Lorraine K. Alexander

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

An Experimental Model for Myocarditis and Congestive Heart Failure after Rabbit Coronavirus Infection

Abstract In a model for virus-induced myocarditis and congestive heart failure, rabbit coronavirus infection was divided into acute (days 2–5) and subacute (days 6–12) phases on the basis of day of death and pathologic findings. During the acute phase, the principal histologic lesions were degeneration and necrosis of myocytes, myocytolysis, interstitial edema, and hemorrhage. The severity of these changes increased in the subacute phase. Pleural effusion and congestion of the lungs and liver were also present at this time. Myocarditis was detected by day 9 and peaked by day 12. Heart weights and heart weight-to-body weight ratios were increased, and dilation of the right ventricular cavity became prominent early in infection and persisted. In contrast, dilation of the left ventricle occurred late in the subacute stage. Virus was isolated from infected hearts between days 2 and 12. These data suggest that rabbit coronavirus infection progresses to myocarditis and congestive heart failure.

Competency-based preparedness training for public health practitioners.

The bioterrorism preparedness training needs of the public health workforce have been described in several studies, assessments, and surveys. To meet these needs, the North Carolina Center for Public Health Preparedness (NCCPHP) and the Public Health Leadership Program (PHLP) at the University of North Carolina School of Public Health developed a new distance learning course, Introduction to Public Health Preparedness for Disasters and Emergencies. After a review of assessment data to identify training needs, we conducted a literature review of methodology and concluded that a distance learning course would be the best approach. The course curriculum is based on the Bioterrorism and Emergency Readiness Competencies for All Public Health Workers. This paper describes the course development process and methods used to make this course an effective training tool.

Partnering to Meet Training Needs: A Communicable-Disease Continuing Education Course for Public Health Nurses in North Carolina

In 2004, the General Communicable Disease Control Branch of the North Carolina Division of Public Health and the North Carolina Center for Public Health Preparedness partnered to create a free continuing education course in communicable-disease surveillance and outbreak investigations for public health nurses. The course was a competency-based curriculum with 14 weeks of Internet-based instruction, culminating in a two-day classroom-based skills demonstration. In spring 2006, the course became mandatory for all public health nurses who spend at least three-fourths of their time on tasks related to communicable diseases. As of December 2006, 177 nurses specializing in communicable diseases from 74 North Carolina counties had completed the course. Evaluations indicated that participants showed statistically significant improvements in self-perceived confidence to perform competencies addressed by the course. This course has become a successful model that combines academic expertise in curriculum development and teaching technologies with practical expertise in course content and audience needs. Through a combination of Internet and classroom instruction, this course has delivered competency-based training to the public health professionals who perform as frontline epidemiologists throughout North Carolina.

An Experimental Model for Dilated Cardiomyopathy after Rabbit Coronavirus Infection

Abstract A rabbit model for coronavirus-induced dilated cardiomyopathy is described. Acute rabbit coronavirus infection results in virus-induced myocarditis and congestive heart failure. Of the survivors of rabbit coronavirus infection, 41% had increased heart weight and heart weight-to-body weight ratios, biventricular dilation, myocyte hypertrophy, myocardial fibrosis, and myocarditis consistent with the development of dilated cardiomyopathy. These changes were also seen in the remaining 59% of the survivors, except that the degree of myocyte hypertrophy was reduced and only right ventricular dilation was present. In most survivors, myocarditis was usually mild (1–5 foci/transverse section), but in some cases it was severe (>20 foci/transverse section). Interstitial and replacement fibrosis was more pronounced in the papillary muscles. These data suggest that rabbit coronavirus infection may progress to dilated cardiomyopathy.

User patterns and satisfaction with on-line trainings completed on the North Carolina Center for Public Health Preparedness Training Web Site.

