108 Charles Brokopp

>> I'm really excited about being able to spend a little bit of time with you this evening to talk about the Wisconsin State Lab of Hygiene. It really is your public health and environmental lab here in Wisconsin. We do a lot more than bioterrorism and emerging infections. But as I go through, I'll emphasize a few of those areas, as well. I'd like to share with you a little history of the State Lab of Hygiene. We'll do almost a virtual tour of some of our areas, and then discuss some of the current roles that the State Lab of Hygiene fulfills here at the University and in Wisconsin. We had some very early beginnings here at the University of Wisconsin. Back in 1903, the legislature passed a law and appropriated the big sum of $1,500 to establish a laboratory known as the Hygienic Laboratory on the campus of the University of Wisconsin. The laboratory was first opened in October of 1903, in the basement of what is now Ag Hall just up the street from this building. It was a very modest one-room laboratory that primarily focused on bacteriological analysis of water and a little later on, some bacteriological testing for a number of infectious diseases. 

The laboratory was founded on what's often being referred to as the "Wisconsin Idea." Back around 1902, Governor Robert LaFollette and the UW President, President Van Hise, got together and they came up with something known as the "Wisconsin Idea." And in short, what the Wisconsin Idea means is a way to take the resources, the knowledge of the University of Wisconsin to the corners of the state, to benefit state government, local government, and really all the citizens of our state. I might point out that this is the year when the School of Medicine at this University is celebrating their 100th anniversary, and not to be outdone, but the State Lab of Hygiene has actually been around a little bit longer than the School of Medicine. The State Lab of Hygiene specifically attached to the University, which is somewhat unique for laboratories like ours, many of the public health and environmental laboratories are really attached to a state executive like the Department of Health or the Department of Natural Resources or Environment. But in Wisconsin, the decision was made very early on to place this laboratory at the University of Wisconsin and give it the challenge of meeting part of a scientific mission of the university, participate in teaching, participate in research, and above all, to promote public health throughout the state. Some early shots from our laboratory. This is the first laboratory. The second laboratory was actually moved from the Agriculture building over to South Hall, which is up on Bascom Hill. That laboratory actually expanded. 

They hired a few more people. They expanded the scope of testing. They primarily focus on water quality, a little bit of air quality, and that's where they really began testing for contagious and communicable diseases, shortly after the turn of the century. From there, in 1928, the lab was moved down to what was then called Wisconsin General Hospital, which is the old University Hospital, right behind where we are. And again the mission of the laboratory expanded, and we became the laboratory to support the Department of Health and Family Services, and the laboratory to support the Department of Natural Resources here in Wisconsin. We're actually established in the statutes. The Wisconsin Statutes, among other things, indicate that the Wisconsin State Lab of Hygiene should be a facility for teaching in the fields of public health and environmental protection. And I think today, as I look at laboratories like ours around the country, I'm one of the few people who have actually directed three other laboratories similar to ours. I can honestly say that here in Wisconsin, we've taken that mission very seriously and have done a lot more with that than what many of the other states have. For example, Dean Bardeen, back in 1914, the Dean of the Medical School, he had a joint appointment as Director of the State Lab of Hygiene. 

Later on, Dr. Al Evans was named director the laboratory. At the time, he was also chair of the Department of Preventative Medicine. And more recently, in my time, and in fact I might mention that I started my public health career in the building and laboratory that I now direct. And Dr. Stan Inhorn was instrumental in convincing me that I really ought to go back to graduate school. And little did I think after going back to graduate school, and going to the CDC, and out west for a number of years that I would have this opportunity to come back to the University of Wisconsin. But Dr. Inhorn was chair of the Department of Pathology and also director of the laboratory. More recently, up until 2006, Dr. 

Ronald Laessig was director of the lab and also a professor of Pathology and in Population Health Sciences. The statutes that created the State Laboratory of Hygiene also indicated that there would be an autonomous or independent board to provide direction to the laboratory. That board consists of the Chancellor of the University or his designee and the secretaries of the three agencies that we support. And those are the Department of Heath and Family Services, the DNR and the Department of Ag, Trade and Consumer Protection. Each of those secretaries can identify an individual to sit on our board. In addition to that, the Governor appoints a physician to represent clinical laboratories, a person from the environmental laboratory industry, someone from the occupational health lab industry, a person from local the health department, and then three public members, one of whom must be a coroner or medical examiner here in Wisconsin. We support and serve a lot of people throughout Wisconsin by providing clinical and environmental testing. More recently, we expanded our laboratory to provide occupational health testing and industrial hygiene testing. I'll say a little bit more about that a little later. But the people who use our laboratories are physicians, hospitals and clinics, as well as a number of federal agencies that rely on the work that we do next door. 

