North Carolina Institute Research Articles

Identification of Rossby Atmosphere-Tropical Cyclone in Eastern Indonesian Waters

Recent research has revealed that tropical cyclones can develop over eastern Indonesian waters influenced by marine heatwaves and Rossby waves in the atmosphere. However, there is no study documenting tropical cyclones that occur in conjunction with atmospheric Rossby waves (Rossby Atmospheric-Tropical Cyclones) and their association with increased sea surface temperatures in eastern Indonesian waters. This study aims to document the influence of Rossby waves in the atmosphere on the formation of tropical cyclones around the Indonesian region using 5 case studies in 2017-2022, namely: December 2017, January 2020, December 2020, December 2021, and April 2022. This study uses wind data, sea surface temperature, specific humidity, and temperature (2m) obtained from the European Re-Analysis (ERA5) with a temporal and spatial resolution of one hour and 0.25°×0.25°. The identification of Rossby waves is based on the Rossby index issued by the North Carolina Institute for Climate Studies (NCICS). In this study, the Rossby Atmosphere-Tropical Cyclone is grouped into three phases, namely: early phase, mature phase, and late phase, using composite and statistical methods to calculate anomalies. The results showed that in the early phase, the existence of Rossby waves was shown by two twin vortices over eastern Indonesia, which was supported by high specific humidity, warming sea surface temperature (>+0.4°C), and higher surface temperature (>+0.3°C) over Timor. In the mature phase, the twin vortices over eastern waters transformed into a tropical cyclone over the Philippines. In the final phase, specific humidity decreases, sea surface temperature cools (<-0.3°C), and surface temperature decreases (<-0.3°C). The results also prove the crucial role of Timor waters in forming Rossby waves that can grow into tropical cyclones around Indonesia.

Fortifying North Carolina's Workforce for Health to Meet Current and Future Challenges.

Two new North Carolina Institute of Medicine task force reports make recommendations for bolstering the state's public health workforce through new funding and partnerships in an effort to prepare for future health crises, achieve health equity, and support the growing economy.

A Hotter, Wetter, and More Humid North Carolina.

This commentary is adapted from the North Carolina Climate Science Report, led by the North Carolina Institute for Climate Studies, drawing from climate science expertise across the state and peer-reviewed research to reach conclusions about the impact of climate change and associated extreme weather on our state.

Leaning In to Serious Illness Care Through Stories and Science.

This volume was planned prior to the COVID-19 pandemic as the North Carolina Institute of Medicine (NCIOM) completed a yearlong task force on serious illness. Beyond the task force report, we wanted to dedicate a special edition of the NCMJ to serious illness issues. We commissioned authors who could discuss the challenges, the current practices, and the extensive personal and professional skills needed to navigate these complicated medical diagnoses that often end in death. Little did we know how timely this would be in light of the current pandemic, and we can only speculate on how the world will look as this is published. Our pre-COVID planning reflected personal experiences we all face with the common denominator of serious illness impacting and shaping our lives. As guest editors, we considered how this NCMJ edition would address personal concerns for you, our reader, as well as ourselves. A physician, a social worker, and a nurse, we each have our stories and we want to invite you to lean in and bring both your head and your heart to this reading. We start by relating two very personal experiences that shaped not only life following loss, but also career choices, clinical practices, and scholarship. As you focus on this journal's content, we hope you will also reflect on the people you care for, as well as the issues we all inevitably face.

Issue Brief: A Report from the NCIOM Task Force on Serious Illness Care.

In spring 2019, the North Carolina Institute of Medicine, in partnership with agencies and organizations that provide care and advocacy around issues of palliative care, hospice care, aging, and long-term supports and services, convened the Task Force on Serious Illness Care. The NCIOM task force

Looking to the Future of Drug-Induced Liver Injury: An Interview With Paul B Watkins

Paul Watkins talks to Francesca Lake, Head of Open Access Publishing: Paul is The Howard Q Ferguson Professor in the Eshelman School of Pharmacy at The University of North Carolina at Chapel Hill (UNC, NC, USA), and an expert in drug safety and drug-induced liver injury (DILI). Since its formation in 2009, he has been the director of the University of North Carolina Institute for Drug Safety Science. He is also Director of the DILI-sim Initiative and Chairman of the Board of Directors for the spin-off company, DILIsym Services, Inc. He is chair of the steering and genetics committees for the US Drug-Induced Liver Injury Network supported by the NIH and has been the recipient of a number of awards.

