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A public health laboratory is a type of medical laboratory that serves regional, national, or in some cases global communities by providing clinical diagnostic testing, environmental testing, disease diagnosis and evaluation, emergency response support, applied research, regulation and standards recommendations, laboratory training, and other essential services to the communities they serve.<ref name="BeckerAnIntro10">{{cite book |url=https://books.google.com/books?id=6SDqL72zPRUC |title=Public Health Laboratories: Analysis, Operations, and Management |chapter=Chapter 1: An Introduction to Public Health Laboratories |author=Becker, S.; Perlman, E.J. |editor=Jenkins, W. |publisher=Jones & Bartlett Learning |pages=1–14 |year=2010 |isbn=0763771023}}</ref><ref name="CommitteeTheGov03">{{cite book |url=https://books.google.com/books?id=qa8XYZQprt0C |title=The Future of the Public's Health in the 21st Century |chapter=Chapter 3: The Governmental Public Health Structure |author=Committee on Assuring the Health of the Public in the 21st Century, Board on Health Promotion and Disease Prevention |publisher=National Academies Press |pages=136–146 |year=2003 |isbn=0309133181}}</ref><ref name="APHLAbout">{{cite web |url=https://www.aphl.org/aboutAPHL/Pages/aboutphls.aspx |title=About Public Health Laboratories |publisher=Association of Public Health Laboratories |accessdate=18 November 2021}}</ref><ref name="BeckerPublic05">{{cite book |url=https://books.google.com/books?id=bFBPMcQe6ogC |title=Public Health Administration: Principles for Population-based Management |chapter=Chapter 27: Public Health Laboratory Administration |author=Becker, S.J.; Blank, E.C.; Martin, R.; Skeels, M. |editor=Novick, L.F.; Mays, G.P. |publisher=Jones & Bartlett Learning |pages=623–627 |year=2005 |isbn=0763740780}}</ref>
Toxicology is a multidisciplinary study of the adverse effects of chemical substances on living organisms, and tangentially the diagnosis and treatment of exposures to those chemical substances. Toxicologists determine how plants, animals, and bacterial organisms are affected by agricultural chemicals, industrial chemicals, metals, vapors and gases, naturally occurring toxins, and drugs, typically caused by the absorption, distribution, metabolism, and excretion of those substances.<ref name="EatonGeneral10">{{cite book |url=https://books.google.com/books?id=jzCAKsa2CpMC&pg=PA1 |chapter=Chapter 1.01 General Overview of Toxicology |title=Comprehensive Toxicology |author=Eaton, D.L.; Gallagher, E.P. |editor=McQueen, C.A. |publisher=Elsevier |edition=2nd |pages=1–46 |year=2010 |isbn=9780080468686}}</ref> Like other fields, many subspecialties are associated with toxicology, including<ref name="EatonGeneral10" />:


A public health laboratory is unlike the average medical laboratory because it is "integrated into the broader public health system."<ref name="BeckerAnIntro10" /> The public health laboratory must typically meet more stringent requirements, including adhering to not only CLIA (for labs in the United States), but also additional regulations laid out by the departments, agencies, and other regulatory bodies of local, state, and/or national governments. Finally, the private medical laboratory focuses on tests that diagnose the diseases of individuals, while the functions of the public health laboratory serve entire populations.<ref name="BeckerAnIntro10" /><ref name="BeckerPublic05" />
* analytical toxicology, for identifying toxicants;
* biomedical toxicology, for identifying how toxicants cause disease;
* environmental toxicology, for evaluating the effects of environmental chemicals and contaminants;
* forensic toxicology, for evaluating how toxicants and other chemicals caused death;
* molecular toxicology, for the application of molecular biology to toxicity;
* occupational toxicology, for evaluating the effects of chemical exposure in the workplace; and
* regulatory toxicology, for applying mechanistic information from toxicology to regulations and standards development.


