Specimen Collection Research Articles

Improving the detection of congenital syphilis: reviewing test utility and adherence to recommendations

Western Australia (WA) has experienced a resurgence of congenital syphilis. Appropriate microbiology testing of the neonate is recommended to confirm infection, including syphilis immunoglobulin M (IgM), rapid plasma reagin (RPR) paired with a maternal sample, and polymerase chain reaction (PCR) on placenta and nasal swabs. We examined the performance of microbiology tests in confirmed congenital syphilis cases and the adherence to testing recommendations in those assessed as high risk. We reviewed the microbiology results of confirmed congenital syphilis cases in WA between 1 January 2018 and 31 December 2023. In addition, microbiology testing of neonates from metropolitan Perth identified as being at a high risk of congenital syphilis between 1 January 2021 and 31 October 2023 was reviewed. Eighteen congenital syphilis cases were identified; data were unavailable for a case born interstate. Of the 17 included cases, the case fatality rate was 35% (6/17; five stillbirths and one perinatal death). Placenta tissue PCR was positive in all stillbirths. Of the 12 live births, 83% were symptomatic at delivery. Perinatal testing was performed in 11 live births (11/12); IgM was detected in 55% (6/11). Placenta tissue PCR was positive in 88% (7/8 tested). Nasal swab PCR was positive in 57% (4/7 tested) of cases. There were 22 neonates classified as being at a high risk for congenital syphilis infection; all had IgM and RPR testing. Syphilis PCR was performed on placenta tissue samples in 64% (14/22) and on nasal swabs in 64% (14/22) of cases. Comprehensive microbiological testing, including syphilis IgM and placenta tissue PCR, is required to confirm congenital syphilis infection. Continuous evaluation of testing will be crucial for individual case detection and monitoring of the ongoing outbreak. Given the risk of incomplete specimen collection, our data support ​the adoption of a risk-based approach for neonates at risk of congenital syphilis, with management guided by maternal serology and treatment history.

Patient Blood Management: Mixing Versus Discard Methods for Central Venous Catheter Blood Specimen Collection.

A quasi-experimental study comparing the mixing and discard methods of laboratory specimen techniques in an adult acute care setting was conducted over a 30-month period. Primary end points were delta hemoglobin (Hgb) and transfusion rates. Secondary end points were redraws related to hemolysis and erroneous results, noting central venous access device (CVAD) type. Primary objectives included the comparison of hospital-acquired anemia and transfusion rates utilizing Hgb and venous sampling methods as part of a patient blood management (PBM) program. Secondary objectives tracked the type of CVAD used to acquire venous specimens and the impact on hemolysis rates or erroneous results. Considerations include exploring the benefits of utilizing the mixing method related to cost savings. In summary, the mixing versus discard method eliminates wasting blood to reduce hospital-acquired anemia as part of a PBM program. CVAD type did not influence hemolysis rates or impact erroneous results. The mixing method is easy to implement in any health care setting. Cost savings are feasible by elimination of external venous or arterial blood management protection devices. Removal of add-on devices supports standards by decreasing access points to reduce infection risk. Results, although inconclusive to superiority, demonstrated noninferiority and encouraged consideration of the mixing method for laboratory specimen collection.

Accuracy of point-of-care SARS-CoV-2 detection using buccal swabs in pediatric emergency departments.

