Evidence-Based Practice for Public Health Project: Final Report

There are numerous clinically based models for finding the “best evidence” for the diagnosis and treatment of disease. This process is called evidence-based medicine or EBM, which has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.1 The need for improved access to high quality public health information has been echoed in various forums involving public health professionals, librarians, and information specialists since the mid 1990s.2-6 The information needs of the public health workforce have become all the more urgent with the increasing frequency of emergence of new infectious diseases such as severe acute respiratory syndrome (SARS) and avian influenza, as well as the increasing concern about acts of bioterrorism, such as spreading anthrax spores via the US Postal Service in 2001. A major difficulty in meeting these needs is the great breadth of the public health discipline that makes it difficult to identify and collect a body of evidence-based literature to address the growing multitude of specific public health information needs. The public health workforce may be more diverse than any other group of health professionals7 and includes professionals trained in dozens of disciplines,4, 6 ranging from environmental health to veterinary medicine, from sanitary engineering to epidemiology. Access to evidence-based public health information has become a growing concern for medical librarians. In 1997, the National Library of Medicine (NLM) along with the Centers for Disease Control and Prevention (CDC), the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and other public health organizations formed the Partners in Information Access for the Public Health Workforce.8 The mission of Partners is to help the public health workforce find and use information effectively to improve and protect the public\u27s health. The Evidence-Based Practice for Public Health Project at the Lamar Soutter Library, University of Massachusetts Medical School, was initiated in 2001. At the start of this project there was little attention paid to best practices for population-based public health. The overall purpose of this project was to address the need for access to quality evidence-based public health information. In an effort to improve access to resources for evidence-based public health practice, the project has identified the knowledge domains of public health, public health journals and bibliographic databases, and evidence-based resources for public health practice. The project compared existing resources for locating, summarizing, synthesizing, and disseminating evidence-based information available to clinical medical practitioners with resources available to public health practitioners. We found that there were many more types of resources focused on clinical medical practice than on public health practice. The clinical medical resources were based on several different models of information search, summary, synthesis, and delivery, and some of most promising models had little or no presence in the public health arena. To explore and address this gap, the project sought to examine and classify the features of the clinical evidence-based medicine models, to assess their potential for improving access to evidence-based public health information, and to develop new models that could effectively address the unique needs of public health professionals. The project team undertook a qualitative study to determine the information needs of public health practitioners and to develop strategies to improve access to credible and relevant information. The study combined three objectives that previous investigators had generally pursued individually: (1) the characterization of information needs of public health practitioners, (2) the assessment of barriers to information access, and (3) the identification of typical information seeking behaviors. We have used the insights gained from the study to inform the construction of an extended classification of the types of information needed by public health professionals and of an information system model that could meet their needs for access to diverse credible sources

Improving Access to Public Health Information: A Study of Information Needs in a State Health Department

Background: Public health challenges can be better addressed if credible information about health risks and effective public health practices is readily available. The need for improved access to evidence-based public health information has been recognized by public health practitioners, researchers, policy makers, and librarians. Objective: To understand the information needs of the public health workforce and to improve access to credible and relevant information for public health practice. Methods: A qualitative study identified how public health professionals currently access information, what barriers they face, and what improvements they need. Nineteen individual interviews were conducted in two state health bureaus – communicable disease control and community health promotion. Follow-on focus groups were conducted to gather additional data on preferences for accessing information. Results: Public health professionals interviewed have a wide variety of needs and use different information sources depending on the areas of public health they work in and the diverse nature of their work. The types of information they use can be arranged in an information needs continuum ranging from early reports of disease outbreaks needed by those dealing with emerging diseases, to published reports, journal articles, systematic reviews, and evidence-based guidelines needed by those working on the prevention and control of well-known diseases and health threats. Information sources used by the participants include news resources, listservs, alert services, journal articles, conference proceedings, and email. The study revealed that public health practitioners face several barriers and limitations to accessing quality information for public health practice. These include lack to time and knowledge to find quality information; feeling bombarded with unfiltered and often duplicative information from listservs; and limited access to grey literature, systematic reviews, and full-text journal articles. Conclusion: Both groups expressed the need for access to information targeted towards their specific public health areas of interest and desired a way to filter information for more efficient access to relevant information. The research team developed a hypothetical model for the delivery and organization of credible and relevant public health information. Some of the participants were not aware of evidence-based public health resources currently available. An outcome of the project that is particularly beneficial to the public health workforce and information professionals is the project’s website, http://library.umassmed.edu/ebpph, which provides free online access to public health journals, databases, and evidence-based public health resources identified by the research team. Presentation at the 2006 Medical Library Association Annual Meeting, Phoenix, AZ

