A science impact framework to measure impact beyond journal metrics.

Measuring the impact of public health science or research is important especially when it comes to health outcomes. Achieving the desired health outcomes take time and may be influenced by several contributors, making attribution of credit to any one entity or effort problematic. Here we offer a science impact framework (SIF) for tracing and linking public health science to events and/or actions with recognized impact beyond journal metrics. The SIF was modeled on the Institute of Medicine's (IOM) Degrees of Impact Thermometer, but differs in that SIF is not incremental, not chronological, and has expanded scope. The SIF recognizes five domains of influence: disseminating science, creating awareness, catalyzing action, effecting change and shaping the future (scope differs from IOM). For public health, the goal is to achieve one or more specific health outcomes. What is unique about this framework is that the focus is not just on the projected impact or outcome but rather the effects that are occurring in real time with the recognition that the measurement field is complex, and it takes time for the ultimate outcome to occur. The SIF is flexible and can be tailored to measure the impact of any scientific effort: from complex initiatives to individual publications. The SIF may be used to measure impact prospectively of an ongoing or new body of work (e.g., research, guidelines and recommendations, or technology) and retrospectively of completed and disseminated work, through linking of events using indicators that are known and have been used for measuring impact. Additionally, linking events offers an approach to both tell our story and also acknowledge other players in the chain of events. The value added by science can easily be relayed to the scientific community, policy makers and the public.

CDC grand rounds: Creating a healthier future through prevention of child maltreatment.

Child maltreatment is abuse or neglect of a child by a parent or other caregiver that results in potential or actual harm or threats of harm to a child. Maltreatment encompasses both acts of commission (abuse) and omission (neglect). Child maltreatment is divided into four types: 1) physical abuse (e.g., hitting, kicking, shaking, or burning); 2) sexual abuse (e.g., rape or fondling); 3) psychological abuse (e.g., terrorizing or belittling); and 4) neglect, which involves the failure to meet a child's basic physical, emotional, or educational needs (e.g., not providing nutrition, shelter, or medical or mental health care) or the failure to supervise the child in a way that ensures safety (e.g., not taking reasonable steps to prevent injury). In 2012, a total of 1,593 children were reported to have died as a result of maltreatment in the United States. Also in 2012, state child protective service (CPS) agencies received an estimated 3.4 million reports of alleged maltreatment, involving an estimated 6.3 million children. Following the CPS investigation or other response, nearly 700,000 children were confirmed as having been maltreated. However, many cases are never reported to authorities; the actual scope of child maltreatment is greater. For example, data from a nationally representative survey in 2011 of children and adult caregivers (usually parents) suggest that 13.8% of children are maltreated each year and 25.6% experienced maltreatment at some point during childhood.

CDC Grand Rounds: preventing hospital-associated venous thromboembolism.

Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT detaches from the site of formation and becomes mobile in the blood stream. If the circulating clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism. The disease process that includes DVT and/or pulmonary embolism is called venous thromboembolism (VTE). Each year in the United States, an estimated 350,000-900,000 persons develop incident VTE, of whom approximately 100,000 die, mostly as sudden deaths, the cause of which often goes unrecognized. In addition, 30%-50% of persons with lower-extremity DVT develop postthrombotic syndrome (a long-term complication that causes swelling, pain, discoloration, and, in severe cases, ulcers in the affected limb). Finally, 10%-30% of persons who survive the first occurrence of VTE develop another VTE within 5 years.

CDC Grand Rounds: discovering new diseases via enhanced partnership between public health and pathology experts.

Despite advances in public health, medicine, and technology, infectious diseases remain a major source of illness and death worldwide. In the United States alone, unexplained deaths resulting from infectious disease agents have an estimated annual incidence of 0.5 per 100,000 persons aged 1-49 years. Emerging and newly recognized infections, such as hantavirus pulmonary syndrome and West Nile encephalitis, often are associated with life-threatening illnesses and death. Other infectious diseases once thought to be on the decline, such as pertussis, again are becoming major public health threats. Animals increasingly are being recognized as potential vectors for infectious diseases affecting humans; approximately 75% of recently emerging human infectious diseases are of animal origin. Increasing global interconnectivity necessitates more rapid identification of infectious disease agents to prevent, treat, and control diseases.

Public health grand rounds at the Centers for Disease Control and Prevention: evaluation feedback from a broad community of learners.