To optimize the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children, specimen collection and testing method are crucial considerations. Ideally, specimen collection is easy and causes minimal discomfort, and the laboratory approach is simple, accurate, and rapid. In this prospective cohort study we evaluated the accuracy of a point-of care nucleic acid device using caregiver/patient self-collected buccal swabs. Participants were recruited in 14 Canadian tertiary care pediatric emergency departments. Children <18 years of age deemed to require SARS-CoV-2 testing were eligible. Caregivers or the patient-collected buccal swabs which were tested on the ABBOTT ID NOW. The reference standard was nasopharyngeal swab specimens collected by a healthcare provider tested via laboratory reverse transcription PCR (RT-PCR). We enrolled 2,640 study participants and 14.4% (381/2,640) were SARS-CoV-2 RT-PCR-positive. Eight percent (223/2,640) and 85.0% (2,244/2,640) were concordant test-positive and concordant test-negative, respectively. Sensitivity and specificity of the investigational approach were 58.5% [95% confidence interval (CI): 53.4, 63.5] and 99.3% (95% CI: 98.9, 99.6), respectively. Cycle threshold values were lower among concordant [median 17 (15, 21)] relative to discordant [median 30 (22, 35)] swabs (P < 0.001). Sensitivity was greatest among children <4 years of age, when caregivers performed the swabs, among unvaccinated children, and those with shorter symptom duration. Across multiple pain measures, less pain was associated with buccal swab testing. Although accuracy of the buccal swab point-of-care SARS-CoV-2 test was good and negative agreement was excellent, sensitivity was only 58.5%. Concordance was greater among those with higher viral loads, and the approach involving buccal swabs was less painful.IMPORTANCETo optimize the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children, specimen collection and testing method are crucial considerations. Ideally, specimen collection is easy and causes minimal discomfort, and laboratory approach is simple, accurate, and rapid. We evaluated the accuracy and pain associated with buccal swab specimen collection by caregivers or children themselves who were tested using a point-of-care isothermal nucleic acid amplification SARS-CoV-2 test. This novel approach was compared to nasopharyngeal swab specimens tested using laboratory-based PCR tests. While negative agreement was excellent, positive percent agreement was less than 60%. Concordance was greater among those with higher viral loads, and thus, sensitivity is excellent when transmissibility is more likely to occur. Importantly, the approach involving buccal swabs was significantly less painful, and thus, children and their caregivers are more likely to agree to testing using such an approach.CLINICAL TRIALSRegistered at ClinicalTrials.gov (NCT05040763).

Integrating genomic and molecular data to predict antimicrobial minimum inhibitory concentration in Klebsiella pneumoniae

Minimum inhibitory concentration (MIC) denotes the in vitro benchmark indicating the quantity of antibiotic required to inhibit proliferation of specific bacterial strains. Determining MIC values corresponding to the infecting bacterial strain is paramount for tailoring appropriate antibiotic therapy. In the interim between specimen collection and laboratory-derived MIC outcomes, clinicians frequently resort to empirical therapy informed by retrospective analyses. Here introduces two deep learning approaches, a Convolutional Neural Network (CNN)-based model and an Enformer-based model, integrating genomic data of Klebsiella Pneumoniae and molecular structural data of 20 antibiotics to anticipate the MIC value of the bacterium for each antibiotic under consideration. These models demonstrate enhanced raw accuracy over the existing state-of-the-art model, which rely exclusively on genomic data. The CNN-based model achieves a notable 20% increase in raw accuracy while further mirroring the 1-tier accuracy of the state-of-the-art model. Although the Enformer-based model does not quite reach the performance levels of the CNN-based model, it offers an advantage by eliminating the need for arbitrary data processing steps. This streamlining of the data processing pipeline facilitates fast updates and improves the model interpretability. It is expected that these deep learning paradigms can significantly inform and bolster clinician decision-making during the empirical treatment phase.

Bits and fragments: documenting an unreported coral genus Heterocyathus Milne Edwards &amp; Haime, 1848 from northwestern Bay of Bengal (Odisha coast) and a call for further assessment

The collection of a dead specimen of the coral Heterocyathus cf. sulcatus on a sandy beach in southern Odisha highlights the importance of exploring offshore waters along this coast. The specimen was identified based on prominent taxonomic characters and association with coral boring worm. This genus was previously known to occur along the eastern coast of India, from the Gulf of Mannar/Palk Bay and off the Chennai coast. The presence of rocky offshore outcrops and a sandy substratum in the vicinity suggests that the specimen likely originated from that location.

Separation of Avian Preovulatory Follicle Granulosa and Theca Cell Layers for Downstream Applications.

Layer hens (egg-laying chickens) and broiler breeders (breeding stock for meat-producing chickens) are crucial to the world's food supply as a reliable source of protein. They are also an emerging animal model for the study of human reproductive disease. As the field of poultry research develops, the health and function of the layer hen and broiler breeder ovary will be an important point of study for both agricultural and biomedical researchers. One of the challenges presented by this emerging interest is the need for replicable techniques that all researchers can employ in ovarian specimen collection. In particular, a detailed visual process must be established to define the proper separation of the specialized granulosa and theca cell layers from hen follicles to achieve agreement and consistency among researchers. This study describes the extraction of preovulatory follicles and ovary tissue in white leghorn hens of prime reproductive age. The separation of these follicles is performed under cold, liquid conditions to congeal the yolk for easier manipulation and to prevent the follicle's own weight from tearing apart cell layers during the separation process. Once the separation is complete, the desired cell layers can be further digested for tissue culture approaches or can be cryopreserved for genomic and proteomic analyses.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.

