Preparing a Nation

For years, researchers at Pitt have been studying ways to improve the nation’s security and national preaparedness, but in this post-September 11 world, Pitt now is helping to lead the way against terrorism and other disasters—and changing the way we look at it all.

These days, everybody is concerned about security issues. So it came as little surprise that Homeland Security Secretary Tom Ridge was one of the luncheon keynote speakers in June 2003 when the global Biotechnology Industry Organization conference convened in Washington, D.C. He addressed the issue head-on.

“Today, I would like to talk a little bit about a very special group of people who work behind the scenes, who may not receive as much public recognition, but who are just as important to our efforts to secure our homeland,” Ridge declared to a packed hall at the Washington Convention Center. “Your work will help us detect biological weapons...treat the diseases they cause...help us find new ways to strengthen our food and water systems...and help make our first responders less vulnerable, our hospitals less exposed, and our physicians and medical professionals much more effective.”

Ridge then thanked “our partners in the private sector and in the academic community” for contributing to homeland security efforts. And that’s when he specifically cited the University of Pittsburgh, trumpeting a now-nationally acclaimed initiative by the University of Pittsburgh called RODS (Real-time Outbreak and Disease Surveillance).

“The president and I visited the campus and saw that in operation last year,” Ridge explained. “It’s been applied at certain venues around the country, and we’re obviously grateful to these institutions for their generosity because they provide free software to cities and health networks to detect symptoms and spot the location of an outbreak.”

No one in that audience should have been surprised, for the University of Pittsburgh’s faculty have been quietly studying—and solving—many of the problems of homeland security, first response in disasters, and, more broadly, national preparedness, long before the events of September 11, 2001, forced such problems into the national spotlight.

Indeed, even before the terrorist attacks, faculty in such schools as the Graduate School of Public and International Affairs (GSPIA), the Graduate School of Public Health (GSPH), and the Schools of Medicine, Law, and Information Sciences were engaged in research on how the United States can better prepare itself for such emergencies on a local and national level. And the work continues with a new fervor today, according to University officials.

What is new, however, is that the University now is bringing many of those disparate research and development efforts together in its new Center for National Preparedness.

Pitt’s Responsibility toward Preparedness

Pitt’s Office of the Provost began to lay the groundwork for the center shortly after September 11, 2001, when it called in a nationally known consultant in national preparedness to evaluate the University’s potential for building its own research program.

The consultant’s conclusion: “You already have one.”

“The Scharpenburg Report confirmed that we have great strength in the areas of health and information science,” says George Klinzing, vice provost for research at Pitt. “We have the only certified school of public health in the state. The knowledge is here. Now we’re pulling it together.”

Codirectors for the Center for National Preparedness—Margaret Potter, associate dean in GSPH; Kenneth Sochats, assistant professor in the School of Information Sciences; and Bernard J. Hibbitts, professor in the School of Law—are coordinating research being done throughout the University. The center will bring together experts in medicine, technology, public policy, and law to study the following issues of preparedness: prevention of possible catastrophes, protection of the population, timely and effective response, and returning to normal life.

“This is not just homeland security,” Klinzing says. “We’re finding that the different aspects of national preparedness add up to a much larger picture.”

Real-Time Outbreak

On February 5, 2002, when President George W. Bush visited the University of Pittsburgh campus, he was given a demonstration of RODS, an information system that can immediately identify spikes in emergency room visits related to specific complaints. Through real-time monitoring of symptoms by region and neighborhood, RODS becomes a front-line defense in detecting disease outbreaks, whether they occur naturally or from bioterrorism.

The system was developed by Michael Wagner, Pitt associate professor of medicine and intelligent systems and director of the RODS Laboratory; Rich Tsui, research assistant professor of medicine and associate director of the RODS program; and Jeremy Espino, director of the RODS Open Source Project. Wagner founded the RODS Laboratory at Pitt in 1999, and, in subsequent years, established ongoing collaborations with researchers from Carnegie Mellon University’s computer science department.

“Here in Pittsburgh,” Bush said at the time of the visit, “I had the honor of seeing a demonstration of the...Real-time Outbreak and Disease Surveillance system, developed right here, which is one of the country’s leading centers on monitoring biological threats.”

