (HPP) and other health care coalitions conceptualize and measure progress or success and to identify strategies to improve coalition success and address known barriers to success.MethodsWe conducted a structured literature review and interviews with key leaders from 22 HPPs and other coalitions. Interview transcripts were analyzed by using constant comparative analysis.ResultsFive dimensions of coalition success were identified: strong member participation, diversity of members, positive changes in members’ capacity to respond to or recover from disaster, sharing of resources among members, and being perceived as a trendsetter. Common barriers to success were also identified (eg, a lack of funding and staff). To address these barriers, coalitions suggested a range of mitigation strategies (eg, establishing formal memoranda of agreement). Both dimensions of and barriers to coalition success varied by coalition type.ConclusionsCurrently, the term health care coalition is a one-size-fits-all term. In reality, this umbrella term describes a variety of different configurations, member bodies, and capabilities. The analysis offered a typology to categorize health care coalitions by primary function during a disaster response. Developing a common typology that could be used to specify capabilities or functions of coalitions may be helpful to advancing their development. (Disaster Med Public Health Preparedness. 2015;9:690–697)

The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework has been widely used for translational research. We used social network analysis (SNA) to explore how innovative research frameworks, such as RE-AIM, have diffused over time in academic literature. A structured literature review was conducted on RE-AIM between 1999 and 2012. SNA indices of degree score, betweenness, centrality, and authorship ties were used to examine use of RE-AIM. Use of RE-AIM has grown since its inception and spread from a few research centers to use internationally. Investigation of co-authorship revealed many have published on RE-AIM, but a much smaller core of RE-AIM researchers have published together two or more times. SNA revealed how the RE-AIM framework has been used over time and identified areas to further expand use of the framework. SNA can be useful to understand how research frameworks diffuse over time.

The wetting characteristics of surfaces of polymers doped with photochromic spiropyran molecules can be tuned when irradiated with laser beams of properly chosen photon energy. In particular, UV laser pulses at 308 nm are responsible for the enhancement of the hydrophilicity of the surfaces, since the embedded non-polar spiropyran molecules convert to their polar merocyanine isomers upon UV absorption. The process is reversed upon irradiation with green laser pulses at 532 nm. When the photochromic-polymeric surfaces are micropatterned using soft lithography or photo-polymerisation techniques, they can change their wettability towards a more hydrophobic or more hydrophilic behaviour depending on the dimensions of the patterned features and on the hydrophilicity-hydrophobicity of the flat surface. Furthermore, the light-induced wettability variations on these structured surfaces are greatly enhanced compared to the flat surfaces. This significant increase to the wettability changes is attributed to the combination of the photochromic interconversions upon laser irradiation together with the photoinduced reversible volume changes of the patterned features.

A growing interest in community-level characteristics such as social capital and their relationship to healthcare access is evident. To assess the rigor with which this construct has been empirically applied in research on healthcare access, we conducted a systematic review. A total of 2396 abstracts were reviewed, with 21 ultimately meeting our criteria of examining some measure of social capital and its effects on healthcare access. Our review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on healthcare access. Insights from the social network literature can help improve the conceptual and measurement problems. We recommend that future work distinguish between bonding, bridging, and linking social capital and their sources and benefits, and that perhaps three dimensions of social capital actually exist –cognitive, behavioral, and structural.

Describes the problems and positive aspects of deployment that have an impact on the retention intentions of reserve component families.

Background Global pandemic influenza preparedness relies heavily on public health surveillance, but it is unclear that current surveillance fully meets pandemic preparedness needs. Methods We first developed a conceptual framework to help systematically identify strategies to improve the detection of an early case or cluster of novel human influenza disease during the pre-pandemic period. We then developed a process model (flow diagram) depicting nine major pathways through which a case in the community could be detected and confirmed, and mapped the improvement strategies onto this model. Finally, we developed an interactive decision tool by building quantitative measures of probability and time into each step of the process model and programming it to calculate the net probability and time required for case detection through each detection pathway. Input values for each step can be varied by users to assess the effects of different improvement strategies, alone or in combination. We illustrate application of the tool using hypothetical input data reflecting baseline and 12-month follow-up scenarios, following concurrent implementation of multiple improvement strategies. Results We compared outputs from the tool across detection pathways and across time, at baseline and 12-month follow up. The process model and outputs from the tool suggest that traditional efforts to build epidemiology and laboratory capacity are efficient strategies, as are more focused strategies within these, such as targeted laboratory testing; expedited specimen transport; use of technologies to streamline data flow; and improved reporting compliance. Other promising strategies stem from community detection – better harnessing of electronic data mining and establishment of community-based monitoring. Conclusion Our practical tool allows policymakers to use their own realistic baseline values and program projections to assess the relative impact of different interventions to improve the probability and timeliness of detecting early human cases or clusters caused by a novel influenza virus, a possible harbinger of a new pandemic. Policymakers can use results to target investments to improve their surveillance infrastructure. Multi-national planners can also use the tool to help guide directions in surveillance system improvements more globally. Finally, our systematic approach can also be tailored to help improve surveillance for other diseases.