Ticks and tick-borne pathogens in ruminant farms of Peninsular Malaysia: First molecular evidence of Borrelia theileri in Rhipicephalus microplus (Acari: Ixodidae).

To shed light on the importance of tick-borne diseases, especially in farm animals that often contact with farm workers, this study aimed to identify ticks and tick-borne pathogens in ruminants in Malaysia. Accordingly, specimen collection was conducted across Peninsular Malaysia yielded a total of 1241 ticks collected from 674 farm ruminants. Among these, four tick species were identified, with Rhipicephalus microplus being the most prevalent, constituting 99.03 % of the total tick population. Analysis of 130 tick pools revealed three positives for Borrelia. BLAST analyses of the flaB and 16S rRNA genes revealed high similarities to Borrelia theileri, ranging from 98.78 to 100 % for flaB and 99.23–99.45 % for 16S rRNA. These results align with the phylogenetic trees, where sequences from both genes clustered together with B. theileri, further supporting this identification. No Rickettsia and Bartonella bacteria were detected. This study represents the first occurrence of B. theileri in R. microplus in Malaysia.

Leveraging social media and community science data for environmental niche models: A case study with native Australian bees

Museum occurrence records are popular sources of information for creating Environmental Niche Models (ENMs), which allow the mapping of the potential niche ranges of species. Occurrence data is often downloaded en masse from established databases. However, the use of non-traditional data sources, such as occurrence records from community/citizen science outreach and social media, is increasing in use and abundance. Data from non-traditional data sources are potentially valuable records of information, particularly for species where museum occurrence records may be comparatively scarce. In the current study, we aimed to determine the impact of adding occurrence data from non-traditional databases to ENMs that were originally created using traditional databases with a group of comparatively understudied species, native Australian bees. We used the Maxent algorithm to model the potential environmental niches of eight species. We created three models for each species: 1) one consisting of only location data from museum specimen collection records from the Atlas of Living Australia (ALA) (a traditional database), 2) one combining ALA and geo-tagged social media (Flickr) data, and 3) a model combining ALA and geo-tagged community science data from iNaturalist. This resulted in 24 different models. By comparing the models produced from each of the augmented data sets with the traditional species data set (ALA vs. ALA & Flickr; ALA vs. ALA & iNaturalist) we showed that there were significant differences, not only in predicted ranges, but also in the weighting of environmental variables used by the models to predict the environmental niche. Differences were more greatly influenced by the geographic location of the extra occurrences rather than the number of additional occurrence points. We demonstrate the potential value and risks of including social media and community science geo-tagged image data in supplementing knowledge of species distributions, particularly for relatively under-sampled species such as native bees.

The collection and application of autologous amniotic fluid to cesarean delivery closure – a feasibility study

Amniotic fluid and amnion membranes have been used in surgery specialties to improve wound healing. The objective was to determine if amniotic fluid could be collected at cesarean delivery and then reapplied to the layers of the closure using the CeaLogic Specimen Collection and Ratio Applicator Kit. Autologous amniotic fluid from 20 subjects was collected at cesarean delivery using the collection kit, and then transferred to the applicator kit, mixed with calcium chloride solution, and applied directly to each of the surgical repair layers during closure. The Modified Hollander Cosmesis Score was used to assess wound appearance from photographs of the incision taken in the postpartum setting. The median (IQR) Modified Hollander Cosmesis Score (range 0-best, to 6-worst) at the one week and four-week postpartum visits was 0 (0,1) and 0 (0,2), respectively. There were no wound complications nor surgical site infections. The CeaLogic Specimen Collection and Ratio Applicator Kits can be used to collect and reapply autologous amniotic fluid at cesarean delivery. Future studies can determine if the application of autologous amniotic fluid to cesarean delivery closure can improve cosmesis and wound healing, as well as decrease the risk for the development of intraabdominal adhesions.

Value, knowledge and reputation: zoological exchange by Australian museums, 1870-1900.

