Estimates of the atmospheric deposition of sulfur and nitrogen species: Clean Air Status and Trends Network 1990-2000

The Clean Air Status and Trends Network (CASTNet) was established by the U.S. EPA in response to the requirements of the 1990 Clean Air Act Amendments. To satisfy these requirements CASTNet was designed to assess and report on geographic patterns and long-term, temporal trends in ambient air pollution and acid deposition in order to gauge the effectiveness of current and future mandated emission reductions. This paper presents an analysis of the spatial patterns of deposition of sulfur and nitrogen pollutants for the period 1990-2000. Estimates of deposition are provided for two 4-yr periods: 1990-1993 and 1997-2000. These two periods were selected to contrast deposition before and after the large decrease in SO2 emissions that occurred in 1995. Estimates of dry deposition were obtained from measurements at CASTNet sites combined with deposition velocities that were modeled using the multilayer model, a 20-layer model that simulates the various atmospheric processes that contribute to dry deposition. Estimates of wet deposition were obtained from measurements at sites operated bythe National Atmospheric Deposition Program. The estimates of dry and wet deposition were combined to calculate total deposition of atmospheric sulfur (dry SO2, dry and wet SO4(2-)) and nitrogen (dry HNO3, dry and wet NO3-, dry and wet NH4+). An analysis of the deposition estimates showed a significant decline in sulfur deposition and no change in nitrogen deposition. The highest rates of sulfur deposition were observed in the Ohio River Valley and downwind states. This region also observed the largest decline in sulfur deposition. The highest rates of nitrogen deposition were observed in the Midwest from Illinois to southern New York State. Sulfur and nitrogen deposition fluxes were significantly higher in the eastern United States as compared to the western sites. Dry deposition contributed approximately 38% of total sulfur deposition and 30% of total nitrogen deposition in the eastern United States. Percentages are similar for the two 4-yr periods. Wet sulfate and dry SO2 depositions were the largest contributors to sulfur deposition. Wet nitrate, wet ammonium, and dry HNO3 depositions were the largest contributors to nitrogen deposition.

The Connecticut Mental Health Center Patient Profile Project: application of a service needs index

This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a statefunded agency that provides comprehensive clinical and rehabilitative services to persons with mental illness. Also described is how this information guided management decisions in both caseload distribution and clinical service development. This "Patient Profile Project" was informed by research principles which view evaluation as continual, rather than terminal activity that involves key stakeholders from all levels within the mental health system of care and makes maximum use of data in ongoing performance improvement initiatives. The service-need index that the project produced represents our first efforts to accurately capture service need and use it in clinical decision making. This review of the Connecticut Mental Health Center Patient Profile Project illustrates the utility of a continuous evaluation system in promoting improvements in a large mental health treatment system.

Davidson and O'Leary talk to each other--and Modern Healthcare. Interview by John Morrissey

The heads of the American Hospital Association and the Joint Commission on Accreditation of Healthcare Organizations waged a war of words this spring. At issue was the JCAHO's plan to seek a contract that the AHA contended would push the commission into the role of a regulator. Modern Healthcare broke the story about the disagreement. Now, Richard Davidson and Dennis O'Leary tell Modern Healthcare in an exclusive interview that they have patched up their differences.

The need for a national infrastructure to improve the rational use of therapeutics

The current medical care environment has created expectations that exceed its capabilities, one effect of which has been an increasing awareness of lapses in the quality of healthcare, including medical errors. As more new therapies reach clinical application, the expectations on the part of the public are unlikely to lessen, and yet the ability to assure patients that the benefits of these therapies are known, and that they are without serious side-effects or untoward consequences, eludes the healthcare system. Based on initial experience with a new federal program, the Centers for Education and Research on Therapeutics (CERTs), we propose a national approach to therapeutics education and research, through a public-private partnership that involves academic medical centers, the federal government, industry, and the public. Through a concerted approach, we believe that significant gaps in our understanding of key issues in therapeutics and our ability to educate practitioners, policy makers, and consumers can be significantly enhanced in a manner that could not be achieved without a coordinated approach.

[External partnerships and prevention relative to psychoactive substances: what should be the position of the school and its partners?]