Rural health care: redefining access.

The population and demographics of rural America are shifting once again. As our nation's unprecedented health care reform unfolds, it is becoming clear that rural communities have unique strengths, and capitalizing on these strengths can position them well for this health care transformation. Equally important are the distinct challenges that--with careful planning, attention, and resources--can be transformed into opportunities to thrive in the new health care environment. The North Carolina Institute of Medicine's Task Force on Rural Health recently published a report that highlights the strengths and challenges of rural communities [1]. In order to fully leverage these opportunities, we must continue to acknowledge the fundamental importance of access to basic health care, while also broadening our discussion to collectively tackle the additional components necessary to create healthy, thriving rural communities. As we reexamine the needs of rural communities, we should broaden our discussions to include an expansion of the types of access that are necessary for strengthening rural health. Collaboration, successful recruitment and retention, availability of specialty services, quality care, and cost effectiveness are some of the issues that must come into discussions about access to services. With this in mind, this issue of the NCMJ explores opportunities to strengthen the health of North Carolina's rural communities.

DOES DESPERATION JUSTIFY DEPARTURES FROM ETHICAL STANDARDS

In 2007, I was a member of a taskforce empanelled by the North Carolina Institute of Medicine and charged with creating a proposal to ethically confront what was expected to be a major, worldwide pandemic of influenza. It was feared that it could create havoc, panic, and deaths that might equal, if

Community health needs assessment in Wake County, North Carolina: partnership of public health, hospitals, academia, and other stakeholders.

Hospitals and other health care agencies are required to conduct a community health needs assessment (CHNA) every 3 years to obtain information about the health needs and concerns of the population. In 2013, to avoid duplication of efforts and to achieve a more comprehensive CHNA, Wake County Human Services, WakeMed Health and Hospitals, Duke Raleigh Hospital, Rex Healthcare, Wake Health Services, United Way of the Greater Triangle, and the North Carolina Institute for Public Health partnered to conduct a joint assessment for Wake County. Information was collected from the community through opinion surveys and focus groups. To understand the social, economic, and health status of Wake County residents, statistics were also collected from state, county, and local sources. Analysis of all data sources allowed 9 areas of community concern to be identified. Five community forums were held simultaneously at locations in east, south, west, north, and central Wake County to inform residents about the main findings of the assessment and to prioritize the 9 areas of concern. The top 3 priority areas identified were poverty and unemployment, health care access and utilization, and mental health and substance use. Results may not be generalizable to counties in North Carolina that are more rural or to counties outside North Carolina. The success of this unique collaborative process provides further opportunity for the project partners and other organizations to coordinate action plans, pool resources, and jointly address the priorities of this assessment over the next 3 years.

Accelerating preparedness: leveraging the UNC PERLC to improve other projects related to public health surveillance, assessment, and regionalization.

The co-location of the University of North Carolina at Chapel Hill (UNC) Preparedness and Emergency Response Learning Center (PERLC) and the UNC Preparedness and Emergency Response Research Center (PERRC) and other smaller projects within the North Carolina Institute for Public Health, a public health practice-oriented unit of the UNC Gillings School of Global Public Health, facilitated many successful collaborations. By sharing personnel, space, and other resources, the UNC PERLC and PERRC and other projects were able to meet the needs of the public health workforce by developing evidence-based training programs and tools around topics including epidemiology, surveillance, and vulnerable populations.

Improving Public Health Preparedness: Strengthening Biosurveillance Systems for Enhanced Situational Awareness

The North Carolina Institute for Public Health, in collaboration with CDC and the Public Health Informatics Institute, developed a set of core requirements for the development and maintenance of electronic biosurveillance systems to achieve situational awareness. The three-stage research process included a literature review, interviews with key informants in the biosurveillance field, and a multi-day workshop attended by surveillance experts across the United States Best practices, innovations, and lessons learned were leveraged to identify the minimum capabilities of effective biosurveillance systems, with the goal of achieving preparedness for natural disasters, disease outbreaks, or hazards during mass gatherings.