The burgeoning nineteenth-century public-museum sector built a significant part of its natural-history specimen collections through extensive international trading. The early 2020s has seen an upsurge of scholarly interest in this largely overlooked trade. Exchange was a distinctive aspect of the natural-history trade that reveals much about the diverse practices and motives of the institutional collectors. Economic-geographic benefits included conserving the limited financial resources of museums and exploiting complementarities in the geographic distribution of specimens. Collection management, institutional reputation, social connection and international diplomacy were also part of a complex mix of value making that shaped this important international trade. We analyse the exchange practices of the three largest museums in the Australian colonies in the final three decades of the nineteenth century who exchanged Australia's 'rare and curious' fauna with collectors across the globe. By deploying and analysing extensive, comparative data on a particular form of natural history, zoology, and a particular kind of trade, exchange trading, among three Australian museums, this paper extends and enriches recent scholarship on the mobility of natural-history specimens and how they were traded.

A Descriptive Study: Evaluation of Delayed Laboratory Testing in Emergency Room

Precision, accuracy, and short turnaround time (TAT) are important to improve the quality and effectiveness of laboratory services in the Emergency Room (ER). Several studies reported an average of 60% the ratio of anticoagulant to sample is not appropriate, lysis, and clotted samples occurred in the pre-analytical part. This part consisted of the request/registration of laboratory tests, patient preparation, specimen collection, and transportation to the central laboratory. The aim of this research is to evaluate the cause of the long TAT for laboratory research so as to obtain problem solving based on the target. This observational study was conducted in 2021 at the ER laboratory outlet. Observations were made started from the workload carried out by the laboratory technician, sample registration, and data collection from the Laboratory Information System (LIS). The study obtained 14.709 samples from the LIS at the Clinical Pathology Department, Cipto Mangunkusumo Hospital. The highest sample rejection rate was from the ER laboratory outlet due to specimen lysis (2.79%). The average time required for re-collecting specimens was around 2-2.5 hours. This rejection was below the minimum quality standards based on the International Federation of Clinical Chemistry (IFCC). Other problems include the limited number of medical laboratory experts compared to the workload also inefficient Computerized Physician Order Entry (CPOE) registration methods. The main problem of delayed laboratory testing in the emergency department is the pre-analytical part including sample registration and rejection specimens. That rejection mostly comes from lysis specimens, which caused invalid laboratory result.

Enhancing Taxonomic Skills in West Africa and Supporting the Growth of GC Herbarium (Ghana)