OBJECTIVE: To evaluate the relevance and educational benefit of monthly Public Health Grand Rounds (GR), an hour-long interactive lecture series featuring 1 current, relevant public health topic. DESIGN: Quantitative and qualitative analysis of data evaluating GR format and content submitted by 2063 continuing education (CE) participants. SETTING: Survey data submitted electronically to the Centers for Disease Control and Prevention online CE system from January 2010 through December 2011. PARTICIPANTS: Physicians, nurses, pharmacists, health education specialists, and other health care professionals seeking CE credits for Public Health GR. MAIN OUTCOME MEASURES: Proportion of respondents agreeing or strongly agreeing that GR is using educational strategies that enhance user learning and is meeting preidentified learning objectives. RESULTS: On questions involving instructional strategies and delivery methods, 95.0% and 95.6% of respondents, respectively, agreed or strongly agreed that the GR was conducive to learning. More than 90% of respondents agreed or strongly agreed that they could describe the burden of the disease/condition in question and identify key preventive interventions, knowledge gaps, and measures of public health progress. CONCLUSIONS: These evaluation results indicate that the GR is meeting content-specific and educational needs of diverse health care professionals. The GR models organized scientific discussions on evidence and translation into real-world impacts of decreased morbidity, mortality, and health care costs, and links public health to clinical practice. This promotes a greater understanding of the interplay of different health fields and may lead to greater and cross-disciplinary collaborations.

Investigations of selected historically important syndromic outbreaks: impact and lessons learned for public health preparedness and response.

Public health readiness has increased at all jurisdictional levels because of increased sensitivity to threats. Since 2001, with billions of dollars invested to bolster the public health system's capacity, the public expects that public health will identify the etiology of and respond to events more rapidly. However, when etiologies are unknown at the onset of the investigation but interventions must be implemented, public health practitioners must benefit from past investigations' lessons to strengthen preparedness for emerging threats. We have identified such potentially actionable lessons learned from historically important public health events that occurred primarily as syndromes for which the etiological agent initially was unknown. Ongoing analysis of investigations can advance our capability to recognize and investigate syndromes and other problems and implement the most appropriate interventions.

The scientific basis for law as a public health tool.

Systematic reviews are generating valuable scientific knowledge about the impact of public health laws, but this knowledge is not readily accessible to policy makers. We identified 65 systematic reviews of studies on the effectiveness of 52 public health laws: 27 of those laws were found effective, 23 had insufficient evidence to judge effectiveness, 1 was harmful, and 1 was found to be ineffective. This is a valuable, scientific foundation-that uses the highest relevant standard of evidence-for the role of law as a public health tool. Additional primary studies and systematic reviews are needed to address significant gaps in knowledge about the laws' public health impact, as are energetic, sustained initiatives to make the findings available to public policy makers.

Investigations of 2 cases of diphtheria-like illness due to toxigenic Corynebacterium ulcerans.

BACKGROUND: We present 2 case reports in the United States and investigations of diphtheria-like illness caused by toxigenic Corynebacterium ulcerans. A fatal case occurred in a 75-year-old male Washington resident who was treated with clindamycin but did not receive equine diphtheria antitoxin. A second, nonfatal case occurred in a 66-year-old female Tennessee resident who received erythromycin and diphtheria antitoxin. METHODS: Both case patients and close human and animal contacts were investigated by their respective state health departments. RESULTS: C. ulcerans isolated from the patient who died was resistant to erythromycin and clindamycin. For both isolates, conventional polymerase chain reaction results were positive for A and B subunits of diphtheria toxin gene tox, and modified Elek tests confirmed toxin production. The source of infection remained undetermined for both cases. Neither patient was up-to-date with diphtheria toxoid vaccination. CONCLUSION: These case reports highlight the importance of early treatment with diphtheria antitoxin, the selection of effective antimicrobial agents, and prevention through up-to-date vaccination.

Characterization of Bacillus cereus isolates associated with fatal pneumonias: strains are closely related to Bacillus anthracis and harbor B. anthracis virulence genes.