The deepening of the information age will alter the nature of the state so thoroughly that something new emerges: cyberocracy. While it is too early to say precisely what a cyberocracy will look like, the outcomes will include new kinds of democratic, totalitarian, and hybrid governments, along with new kinds of state-society relations. Thus, optimism about the information revolution should be tempered by an anticipation of its potential dark side. This paper reiterates the view of the cyberocracy concept as first stated in 1992, and then offers a postscript for 2008. It speculates that information-age societies will develop new sensory apparatuses, a network-based social sector, new modes of networked governance, and ultimately the cybercratic nexus-state as a successor to the nation-state.

Introduction Les nouvelles therapies ciblees dans le melanome reposent sur la caracterisation moleculaire des tumeurs de chaque patient, pour optimiser la prise en charge therapeutique. De plus, l’etude des biomarqueurs de reponse est en constante evolution avec le developpement de la pharmacodynamique moleculaire. Dans ce contexte, nous avons developpe une strategie preclinique qui permet l’evaluation rapide de la reponse a differents traitements a partir des xenogreffes des melanomes de patients. Materiel et methodes Dix-sept melanomes humains de differents genotypes (mutes BRAF , NRAS, C-KIT et sauvage) ont ete xenogreffes puis amplifies par plusieurs passages successifs dans des souris immunodeprimees. Huit ont ete caracterises au niveau genomique, transcriptionnel et de leur pouvoir invasif, pour evaluer la stabilite des modeles au cours des passages. Des tests pharmacologiques (inhibiteur de BRAF et de MEK) ont ete conduits sur 2 xenogreffes et les histocultures qui en derivaient. Observations La caracterisation des 8 modeles a montre une tres grande stabilite genomique, moleculaire (genes d’invasion : VEGF, VEGFR, uPA, MMP, EMMPRIN) et du pouvoir metastatique entre les passages successifs. Deux modeles de xenogreffes, portant respectivement des mutations RAS et BRAF , ont ete utilises pour le developpement d’un test d’histoculture ex-vivo de sensibilite au vemurafenib et au pimasertib. Les resultats obtenus sur les xenogreffes (inhibition de la croissance tumorale) etaient similaires a ceux obtenus sur les histocultures correspondantes (inhibition de la proliferation) et a la reponse therapeutique observee chez les patients. Discussion Ce travail met en avant une nouvelle methode pour predire rapidement la reponse therapeutique d’un melanome a differents traitements. En effet, les modeles de xenogreffes derivees des melanomes de patients, implantees chez la souris, sont utilises dans le developpement preclinique de nouvelles drogues, mais le delai necessaire a leur instauration ne permet pas d’en faire un outil de prediction en pratique quotidienne. En revanche, les tests de sensibilite sur histocultures, menees ici sur des cultures cellulaires derivees des xenogreffes de patients, sont conduits en 1 semaine. Nous avons mis en evidence a la fois la stabilite des xenogreffes au cours des passages, et la reproductibilite des resultats obtenus entre xenogreffes et histocultures au test pharmacologique. Si ces resultats sont valides a plus grande echelle, ils pourraient conduire a prendre en compte les resultats des tests pharmacologiques sur histocultures ex-vivo dans la decision therapeutique en pratique quotidienne. Conclusion Ce travail a permis de developper et de valider un outil preclinique efficace qui pourrait permettre d’orienter la strategie therapeutique dans la prise en charge des patients porteurs de melanome.

The wetting characteristics of surfaces of polymers doped with photochroinic spiropyran molecules can be tuned when irradiated with laser beams of properly chosen photon energy. The hydrophilicity is enhanced upon UV laser irradiation since the embedded nonpolar spiropyran molecules convert to their polar merocyanine isomers. The process is reversed upon green laser irradiation. Structuring of the photochromic polymeric surfaces with soft lithography enhances significantly the hydrophobicity of the system, indicating that the water droplets on the patterned features interact with air that is trapped in the microcavities, thus creating superhydrophobic air-water contact areas. Furthermore, the light-induced wettability variations of the structured surfaces are enhanced by a factor of 3 compared to those on the flat surfaces. This significant enhancement is attributed to the photoinduced reversible volume changes to the imprinted gratings, which additionally contribute to the wettability changes due to the light-induced photochromic interconversions.

We demonstrate the enhancement of the wetting properties of smart photochromic surfaces by a specifically developed, gentle interferometric patterning employing green light. We realized photochromic gratings with 2.5-10.0 mu m period by a blend consisting of a green-curable matrix and spiropyran molecules. The structured surfaces exhibit photocontrolled and reversible wettability, and enhanced hydrophilicity with respect to the native substrates. The dynamics of liquid spreading onto the gratings was also investigated, and the wetting behavior analyzed according to Wenzel's [Ind. Eng. Chem. 28, 988 (1936)] model for rough surfaces. These results indicate switchable gratings as promising functional components for microfluidics and modulation, and green-light interferometry as a reliable lithographic method for patterning organics without degradation or photochemical reactions. (c) 2006 American Institute of Physics.