A 2002 Association of Public Health Laboratories (APHL) report helped identify 11 core functions that state public health laboratories in the United States should accomplish, giving clearer insight into how the average public health laboratory in most parts of the world should operate. Note that this is not a guarantee every lab will perform these tasks, but it's a standard of what the lab should be responsible for doing. Those suggested 11 core functions are<ref name="MMWR2">{{cite journal |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a1.htm |title=Core Functions and Capabilities of State Public Health Laboratories |author=Witt-Kushner, J.; Astles, J.R.; Ridderhof, J.C. et al. |journal=Morbidity and Mortality Weekly Report |volume=51 |issue=RR14 |pages=1–8 |date=20 September 2002 |accessdate=18 November 2021}}</ref>:
Similar to a medical laboratory, a toxicology laboratory may focus on diagnostics or research. Test types may vary based on the focus. For example, toxicity testing on research animals may involve testing for acute toxicity, subacute toxicity, short-term subchronic toxicity, long-term chronic toxicity, reproductive toxicity, developmental toxicity, mutagenicity assays, irritation, allergic reaction, inhalation, and immunotoxicity.<ref name="EatonGeneral10" /> However, diagnostic testing will involve testing for drugs of abuse, poisons, and heavy metals, or other toxicants. Pharmacogenetic testing may also be performed to develop dosing regiments for a specific drug.<ref name="ARUPClin19">{{cite web |url=https://arupconsult.com/content/clinical-toxicology-testing |title=Clinical Toxicology Testing |work=ARUP Consult |publisher=ARUP Laboratories |date=June 2021 |accessdate=18 November 2021}}</ref><ref name="SofronescuPurpose18">{{cite web |url=https://www.aacc.org/cln/articles/2018/december/purpose-driven-toxicology-services-the-key-to-financial-success-and-client-confidence |title=Purpose-driven Toxicology Services: The Key to Financial Success and Client Confidence |author=Sofronescu, A.G. |work=Clinical Laboratory News |publisher=American Association for Clinical Chemistry |date=01 December 2018 |accessdate=18 November 2021}}</ref>


* ''disease prevention, control, and surveillance'': provide timely and accurate analytical results for the assessment and surveillance of exposures; rapidly recognize and prevent the spread of communicable diseases; detect and identify biologic agents of significance in human disease; provide specialized tests for low-incidence, high-risk diseases;
Toxicology laboratories in unique settings such as emergency departments of hospitals require extra consideration. For example, while toxicology testing in the emergency department is normal in regards to supporting and validating clinical findings, the testing must also take into account the legal ramifications of test results. Those results may be used in court cases, requiring strict chain-of-custody, full documentation, methodologies, and quality control results to be maintained. Additional specimens may be required by government bodies for their own testing, and as such the lab may want to add additional specimen collection to its official workflow. Additionally, personnel may need to become familiar with testimony procedures if required to testify in a criminal court case.<ref name="MagnaniClinical12">{{cite book |url=http://webapps.cap.org/apps/docs/store/PUB220_Toxicol_Sample.pdf |format=PDF |chapter=Chapter 2: Supporting the Emergency Department |title=Clinical Toxicology Testing: A Guide for Laboratory Professionals |author=Magnani, B.; Kwong, T.C. |editor=Magnani, B.; Bissell, M.G.; Kwong, T.C.; Wu, A.H.B. |publisher=College of American Pathologists |pages=7–14 |year=2012 |isbn=9780983706816}}</ref>
* ''integrated data management'': accumulate, blend, and disseminate scientific [[information]] in support of public health programs; collect, monitor, and analyze laboratory data using national database systems; assist state epidemiologists, other laboratories, and practitioners with data needs
* ''reference and specialized testing'': serve as a primary reference microbiology laboratory for a wide variety of needs
* ''environmental health and protection'': conduct scientific analyses of potentially threatening environmental samples; detect, identify, and quantify toxic contaminants in environmental and biological specimens; provide air, water, soil, and other environmental laboratory testing services; provide environmental chemistry testing; determine the relationship between environmental hazards and human health; determine extent of a community's exposure to environmental hazards; provide industrial hygiene/occupational health testing
* ''food safety'': test specimens implicated in foodborne illness outbreaks to identify causes and sources; detect, identify, and quantify toxic contaminants in food specimens; monitor radioactive contamination of water, milk, shellfish, and other foods
* ''laboratory improvement and regulation'': coordinate and promote quality assurance programs in other laboratories; act as a standard and leader for other laboratories; develop and oversee quality assurance and laboratory improvement programs; oversee the licensure, certification, and accreditation of other laboratories
* ''policy development'': assist the development of state and federal public health policy; assist in the development of standards for all health-related laboratories
* ''emergency response'': provide laboratory support to state and national disaster preparedness plans and environmental or health emergencies
* ''public health-related research'': evaluate and implement new technologies and analytical methodologies in support of public health and healthcare communities; adapt emerging technologies to public health laboratories; conduct applied studies into new and improved analytical methods and services; assist the private sector with newly marketed tests
* ''training and education'': sponsor training opportunities for public health laboratory staff; provide or facilitate training and workshops for laboratory staff in private and public sectors; provide training opportunities for careers in public health laboratory practice; provide continuing education opportunities to staff
* ''partnerships and communication'': develop and strengthen partnerships among state, county, and city entities public and private; emphasize the role and value of the public health laboratory to state public health programs; participate in strategic policy planning and development processes; build and strengthen diverse communication networks