Enhancing evidence-based information access to inform public health practice

It is clear from the trend towards evidence-based practices in many fields that public health (PH) practice can be better informed if credible information about effective practices is accessible. Comparing sources of evidence-based information in clinical medicine to what is available for PH, we found fewer examples of readily accessible sources in PH. This project was conceived to identify enhancements to evidence-based information accessing needs of PH professionals. A qualitative study identified how PH professionals currently access information and what enhancements they need. Nineteen individual interviews were conducted across two state health department bureaus – communicable disease control and community health promotion. Follow-up focus groups were conducted to gather additional data on preferences for information accessing models and features. An information maturity continuum emerged ranging from fast-breaking news about emerging health threats to evidence-based practice guidelines. Needs within this continuum varied somewhat across bureaus, but both groups expressed needs for improved information access such as better organizing/filtering of information, access to systematic reviews and/or summaries as well as full text of articles, one portal access with a good search engine, and broader access to best practice information. Both groups identified a need for PH-specific filters to create more efficient access to relevant information either delivered to their desktops via listservs or sought via search engines. Informants stated a preference for making enhancements to systems with which they were already familiar such as PubMed. Oral presentation at the 133rd Annual Meeting of the American Public Health Association; Abstract 108127, Session 5134. Philadelphia, PA

Improving Access to Credible and Relevant Information for Public Health Professionals: A Qualitative Study of Information Needs in Communicable Disease Control

In order to understand the information needs and the current and ideal approaches to information access in one major area of public health, semi-structured key informant interviews were conducted with 12 communicable disease control public health professionals in Massachusetts at their worksite. Examples of the types of information they commonly accessed and how it was accessed were solicited and/or observed where feasible. The interviews were transcribed and analyzed thematically. Information needs ranged from breaking news (e.g. epidemiology of emerging disease outbreaks) and untested programmatic ideas (e.g. how to handle prevention and treatment of West Nile Virus and SARS) to the need for published evidence-based information about better known diseases (e.g. tuberculosis and HIV/AIDS). Current preferences for information delivery mechanisms varied according to the type of information sought. Information about emerging diseases and programmatic interventions to address these were more often obtained from email alert systems and from informal local and national networks of colleagues via telephone, teleconference or special interest listservs. Information about more well-known diseases was often obtained via websites, general or specific journal search engines, or from listservs providing citations to new or updated sources of information about these diseases. Informants identified improvements to the existing information access and delivery systems that could meet their needs more effectively. This session will review areas for improvements identified by informants and suggest models that can be implemented to help public health professionals access credible and relevant information. Oral presentation at the 2004 American Public Health Association Annual Meeting, Washington, DC

Accelerator Mass Spectrometry at Arizona: Geochronology of the Climatic Record and Connections with the Ocean

There are many diverse uses of accelerator mass spectrometry (AMS). 14C studies at our laboratory include much research related to paleoclimate, with 14C as a tracer of past changes in environmental conditions as observed in corals, marine sediments, and many terrestrial records. Terrestrial records can also show the influence of oceanic oscillations, whether they are short term, such as ENSO (El Niño/Southern Oscillation), or on the millennial time scale. In tracer applications, we have developed the use of 129I as well as 14C as tracers for nuclear pollution studies around radioactive waste dump sites, in collaboration with IAEA. We discuss some applications carried out in Tucson, AZ, for several of these fields and hope to give some idea of the breadth of these studies