The RODS system, unlike other medical data systems, receives data directly—and in real time—from computers in emergency departments and hospitals. The system examines the aggregate and “de-identified” data—which include a patient’s symptoms, gender, and age—for trends and anomalies suggestive of disease outbreak. A rise in flu-like symptoms in a specific hospital, for instance, could indicate the presence of a flu in a particular area of the city. Or it could mean that a chemical or biological weapon has been released.

The concept behind the RODS system is that a cluster of symptoms may be the first tangible warning of a bioterrorist event, and with early detection medical personnel can better contain the outbreak and treat patients. Shortly after the anthrax attacks of October 2002, Wagner testified before the U.S. House of Representatives’ Energy and Commerce Subcommittee on Oversight and Investigations regarding the urgency for creating a public health surveillance system as an essential part of a national preparedness program.

The system was put to the test when the RODS laboratory collaborated with informatics experts and public health specialists at the University of Utah and the Utah Health Department to provide surveillance coverage for the 2002 Winter Olympics. The coverage was implemented in seven weeks and ultimately monitored 114,000 acute-care encounters. It was so successful that RODS has become a permanent feature in the Utah health system, collecting data from 80 percent of the healthcare sites in the state.

The RODS system is also in use throughout 15 counties in Pennsylvania. It was used in 81.7 percent of all emergency room visits in Allegheny County, 78.1 percent in Washington County, 68.3 percent in Butler County, and 84.1 percent in Erie County. The RODS system is also in use in counties in New Jersey, Ohio, and, as mentioned, Utah. (In response to inquiries about the hepatitis A outbreak in Beaver County, though, the RODS laboratory reported that RODS could not have detected the outbreak because hospitals in that county do not contribute their data to the RODS system.)

The RODS Laboratory is working on a National Retail Data Monitor (NRDM), a public health surveillance tool that collects and analyzes sales of over-the-counter healthcare products as a means of rapidly identifying disease outbreaks, either natural or as a result of bioterrorism. The NRDM was built by RODS Laboratory researchers in collaboration with the food and drug retail industry, state and local health departments, and the Centers for Disease Control (CDC).

The NRDM project began in October 2002 with seed funding from the Commonwealth of Pennsylvania and quickly grew into a high-profile, high-priority national project. As of September 2003, 18,000 retail stores and pharmacies from major retail chains across the nation were participating or had agreed to participate. Likewise, 218 people in health departments from across 33 states, Washington, D.C., and the CDC are participating.

Organizing Emergency Response

Even though Michael Allswede, assistant professor in Pitt’s Department of Emergency Medicine in the School of Medicine, is a national expert on how emergency medicine can respond to weapons of mass destruction, he prefers not to use that term.

“It leads you into believing that weapons of mass destruction are a single entity, like nuclear bombs,” says Allswede, who also is section chief of special emergency medical response at Pitt. “They’re not. And that’s one of the greater barriers in conceptualization that America has in this fight.”

Allswede served as a U.S. Army medical company commander while he was completing his medical education. In that role, he was in charge of a company of soldiers responsible for identifying chemical, biological, and radiological agents, as well as providing decontamination services, force protection, and triage. This assignment, he says, first alerted him to the complexity of chemical, biological, and radiological weapons management, a passion that stayed with him throughout his military duty in the Gulf War and antidrug operations in South America.

Allswede eventually became an instructor for the Department of Defense’s National Preparedness Program, and in 1997 he was appointed by then-U.S. Attorney General Janet Reno to the National Domestic Preparedness Office. He also found time to author what became the RaPiD-T Course, an acronym standing for the consecutive steps in the first-responder decision-making process—recognition, protection, decontamination, triage, and treatment. RaPiD-T currently is used to train UPMC emergency physicians and Pittsburgh EMS workers.

Recently, Allswede testified before the House Veterans’ Affairs and Emergency Preparedness Committee about what he calls the “Pittsburgh Matrix,” a project that measures survivorship and cost with respect to the timeline of detection of a biological contaminant as well as the scale and degree of medical resources needed to respond to the catastrophe. This project is the first attempt to assess the value of the multitude of bioterrorism projects and uses UPMC as its base model.

“There are innumerable diseases, lots of terrorists, lots of different modes of attacking,” Allswede says. “Take all those permutations together and you come to a colossal number of potential scenarios. But if you think about it from the response perspective, there are only a few real key parameters that you have to worry about.”