We work very closely with the Center for Disease Control, the EPA, with OSHA, with the USGS, and a number of public health environmental projects that impact many of us here in Wisconsin. We also like to think that we are the laboratory that supports the local health department infrastructure throughout the state. We support them, as well as the Tribal Health Centers here in Wisconsin. We also have an academic mission. And we are always looking out for other places on campus where we could link up with other researchers to provide laboratory support to projects that they are already undertaking. Our staff are actively involved in a number of professional and research associations such as the American Waterworks Association, the American Professional Hygiene Association, and the Association of Public Health Laboratories. Although we are not a private laboratory like you would see elsewhere in the state, we do do some work directly for the citizens upon request. Usually these requests are funneled through the Department of Health or through the Department of Natural Resources. And one of the other things that we have become since the late 1980s, has been the primary bio and chemical terrorism laboratory to support emergency responses here in Wisconsin. And we do that by being a part of the National Environmental Response Network. 

So what do we do? If we look at the scope of everything that we do in our laboratory, we're primarily a reference testing laboratory for clinical specimens. We're involved in the teaching mission at the university. We have an active research program, and a very active outreach program, looking for ways to take our services throughout the entire state. We do that from two main locations here in Madison. The first is the building next door, 465 Henry Mall. That's the building that was built specifically for the State Lab of Hygiene in 1953. And that building today houses our communicable disease division, the disease prevention division, and our laboratory improvement division, and the management offices for our laboratory. That's about a 100 square foot building. In addition to that, in 1999, we dedicated a building out on the East Side of Madison out near the Department of Agriculture. 

And that's where we house our environmental health division, where we have a large environmental sciences laboratory, an occupational or industrial hygiene laboratory, as well as our forensic toxicology laboratory is housed in that building, which is about 72,000 square feet. That, for some reason, shrank down. You can probably see it a whole lot better on your handout. I apologize for that. This is sort of the organizational structure of our laboratory. And I don't want to really go into that, in much detail. I guess I would rather talk about the staff that we have at our laboratory. We currently have about 340-350 staff. About 25 of those are either faculty or academic staff. We've got a little over 300 classified staff, mostly microbiologists, chemists, medical technologists in the laboratory. 

And then we always have a number of students who are coming in for various types of training at the lab. If you look at kind of the budget of our operation, we're about a $40 million a year laboratory. And of that amount, we are required to raise funding for three-quarters, or about $30 million. We do that by charging fees for some of the testing, by entering in to agreements with other governmental agencies to do special work for them, and by soliciting research proposals, grants and contracts to support our operation. Only about a quarter of the resources that we use in the laboratory come from the state GPR and state tax dollars. Of that one-quarter, we spend two-thirds of that basically providing laboratory services to the Department of Health and Family Services and to DNR. Only about a third of that amount, or something less than $2 million to support the academic mission of our laboratory. Our lab has some very well defined strategic goals. I won't go into those in a lot of detail, but I just want to highlight a couple key areas. We believe that the future, for us to be successful in the future, we really need to network with a number of laboratories around the state. 

So we've developed fairly sophisticated networks of these laboratories, both clinical laboratories and environmental laboratories, that could help us in the event we ever encountered some type of a severe public health or environmental disaster, including things like biochemical, or biological, or radiological emergencies. One of our other goals is to implement and integrate new technologies throughout the laboratory. Some of these are emerging technologies that we work mostly with others on campus to develop. And we're constantly looking for ways to implement, for example, molecular assays not just in a clinical laboratory, but in our environmental laboratory, our newborn screening lab, as well as other cytogenetic lab services. One of the most difficult things, I think, today about directing a laboratory is finding qualified people to fill the positions that we have. It's getting more and more difficult all the time to attract people to your lab and then also to keep people in our laboratory. We see people come in, and they spend a couple years. They retrain them. The next thing you know they're going across town or they're doing what I did, and get out of the state because of better professional opportunities. One of our major goals is to focus on workforce development in an effort to hire the best and keep the rest. 