School health education is one of the primary missions of the educational system which is characterised by the involvement of numerous professional institutions, associations, and others, at the heart of academic establishments. The need for partnership within this complex domain has been recognised and affirmed by the official publications of the national Ministry of Education as it has been in actions. In so far as the move towards the recourse of external intervention, should this be considered as the result of a true partnership or an act of simple delegation (or subcontracting)? Firstly, this article proposes to define the concept of partnership. Secondly, it presents the results of a study on the implementation of drug-use prevention in high schools who underline the importance of the problems associated with partnership in this field and attempt to put into perspective the respective points of view of the educational teams and external actors. On the basis of these results, it proposes a typology of the networks from which the activities are built, then analyses the conditions necessary in order that health education be implemented within a framework of partnership established on the competencies, differences and contributions of each partner.

Nursing exploration summer camp: improving the image of nursing

Improving the image of nursing and finding ways to encourage young people to enter the nursing field are two areas that need attention from nurse executives. That concept was turned into reality with Inova Nursing Exploration Summer Camp 2001, a camp for seventh and eighth graders who are exploring their interest in nursing careers. The camp was a unique partnership among a county public school system, a local university, and an integrated healthcare system. The program, developed by the system nurses in consultation with middle school educators, introduced students to the nursing profession via demonstrations, site visits at multiple hospitals, role-playing, discussions, and a trip to the local nursing school to experience life as a nursing student. The authors discuss the planning, implementation, and outcome of this unique summer camp.

NGO and state: co-operation between a leprosy relief association and other institutions in South America

In a structured questionnaire format, the German Leprosy Relief Association (GLRA) interviewed its representatives in two Federal states of Brazil and four other Latin American countries about the distribution, between itself, the state and other institutions of a) responsibility for funding and b) implementation of activities, in relation to leprosy control. Wherever the political commitment was given, GLRA's role could be reduced to the highly effective support of the government structure in well-defined areas, most particularly in staff training, health education and eventually in programme supervision. This public-private partnership under the umbrella of the host government sustains a small, but important specialized leprosy component whilst routine services are well integrated into the general health system.

Expanding pediatric psychology beyond hospital walls to meet the health care needs of ethnic minority children

OBJECTIVE

To discuss the need for an ecological model and new approaches for meeting the psychological and physical health care needs of minority children.

METHOD

I support approaches that are informal, empowerment oriented, and culturally sensitive and that address illness prevention and health promotion.

DISCUSSION

Assessment, intervention, and research challenges involved in implementing these approaches are identified, and some strategies for overcoming these challenges are discussed.

CONCLUSIONS

Pediatric psychology can be expanded to embrace the advocated model and intervention approaches to better meet the health care needs of minority children.

International care. Crossing borders

Searching for a new line of business to boost revenues, some providers look abroad. It's a decent strategy, but don't expect the big score right now: instead, keep looking at the long-term benefit.

Tobacco industry surveillance of public health groups: the case of STAT (Stop Teenage Addiction to Tobacco) and INFACT (Infant Formula Action Coalition)

OBJECTIVES

The goal of this study was to describe how the tobacco industry collects information about public health groups.

METHODS

Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach.

RESULTS

The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as "extreme," identifying and exploiting disagreements, and planning to "redirect the funding" of tobacco control organizations to other purposes.

CONCLUSIONS

Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives.

SALUS: online co-operation between South Australian health libraries

The establishment of the South Australian Health Libraries Consortium led to the development of the SALUS project which enabled the online delivery of core health, clinical information and bibliographic databases with full-text resources across South Australian government health services. This was the first venture of Australian health librarians to create an online consortium. This article discusses the policy and management issues surrounding the implementation of the SALUS project and its influence on the evolution of the health Libraries Consortium over several years. Lessons learned during this process included: the necessity to plan well ahead yet to remain flexible in implementing those plans, to avoid procedure becoming more important than improvization during planning, to be willing to take well judged risks on occasions, and to be fully aware of changing circumstances in the project's funding and political environment. The importance of securing influential advocates outside of the participating libraries to support continued project funding is also considered.