By breaking the parameters down to 20 possible scenarios, responders can make informed decisions about how to treat patients and the type of medical staff needed to provide sufficient primary care, Allswede adds.

But as Allswede points out, clinical medicine is only one aspect of bioterrorism detection and response. Public health and law enforcement also are integral to successful detection and management of a “clandestine event,” he says. Working with the former Pennsylvania Homeland Security director and the Pittsburgh field office of the FBI, Allswede has created a program called Strategic Medical Intelligence. The initiative is developing an investigation section at the FBI directed to concentrate state and federal resources for rapid first-case determination of a bioterrorism event.

Says Allswede: “You cannot underestimate the value of a firm, early-case diagnosis in the response to bioterrorism.”

Public Health and Bioterrorism

Margaret Potter, director of Pitt’s Center for Public Health Practice (CPHP) in GSPH, didn’t mince words when she testified in July 2002 before the Pennsylvania House of Representatives on the state of the commonwealth’s preparedness.

“The best preparation we can make for responding to a bioterrorist event is to have the best possible public health infrastructure in place,” she informed the House.

It might not have been something they wanted to hear, but Potter says she felt it was necessary. In the years before the September 11 attacks, she says, Pennsylvania’s public health system had slowly deteriorated. The state had the lowest ratio of public health workers to population—37 workers for every 100,000 residents—in the nation. No statewide public health communications network existed, and only 10 of Pennsylvania’s 67 counties had comprehensive public health programs.

So what does this have to do with preparedness?

“Everything,” says Potter, who is the principal investigator of the University of Pittsburgh Center for Public Health Preparedness (UPCPHP), one of 22 academic centers for public health preparedness funded by CDC, which works with agencies and professionals in Pennsylvania and Ohio to boost the states’ capacities to respond to emergencies. “When a disaster strikes, everything is local.”

For example, Potter points to the anthrax scare that shook New York, Washington, D.C., and Florida. “Everyday water quality, air quality, clinical programs—everything that’s run in public health agencies—came to a dead standstill,” she says. “Why? Because anthrax was something new, and nobody had training in it.”

Working in the field is nothing new to Potter, who has served as the director of CPHP—which links academics in the discipline with public health practitioners—since its inception in 1995, when it received funding from the commonwealth. But work in preparedness and response has stepped up since Bush visited the campus and Potter received news that Pitt had been selected to be one of the preparedness centers.

The UPCPHP, which is housed in CPHP, also is involved in such efforts as enhancing the existing public health infrastructure in the state, particularly in rural areas, and solving capacity issues with regard to large-scale medical emergencies. The UPCPHP, for instance, has been working to identify secondary care providers who can respond to medical emergencies when hospitals and primary first responders are working at full capacity.

Potter also has been working with the Allentown City Health Bureau to ensure that the Public Health-Ready (PHR) pilot test is a success. Allentown recently received funding from CDC and the National Association of County and City Health Officials (NACCHO) to become one of 10 PHR sites in the country. Potter and her team have collaborated with Allentown by offering consultation in planning and training, as well as serving as observers and evaluators of the tabletop simulation.

“By assessing preparedness in Allentown,” Potter said, “we’ll have the kind of guidelines and resources that will help all local public health agencies.”

National Security and Civil Liberties

William Keller, who directs Pitt’s Matthew B. Ridgway Center for International Security Studies, says he understands why increased vigilance spurs new projects in science and technology. But he also is concerned about how that technology may be used.

“We must make every attempt to secure the nation against terrorist attacks, if that is, indeed, possible,” Keller says. “At the same time, in our zeal to protect the nation, we may inadvertently dismantle some of the basic institutions upon which our freedoms are founded.”

The Ridgway Center was launched in 1988 under the auspices of GSPIA and the University Center for International Studies. Its aim is to promote a scholarly exchange of ideas and opinions regarding questions of national security and international politics that can inform a new generation of security analysts. One project, for instance, which is codirected by Keller and Lisa Nelson, assistant professor of public and international affairs, is titled Civil Liberties and Homeland Security.

“We are examining new intelligence technologies and law enforcement practices that deal specifically with internal security, but which also may be hard to reconcile with core American values like freedom of speech and association, and the right to privacy,” Keller says. “We are interested in understanding how new surveillance technologies can assist in the struggle against terrorism, but, at the same time, we are acutely aware of their potential for political abuse.”