Our fourth goal is one that builds upon what we see as one of those key goals of the laboratory. And that is as a collector and distributor of laboratory information. We're actively involved in collecting information from clinical labs and we're working on the environmental laboratory sector as well, so we can collect that information as part of a statewide surveillance network. And we can report that to either the DNR or to the Department of Health to support their surveillance activities. The next few slides deal with our communicable disease division. We have a very highly respected and well-equipped, and well-trained bioterrorism laboratory next door. This laboratory is registered as a select agent laboratory with the Center for Disease Control, which basically means they're registered to handle some of the most dangerous biological pathogens. We have BSL-3 laboratory capability, which means that many of these pathogens, things like the organisms that cause Anthrax, Tularemia, and others, can be safely handled within our laboratory. The communicable disease lab supports outbreak responses throughout the state by working closely with local health departments and the Department of Health. And we've really become quite good at being, or priding ourselves on the fact that we, on several occasions, have been the first lab in the country to identify a multi-state outbreak of a disease, and to characterize the organism or the cause of the disease, and to submit that and share that information with CDC and other states. 

We're actively involved in a program called pulse-net, which is a technology that allows us to take an organism that might be isolated from food, and an organism that comes from somebody who might have been ill, or some other source; and can not only identify them as the same genus and species, but to say that genetically they are identical strains. And that capability has been a real boon to us in public health, because we now have a tool that allows us to track definitively associations, where before we just couldn't. "Well it's the same organism, but so what?" There's a lot of people in the community that may have the same organism. Now we can go to a subspecies level and identify whether it's actually the same strain. That's been very helpful in these multi-state outbreaks of E. coli 0157 on spinach and lettuce, and outbreaks of Salmonella in various types of food recently. The communicable disease lab provides reference testing for a whole host of infectious diseases. We do very little primary testing, meaning we don't look at a lot of clinical specimens. They go to a clinical laboratory first. 

The clinical lab identifies something that needs further work up, and that organism comes into our lab, so we can do the definitive testing on diseases like Tuberculosis, Rabies, HIV, Measles, and a whole host of other infectious diseases. (inaudible) >> In the case of bioterrorism, if there was a powder that somebody really thought contained a bioterrorism agent, that would come to us directly from law enforcement. We've set up very good working relationships with law enforcement and those who would be on-scene to initiate those investigations. They would bring those types of samples directly to our lab. But in a clinical sense, if someone was exposed to one of these agents, and after an incubation period they developed Tularemia, or they developed Anthrax, and the clinical lab isolates the organism from blood culture, or from another clinical specimen-- When they have worked that up sufficiently to suspect that this could possibly be Anthrax, at that point, they will package that and get it in to us, and we will do additional definitive testing on those organisms to support any kind of an outbreak. >> Is it safe that they bring samples to you, instead of you going and picking up the samples and holding them with proper procedure? >> It's probably safer to have people bring that sample to us. Now the people who would be bringing that sample to us, we have actually trained on the safe handling practices, how to safely collect the sample, how to package that, how to ensure that nothing is going to leak, and there's not going to be any hazard associated with them bringing a sample into our lab. Once it gets into our lab, then we put it into containment and handle that so that none of our people would be exposed. (inaudible) We have a network of people primarily in law enforcement and emergency responders who would likely maybe be out on the scene. 

We have those people trained. We've also trained laboratorians in about 135 labs around the state, so if they see a specimen that is suspicious for one of these organisms, that they will then safely package that and ship that in to us in a safe and rapid manner. (inaudible) That's a little bit hard to define but we are-- >> Could you repeat the question? >> Yes, how many cases do we get in a year? I'm really not sure how I can answer that. I'm just not sure how to give you an exact number. If you were talking about something like tuberculosis, you know, how many samples would we get to support that? (inaudible) Most of the things that come into our lab come in by courier or they are shipped through another means. On any given day, we probably receive in the neighborhood of five to 500 or 1,000 samples to be worked up. Does that give you some idea? 

I mentioned earlier this ability to differentiate between organisms of the same strain. We do that by a technology known as PFGE or Postfield Gel Electrophoresis. Basically that's a molecular typing assay. Our laboratory is probably one of the more advanced in the country in developing and using these types of tools. We also have a diagnostic virology lab. One of our main focuses there is influenza. And the laboratory is also involved in doing tests for rabies. Whenever there is a potential rabies exposure, someone gets bit by a bat, and the bat is captured, that comes in and we'll test the animal for rabies in an effort to minimize the need for prophylaxis of people who may be exposed. I mentioned tuberculosis. Yes? 

(inaudible) Everything gets autoclaved. Then we have a commercial company that will come by and pick up all of that material. Then I believe it's either incinerated or landfilled. (inaudible) What do we use that for? (inaudible) We use Postfield Gel to take DNA, make the fragments, and then compare the fragments from one organism to the fragments we get from another organism from another source. Basically, if we get a similar distribution of the fragments, we can say they are the same strain. (inaudible) Yes. Did you have a question? >> Do you do anything that would be resistant to autoclaving...? (inaudible) >> We do not in our laboratory. 

