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This article describes the process for developing a population health driver diagram to address a priority health issue in East Tennessee: neonatal abstinence syndrome (NAS). Population health driver diagrams are used in quality improvement processes for determining and aligning actions that a community can take to achieve a specified outcome. The Tennessee Department of Health contracted with the University of Tennessee's Department of Public Health to conduct a community participatory process to contribute to a statewide health improvement plan. Colleagues in local public health practice identified NAS as the leading perinatal health issue, and community engagement was achieved by involving community health councils. Qualitative and quantitative data were collected, analyzed, and provided to these councils. A region-wide stakeholders' meeting resulted in the development of a population health driver diagram to address NAS. We describe this process and provide lessons learned that can be valuable in other settings. Population health diagrams have important implications for practice because of their use as a framework for community action, especially in the context of a community health assessment.

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes.

The American Nurses Credentialing Center (ANCC) Commission on Magnet® Recognition is a voluntary governing body that oversees the Magnet Recognition Program®. Commission members are appointed by the ANCC Board of Directors and are expert representatives from various sectors of the nursing community. In addition, 1 commission member represents public consumers.

Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative.

Traditional gunshot residue (GSR) analysis is based on detection of particulates formed from metals found in the primer. Recent concerns regarding the interpretation of GSR evidence has led to interest in alternatives such as the organic constituents (organic gunshot residue, OGSR) found in propellants. Previous work has shown OGSR to be detectable on hands for several hours after a firing event, and given the lipophilic nature of these compounds, it was expected that losses due to secondary transfer (an issue with GSR particulates) would be negligible. However, other loss mechanisms have been identified, specifically skin permeation and evaporation. This paper describes experimental and modeling studies used to elucidate characteristics of skin permeation of 5 compounds present in OGSR. Pharmaceutical methods were adapted to characterize skin permeation using a skin surrogate and Franz diffusion cells. The amount of compounds deposited on skin after an authentic firing event (1 and 2 shots) was experimentally determined and applied for the permeation experiments. A fully validated selected ion monitoring GC/MS method was developed for quantitative analysis, and easily accessible online tools were employed for modeling. Results showed that OGSR residues should be detectable on skin for many hours after a firing event of as few as one or two shots, with detection capability being a function of the efficacy of sampling and sample preparation and the instrumental method employed. The permeation rates of the OGSR compounds were sufficiently different to suggest the potential to develop methods to approximate time-since-deposition.

Context: This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI., Objective: To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs., Design: Quantitative data from a self-reporting survey and qualitative data from telephone interviews., Setting: Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews., Participants: QI lead staff at LHDs that are advanced in accreditation preparation and QI., Main Outcome Measures: Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives., Results: Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI., Conclusions: When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Maxiban and Monteban are 2 products marketed by Elanco Animal Health. They contain narasin and are used for the prevention of coccidiosis in chickens. Products used in the European market must be regularly re-registered with new data to support label claims. This study was undertaken as part of such a re-registration effort. A method for the determination of narasin in poultry tissue was previously registered with the authorities; however, a method with more environmentally friendly solvents was desired. The Canadian Food Inspection Agency accomplished this goal and published an improved method. In order to register the method with European authorities as the official Elanco method for determination of narasin, Elanco scientists were required to provide validation data for all edible poultry tissues. This paper shows the validation of the method to detect residues of narasin using solid-phase extraction followed by liquid chromatographic analysis utilizing post-column derivatization.

A method was developed and validated for determination and quantitation of tilmicosin residues in swine, cattle, and sheep edible tissues, as well as chicken fat, skin, and muscle over a concentration range of 0.025 microg/g-20 microg/g. For chicken kidney and liver, the method was validated over a range of 0.060 microg/g-20 microg/g. The tissue sample was extracted with methanol and a C18 cartridge was used for solid-phase extraction cleanup. A reversed-phase gradient liquid chromatographic method with detection at 280 nm was used to separate the tilmicosin from matrix components in 30 min run time. The limit of quantitation (LOQ) of the method was 0.025 microg/g for all tested tissues except chicken kidney and liver, for which the LOQ was 0.06 microg/g. Average recoveries for tissue samples ranged from 73 to 98%. Relative standard deviation values ranged from 0.6 to 14.7%.

Major changes such as prospective payment and managed care are rocking the boat for today's home care providers. To stay afloat a number of providers are redesigning their organizations. Using Core Process Redesign, a team-based methodology for improving what, where, and how work is done in an organization, one agency saved nearly a half million dollars in one year.