Keller, author of a book on FBI domestic intelligence programs, The Liberals and J. Edgar Hoover: Rise and Fall of a Domestic Intelligence State (Princeton University Press, 1989), argues that terrorism poses a threat both to national security and to the civil liberties that distinguish American society.

“If the price of containing terrorism is the end of the open society and the end of the American experiment with democracy and human freedom,” Keller says, speaking in 2003 at the Provost’s Inaugural Lecture, “then the price is too high. We will have delivered to Osama bin Laden that which he could never have achieved on his own.”

Keller says he sees the Ridgway Center’s work as an essential piece of Pitt’s scholarship in the wake of September 11.

“Universities such as Pitt, where great medical research facilities are located, have a role to play and can be very helpful in the research they do,” he says. “On the other hand, universities can also perform a very valuable function of critiquing public policy. That’s one place where the Ridgway Center will make a contribution.”

Information for Quick Decisions

Louise Comfort, professor of public and international affairs in GSPIA, knows how confusion can reign in the heat of a crisis. After studying emergency responses in Costa Rica, Turkey, Taiwan, and India, as well as San Francisco and Los Angeles, Comfort developed a computer software system known as the Interactive, Intelligent, Spatial Information System (IISIS). The software is designed to provide the first people on the scene of a disaster with the information they need to make quick, informed decisions.

Comfort points to a 1988 oil spill into the Monongahela River near Pittsburgh as an example. “There was one oil worker on shift, very inexperienced and not very well trained,” Comfort says. “We have a very top-down system in this country. Instead of calling local police or fire departments, you’re supposed to call the EPA first. So the oil worker called the company’s head office in Ashland, Kentucky, and staff there called the EPA.”

Soon, Comfort says, the roads to the local oil tank farm were jammed with fire trucks from various local departments. No one knew who was in charge or the chemical nature of the spill. With IISIS, the oil worker would have known what the substance was and which local fire department to call first.

Comfort has been busy since September 11, 2001. “Now, emergency managers are asking for assistance with decision support,” she says. “As practicing managers on the county level, they recognize that the existing software is inadequate. They’re looking for a new way.”

But, she cautions, “The software is the easy part. The hard part is organizational analysis, keeping your knowledge base updated, sorting out the different levels of communication, and learning how to transmit information.”

Cyber-Security

Comfort also is collaborating with faculty from Pitt’s Department of Computer Science in Arts and Sciences in another project that will create advanced computer and network systems for emergency response. As part of the interdisciplinary project titled Secure CITI: A Secure Critical Information Technology Infrastructure for Disaster Management, Assistant Professor José Brustoloni is investigating the use of ad hoc networks for coordinating emergency teams. Because ad hoc networks tend to self-organize and, therefore, don’t require infrastructures, they can provide a more resilient and agile response, he says.

“Major catastrophes can knock communication infrastructure down,” Brustoloni said, “making it difficult to receive help requests and dispatch responders.”

Meanwhile, the University awarded Brustoloni an Innovation in Education Award for the creation of a network security laboratory where Pitt students can receive hands-on instruction on how to defend computer and network systems from cyber-attacks.

“The nation cannot be considered prepared unless it has a well-trained workforce with the necessary skills to defend the integrity, availability, and confidentiality of its information resources,” says Brustoloni, who also is creating continuing education courses on security for practicing engineers in a project funded by the Pittsburgh Digital Greenhouse. “It used to be that engineers didn’t have to think much about security, but that’s no longer the case.”

Virtual Reality for First Responders

The name 707 First Responder Support System may conjure up fast jets or James Bond-type spies. But there is nothing mysterious about it: 707 is the room number of the Visual Information Systems Center in Pitt’s School of Information Sciences, where Ken Sochats, assistant professor in the school and director of the center, runs his laboratory.

What drives his research into virtual reality practice systems for emergency workers?

“September 11 took out 5 percent of New York’s first responders—a significant number,” Sochats says.

After attending a meeting at Pennsylvania’s Department of Homeland Security, Sochats says he knew that the work he had done with imaging could be of enormous benefit to firefighters and other responders entering an unfamiliar building.

The task may seem clear-cut: A firefighter enters a building and marshals its occupants to safety. But as Sochats pointed out, a first responder—faced with an unknown floor plan—may have to spend valuable seconds looking for the nearest exit, checking behind doors, or searching for possibly explosive materials. And the room may be pitch-black with smoke.