Short online training modules have been developed by the North Carolina Center for Public Health Preparedness (NCCPHP) and provided to registered users for free on its Training Web Site. Use of these modules can improve the knowledge, skills, and awareness of public health professionals in topics related to public health preparedness. According to the results of a survey implemented in October 2004, the NCCPHP Training Web Site is effectively reaching its target audience of local and state public health workers. The utilization of distance learning technology allows for broad distribution of training materials, with registered users in all 50 US states and 122 foreign countries. In addition, the NCCPHP Training Web Site is providing training materials in topics most requested by the public health workforce. According to the findings of this survey, online training in public health preparedness and response is an efficient way to improve the knowledge and skills of our public health workforce to increase competency.

Electrocardiographic changes following rabbit coronavirus-induced myocarditis and dilated cardiomyopathy

Rabbit Coronavirus (RbCV) infection was divided into two phases based upon day of death and pathologic findings. During the acute phase (days 2-5) heart weights (HW) and heart weight-to-body weight (HW/BW) ratios were increased with striking dilation of the right ventricle. These changes as well as increased dilation of the left ventricle were especially pronounced during the subacute phase (days 6-12). Myocytolysis, pulmonary edema, and degeneration and necrosis of myocytes, were seen during both phases. Myocarditis, pleural effusion, calcification of myocytes, and congestion in the liver and lungs were seen in the subacute phase. Electrocardiograms (ECGs) exhibited low voltage, nonspecific ST-T wave changes, sinus tachycardia, occasional ventricular and supraventricular premature complexes and 2(0) AV block consistent with myocarditis and heart failure. Forty-one percent of the survivors exhibited increased HW and HW/BW ratios, biventricular dilation, interstitial and replacement fibrosis, myocyte hypertrophy and myocarditis. ECGs exhibited nonspecific ST-T wave changes, sinus arrhythmia, occasional ventricular and supraventricular premature complexes and 2(0) AV block. These data suggest that RbCV infection may result in viral myocarditis and heart failure with a proportion of survivors progressing into DCM.

10 Guiding Principles of a Comprehensive Internet-Based Public Health Preparedness Training and Education Program

Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHPs overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs.

Echocardiographic Changes Following Rabbit Coronavirus Infection

Much of our understanding of the mechanisms by which viruses cause myocarditis and/or dilated cardiomyopathy (DCM) is based on animal models of virus-induced heart disease. Information concerning cardiac function during acute and/or chronic viral infection in these models is limited (1). A well defined model in a species conducive to monitoring of cardiac function is needed to enhance our understanding of viral induced heart disease. We have previously demonstrated that rabbit coronavirus (RbCV) infection results in degeneration and necrosis of myocytes, myocarditis, and gross organ and histopathologic changes of DCM (2,3). We have also shown that electrocardiographic changes observed during RbCV infection mimic those in humans with myocarditis and DCM (submitted). This chapter describes the echocardiographic changes observed during RbCV infection.

ECG changes after rabbit coronavirus infection.

Abstract This study examines the electrocardiographic (ECG) changes following rabbit coronavirus (RbCV) infection. We have shown that infection with RbCV results in the development of myocarditis and congestive heart failure and that some survivors of RbCV infection go on to develop dilated cardiomyopathy in the chronic phase. Serial ECGs were recorded on 31 RbCV-infected rabbits. Measurements of heart rate; P-R interval; QRS duration; QTc interval; and P-, QRS-, and T-wave voltages were taken. The recordings were also examined for disturbances of conduction, rhythm, and repolarization. The acute and subacute phases were characterized by sinus tachycardia with depressed R- and T-wave voltages as well as disturbances of conduction, rhythm, and repolarization. In most animals in the chronic phase, the sinus rate returned to near-baseline values with resolution of the QRS voltage changes. The ECG changes observed during RbCV infection are similar to the spectrum of interval/segment abnormalities, rhythm disturbances, conduction defects, and myocardial pathology seen in human myocarditis, heart failure, and dilated cardiomyopathy. Because animals often died suddenly in the absence of severe clinical signs of congestive heart failure during the acute phase, RbCV infection may increase ventricular vulnerability, resulting in sudden cardiac death. RbCV infection may provide a rare opportunity to study sudden cardiac death in an animal model in which the ventricle is capable of supporting ventricular fibrillation, and invasive techniques monitoring cardiac function can be performed.