Infant Botulism

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66984/2/10.1177_000992289303201105.pd

Structural insights into Clostridium perfringens delta toxin pore formation

Clostridium perfringens Delta toxin is one of the three hemolysin-like proteins produced by C. perfringens type C and possibly type B strains. One of the others, NetB, has been shown to be the major cause of Avian Nectrotic Enteritis, which following the reduction in use of antibiotics as growth promoters, has become an emerging disease of industrial poultry. Delta toxin itself is cytotoxic to the wide range of human and animal macrophages and platelets that present GM2 ganglioside on their membranes. It has sequence similarity with Staphylococcus aureus β-pore forming toxins and is expected to heptamerize and form pores in the lipid bilayer of host cell membranes. Nevertheless, its exact mode of action remains undetermined. Here we report the 2.4 Å crystal structure of monomeric Delta toxin. The superposition of this structure with the structure of the phospholipid-bound F component of S. aureus leucocidin (LukF) revealed that the glycerol molecules bound to Delta toxin and the phospholipids in LukF are accommodated in the same hydrophobic clefts, corresponding to where the toxin is expected to latch onto the membrane, though the binding sites show significant differences. From structure-based sequence alignment with the known structure of staphylococcal α-hemolysin, a model of the Delta toxin pore form has been built. Using electron microscopy, we have validated our model and characterized the Delta toxin pore on liposomes. These results highlight both similarities and differences in the mechanism of Delta toxin (and by extension NetB) cytotoxicity from that of the staphylococcal pore-forming toxins

Identifying strategies to improve access to credible and relevant information for public health professionals: a qualitative study

BACKGROUND: Movement towards evidence-based practices in many fields suggests that public health (PH) challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access. METHODS: Nineteen individual interviews were conducted among employees of two domains in a state health department – communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts. RESULTS: Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who reviewed it. CONCLUSION: Many critical information needs of PH practitioners are not being met efficiently or at all. We propose a dual strategy of: 1) promoting incremental improvements in existing information delivery systems based on the expressed preferences of the PH users of the systems and 2) the concurrent development and rigorous evaluation of new models of information organization and delivery that draw on successful resources already operating to deliver information to clinical medical practitioners

Characterization of Botulinum Neurotoxin Type A Neutralizing Monoclonal Antibodies and Influence of Their Half-Lives on Therapeutic Activity

Botulinum toxins, i.e. BoNT/A to/G, include the most toxic substances known. Since botulism is a potentially fatal neuroparalytic disease with possible use as a biowarfare weapon (Centers for Disease Control and Prevention category A bioterrorism agent), intensive efforts are being made to develop vaccines or neutralizing antibodies. The use of active fragments from non-human immunoglobulins (F(ab')2, Fab', scFv), chemically modified or not, may avoid side effects, but also largely modify the in vivo half-life and effectiveness of these reagents. We evaluated the neutralizing activity of several monoclonal anti-BoNT/A antibodies (mAbs). F(ab')2 fragments, native or treated with polyethyleneglycol (PEG), were prepared from selected mAbs to determine their half-life and neutralizing activity as compared with the initial mAbs. We compared the protective efficiency of the different biochemical forms of anti-toxin mAbs providing the same neutralizing activity. Among fourteen tested mAbs, twelve exhibited neutralizing activity. Fragments from two of the best mAbs (TA12 and TA17), recognizing different epitopes, were produced. These two mAbs neutralized the A1 subtype of the toxin more efficiently than the A2 or A3 subtypes. Since mAb TA12 and its fragments both exhibited the greatest neutralizing activity, they were further evaluated in the therapeutic experiments. These showed that, in a mouse model, a 2- to 4-h interval between toxin and antitoxin injection allows the treatment to remain effective, but also suggested an absence of correlation between the half-life of the antitoxins and the length of time before treatment after botulinum toxin A contamination. These experiments demonstrate that PEG treatment has a strong impact on the half-life of the fragments, without affecting the effectiveness of neutralization, which was maintained after preparation of the fragments. These reagents may be useful for rapid treatment after botulinum toxin A contamination