Dietary protein intake and renal function

Recent trends in weight loss diets have led to a substantial increase in protein intake by individuals. As a result, the safety of habitually consuming dietary protein in excess of recommended intakes has been questioned. In particular, there is concern that high protein intake may promote renal damage by chronically increasing glomerular pressure and hyperfiltration. There is, however, a serious question as to whether there is significant evidence to support this relationship in healthy individuals. In fact, some studies suggest that hyperfiltration, the purported mechanism for renal damage, is a normal adaptative mechanism that occurs in response to several physiological conditions. This paper reviews the available evidence that increased dietary protein intake is a health concern in terms of the potential to initiate or promote renal disease. While protein restriction may be appropriate for treatment of existing kidney disease, we find no significant evidence for a detrimental effect of high protein intakes on kidney function in healthy persons after centuries of a high protein Western diet

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

Implementing a Case-Based Research Data Management Curriculum

OBJECTIVE: The Lamar Soutter Library of the University of Massachusetts Medical School is working with partner librarians at MBL-WHOI, Northeastern, Tufts and UMass Amherst on a NN/LM NER grant to author online modules and develop additional Research Data Management (RDM) Teaching Cases based on the UMMS/WPI Data Management Frameworks. The goal is to create an online curriculum to support these institution’s researchers’ data management (RDM) practices. METHODS: The criteria for module content were developed by an evaluation expert using the NSF data management plan requirements. To develop additional RDM Teaching Cases librarians conducted semi-structured data interviews with researchers. The librarians transcribed and coded these interviews using a validated RDM planning instrument to categorize the projects’ RDM challenges. The librarians then authored case narratives based on the data interview, highlighting these authentic challenges along with a set of discussion and comprehension questions to support learner outcomes. RESULTS: Currently there are seven modules in addition to the RDM Teaching Cases being authored by the project partners. The first drafts of the Module content and Teaching Cases are due for completion in spring 2013. CONCLUSIONS: A Data Management Curriculum and RDM Teaching Cases will provide libraries with an educational resource for teaching best practices and supporting their student and faculty research. These educational materials will help to provide researchers and future-researchers with valuable lessons to improve the management of their data throughout the stages of their projects, and will encourage them to see the relationships between managing their data and sharing their data in the future

The Outreach Continuum: Expanding the Medical Librarian’s Role

Objective: With the closing of the reference desk and implementation of a single service point, librarians have more time to engage in outreach. However, questions remain. What does management mean by outreach? What skills are needed to conduct outreach? The objectives of this study are to: (1) reach a common definition of outreach; (2) identify skills needed to perform outreach. Methods: Focus groups were conducted with librarians from three departments (clinical services, research, and technology initiatives) to gain an understanding of initial perceptions of the outreach function and work currently perceived as outreach. Findings from a cross-group analysis were validated with participants and used to inform a definition of outreach and a continuum of outreach activities requiring increasing skill levels. The skills and tools needed to perform outreach activities at each stage of the continuum were identified and cross-group collaboration will be used to develop tools and acquire needed skills. Results: Using a working definition of outreach detailed in the continuum (basic, relationship building, and partnering), librarians tracked outreach activities and mapped them to the continuum for three months. Through discussion, it became clear to librarians where current activities fell, where they needed to concentrate future efforts, and what strategies to use to move from basic interactions to relationship building and then to partnering. The continuum and tracking logs served as a data source for strategic planning and to assist staff with individual goal setting. Librarians found the tracking log to be cumbersome, but the benefits to management were evident. Conclusion: Tracking and categorizing the defined outreach activities is useful to raise awareness of the different types of outreach activity and identify areas for skill development. In the future tracking logs will be streamlined and automated. Presented at the Medical Library Association Annual Meeting on May 23, 2010, in Washington, DC

DVT Surveillance Program in the ICU: Analysis of Cost-Effectiveness

Background Venous Thrombo-embolism (VTE – Deep venous thrombosis (DVT) and/or pulmonary embolism (PE) – in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. Methods All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period – SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs – diagnostic, therapeutic and surveillance – for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated. Results 4234 patients were eligible (PSP – 1422 and SP – 2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) – p Conclusions Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society

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

Climate Change Implications for Irrigation and Groundwater in the Republican River Basin, USA

This study investigates the influence of climate change on groundwater availability, and thereby, irrigation across political boundaries within the US High Plains aquifer. A regression model is developed to predict changes in irrigation according to predicted changes in precipitation and temperature from a downscaled dataset of 32 general circulation models (GCMs). Precipitation recharge changes are calculated with precipitation recharge curves developed for prognostic representations of precipitation across the Nebraska-Colorado-Kansas area and within the Republican River Basin focal landscape. Irrigation-recharge changes are scaled with changes in irrigation. The groundwater responses to climate forcings are then simulated under new pumping and recharge rates using a MODFLOW groundwater flow model. Results show that groundwater pumping and recharge both will increase and that the effects of groundwater pumping will overshadow those from natural fluctuations. Groundwater levels will decline more in areas with irrigation-driven decreasing trends in the baseline. The methodologies and predictions of this study can inform long-term water planning and the design of management strategies that help avoid and resolve water-related conflicts, enabling irrigation sustainability

Studies of a Lacustrine-Volcanic Mars Analog Field Site with Mars-2020-like Instruments

On the upcoming Mars‐2020 rover two remote sensing instruments, Mastcam‐Z and SuperCam, and two microscopic proximity science instruments, SHERLOC and PIXL, will collect compositional (mineralogy, chemistry, and organics) data essential for paleoenvironmental reconstruction. The synergies between and limitations of these instruments were evaluated via study of a Mars analog field site in the Mojave Desert, using instruments approximating the data that will be returned by Mars‐2020. A ground truth dataset was generated for comparison to validate the results. The site consists of a succession of clay‐rich mudstones of lacustrine origin, interbedded tuffs, a carbonate‐silica travertine deposit, and gypsiferous mudstone strata. The major geological units were mapped successfully using simulated Mars‐2020 data. Simulated Mastcam‐Z data identified unit boundaries and Fe‐bearing weathering products. Simulated SuperCam passive shortwave infrared and green Raman data were essential in identifying major mineralogical composition and changes in lacustrine facies at distance; this was possible even with spectrally downsampled passive IR data. LIBS and simulated PIXL data discriminated and mapped major element chemistry. Simulated PIXL revealed mm‐scale zones enriched in zirconium, of interest for age dating. SHERLOC‐like data mapped sulfate and carbonate at sub‐mm scale; silicates were identified with increased laser pulses/spot or by averaging of hundreds of spectra. Fluorescence scans detected and mapped varied classes of organics in all samples, characterized further with follow‐on spatially targeted deep‐UV Raman spectra. Development of dedicated organics spectral libraries is needed to aid interpretation. Given these observations, the important units in the outcrop would be sampled and cached for sample return