A liquid chromatographic (LC) assay is described for determining tilmicosin in bovine and porcine blood sera. Tilmicosin is isolated from the serum matrix and purified by solid-phase extraction with C18 sorbent. Sample is analyzed by LC using a gradient system with a phenyl reversed-phase column that separates tilmicosin from the matrix in 30 min. Tilmicosin is measured by UV absorbance at 280 nm. Validation of assay included evaluation of accuracy, precision, linearity, specificity, sensitivity, range, and sample stability. The method has a limit of quantitation of 0.1 ppm and a validated range of 0.1 to 10.0 ppm. Recoveries were 91-95% for bovine serum and 85-93% porcine serum. The limit of detection was 0.05 microgram/mL. Limits of detection and quantitation were based on 3 and 6 times the baseline noise of control serum samples, respectively. Relative standard deviations of precision samples (n = 6) were 2% or less for both sera. The method has better specificity and analysis time than previous microbiological methods for tilmicosin in sera.

An interlaboratory study of a liquid chromatographic (LC) method for determining monensin in premix (60-80 g/lb or 132-176 mg/g) and animal feeds (5-200 g/ton or 0.0055-0.22 mg/g) was conducted in laboratoriesin the United States, Canada, France, and Germany. The LC system used a reversed-phase column, postcolumn derivatization with vanillin, and UV detection. The method separates monensin from other ionophores such as narasin and salinomycin. Each laboratory analyzed a total of 20 samples of premix, liquid feed supplements, poultry, and cattle feeds. Concentrations of monensin in all samples ranged from 0 to 176 mg/g (80 g/lb). Reproducibility relative standard deviation (RSDR) for premix ranged from 2.8 to 3.4%. For feed samples containing monensin, repeatability standard deviation (sr) ranged from 0.9 to 7.0. Reproducibility standard deviation (sR) ranged from 1.2 to 11. Repeatability relative standard deviation (RSDr) ranged from 6.1 to 21% and RSDR values-ranged from 8.6 to 25%. Sample preparation for the LC method is less labor intensive than that for the microbiological assays. The LC assay is more efficient than the microbiological assays. This LC method for determination of monensin in premix and animal feeds has been adopted first action by AOAC INTERNATIONAL.

An existing liquid chromatographic method using postcolumn derivatization has been used extensively to quantitate monensin in animal feeds. Because of the relatively high moisture content of many cattle feed rations, some modifications were made to this method. Several sample-processing steps were evaluated to determine optimum sample-processing procedure. The sample weight/sample diluent ratio was modified, and method linearity was validated for the lower monensin concentrations anticipated in high-moisture cattle rations. The accuracy and precision of data generated at these lower concentrations were also determined. Because of the high moisture content of these rations, data analysis for this method required correction of feed potency for loss on drying. With these modifications, monensin can be accurately determined in high-moisture cattle rations.

A microbiological agar plate assay is described for determination of tilmicosin in bovine blood serum. The serum or serum dilution is added directly to wells cut in the agar plates. Tilmicosin activity is determined by measuring the zone of bacterial growth inhibition in agar medium inoculated with Micrococcus luteus, ATCC 9341. The assay was validated by evaluating the following parameters: accuracy, precision, linearity, parallelism, ruggedness, storage stability, and relative activity of isomers. Accuracy was evaluated with freshly collected bovine serum and with commercially available sera. Recoveries ranged from 93.4 to 97.5% across a fortification range of 0.08 to 1.28 micrograms/mL. Precision was estimated over a 6-day period with serum obtained from a tilmicosin-treated animal. Relative standard deviations were 0.63 to 3.13% within day and 5.23% across 6 days. Standard curves were linear with little variation in slope. No parallelism was observed between tilmicosin in serum and tilmicosin in buffered saline. The limit of detection was estimated to be 0.05 micrograms/mL, and the validated limit of quantitation was 0.08 micrograms/mL. Ruggedness was evaluated with different lots of antibiotic medium, different lots of sera, and different analysts. These variables did not affect method performance. Analyses of tilmicosin in frozen sera demonstrated that tilmicosin is stable for up to 16 days when stored at -20 degrees C. A comparison of the relative microbiological activities of the purified cis and trans isomers of tilmicosin to that of the reference standard indicated no differences in microbiological activities, and showed a parallel response among the 3.(ABSTRACT TRUNCATED AT 250 WORDS)

A method is described for detection and quantitation of monensin in bovine tissues by liquid chromatography (LC) with postcolumn derivatization (PCD) with vanillin. Monensin is extracted from the tissues by homogenization with methanol-water and is isolated and concentrated by liquid-liquid partition and sorbent extraction with silica gel. Monensin is mixed postcolumn with vanillin under acidic conditions and heated, and the resulting products are measured by a variable-wavelength detector at 520 nm. The method has a limit of quantitation of 5 ppb monensin in milk and 25 ppb monensin in bovine muscle, liver, kidney, and fat. Standard recovery over the levels and matrixes tested ranged from 80 to 88%. The method is an improvement in specificity, accuracy, and analysis time over existing monensin residue methods for bovine tissues.

