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While ICU health care workers consistently identify a number of patient factors as important in decisions to withdraw care, there is extreme variability, which may be explained in part by the values of individual health care providers.

The remission of occupational asthma caused by certain known antigens improves with early diagnosis and removal from exposure. As a suspected antigen-mediated disease, sarcoidosis might also benefit if affected persons are isolated from continued exposure. Our investigation identified a high prevalence of new-onset sarcoidosis, and asthma among workers of a water damaged building with a history of indoor environmental quality complaints. Removal of all individuals from such environments until completion of building diagnostics, environmental sampling and complete remediation is a prudent measure when feasible.

Public health surveillance is focused on the detection of acute, chronic, and emerging threats to the health of the population to direct disease control and prevention efforts. 1 Public health surveillance relies on health care providers to report to public health agencies conditions or outbreaks that may impact the broader population. This case reporting is mandated through laws and regulations at the state and local levels. Notification of cases to the Centers for Disease Control and Prevention (CDC) is facilitated by agreements between states and the federal government. 2 Historically, case reporting has been based on paper reports or Internet-based entry of reports to state health department systems, but these reports are often slow or incomplete and place a substantial burden of work on health care providers and public health agencies. 3 The future of surveillance is electronic case reporting (eCR), by which cases of reportable conditions are automatically generated from electronic health record (EHR) systems and transmitted to public health agencies for review and action. eCR holds promise for enhancing the quality and effectiveness of public health surveillance. 4 Greater use of eCR could result in (1) more complete and accurate case data in near real time for public health action; (2) earlier detection of cases, permitting earlier intervention and lowered transmission of disease; (3) improved detection of outbreaks to allow earlier investigation and, potentially, earlier identification of risk factors for the spread of disease; and (4) creation of a new infrastructure to support rapid reporting of newly recognized and emerging conditions. In this commentary, we review the promise of eCR and present our vision for a nationally interoperable eCR system that allows for timely reporting to public health and information sharing among jurisdictions. Coordination between health care providers and public health agencies is essential for the monitoring, control, and prevention of disease and is best carried out through a bidirectional exchange of information. In 2009, the US Congress passed the Health Information Technology for Economic and

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Context:State health officials (SHOs) serve a critical role as the leaders of state public health systems. Despite their many responsibilities, there is no formal process for preparation to become an SHO, and few requirements influence the selection of an SHO. Furthermore, to date, no studies have examined SHO tenure or their experiences.Objective:This study examines SHO tenure over time and the relationship between SHO tenure and organizational and state attributes.Design:This longitudinal study employed primary data on SHOs and secondary data from the Association of State and Territorial Health Officials on organizational attributes of state public health agencies.Setting:This study examines SHOs within the United States.Participants:SHOs who served in years 1980-2017.Main Outcome Measures:Annual average SHO tenure; average SHO tenure by state.Results:In the 38 years of this study, 508 individuals served as SHOs in the 50 states and the District of Columbia. The average tenure over this period was 4.1 years, with a median tenure of 2.9 years. During the study period, almost 20% of SHOs served terms of 1 year or less. A total of 32 SHOs (32/508 or 6.3%) served for 10 years or longer. Excluding SHOs who served 10 years or longer (n = 32 SHOs who had a collective 478 years of tenure) reduces the average term in office to 3.5 years. The average number of new SHOs per year is 12.3. SHOs appointed by a board of health averaged more than 8 years in office compared with averages just under 4 years for those appointed by governors or secretaries of state agencies.Conclusions:There are notable differences in SHO tenure across states. Future research is needed to further examine SHO tenure, effectiveness, job satisfaction, transitions, and the relationship between SHOs and state health. It may be valuable to expand on opportunities for new SHOs to learn from peers who have moderate to long tenures as well as SHO alumni. Given that average SHO tenure is approximately 4 years and that an SHO could be thrust into the national spotlight at a moment's notice, governors may want to consider experience over partisanship as they appoint new SHOs.

The purpose of this project was to increase the number of students participating in public health nursing experiences at Vermont Department of Health through creation of a mentoring partnership model. The model targeted preceptor needs, including roles and responsibilities when working with students; educational needs of faculty, particularly related to evolving roles of public health nurses; and creation of additional clinical opportunities for students. Outcomes included improved working relationships among students, faculty, and public health mentors as measured by narrative evaluative comments of project participants; a 150% increase in the number of students participating in public health nursing clinical experiences; expanded involvement of Vermont Department of Health district offices and central office, with the addition of two new clinical sites and increased numbers of students in sites used prior to this project. Guidelines for preceptors working with students were also developed.

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