Packaging and shipping capabilities of New York State hospital laboratories: a 3-year drill assessment.

In a previous publication, we discussed the results of the 2006-2007 New York State (NYS) Hospital Laboratory Drill Series which emphasized the need for ongoing testing and evaluation of laboratory preparedness capabilities, particularly those required to support hospital functions during a public health emergency. In this paper, we will discuss how a followup drill series in 2007-2008 was implemented in an effort to re-assess the ability of NYS acute care hospital facilities to recognize and respond to a suspected bioterrorism, chemical terrorism or pandemic flu emergency specimen submission event. We will explain how the results of the follow-up drill series, when compared to those of the original exercise, warranted a statewide hospital laboratory preparedness drill held in 2009, focused solely on addressing the overarching deficiency of chemical terrorism (CT) specimen submission capabilities. Although drill results conclude that NYS acute care hospital facilities are much better prepared than 3 years ago to support hospital functions during a CT public health emergency event, they also highlight the continued need to improve competency.

Functional assessment of hospital laboratory packaging and shipping preparedness in New York State.

The 2006-2007 New York State (NYS) Hospital Laboratory Drill Series was implemented in order to test notification, referral and packaging and shipping (P&S) procedures at acute care hospital facilities (statewide, excluding New York City) that submit suspect bioterrorism (BT), chemical terrorism (CT), and/or pandemic influenza (Pan Flu) clinical specimens to the NYS Department of Health (DOH) Wadsworth Center for confirmatory testing. Results showed that 97% and 84% of hospital facilities had the ability to directly access the notification network and retrieve drill guidance, respectively. Most hospital laboratories (92%) demonstrated the ability to refer specimens to the Wadsworth Center laboratory. Evaluation of specimen submissions found that 68% of BT packages, 27% of Pan Flu packages, and 20% of CT packages arrived to the laboratory with no P&S deficiencies. It can be concluded that acute care hospital facilities in NYS are more prepared to refer and submit clinical specimens during a BT public health emergency than during a Pan Flu or CT emergency event.

Progression or resolution of coxsackievirus B4-induced pancreatitis: a genomic analysis.

Group B coxsackieviruses are associated with chronic inflammatory diseases of the pancreas, heart, and central nervous system. Chronic pancreatitis, which can develop from acute pancreatitis, is considered a premalignant disorder because it is a major risk factor for pancreatic cancer. To explore the genetic events underlying the progression of acute to chronic disease, a comparative analysis of global gene expression during coxsackievirus B4-induced acute and chronic pancreatitis was undertaken. A key feature of acute pancreatitis that resolved was tissue regeneration, which was accompanied by increased expression of genes involved in cell growth, inhibition of apoptosis, and embryogenesis and by increased division of acinar cells. Acute pancreatitis that progressed to chronic pancreatitis was characterized by lack of tissue repair, and the expression map highlighted genes involved in apoptosis, acinoductular metaplasia, remodeling of the extracellular matrix, and fibrosis. Furthermore, immune responses appeared skewed toward development of alternatively activated (M2) macrophages and T helper 2 (Th2) cells during disease that resolved and toward classically activated (M1) macrophages and Th1 cells during disease that progressed. Our hypothesis is that growth and differentiation signals coupled with the M2/Th2 milieu favor acinar cell proliferation, while diminished growth signals and the M1/Th1 milieu favor apoptosis of acinar cells and remodeling/proliferation of the extracellular matrix, resulting in fibrosis.