Public health laboratories are the first line of defense in the fight against communicable diseases and bioterrorism. The local public health laboratories in particular serve important functions including the identification and monitoring of pathogens in the community. They have the ability to respond to individual challenges within their jurisdictions with creative and innovative solutions. Unfortunately, instead of investing in and expanding the functions of their public health laboratory, many jurisdictions are forced by budget cuts, workforce shortages, and competition with private/commercial laboratories, to consider downsizing or closure of these essential facilities.2-4 California has been especially targeted by reorganization approaches, including regionalization, consolidation and privatization, because it has a unique, decentralized system consisting of one state- and 35 local laboratories, many more than other states.5 Reorganization, however, might be applicable only in a few isolated settings and faces opposition from many lab directors and health officers.2 It would result in further public health laboratory closures to the detriment of the overall mission of public health.

It would be imperative to strengthen the local public health laboratories, improve their cost-effectiveness and maintain their quality service. This could be achieved through specimen volume increases in certain testing areas. Economies of scale would arise due to costs being distributed over more samples, and quality might be improved. One strategy to achieve volume increases is specialization, or the sharing of testing services amongst several neighboring public health laboratories. If focused on the particularly cost-inefficient low-to-moderate volume tests, specialization might be able to achieve the greatest benefits. It was the goal of this research to identify the current level of support for and the prevalence of specialization in low-to-moderate volume tests in the local jurisdictions of California and to examine how feasible wider implementation would be. Additionally, a Cost-Effectiveness Evaluation Model was developed to evaluate past or future service changes, such as volume increases or service sharing, based on their effect on the cost, revenue and quality of testing. Overall, this alternative strategy to strengthen the public health laboratories was examined so that public health policy makers, administration, and lab directors can make a more informed decision about the future of their public health laboratory.

Introduction: The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC) research. These guidelines require community consultation (CC) events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS) technology in EFIC CCs.

Methods: As part of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART), 13 CC events were conducted. We prepared a PowerPoint™ presentation with 4 embedded ARS questions,according to specific IRB guidelines to ensure that the pertinent information would reach our targeted audience. During 6 CCs, an ARS was used to gauge audience comprehension. Participants completed paper surveys regarding their opinion of the study following each CC. Results: The ARS was used with minimal explanation and only one ARS was lost. Greater than 80% of the participants correctly answered 3 of the 4 ARS questions with 61% correctly answering the question regarding EFIC. A total of 105 participants answered the paper survey; 80-90% of the responses to the paper survey were either strongly agree or agree. The average scores on the paper survey in the ARS sites compared to the non-ARS sites were significantly more positive.

Conclusion: The use of an audience response system during the community consultation aspects of EFIC is feasible and provides a real-time assessment of audience comprehension of the study and EFIC process. It may improve the community’s opinion and support of the study. [West J Emerg Med. 2014;15(4):414-418.]