The Affordable Care Act

Electronically published March 11, 2014. Address correspondence to Dr. Richard A. Dickey, 51 Players Ridge Rd, Hickory, NC 28601 (radmd51@gmail.com). N C Med J. 2014;75(2):151. ©2014 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved. 0029-2559/2014/75221 To the Editor—The November/December 2013 issue of the NCMJ included a Letter to the Editor titled “Health Care Costs Must Come Down” by Ron Howrigon [1], which I feel demands a response. I heartily agree with Howrigon that health care costs must come down. This is inarguable, and the rate at which health care costs are rising has already been moderated since the Patient Protection and Affordable Care Act of 2010 (ACA) was passed—although costs may rise again as the ACA is fully implemented and coverage is extended to millions of uninsured individuals. However, Howrigon totally avoided discussion of the ethical and moral issues the ACA sought to address, particularly the American public’s right to good health care. As members of a wealthy nation, it is our obligation to provide that coverage, and the ACA attempts to do so. As a consultant to physicians, Howrigon is not a disinterested party in the health care system. He admits his biggest concern is that the ACA “will try to control costs by drastically reducing reimbursement to physicians.” He (and we) must realize that our health care system is rapidly evolving and will not be nearly as dependent on physicians in the future as it was in the past. When the ACA was being considered by Congress, this law was read and studied carefully by those whose corporate bottom lines might be significantly impacted by it, and by the lobbyists who represented those interests. I too read it—all of it. As I discussed the ACA with others who had not read it, I shared my excitement about how much of the law was directed toward finding ways to assess and improve cost effective medical care and coverage. I believe these aspects of the ACA were included with the expectation that, someday, the findings of this research would be used to improve health care and to save money through the implementation of evidence-based practices and payment policies identified by that research. I am aware of the considerable compromises our elected officials in Washington, including our President, had to accept to get the ACA through Congress. I hope that, over time, the positive effects and benefits of the ACA—such as the coverage of nearly 50 million uninsured Americans and the removal of pre-existing condition clauses—will be appreciated by most Americans. While I am dismayed by the unrelenting efforts in Congress to undo or limit funding for the ACA, the deficiencies of which are remediable, I remain excited about the good things which have already come—and will continue to come—from this legislation, which I believe is one of the most courageous, morally right steps our nation has ever taken.

Evaluating Use of Custom Survey Reports by Local Health Departments

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report both internally and to external preparedness partners. Through evaluation of custom report use, we have found that survey feedback is a valuable part of a participatory research approach that promotes and encourages discussion, motivates improvement, and provides opportunities to identify potential solutions relevant to both researchers and LHDs.

Legal Frameworks Supporting Public Health Department Accreditation

The existence of different types of accreditation legal frameworks, embedded in complex and varying state legal infrastructures and political environments, raises important legal implications for the national voluntary accreditation program. To increase an understanding of accreditation-enabling laws nationwide. In 2010 to 2011, the North Carolina Institute for Public Health conducted a study of state legal frameworks supporting public health department accreditation or related programs (ie, certification/assessment, performance management, and quality improvement). First, a mapping study was conducted to identify current programs and their legal frameworks. Ten states were then selected for in-depth qualitative case study. Data were gathered through semistructured interviews with public health practitioners and key stakeholders. The findings from the mapping study delineate the accreditation, certification/assessment, performance management, or quality improvement program currently in place and the type of legal framework supporting it. The citations for statutes and regulations are also included. Among the 18 states in the sample, 4 have accreditation programs, 6 have certification/assessment programs, and 8 have performance management/quality improvement programs. Accreditation programs were most likely to have a statutory basis, while performance management and quality improvement programs were most often supported via health department policy. The findings from the case study provide greater detail about each state, reflecting public health structures, programs, legal frameworks, approaches to Public Health Accreditation Board (PHAB) accreditation, and legal strategies for achieving accreditation. Early adopter states have pursued a variety of legal frameworks to develop their accreditation, certification/assessment, performance management, and quality improvement programs. With the voluntary national accreditation program scheduled to go live in late 2011, these 10 states have also carefully considered options for aligning their activities with PHAB accreditation. Lessons derived from this examination can inform public health practitioners, advocates, and elected officials about how to best structure legal frameworks to support accreditation and related activities.