I think there's maybe another lab on campus that may handle something like that. Yes? >> Do you do anything with all of the hospitals in the United States and the incidence of Staph infections, MRSA, or others like it? >> The question was do we do anything with the hospitals and look for unusual or maybe drug resistant organisms. And we do. We work with the hospitals, not in the United States so much, but particularly here. >> Where's here? >> On campus. It is a nationwide problem, but we work with the hospitals here. If we isolate an organism like MRSA, VRSA or a highly drug-resistant organism, we can identify that. 

We will then share that organism with colleagues at the Center for Disease Control in Atlanta, where they can then do additional typing and susceptibility on that organism. But in most cases, the clinical labs would refer that organism to us initially. I mentioned tuberculosis is a disease here in Wisconsin that we thought we would get rid of, but it just hasn't quite happened. In our lab, it's primarily the tuberculosis lab for the state. We not only isolate the organism, but we determine the drug susceptibilities to that. And with newer technology, it no longer takes six to eight weeks to identify the organism. We can actually do it in about 24-48 hours. We've got new technologies for working with influenza virus. Primarily, this will allow us to determine drug susceptibilities of some of the newer anti-viral agents. And this is very important, because some of the more common strains of influenza, about 80% of them have recently been shown to be resistant to some of the drugs that we have been using for a number of years. 

We've got the ability to do a variety of influenza testing to support any kind of surveillance. Dr. Pete Shult and Carol Kirk in our lab have developed a national reputation, a national leader in providing that information to other labs around the country on an annual basis. They've established a network of hospital laboratories to submit clinical specimens to us, and have also identified several hundred positions in clinics that are using rapid tests with influenza. So when they get a positive with that, they send not only that positive in, but the clinical specimen in for us to attempt to isolate that virus. One of the other successful things that we have done in our communicable disease lab is to participate in the National Laboratory Response Network. The Lab Response Network is a large group of diverse laboratories that have agreed to standardize procedures for how we would respond to a bioterrorism attack or other significant public health event. This includes sentinel laboratories, which is a kind of clinical labs, reference laboratories, which we are a state reference and kind of a national reference lab, and then those few laboratories at the top of this pyramid, laboratories like the CDC in Atlanta, and others, that have the ultimate BSL-4 Laboratory Safety capabilities, serve as the definitive lab for this network. This is a network that has evolved since about 1990, when CDC, the FBI and the Association of Public Health Laboratories formed a partnership and have been working on this ever since. We often criticize government, particularly federal government for not doing things correctly, or not doing it right. 

But I've got to say that this was a true partnership that took some very enlightened leadership at the federal level to bring CDC, the FBI, and all of the state public health labs together to sit down and identify what do we really need to have as a nation to respond appropriately to a bioterrorism attack. Not only did they work out the methods and the details, standardize a lot of that, but the Department of Health and Human Services went to bat to Congress to obtain funding that funded not only the federal component of this, but they recognized the need to have these labs established around the country. So they put money in there to support laboratories in all 50 states to develop this capability and to support this network. The slide that shows the laboratories that have been established. I think there are about 170 or so, now. Every state has at least one LRN lab. We followed that national model here in Wisconsin. Dr. Pete Shult and others were instrumental to developing what we refer to as the Wisconsin Lab Response Network. We've got about 135 hospitals and clinical labs that participate in this network. 

As part of that they receive training, consultation, and reference testing to support their local activities. If it wasn't for this network, we would never identify a number of the outbreaks that you read about in the newspaper. Outbreaks like the contaminated spinach that occurred in the Fall of '06. The reason that we were able to be the first in the nation to identify there was this outbreak, was the fact that some of these local labs identified the organism, shipped it in to us. And all of a sudden, we're getting the same organism from three different areas of the state. And something like that should lead one to wonder, there is a common source. Why are we seeing this? Is it a new strain? Is there something unusual about it? Because of the way that we have established this network of labs in the state, they're well-primed to quickly ship these specimens to us so that we can follow up and make those associations. 

Yes? (inaudible) >> What do they do? Do they actually take samples from the patient? How do they know that what they're isolating is something that's important? >> Well, the microtechnologists or the microbiologists in the hospital laboratory, they have been trained. And most of them understand that they can work up a sample to identify an organism. And if that organism is one that causes a recordable disease here in Wisconsin, a Salmonella, a Shagella, you know, something like that, then that organism would be sent to us. Now for clinical management purposes, simply knowing what the organism is, and probably more importantly, knowing what drugs it's susceptible to, that testing can be done at the local level. But when it comes time to making associations between a person who is sick in Monroe, and one in Deerfield, and three in Madison, someone on a larger scale needs to get those organisms, bring them into the lab and do that epidemiological typing that helps us out in Public Health. >> They have a clinical sample. 