Training the next generation of environmental scientists is critical to the future of life on Earth as acknowledged in 2021 by the Royal Botanic Gardens, Kew (RBG, Kew) in Our Manifesto for Change. RBG, Kew is also committed to strengthening capacity in the most biodiverse tropical countries by sharing expertise and collections, to enhance the global conservation effort. Developing training programmes to enhance taxonomic capacity in Africa and meeting the demand for early career in-country taxonomists was identified as the first step to accelerate the documentation and conservation of African plant diversity. Two years ago, RBG, Kew, in collaboration with the University of Ghana and the Ghana Herbarium (GC) and with support from the Schroder Charity Trust and Mallinckrodt Foundation, developed a tailored “Plant Taxonomy Skills for Ecology and Conservation” training course. This was planned to run in Africa, South America and Asia, alternating each year. The pilot was organised in Ghana, Africa in 2022. Participants for this 5-week course were selected from over 260 applicants. Delivered in a hybrid format, the course started with 3 weeks of online lectures, pre-recorded by 15 plant scientists and curators at RBG, Kew, as well as online interactive sessions. This was then followed by 2 weeks of in-person training in Ghana, including a 1-day field trip for practical collecting tips. The training covered herbarium curation techniques as well as concepts and skills needed for taxonomic revisions such as nomenclature, taxonomy, analysis of herbarium specimens, databasing, geo-referencing, preparation of morphological descriptions, diagnosis and identification keys as well as building distribution maps and red listing. The in-country teaching team included a curator-botanist, a plant taxonomist, a science education coordinator from RBG, Kew and two professors from University of Ghana. The course ended with a written assignment in the form of a taxonomic revision. A short survey was sent out to all course participants two years after the course to gather impacts of the training on their careers and uncover the most positive and negative aspects of the course. The course provided many positive outcomes: 15 plant taxonomists from eight African countries were trained, and jointly produced a taxonomic revision of 28 species of Ipomoea L. (Convolvulaceae) from Ghana (Williams et al. 2024). Additionally, The African Taxonomists Network was initiated by the course participants with a mission of ‘Fostering the next generation of taxonomists to bridge the generational gap and revitalize the relevance of taxonomy in Africa for the future.’ This network now has over 60 members, meets regularly online, and has a large presence on social media. Furthermore, the course also resulted in the awarding of the International Association for Plant Taxonomy (IAPT) Biodiversity Challenge grant to the GC Herbarium in 2022. This grant enabled acquiring essential plant collecting equipment and herbarium materials, either by sourcing them in Ghana or from abroad. The GC herbarium, founded in 1952, contains ~85,000 collections of plant and algae specimens from Ghana and across West Africa with high historical, teaching and research value. This collection is vital to enhancing in-country taxonomic capacity. Therefore, the improvement and upgrade supported by the grant, as well as its recognition, are essential. Another rewarding impact of the course is strengthening of links between RBG, Kew and African institutions of higher education. These links have quickly developed into a larger partnership and were the first step towards a long-term collaboration. The ultimate objective of this collaboration has been to create the necessary conditions, both in infrastructure and human capacity to deliver the Flora of Ghana. This will be achieved by implementing a project to support the maintenance and growth of the GC herbarium in addition to taxonomic capacity building and teaching. The participants benefited from the course by engaging with mentors, networking and exchanging ideas, forming links with individuals with similar research interests and obtaining additional training and career progression opportunities. In the feedback survey, all participants reported that this course made them consider a career or future studies in plant taxonomy and 80% of the participants reported securing a new job or a student position in plant taxonomy two years after the course. In addition, all participants listed several positive impacts of the course on their career such as confidence in producing a taxonomic revision, gaining herbarium management skills and opportunities for new collaborations. This course has been subsequently successfully run in South America (Bolivia) and Asia (Indonesia), with expectations of similarly positive outcomes, and is already planned to return to Africa (Kenya) in 2025.

Dynamics of Amphibian Pathogen Detection Using Extended Museum Specimens.

Natural history collections have long served as the foundation for understanding our planet's biodiversity, yet they remain a largely untapped resource for wildlife disease studies. Extended specimens include multiple data types and specimen preparations that capture the phenotype and genotype of an organism and its symbionts-but preserved tissues may not always be optimized for downstream detection of various pathogens. Frogs are infected by an array of pathogens including Batrachochytrium dendrobatidis (Bd), Ranavirus (Rv), and Amphibian Perkinsea (Pr), which provides the opportunity to study differences in detection dynamics across tissue types. We used quantitative PCR protocols to screen two tissue types commonly deposited in museum collections, toe clips and liver, from two closely related host species, Rana catesbeiana and Rana clamitans. We compared Bd, Rv, and Pr infection prevalence and intensity between species and tissue types and found no significant difference in prevalence between species, but Bd intensity was higher in R. clamitans than R. catesbeiana. Toe tissue exhibited significantly higher Bd infection loads and was more useful than liver for detecting Bd infections. In contrast, Rv was detected from more liver than toe tissues, but the difference was not statistically significant. Our results support the use of extended specimen collections in amphibian disease studies and demonstrate that broader tissue sampling at the time of specimen preparation can maximize their utility for downstream multipathogen detection.

Red herrings and zebras and TB, oh my! Unexpected bone marrow presentation of Mycobacterium tuberculosis

