Task 3.1: Respond to Questions and Suggest Next Steps

Dr. Lyons has asked for guidance on what next steps should be communicated to Mr. Mayer in order to answer his concerns about safety at the plant. For this task, you need to take another look at the data you have collected so far. You then need to consider your options in terms of where the investigation should go next, and come to a consensus as a team as to which avenues to pursue. The steps below will walk you through this process.

1. Review the emails from Dr. Lyons, Mr. Cooper and Mr. Mayer to confirm your understanding of the task.
   
   
   • Each team member should download a copy of the relevant documents and keep his/her own notes. Each of you may notice different things, which will be helpful to share with each other and discuss.
     

Review the Issues at Hand

1. Review each question that Jim Mayer poses in his email. Make sure any questions asked in Dr. Lyons' email are also addressed. For each question, identify whether you have the information to answer it.
   
   
   • If the answer is yes, make a note of the answer and discuss with your teammates.
     
     
   • If the answer is no, assess with your teammates whether it is a critical question to be answered, and then determine how you could go about answering it.
     

2. Once you have identified all answerable questions, work together as a team to determine the best strategy to gather the information that Jim Mayer has requested.
   

Determine the Next Steps

1. Refer back to the Investigation Process Flow, in the Resources (above) to remind yourself of any protocol to follow in these circumstances. Use information you know from other sources such as previous rotations as well.
   
   
2. Discuss all the different potential actions with your team, and come to consensus about how to proceed. Consider the next steps in the three areas listed below.
   
   
   • Data collection and analysis: Do you need to collect more data at this point to answer Mr. Mayer’s questions?
     
     Tip: Remember that information about cocci as well as information received in emails is considered data.
     
     
   • Hypothesis development and testing: Now that you have located the source of the outbreak (the plant), there are ways to go further to locate where the greatest risk is within the plant. Would this be best conducted with a case-control or cohort study?
     
     
     • If you determine that a case-control study is the best way to go, provide a description of how you would determine the cases and controls.
       
       
     • If you determine that a cohort study is best, provide a definition of the cohort and a plan for determining who might be infected.
       
       
   • Management and communication:
     
     
     • Management: What action, if any, would you recommend that the plant take at this point to safeguard its workers? Do you think that shutting down the plant is the correct action at this point? Why or why not? If not, what action is appropriate at this point?
       
       
       • Note: The lab results described by Mr. Mayer and the information on how cocci is transmitted suggest that a shipment of Snuffles dolls became contaminated and that the equipment used in the manufacturing process isn't necessarily still contaminated (as might happen when dealing with bacteria when packaging food products). Your suggestions should reflect that.
         
         
     • Communication: Besides Mr. Mayer, is there anyone else to communicate new findings or data to at this point? Do you need to communicate with the plant workers directly?
       
       
3. Record your plan in the Investigation Status and Plan Template (ISP).
   
   
• Note: While some information from your previous ISP may be useful here, other information ISP will not pertain to this stage of the investigation. You should update the ISP for this task accordingly (keep, change, delete) based on your team discussion (above).
  
  
4. Provide a summary of your thoughts in an email to Dr. Lyons, including the following elements in your response:
   

• each possible area of action,
  
  
• your suggested next steps in relation to that area, and
  
  
• your rationale for the actions you have chosen, including where you have decided not to act.
  

Review and submit your work.

1. Review your work.
   
   
   • Did your plan answer all of Mr. Mayer’s critical questions?
     
     
   • Did you conduct a thorough analysis of your existing data?
     
     
   • Did you review all possible avenues of exploration at this juncture, develop a plan to move forward and back it up with sound reasoning in your ISP?
     
     
   • Did you summarize your plan in your email response to Dr. Lyons?
     
     
2. Submit your work.
   
   
   • Review the checklist located in the Submit Your Work section of this task to ensure completion of the task before submitting your deliverables to your mentor.
     
     
   • Please note: Only one set of deliverables need to be submitted per team. Any additional notes not captured in that set of deliverables should be retained by the team members for possible use in future tasks.

Cross-Team Conference

During outbreak investigations, investigators are charged to continually apprise their colleagues of any progress that has been made. In the spirit of this tradition, you will have periodic 'cross-team' conferences where one team presents the state of the world and any recommendations made for next steps.

On these “What next?” tasks, all the teams in the cohort will meet to have a roundtable discussion of what steps were suggested. One team per conference will be responsible for presenting their thoughts on next steps and strategies.

1. Contact your mentor to determine which team will be presenting in this round.
   
   
   • If your team will be presenting, meet with your teammates briefly to determine how to divide up the presentation of a brief history of the outbreak, and strategies and next steps in each of the three areas (data collection and analysis, hypothesis development and testing, and management and communication). Since you are presenting material you have already been discussing for a substantial period of time, the preparation required should be minimal. Remember: This is intended to be an informal discussion.
     
     
   • If your team will not be presenting, it is still important to review the strategies and next steps you recommended, so as to be ready to give thoughts and feedback to the team who does present.
     
     
2. The presenting team leads the discussion with a brief overview of pertinent facts about the outbreak and the key strategies that they recommended to Dr. Lyons.
   
   
3. The other teams are given an opportunity to respond with thoughts and comments. The discussion is mediated by the mentor.
   
   
4. The mentor summarizes the points made before closing the discussion.

Task 3.1 Resources

While Wikipedia is a valuable resource, unlike some other websites anyone can contribute to or modify the site (whether they're knowledgeable about the topic or not). As a result, the site is subject to constant change by questionable sources. Be sure to cross-check information on Wikipedia with other reputable sites to ensure accuracy.

General Resources

Hypotheses and the Scientific Method FAQ
This FAQ supports you in creating and testing scientific hypotheses, with examples and explanations.

Hypotheses for Epidemiology FAQ
General information on hypotheses and testing with emphasis on hypotheses for epidemiology studies.

Medline Plus
A medical dictionary from Medline Plus to help with scientific terms.

Investigation Process Flow
A flowchart that explains the standard procedure that is taken at the CDC during an outbreak investigation.

Case-Control and Cohort Study FAQ
Frequently Asked Questions about Case-control and Cohort studies including the steps involved in each study, the advantages and disadvantages to each, how to calculate Odd Ratios and Relative Risk, and how to interpret the results.

Coccidioidomycosis (cocci)

Cocci Overview from CDC
Information from the Centers for Disease Control and Prevention (CDC) on cocci clinical features, transmission, risk groups, challenges, and other important info.

Cocci Overview 1
Includes common symptoms as well as tests and exams to detect the disease.

Cocci Overview 2
Includes x-rays of a cocci patient.

Cocci Overview 3
Includes a map of endemic areas (from Wikipedia).

Cocci Overview 4
Includes incubation periods, clinical signs, and communicability in both humans and animals from The Center for Food Security and Public Health at Iowa State University.