They identify it. They type it so they know what it is? >> They could do that, yes. >> What are their requirements? >> To report the disease. With laboratories, there is a strong recommendation that those isolates be submitted to the State Lab of Hygiene. There is not a hard and fast requirement that the organism be sent. In some states there is. >> Samples like that from several diverse places, do you have staff of epidemiologists or people who do the quick work to rule out and find out where the factory is that produced...? >> We have two epidemiologists on staff. 

But we refer that information to the Department of Health, the Division of Public Health. They then work closely with the local health departments to track down possible sources, to go out and bring in additional samples that will help us further track these things down. I'd like to move on to another area of our lab. And that's our disease prevention area. Many of you have probably heard of newborn screening. I want to highlight this one because in my mind, this is the most effective public health program that I can think of. Every child born in Wisconsin, shortly after birth, has somebody prick them in the heel and take five drops of blood and put in on a piece of filter paper. That filter paper is then sent into our laboratory, where we test it for about 47 different metabolic, endocrine, or immunologic diseases. We're testing about 70,000 newborns in Wisconsin every year, and we test them for things like PKU, which is a metabolic disease that results when the body cannot break down an amino acid, and so it builds up in the body and then has some very serious developmental effects on the child at a very early age if it's not detected. All states perform newborn screening. 

Some states only test for about 12 of these conditions. Other states test for 60-65 of these conditions. We're currently testing for about 47 of them here in Wisconsin. And even though these children are quite rare, depending on the condition we may find 20 children a year, we may find five, or we may not find any in any given year. They're that rare. But the things that we screen for, are things that if identified, there is an intervention, or there is a treatment, or there is a special diet that will result in that child having a much better life. Without screening, many of these children would end up in state institutions, many would not live beyond their first year of life. So this is really a very successful public health program that the laboratory supports. I want to mention just one of these you'll probably be reading more about in the next few days. And that's Severe Combined Immunodeficiency. 

This is the "bubble baby syndrome" where a child is born without any immune system. They don't have the cells to produce an immune response. We're not sure how frequent that is in Wisconsin. Some of our early studies have shown that maybe we might see one a year. We're aware of about 15 children at the present time who are from Wisconsin who have had that condition. The reason we're going to begin screening for that, one is we have developed a technology in the last year that we are very comfortable with. If we can identify these children shortly after birth, these children can undergo a bone marrow transplant and completely turn this around. So by having this transplant they can develop a fairly normal immune system. And we believe they'll live a normal life. Without it, six months, maybe a year, and that would be all. 

We're quite excited about this. It's been one of the major research efforts this past year. And just today we have been working with the Department of Health to put in place an emergency rule to actually add this to the newborn screening panel here in Wisconsin. We also have, in our laboratory a school of cytotechnology that trains people primarily to do pap smears and others. We have a laboratory that does cytogenetics. Some of the people in our lab have been pioneers in the development of some of these assays. They're rapidly involved in teaching both the medical genetics and in research to develop new methods for identifying, at the molecular level, a number of these types of diseases. (inaudible) What cytogenetics is? Oh, what that is. What those are, that's chromosomes. 

And I've got one-- There's something that's abnormal. And I don't see exactly-- It's chromosome 11. I'll do this. It's chromosome 11. You see? They should be identical when you look at them. Now the fact that they're curved is just the way that they're isolated from the cell itself. But if you look at 11 and 13, what's actually happened here is a piece of 13 is missing. It attached to 11. We do that type of chromosome analysis in our cytogenetics lab. 

And depending on the rearrangement, the abnormality of the chromosome, some of those things are associated with clinical conditions. So we do this looking at, in some cases, prenatal tests. In some cases, we'll run this on infants that may be born with a condition that might be of chromosome or genetic origin. (inaudible) There are 21 pair of chromosomes here. And these would be chromosomes from a single cell and a single person. We basically process the specimen and isolate the chromosomes and then analyze them under a microscope. (inaudible) Bone marrow donors are, in many cases, a sibling, another child if there is one. It could be a parent, would be a pretty close match. And the fact that there's a transfusion that occurs early in life, there are fewer rejection problems in the child themselves. The treatment has been very successful in most cases. 