Abstract Introduction/Objective Epithelioid granulomas are uncommon and non-specific findings in bone marrow samples, and should prompt additional testing for appropriate diagnosis and treatment, especially in the immunocompromised patient. The differential diagnosis for bone marrow granulomas includes infections, neoplasia, autoimmune disease, sarcoidosis, and drug/therapy reaction. Although bone marrow workup to delineate the cause of granulomas should include staining to rule out both infection and lymphoma, morphologic review is often inconclusive. Final diagnosis requires clinical consultation and additional testing. Methods/Case Report A 76-year-old male was admitted to the hospital from the emergency department for a level 2 trauma after being found on the ground ~3 hours after a fall. The patient reported a recent increasing frequency of falls with associated weakness, as well as an almost 30 lb weight loss over the last 3.5 months and low grade fevers over several weeks. His past medical history was significant for treatment for urothelial carcinoma with transurethral resection and BCG therapy, hypertension, coronary artery disease, and peripheral vascular disease. Imaging showed hepatosplenomgaly, suspicious for early cirrhosis, and mild peripancreatic lymphadenopathy. Initial laboratory abnormalities demonstrated mild anemia, low albumin, and mild increase in ALT, AST, and alkaline phosphotase. Initial Infectious Diseases workup was negative for causative etiology (blood cultures, tick-borne parasites, and respiratory pathogens). Patient symptoms did not improve and cytopenias worsened. A bone marrow biopsy showed multiple non-necrotizing epithelioid granulomas. Despite low clinical concern for infectious etiology, mycobacteria blood culture isolated Mycobacterium tuberculosis complex. Final results were available 112 days after specimen collection. Results (if a Case Study enter NA) NA Conclusion Although tuberculosis is commonly associated with granulomatous pathology, infection is very uncommon in North American patients who have not traveled and alternative diagnoses might initially be favored. A high suspicion for mycobacterial infections is essential for diagnosis even in low-incidence populations with no known exposure or risk factor(s).

Critical Value Reporting Performance Improvement Initiative: A Journey Towards Timely Patient Safety

Abstract Timely reporting of critical values serves as a quality indicator for the National Patient Safety Goal. Since the oncology inpatient unit at our institution has the highest number of critical values and often struggles to meet the targeted goal of timely results acknowledgement, this prompted a performance improvement initiative. By utilizing the Institute for Healthcare Improvement (IHI) Model for Improvement, the study aimed to decrease the time from specimen collection to acknowledgment of a complete blood count critical values (overall TAT). Three key metrics were monitored, including unit turnaround time (time from collection to receipt in laboratory; uTAT), laboratory turnaround time (time from receipt in laboratory to verified results) and timely critical value acknowledgment rate (% acknowledgement within 30 minutes). Quality improvement tools such as process maps and fishbone diagrams were employed, and two areas for improvement were identified. Firstly, it was observed that samples collected by the phlebotomists were delivered in batch to the laboratory via carts. However, samples collected by nurses were sent to the laboratory via a pneumatic tube. Hence, the uTAT varied drastically due to the different delivery methods. Secondly, the mode of alerting providers regarding critical values, which was via telephone calls from telecommunication staff, was deemed disruptive and redundant, as the providers often were already aware of the results from the electronic medical record (EPIC). Two multi-cycle Plan-Do-Study-Act (PDSA) interventions were implemented by a multidisciplinary team. The first focused on sending samples via pneumatic tube. The second PDSA intervention focused on a direct clinician acknowledgment of critical values within EPIC, by creating an auxiliary column on the EPIC patient list. Consequently, the overall TAT decreased from a median time of 167 minutes in July 2021 to 140 minutes by March 2022 in the oncology inpatient unit, with a sustained result (139 minutes) by October 2023. This reduction was driven by the standardization of pneumatic tube delivery system; the uTAT decreased from a median time of 104 minutes to 46 minutes by March 2022 and remained low at 52 minutes by January 2024. Notably, the rate of timely acknowledgment of critical value results worsened, dropping from 67% to as low as 51 % (March 2022) and improved to 64% by January 2024. It was realized that this unintended consequence was attributed to the decrease in uTAT, leading to more critical value results reported in early morning when there was less staffing. Despite the worsening in timely critical value acknowledgment, the overall TAT showed a discernible reduction. The application of IHI methodology played a pivotal role in expediting result reporting. Subsequent steps will focus on utilizing secure communication channels to augment the success rate of critical values acknowledgment within 30 minutes.

Circulating Levels of Vitamins A, C, and E-Alpha in Organ Donors After the Neurologic Determination of Death.