Civil society and the state: Turkey after the earthquake

On 17 August 1999 Turkey was hit by a massive earthquake. Over 17,000 lives were lost and there was extensive damage to Turkey's heartland. This paper examines how various public and private institutions, including state and civil society institutions such as NGOs and the media responded to the needs of earthquake survivors. It documents the extensive involvement of NGOs in the relief efforts immediately after the disaster and examines the impact of such participation on state-civil society relations in the country. The data show that state response to the disaster went through several phases from a period of ineptitude to effective management. The paper credits the media and the NGOs for acting as advocates for survivors and forcing changes at the state level. The paper argues that an ideal response system, which fully addresses the needs of victims, can only be based on state-civil society relations that are both collaborative and adversarial.

Involving mental health service users and carers in curriculum development: moving beyond 'classroom' involvement

Recent policy statements that address the future priorities for nurse education have emphasized that service users and carers should be actively engaged in partnerships with education professionals in all aspects of the curriculum. The development of this agenda is well advanced; however, examples of 'how to do it' are sparse. The development of a strategy to involve users and carers in the design and delivery of the Diploma of Higher Education in Nursing at Napier University provided an opportunity to evaluate the process of developing partnerships in this area of nurse education. This paper presents the findings from a process evaluation from the various standpoints of the key interest groups. The overall project and evaluation is outlined, along with methodological and practical issues surrounding this type of 'collaborative' evaluation. The importance and satisfaction of practical aspects of the project are examined. The issues of representativeness, expertise in 'involvement' and the importance of the 'process' of involvement are explored. Finally, the challenges to developing 'meaningful involvement' that goes beyond 'classroom involvement' in nurse education are identified and discussed.

Improving serious mental illness through interprofessional education

Current health policies emphasize partnership between professional groups, between agencies and with users, to ensure more integrated health and social care services. However, a number of reasons have been consistently identified as inhibiting interprofessional working. Among the many factors identified are poor communication, conflicting power relations and role confusion, and these present immense challenges to those who wish to offer interprofessional education and training opportunities. East Gloucestershire NHS Trust worked in partnership with the University of Gloucestershire (formerly the Cheltenham and Gloucester College of Higher Education) to overcome these problems and deliver an important postqualifying interprofessional training for those working with people with serious mental illness - the Thorn-based 'Diploma in Integrated Approaches to Serious Mental Illness'. This collaborative initiative represents a good model by which practitioners of all disciplines can be trained to a high standard and meet the requirements of the National Service Framework for Mental Health. This paper describes the initiative and identifies the extent to which the course has, by mirroring the practice it is seeking to generate, 'pulled together' to ensure interprofessional, intersectoral and professional/user collaboration. The key challenges associated with interprofessional working (with people with serious mental illness and with others) and with course implementation and how these were met are discussed and further opportunities are identified.

The Outcomes of Cancer Outcomes Research: focusing on the National Cancer Institute's quality-of-care initiative

BACKGROUND

To assess the impact of outcomes research, the Agency for Healthcare Policy and Research has proposed a four-level typology that successively distinguishes between research that (1) adds to the knowledge base only, (2) affects practice policies, (3) influences the delivery of care, and (4) leads to changes in health outcomes. The agency has concluded that outcomes research to date has made substantial contributions at level 1, but has had little impact at levels 2 to 4.

OBJECTIVE

To describe the National Cancer Institute's emerging agenda in cancer outcomes research, focusing on how it has been shaped early on to support the institute's quality of care initiative and noting whether each new project represents outcomes research at level 1, 2, 3, or 4.

RESULTS

Cancer outcomes research describes, interprets, and predicts the impact of various influences, especially (but not exclusively) interventions on endpoints that matter to decision makers. The institute's projects to improve the scientific quality of final endpoint measures, strengthen the methodologic and empirical basis for quality of care analysis, and enhance the application of health-related quality-of-life measures in clinical trials represent level 1 applications of outcomes research. Collaborative projects with federal agencies to translate evidence into practice and a new public and private effort to identify core measures of cancer quality represent level 2 and level 3 outcomes research.

CONCLUSION

The stage has been set for carrying out a balanced portfolio of level 1 to 3 outcomes research projects in cancer, with the ultimate (level 4) aim of improving cancer-related health outcomes.

The Glaxo Award: is the American Public Health Association moving toward corporate governance?

The author, member of the American Public Health Association, questions the wisdom of the association's accepting donations from corporate sponsors, whose primary responsibility is not to public health but to their stockholders.