Yes? >> With all this information we have, has anyone looked at... (inaudible) >> We are beginning to do some of that in our cytogenetics lab where we know certain types of cancers are associated with certain abnormalities in chromosomes. And probably about a third of the work in cytogenetics is cancer patients. We're trying to associate abnormalities in the chromosomes with the type of cancer that they have. Yes? (inaudible) There are requirements about who can be a donor. If they have some type of known genetic condition, if they have various types of other things, they don't use them for a donor. We're running low on time. I would like to just mention a little bit about our environmental health lab. 

We analyze local drinking water to determine if there are contaminates in drinking water, either microorganisms or various chemicals that might be present in the water. That's been one of the things that the public health lab has been doing for over 100 years. An example of someone in our radiochemistry laboratory looking for radioactive material that might be present in primarily surface water. Our laboratory does a lot of outdoor air quality measurement to support DNR. A lot of this is research testing, looking for very, very low levels of contaminants in the air. We do some of this in cooperation with colleagues in civil and environmental engineering who have a number of research projects underway. In order to test air samples and look for say, metals at a very low level, you have to do that at a lab that is virtually metal free. This is an example of our ultra-low trace element laboratory. If you look in there, the hoods here, a lot of the counterwork, wherever we can, we've taken the metal out of the lab and replaced that with plastics and other types of materials, so we're not contaminating the testing that we do. In our OSHA laboratory, industrial hygiene lab. 

That's a fairly large operation, it's about $3.5 million a year, that we get from OSHA to be one of only two labs in the country that provide regulatory testing for OSHA. We currently have agreements in place with 40 states that will send their work to us here in Madison. We do a lot of work with DNR to identify sources of pollution and monitor on an ongoing basis the environment. Numbers of samples, we have a whole host of things that we can test the samples for, anything from endocrine disrupters, or we'll look for non-specific things or chemicals in water samples that might impact organisms or fish. And then we can actually use this chemical analysis for a number of things. This is an example of one of our chemists in our environmental toxicology lab. We actually have little fish, little flathead minnows in these tanks. Then we put the sample in there and we look to see if they have a negative impact on the fish themselves. It doesn't tell us what's causing the toxic effect, but it will say there's something there, keep looking. Other important areas are forensic toxicology. 

If you are ever stopped in Wisconsin for a DUI or OWI, we'll probably get a blood into our lab, we'll test it to see how much alcohol you have on board, if you've got any illegal drugs or prescription drugs at a very high level that might cause impairment in your ability to drive an automobile, snowmobile, motorcycle, boat. If you're ever arrested on those charges, that work will come into our laboratory. We receive about 2,000 OWI cases a month to work up in our lab. Part of that work up not only includes the laboratory analysis of these, but the chemists often have to go to court and testify on the lab findings. This laboratory also supports work for the coroners and medical examiners around the state. We're not quite CSI, but we're getting close. We've got capability here to identify several hundred prescription drugs. And in some cases, the person may have a prescription drug on board, and they should only have this much, but when we get a sample from them on part of an autopsy they've got this much. There's a problem. In many cases, we've been able to help the coroners and medical examiners identify a possible cause of death by doing this type of analysis. 

We have a lab improvement division. I credit this to my predecessor, who set up a system to send out unknown samples to other labs, have the other labs do the test, and send the results back to us. It's called proficiency testing. In all laboratory regulatory programs, there's a requirement to participate in some kind of proficiency testing. Where do you get those samples? We saw that here in Wisconsin, there's an opportunity to make a little money. About $3.5 million a year. So we prepare these samples. We package them. We say they're unknowns. 

We sell that to, right now, about 5,000 laboratories around the country, and about 100 or so laboratories overseas. We're providing a very vital laboratory service and capitalizing on the expertise that the staff in the lab have developed over the years. This is what some of the samples look like. And we now have about 200 different proficiency testing challenges that we make available. These go out maybe once a year, four times a year. The laboratory automatically gets sent one of these. Then they do the test, report the results to us, electronically now, to save us from paperwork. Then we report that on to the regulatory agency, if that's on the clinical side, it's CMS, the Center for Medicaid Services. On the environmental side, it may be EPA. (inaudible) We're very cautious and careful about what organism we put in that unknown vial. 

There have been some problems with proficiency testing programs that have sent a virulent, but a pathogenic sample, pathogenic to humans, and there have been a few accidents with that. And you'll probably be hearing about one of those within a week. But fortunately, we select the organisms we send out very carefully. They're generally the ones that are not as highly pathogenic to humans, but would be the type of organism that might be found in a clinical specimen. We send very, very small quantities of these things. On the chemistry side, we end up sending, it's either a horse serum or cow serum that's been spiked with a certain amount of a chemical. So again, even though there is something in there that could be bad, quantities are minimal and we've been very fortunate that there really have not been accidents as a result of that. The last slide is the Health Informatics and Surveillance. This is where we are developing the capability to electronically share a lot of laboratory information. We're developing Web portals so this can all be done securely over the Web. 