The 707 System creates a virtual reality that lets rescue teams practice their response while still in the firehouse and review the specific floor plan on the way to the disaster scene. Sochats and his team start with a builder’s floor plan. But instead of looking at it from above, the program simulates a three-dimensional version of a room. After that, they take digital photos of the rooms on the floor and “paint” these pictures onto the corresponding walls of the plan. Finally, they mark up the building with a series of simple codes that indicate particular dangers.

Training is only the first possible use of the 707 system. Sochats also envisions using the system applications at the disaster scene itself. For instance, he says, the responder’s helmet could be outfitted with virtual building information that would allow the rescuer to “see” the scene, even if it’s a smoke-filled room, as well as know what’s behind each wall.

“The interest in this technology has been sparked by September 11,” he says. “But it’s very much like how the NASA program brought about all kinds of practical uses for its technologies.”

Many of his ideas come from the first responders themselves. “I happen to bowl on a firemen’s team,” he says. “I’m never at a loss for resources.”

Freedom, Ethics, and Law in the Wake of September 11

Within minutes of the September 11 terror strikes on New York and Washington, D.C., a Pitt-based legal information and education Web portal was carrying news and analysis of the legal implications of the attacks. The portal, called JURIST, is the creation of Professor Bernard J. Hibbitts in Pitt’s School of Law.

In the days and weeks following the terrorist strike, Hibbitts, who continues to direct the Web portal, and a team of Pitt law students put together what he describes as the first comprehensive online guide to terrorism law and policy. The guide, he says, provides quick and easy access to relevant national legislation and case law, key international instruments, and background policy papers on what new laws in this area might mean for traditional rights and liberties. USA Today and other news and reference services were quick to peg the collection as a “Hot Site.”

Today, JURIST continues to regularly monitor and report on developments in the war on terror. In JURIST’s Forum op-ed series, for instance, law professors from law schools around the country offer perspectives on the shifting balance between security and rights. Pitt Law Professor Darryll Jones, who recently was accepted by the U.S. Department of Defense as an attorney qualified to represent terror suspects held at Guantanamo Bay, writes a regular feature about military justice.

In a JURIST Web log called Paper Chase, Pitt law students regularly report on U.S. Attorney General John Ashcroft and the Patriot Act. They monitor and filter legal news in real time, supplementing it with links to relevant online research material to give readers access to stories behind the news. Meanwhile, news of terrorist and counterterrorist activity has become a staple of JURIST’s World Law section, which includes Web pages about the legal systems and structures of Afghanistan, Iraq, Indonesia, the Philippines, and other countries that figure prominently in news about terrorism.

Says Hibbitts of his JURIST efforts: “Terrorism strikes in an instant. Effective response to it requires good information, accurate assessment, and reasoned analysis. JURIST can help provide those things at critical junctures.”

The World of Federally Sensitive Research

Saleem Khan’s foray into the world of international terrorism began with spoiled potato salad.

A professor of molecular genetics and biochemistry, Khan has worked for years on staphylococcal enterotoxin B, a toxin produced by strains of Staphylococcus aureus in contaminated food.

“Enterotoxin-induced food poisoning is particularly common in summer,” Khan says, “due to contaminated food at a lot of picnics.”

Khan also has worked on S. aureus plasmids for many years. Plasmids usually are associated with antibiotic resistance and are responsible for the production of toxins by Bacillus antrhracis, more commonly known as anthrax. So when the anthrax scare hit in the fall of 2001, Khan says he knew he could make a contribution to the research.

“There was an initiative to come up with new drugs, since we knew Cipro would not always be effective,” he says.

“We had isolated a related DNA helicase gene in staph, and thought we could work toward developing drugs that target a similar helicase in anthrax.”

To do this, Khan entered the byzantine world of federally sensitive research. Used to being at the helm of a laid-back laboratory, Khan now has to negotiate an intricate security system to access the work area. All of the lab workers have to be fingerprinted and registered with CDC and the FBI.

It also has been a challenge to secure samples of a certain anthrax strain for research. When he does receive samples, the strain, like all sensitive materials, must be registered with Pitt’s Institutional Review Board, as well as with CDC and the National Institutes of Health.