Bacillus cereus is ubiquitous in nature, and while most isolates appear to be harmless, some are associated with food-borne illnesses, periodontal diseases, and other more serious infections. In one such infection, B. cereus G9241 was identified as the causative agent of a severe pneumonia in a Louisiana welder in 1994. This isolate was found to harbor most of the B. anthracis virulence plasmid pXO1 (13). Here we report the characterization of two clinical and one environmental B. cereus isolate collected during an investigation of two fatal pneumonia cases in Texas metal workers. Molecular subtyping revealed that the two cases were not caused by the same strain. However, one of the three isolates was indistinguishable from B. cereus G9241. PCR analysis demonstrated that both clinical isolates contained B. anthracis pXO1 toxin genes. One clinical isolate and the environmental isolate collected from that victim's worksite contained the cap A, B, and C genes required for capsule biosynthesis in B. anthracis. Both clinical isolates expressed a capsule; however, neither was composed of poly-D-glutamic acid. Although most B. cereus isolates are not opportunistic pathogens and only a limited number cause food-borne illnesses, these results demonstrate that some B. cereus strains can cause severe and even fatal infections in patients who appear to be otherwise healthy.

Capsule production in Bacillus cereus strains associated with severe pneumonia.

We identified three encapsulated Bacillus cereus strains, isolated from patients with severe pneumonia, in a collection of B. cereus isolates associated with human illness. We found that the extent of capsule expression was influenced by culturing conditions. Our findings highlight consequent clinical and laboratory diagnostic challenges posed by such isolates.

Morphologic, immunologic, and molecular methods to detect bacillus anthracis in formalin-fixed tissues.

Due to the importance of Bacillus anthracis as a cause of naturally occurring infection among humans and as an agent of bioterrorism, there is a vital need for rapid and specific assays, including immunohistochemistry (IHC) and polymerase chain reaction (PCR) assays, to detect the bacterium in formalin-fixed tissues. Colorimetric IHC assays were developed using a multistep indirect immunoalkaline phosphatase method with anti-B. anthracis cell wall (EAII-6G6-2-3) and anti-B. anthracis capsule (FDF-1B9) mAbs to detect B. anthracis antigens in formalin-fixed, paraffin-embedded bacterial cultures and tissues. B. anthracis antigens were localized, using both antibodies, in samples from B. anthracis-infected animals and humans. The colorimetric IHC assay with both antibodies was expedient in diagnosing the presence of B. anthracis in formalin-fixed, paraffin-embedded tissue from bioterrorism-associated cases of inhalational and cutaneous anthrax and from a case of naturally occurring cutaneous anthrax. Using the same antibodies, confocal microscopy demonstrated the structure of replicating B. anthracis in tissues. B. anthracis-specific primers were successfully used with PCR to amplify and detect B. anthracis sequences derived from formalin-fixed tissues of anthrax cases. In this study, morphologic, immunologic, and molecular assays were used to study and diagnose 22 veterinary and human anthrax cases.

Molecular approaches to identify and differentiate Bacillus anthracis from phenotypically similar Bacillus species isolates.

BACKGROUND: Bacillus anthracis and Bacillus cereus can usually be distinguished by standard microbiological methods (e.g., motility, hemolysis, penicillin susceptibility and susceptibility to gamma phage) and PCR. However, we have identified 23 Bacillus spp. isolates that gave discrepant results when assayed by standard microbiological methods and PCR. We used multiple-locus variable-number tandem repeat analysis (MLVA), multiple-locus sequence typing (MLST), and phenotypic analysis to characterize these isolates, determine if they cluster phylogenetically and establish whether standard microbiological identification or PCR were associated with false positive/negative results. RESULTS: Six isolates were LRN real-time PCR-positive but resistant to gamma phage; MLVA data supported the identification of these isolates as gamma phage-resistant B. anthracis. Seventeen isolates were LRN real-time PCR-negative but susceptible to gamma phage lysis; these isolates appear to be a group of unusual gamma phage-susceptible B. cereus isolates that are closely related to each other and to B. anthracis. All six B. anthracis MLVA chromosomal loci were amplified from one unusual gamma phage-susceptible, motile, B. cereus isolate (although the amplicons were atypical sizes), and when analyzed phylogenetically, clustered with B. anthracis by MLST. CONCLUSION: MLVA and MLST aided in the identification of these isolates when standard microbiological methods and PCR could not definitely identify or rule out B. anthracis. This study emphasized the need to perform multiple tests when attempting to identify B. anthracis since relying on a single assay remains problematic due to the diverse nature of bacteria.