I'd like to end by saying that we are YOUR Wisconsin State Lab of Hygiene. We take pride in the fact that we support not only the university, we support state agencies, we support local agencies, but we really support the people of Wisconsin in all that we do. Without us, there would be no effective way to respond to disease outbreaks and other public health emergencies. When I look at our staff, I tell them frequently that they are really on the front lines of protecting you and protecting our state's public health and environmental health throughout the state. That's all we've got up there. But if you have any questions, I'll be happy to take them. Yes? (inaudible) Very good question. I've had the pleasure or what, when I was State Epidemiologist in Idaho, of closing the last TB Sanitarium that they had in Idaho. We no longer isolate TB patients like we did 50 years ago. 

We now can effectively treat these patients with multiple drugs over a long period of time. It may be three months, six months, 12 months or more. We can basically render them non-infectious, so that they can be treated effectively in the community. And we do not need to put them in a facility like they did in the '30s, and I think into the early '40s, and maybe into the '60s in some states. My understanding is that Wisconsin had a TB Sanitarium on the north side of Lake Mendota. Now it's converted into another, I think, Dane County or Madison Health Department is using that health facility. I remember those days well. But with today's therapy, and the incidence of TB going down, we can find other effective ways of dealing with that. Any other questions? Yes. 

>> The lab has a lot going on, various lines of work, some of them pretty large scale, with large quantities of material for 340 staff. How does the staffing level compare with other labs that you've run? >> Given the amount and the scope of the program here, the amount of laboratory work that's performed, I think we're probably a little bit on the low side. I think other labs that don't have quite the scope that we have here certainly have more people in it than we do. We sort of pride ourselves on doing it a little better, quicker and more automated than other places. But from time to time, we find ourselves still struggling to fill important key positions, and in some cases there just are not enough laboratory scientists coming out of our training programs around the country. We have recognized that. And because of that, we're participating in a couple fellowship programs, jointly with CDC, where they have emerging infectious disease fellows that will come in for two years. We train them and do our best to keep them. We have a fellowship in our lab to train cytogeneticists. 

They go through our training program. We do everything we can to make sure they stay with us once they complete the fellowship. So it's difficult, but we're hanging in there. Yes? >> Do you have a backlog? >> In most areas of the lab we do not have a significant backlog. I can think of one area where we have a backlog that I wish was a little bit shorter. And that was in our toxicology area. But generally there is not that much of a backlog throughout our laboratory. Yes? 

>> Politically, have there been problems with budgeting? Did any people at the State Capitol decide that they want to cut down on the budget and you're strapped for funds? Is that a problem? >> Well, you know, I've only been here a year. And I guess I want to say that we had a very successful budget this last round, even though the state budget was laid way out there much longer than it should have been, that only impacts about 25% of our budget. Ultimately, the state budget was passed and we were able to obtain the state support for our lab. But the bulk of it, what we bring in to run the lab does not come from the state. So it's one of the things I tell people that's one of the great things about being in Wisconsin and being director of this lab, versus a lab associated with the Health Department in another state where you are really at the mercy of the legislature. There are some risks that can be associated with that. Yes? 

>> I understand that a lot of people throw away their drugs and decide not to use them. It goes into the water supply eventually. And a lot of us older people aren't taking benefit of the drugs, in other words, it goes into urine and gets back into the water supply. Are you testing for that? >> We are, but some of these drugs, when they break down, are known as endocrine disrupters. We've done an active research program in that area. We're also working with some of the sewer treatment facilities to help look for ways that they can maybe change some of their processes that would do a better job of inactivating some of these materials that may end up in the sludge, before it can get back into the water supply. That is an area that we're actively conducting research in. Yes? >> Where can we take leftover drugs? 

>> I don't know. >> I have a sister who died. I have a house full of drugs. I don't know what to do with them. >> We do not take drugs. But I understand that here in the Madison area there is a program. I'm not exactly sure who runs that, but if you've got my name and number, send me a note. I'll look that up for you. I think it may be the Madison Dane County Health Department. Does anybody else know who that is? 