“It’s a strain, sealed in a vial,” he says. “Unlike the spores sent in the mail in 2001, they’re not airborne. Everything is done to procedure.”

Khan’s life may have changed drastically since September 11, but thanks to research he and others at Pitt are doing, the future is looking more and more secure.

Initiatives in Bioterrorism Preparedness

As fast as the University of Pittsburgh works to bring together its many already-existing, diverse research efforts in the areas of bioterrorism and national preparedness, several new initiatives have taken the University by storm, and they promise to elevate Pitt’s national and international prominence in such research even higher than before.

The new initiatives bring with them extensive federal funding for new labs, research, and expertise; world-renowned leadership; and opportunities to collaborate on some of the nation’s leading research in bioterrorism and national preparedness.

“These initiatives will position the University to make major contributions to global health by enhancing our defense against both naturally occurring and man-made infectious agents, and by offering data-based strategic advice, planning, and scholarly analysis with respect to biodefense, cybersecurity, and public health infrastructure,” says Arthur S. Levine, senior vice chancellor for the health sciences and dean of the School of Medicine.

Following is a list of recent initiatives at Pitt.

• Center for Biosecurity: This new center is the result of the world’s leading biodefense research and analysis center, the Johns Hopkins Center for Civilian Biodefense Strategies, becoming part of the University of Pittsburgh/University of Pittsburgh Medical Center team in the fall of 2003. The center remains headquartered in Baltimore, along with its senior faculty and staff, but it also will open offices in Pittsburgh and Washington, D.C.

  The staff includes eight faculty members from the Johns Hopkins center who have received appointments in Pitt’s School of Medicine and Graduate School of Public Health. Among them is the world-renowned D.A. Henderson, who is known for his work to eradicate smallpox. He is a senior advisor at the new center. Tara O’Toole, a former assistant secretary in the U.S. Department of Energy, serves as chief executive officer of the center, and Thomas Inglesby, who has served as deputy director of the Johns Hopkins center, is chief operations officer of the new center.

  The center’s mission, according to University officials, is to establish the University and UPMC as international leaders in bioterrorism preparedness, research, and response.

• Regional Center of Excellence member: The National Institute of Allergy and Infectious Diseases (NIAID) recently awarded five-year grants totaling $350 million to establish eight Regional Centers of Excellence (RCE) for Biodefense and Emerging Infectious Diseases Research. Pitt will receive a portion of this funding and serve as the primate research core facility for the institutions comprising the Mid-Atlantic RCE consortium, which is headquartered at the University of Maryland in Baltimore.

• Regional Biocontainment Laboratory: The NIAID has awarded the University of Pittsburgh a $17.5 million grant to construct a Regional Biocontainment Laboratory (RBL) in the University’s Biomedical Science Tower 3, which is under construction. When completed, RBL will be considered a Biosafety Level 3 facility, which means the laboratory will include double, self-closing doors; sealed windows, floors, ceilings, and walls; and its own ventilation system.

  This RBL, which is one of nine in the country being built with NIAID funding, will support the development of vaccines and treatments for a variety of exotic viruses and bacteria, including anthrax, dengue, hemorrhagic fever viruses, and encephalitis viruses. According to Levine, the University’s RBL will facilitate biodefense research efforts of the Middle Atlantic RCE for Biodefense and Emerging Infectious Disease Research, as well as new and continuing biodefense and vaccine research programs of Pitt investigators.

• Keystone Alliance: On April 28, 2003, the University joined Carnegie Mellon University, Penn State, and the University of Pennsylvania in kicking off the Keystone Homeland Security University Research Alliance. The alliance draws on the diverse but related research at the four universities. Together, they are among only a few sites nationally that are leading the work in national preparedness research and development.

  Pitt is contributing primarily its expertise in medicine, public health, international affairs, and computer science. The four schools together present a depth of research in nanotechnology, agricultural science, computer engineering, and food research.

  The alliance’s goal is to advance the educational needs of the U.S. Department of Homeland Security and its work in protecting the nation against bioterrorist attacks and medical emergencies, defending the food and water supply, and providing better computer network security.

  The alliance comprises two of the nation’s leading National Institutes of Health-funded medical research schools, two of the country’s top U.S. Department of Defense-funded universities, one of the largest agricultural science research colleges, and one of the top public health schools in the country.