==References==
==References==
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Revision as of 23:14, 21 January 2022

Toxicology is a multidisciplinary study of the adverse effects of chemical substances on living organisms, and tangentially the diagnosis and treatment of exposures to those chemical substances. Toxicologists determine how plants, animals, and bacterial organisms are affected by agricultural chemicals, industrial chemicals, metals, vapors and gases, naturally occurring toxins, and drugs, typically caused by the absorption, distribution, metabolism, and excretion of those substances.[1] Like other fields, many subspecialties are associated with toxicology, including[1]:

  • analytical toxicology, for identifying toxicants;
  • biomedical toxicology, for identifying how toxicants cause disease;
  • environmental toxicology, for evaluating the effects of environmental chemicals and contaminants;
  • forensic toxicology, for evaluating how toxicants and other chemicals caused death;
  • molecular toxicology, for the application of molecular biology to toxicity;
  • occupational toxicology, for evaluating the effects of chemical exposure in the workplace; and
  • regulatory toxicology, for applying mechanistic information from toxicology to regulations and standards development.

Similar to a medical laboratory, a toxicology laboratory may focus on diagnostics or research. Test types may vary based on the focus. For example, toxicity testing on research animals may involve testing for acute toxicity, subacute toxicity, short-term subchronic toxicity, long-term chronic toxicity, reproductive toxicity, developmental toxicity, mutagenicity assays, irritation, allergic reaction, inhalation, and immunotoxicity.[1] However, diagnostic testing will involve testing for drugs of abuse, poisons, and heavy metals, or other toxicants. Pharmacogenetic testing may also be performed to develop dosing regiments for a specific drug.[2][3]

Toxicology laboratories in unique settings such as emergency departments of hospitals require extra consideration. For example, while toxicology testing in the emergency department is normal in regards to supporting and validating clinical findings, the testing must also take into account the legal ramifications of test results. Those results may be used in court cases, requiring strict chain-of-custody, full documentation, methodologies, and quality control results to be maintained. Additional specimens may be required by government bodies for their own testing, and as such the lab may want to add additional specimen collection to its official workflow. Additionally, personnel may need to become familiar with testimony procedures if required to testify in a criminal court case.[4]

References

  1. ↑ 1.0 1.1 1.2 Eaton, D.L.; Gallagher, E.P. (2010). "Chapter 1.01 General Overview of Toxicology". In McQueen, C.A.. Comprehensive Toxicology (2nd ed.). Elsevier. pp. 1–46. ISBN 9780080468686. https://books.google.com/books?id=jzCAKsa2CpMC&pg=PA1. 
  2. ↑ "Clinical Toxicology Testing". ARUP Consult. ARUP Laboratories. June 2021. https://arupconsult.com/content/clinical-toxicology-testing. Retrieved 18 November 2021. 
  3. ↑ Sofronescu, A.G. (1 December 2018). "Purpose-driven Toxicology Services: The Key to Financial Success and Client Confidence". Clinical Laboratory News. American Association for Clinical Chemistry. https://www.aacc.org/cln/articles/2018/december/purpose-driven-toxicology-services-the-key-to-financial-success-and-client-confidence. Retrieved 18 November 2021. 
  4. ↑ Magnani, B.; Kwong, T.C. (2012). "Chapter 2: Supporting the Emergency Department". In Magnani, B.; Bissell, M.G.; Kwong, T.C.; Wu, A.H.B. (PDF). Clinical Toxicology Testing: A Guide for Laboratory Professionals. College of American Pathologists. pp. 7–14. ISBN 9780983706816. http://webapps.cap.org/apps/docs/store/PUB220_Toxicol_Sample.pdf. 
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