A method is described for the detection and quantitation of monensin in chicken tissues by liquid chromatography with postcolumn derivatization with vanillin. Monensin is extracted from the tissues by homogenization with methanol-water and is isolated and concentrated by liquid-liquid partition and sorbent extraction with silica gel. Monensin is mixed postcolumn with vanillin under acidic conditions and heated, and the resulting products are measured by a variable-wavelength detector operating at 520 nm. The method has a limit of quantitation of 0.025 microgram/g and is validated for use in the analyses of chicken muscle, liver, and skin (with adhering fat tissues) for monensin. Standard recoveries from the 3 tissue types tested at 3 levels ranged from 82 to 96%. The method represents an improvement in specificity, accuracy, and analysis time over existing methods, which use microbiological techniques.

Sampling an animal feed containing a granulated analyte is extremely difficult. A granulated feed additive, Tylan (Elanco, tylosin), was used to demonstrate how a granulated product can increase assay variability if steps are not taken to reduce and control this variability. The number of tylosin granules was determined for Granulated Tylosin Concentrate, the active ingredient of Tylan Premix. Multiple weighings of 3 lots of the concentrate were prepared, and the average number of granules per gram of concentrate was determined with the aid of image analyses. The total weight of Tylan Premix in varying analytical samples was calculated. Finally, the average number of tylosin granules per analytical sample was calculated based on the average number of granules per gram. A 10 g analytical sample obtained from an animal ration containing 8 ppm tylosin activity would contain an average of 1.16 granules of tylosin, and a 100 g analytical sample would contain 11.6 granules. These calculations demonstrate the need to increase the analytical sample size in analyzing an animal feed containing a granulated feed additive.

The transport of the branched-chain amino acids in Streptococcus agalactiae was characterized. Glucose-grown cells were able to utilize only glucose as an energy source for transport of L-leucine, whereas lactose-grown cells could utilize both glucose and lactose. It was determined from metabolic inhibitor studies that energy from glycolysis and substrate level phosphorylation was required for active transport. Energy was found to be coupled to transport by the action of adenosine triphosphatase and the generation of a proton motive force. The branched-chain amino acids were found to share a common transport system that may consist of multiple components.

The effect of sugars on the production of d-arabitol and on the glucose catabolic pathways was investigated in the osmotrophic yeast Saccharomyces rouxii. The activity of d-arabitol dehydrogenase, which served as a measure of total d-arabitol production, increased when cells were grown in the presence of increasing glucose concentrations. Growth in sucrose had no effect on the enzyme activity. A high intracellular concentration of d-arabitol could be demonstrated when the cells were grown in a 60% glucose medium and could be eliminated by anaerobic growth or growth in the presence of 4 mg of chloramphenicol per ml. A mutant was isolated that would not grow in 60% glucose; although the regulation of d-arabitol dehydrogenase was altered in this strain, the production of d-arabitol was not eliminated. The activity of d-arabitol dehydrogenase followed the growth phases of the parent strain when the cells were preadapted to 30% glucose. If the cells were adapting from 1 to 30% glucose, a large increase in enzyme activity was detected before growth occurred. Protein synthesis was found to be involved in this increase in activity. There was an increased participation of the pentose phosphate pathway when the cells were grown in the presence of increasing glucose concentrations. The mutant strain had only an 11% pentose phosphate pathway participation compared with 20% for the parent strain in glucose. The results suggest that the active pentose phosphate pathway is involved in glucose tolerance by providing a plentiful supply of reduced nicotinamide adenine dinucleotide phosphate which is necessary for cell survival.

The stability of spheroplasts from the osmotrophic yeast Saccharomyces rouxii was studied in buffered solutions of mannitol and glucose. The plasma membranes from cells grown in high glucose concentrations were more stable to osmotic lysis than were membranes from cells grown in lower glucose concentrations. Mannitol was a better osmotic stabilizer than glucose, except when the cells were grown in a high glucose concentration. Spheroplasts from a glucose tolerant-deficient mutant were much less stable than the corresponding spheroplasts from the parent strain, especially when suspended in glucose solutions. These results suggest an involvement of the plasma membrane in the glucose-tolerant mechanism of S. rouxii.

The rate of thermal inactivation of glutamate decarboxylase (EC 4.1.1.15) from Escherichia coli was determined in terms of the z value and thermodynamic parameters. The enzyme was inactivated at a faster rate than E. coli when heated at food process temperatures in buffer.

The effect of selected potential inhibitors that may be found in water or wastewater on the activity of glutamate decarboxylase (EC 4.1.1.5) from Escherichia coli was determined. Several classes of compounds inhibited the enzyme, but those expected to be most frequently encountered were the heavy metal ions, the phosphates, and possibly the sulfates. From the results, it was judged that these compounds should not adversely affect the routine usage of this enzyme in an automated rapid test for E. coli.