>> I was told to bring all unused medications to your pharmacist, and they know how to take care of them. >> Some pharmacists, I think, would do that, others might not. (no audio) >> The county, a couple months ago, had a drug collection day where you could bring in your unused drugs, and other cosmetics, and things like that for disposal by them. So probably, the Dane County Health Department or the City of Madison. >> Yes, I remember something just recently. I think they do this a couple of times a year, where they will take those and properly dispose of them. Yes? >> You're not supposed to throw them down the toilet. >> Right, you're not supposed to throw them down the toilet. Anything that goes down the toilet goes into the sewer system. 

And all that stuff may actually go all the way through. Yes? >> The fact that you can't get and hold scientists is a sorry reflection about our own country. (inaudible) But I will ask you, do you seek scientists from overseas to fill those positions? >> The short answer to that is yes, we do. We look wherever we can to find the scientific expertise that we really need. We have a very diverse staff in the laboratory. Prior to coming back to Wisconsin, I was at CDC in Atlanta, and they are having a serious time identifying scientists for their key positions. And so they are actively recruiting in various countries around the world. Yes? 

>> Is it salary or benefits? If you go into high schools or middle schools for outreach for microbiology, it's the most fascinating thing there is these days. >> I think it's a little bit of both, you know, sometimes we have salary issues. We seem to do fairly well when we're compared locally. But I think the more we can get out and the more we can engage people in high school to think about science. It's an exciting career, There are a lot of things you can do. I started out as a med-tech right next door. I became an epidemiologist. I could share stories for hours about some of the neat investigations, and some of the opportunities that I've had here in this country and overseas, because of the science background. And I think that's a message that we need to get out to young people today. 

(inaudible) In our lab, I would say about half of the people who leave our lab probably go to an industrial setting. In those cases, it's generally for quite a bit more money. (inaudible) We have an employee health monitoring program in place, where if any of our employees say, developed a fever, if they develop any kind of symptoms, one of the things that they are trained to do is to, if they become ill, and they see a physician, they say you know, "I work at the State Lab of Hygiene. I work with Tularemia. And maybe you ought to check that out." We really have a very, very good record in terms of not having accidents in the lab where exposures occur, and somebody actually becomes infected with something. But we do have kind of a monitoring program where we watch the employees for things that they may be exposed to. >> You're in a building that's old... (inaudible) Will the new building be on this campus? >> We're in a building that's over 50 years old right next door. 

Mechanical systems in the building after 50 years have never been upgraded. They're failing. In fact, some of the ventilation systems, the ducts in there are starting to fall apart. They're held together with duct tape. (inaudible) We've engaged an architectural firm to develop a plan for a new lab. As part of that, one of the sites that is being considered is out by the other lab on the east side of Madison. I think this will benefit the state in the heart of campus, to stay here on campus with that laboratory. In order to interact with students, to fulfill our research mission, our teaching mission I think it's important that we have that presence. So there are other options we're also pursuing. One may be to move off, renovate the building and then move back. 

That's about a $20 million project. A new building is way up here. But we're actively exploring a number of different options to address the facilities that we have. (inaudible) For some of you, the Wisconsin Vet Diagnostic Lab is a lab that's similar to ours. It's a little bit smaller, but it's a brand new, very nice facility just down the road. It used to be out on Mineral Point Road somewhere, but was recently moved back on campus when they built a dedicated a new lab. I think they've been there about a year. That lab actually came back onto campus. And is administratively very similar to our lab. They have the same statutory basis. 

They have a board that's operated very similarly to our lab. But there focus is primarily on animal diseases. That lab was funded primarily by the state, a little bit of University money, and a little bit of revenue money went into that building. That building is probably about a third of the size of our operation. One more. >> Do you have anything to do with Radon? >> Our laboratory can test for Radon. And for those of you who may not be familiar, Radon is a radioactive gas that is naturally released in various types of geological formations. I think granite is one of them. And in some locations, Radon can seep through the floors of the homes and buildings, and accumulate to levels that are thought to be harmful. 

We can do Radon testing, although I think most of the Radon testing here goes to private labs in the area. Another one. (inaudible) That's a difficult question for me to answer, because I'm really not that familiar with that. But the one area that I can think of where some of our work butts up against that is where I was talking about newborn screening. A couple of those conditions that we screen for, for example PKU, could cause very severe mental illness in a child at a very early age. If you can identify the child, you can provide them with a restrictive diet. They come right around and they can lead a fairly normal, healthy life. That's the only one area where our work really bumps against that. >> For the state of Wisconsin, is there anything that's even a little bit comparable to what you describe for physical... (inaudible) >> Not that I'm aware of. 

But I know there is something like that. The Department of Health and Family Services have some mental health capabilities and facilities. I just really don't know much about that. Okay? Thank you very much. (applause)