Honoring Their Service: Behavioral Health Services in North Carolina for Military Service Members, Veterans, and Their Families

The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina.

Support and Services Provided by Public Health Regional Surveillance Teams to Local Health Departments in North Carolina

Since 2001, many states have created regional structures in an effort to better coordinate/public health preparedness and response efforts, consolidate services, and supplement local government capacity. While several studies have identified specific benefits to regionalization, including enhanced networking, coordination, and communication, little research has examined the effect of regionalization on specific preparedness and response activities. To better understand the impact of regionalizing public health workforce assets in North Carolina, a survey aimed at documenting specific support and services that Public Health Regional Surveillance Teams(PHRSTs) provide to local health departments (LHDs) was developed and administered by the North Carolina Preparedness and Emergency Response Research Center, located at the North Carolina Institute for Public Health. Of80 potential types of assistance, 26 (33%) were received by 75% or more LHDs, including 9 related to communication and 7 related to exercises. There was significant variation by PHRST region in both the quantity and quality of support and services reported by LHDs. This variation could not be explained by county- or LHD-level variables. PHRST assistance to LHDs is largely focused on communication and liaison activities, regional exercises, and planning. On the basis of these findings, regionalization may provide North Carolina with benefits consistent with those found in other studies such as improved networking and coordination. However, further research is needed to identify whether regional variation is the result of varying capacity or priorities of the PHRSTs or LHDs and to determine how much variation is acceptable.

Injury Prevention: North Carolina’s Challenge and Capacity to Respond

North Carolina has worked to develop an infrastructure and identify priorities to reduce the high morbidity and mortality from injuries. Findings of the North Carolina Institute of Medicine (NCIOM) Task Force on Adolescent Health and the NCIOM Task Force on Prevention, combined with the North Carolina Division of Public Health strategic plan and the Injury and Violence Prevention State Advisory Council, have laid the path toward this goal.

Preventing Child Maltreatment in North Carolina

Child-maltreatment prevention has become more robust in North Carolina since the North Carolina Institute of Medicine Task Force convened in 2005. The commitment by state governmental and nongovernmental leadership and funding agencies has been instrumental to this achievement. This commentary highlights several successful approaches used to prevent child maltreatment in the state, although there is much work to be done.

Planning for Ecosystem Service Markets

Problem: Market mechanisms are emerging as means of offsetting the environmental effects of growth. Unfortunately, formal regulation of ecosystem markets is often separated from broader planning for urban development, resulting in offsets that are unsustainable in the face of future urban growth. Purpose: We aimed to assess how 2008 federal regulations that actively promote aquatic resource markets and encourage watershed planning to restore wetlands and streams damaged during development will affect reputedly efficient existing wetland and stream ecosystem markets in North Carolina. We explore how coordination between regulators and planners can improve long-term viability of market-created resource offsets and improve the ability of markets to respond to rapid urban growth. Methods: We analyzed new state and federal regulations and watershed planning efforts and convened a stakeholder forum including representatives of state and federal agencies, land developers, environmental groups, aquatic restoration companies, and academia. Results and conclusions: Problems with aquatic ecosystem markets in North Carolina stem from poor communication among local and regional planners, federal regulators, and state agencies. Institutional barriers and poor coordination cause federal regulatory decisions made without knowledge of land use plans or urban development patterns, faulty projections of market demand for aquatic offsets, and local land use plans that do not provide long-term protection for the offsets. Although regulators consider current surrounding land uses, they do not consider future land uses. We conclude that local land use projections should be required components of ecosystem restoration site plans and that state environmental management agencies' watershed plans should reflect urban development patterns. Takeaway for practice: Local planners should have input into the design of restoration sites providing environmental offsets as well as into state and regional ecosystem service market implementation plans. Federal, state, regional, and local agencies should facilitate and require information sharing, making planning and regulating ecosystem service markets part of the development process. Research support: This research was supported by the University of North Carolina's Institute for the Environment.

2009 North Carolina Child Health Report Card: Action for Children North Carolina and the North Carolina Institute of Medicine

2009 North Carolina Child Health Report Card: Action for Children North Carolina and the North Carolina Institute of Medicine