The antioxidant effects of vitamins may attenuate the oxidative stress on organs imposed by ischemia-reperfusion injury during the process of organ transplantation from brain-dead donors. Circulating levels of vitamins A, C, and E-α in donors after brain death and their relationships to donor demographics, management, organ utilization, and recipient outcomes are largely unknown. An observational, prospective, cohort study of 84 consecutive brain-dead organ donors managed at a single organ procurement recovery center was conducted. Vitamin levels were drawn immediately prior to procurement. Levels of serum vitamins A and E-α and plasma vitamin C were below normal in 80%, 85%, and 92% of donors and deficient in 40%, 62%, and 63%, respectively. Vitamin C deficiency was associated with a longer time between death and specimen collection (P = .004). Death from head trauma and stroke were associated with lower levels of vitamin A than from anoxic causes (P = .003) and smokers had greater vitamin C deficiency (P = .03). During donor management, vitamin C deficiency was associated with longer vasopressor support (P = .03) and normal levels of vitamin E-α were associated with reaching a lower alanine transferase compared to those with subnormal levels (P < .05). Donors deficient in vitamin E-α were less likely to have a liver recovered for transplantation (P = .005). Vitamin levels were not associated with the recipient outcomes examined. Circulating vitamins A, C, and E-α is profoundly low in brain-dead organ donors, associated with relevant demographic features of the donor, and may influence donor management and organ utilization.

A Taxonomic Account of Mucuna (Leguminosae–Papilionoideae) in Africa, Madagascar, and the Indian Ocean Islands, with Comments on Its Biogeographic History

A taxonomic account of the papilionoid legume genus Mucuna Adans. in Africa, Madagascar, and the Indian Ocean islands is presented. Fifteen large herbaria that host representative collections of African specimens were visited and online databases consulted. A new phylogenetic analysis is also presented. Nineteen taxa are described and mapped. Twelve species and six infraspecific taxa (including autonyms, thus 15 terminal taxa) of Mucuna are present on the African mainland, where three species are representatives of Mucuna subg. Mucuna and the other nine are members of Mucuna subg. Stizolobium (P. Browne) Baker. In the Madagascar and Indian Ocean islands biodiversity hotspot, Mucuna is represented by six species, two of which (M. gigantea (Willd.) DC. and M. pruriens (L.) DC.) also occur on the African mainland. The other four species are endemic to Madagascar or adjacent islands and are representatives of Mucuna subg. Mucuna. The only representative of Mucuna subg. Stizolobium in Madagascar is M. pruriens. Our study suggests that the African mainland is the center of origin of Mucuna subg. Stizolobium. It is also revealed as the world’s most species-rich region in representatives of this subgenus, whereas on the other continents, subgenus Mucuna is the most diverse.

Exploring the causes of variability in quality of oropharyngeal swab sampling for SARS-CoV-2 nucleic acid testing and proposed improvement measures: a multicenter, double-blind study.

Although coronavirus disease 2019 (COVID-19) has not been considered a public health emergency of international concern since last year, intermittent regional impacts still persist, and accurate testing remains crucial. Ribonuclease P protein subunit P30 (RPP30) RNA, known for its broad and stable expression in tissue cells, was used to evaluate samples from 10 hospitals with over 3,000 negative nucleic acid tests. The results revealed that the overall pass rate for the collected samples was consistently low and exhibited significant heterogeneity. After reassessing the evaluative effectiveness of RPP30 RNA Ct values from the samples of 132 positive individuals under quarantine observation, it was used to identify factors affecting sampling quality. These factors included different stages ranging from sample collection to PCR processing, various characteristics of both samplers and individuals being sampled, as well as sampling season and location. The results indicated that post-sampling handling had minimal impact, winter and fever clinic samples showed higher quality, whereas children's samples had lower quality. The key finding was that the characteristics of samplers were closely related to sampling quality, emphasizing the role of subjectivity. Quality control warnings led to substantial improvements, confirming this finding. Consequently, although there are various factors during the testing process, the most critical aspect is to improve, supervise, and maintain standardized practices among sampling staff.IMPORTANCEThis study further confirmed the reliability of internal references (IRs) in assessing sample quality, and utilized a large sample IR data to comprehensively and multidimensionally identify significant interference factors in nucleic acid test results. By further reminding and intervening in the subjective practices of specimen collectors, good results could be achieved.

Streamlined chemical fixation method for morphological investigation of Candida albicans with scanning electron microscopy

This method describes the preparation of Candida albicans specimen for scanning electron microscopy (SEM), starting from specimen collection to obtaining SEM images. Our approach involves preserving cellular structure and preventing cell degradation through chemical fixation and post-fixation without Osmium tetroxide (OsO4), followed by air dried specimen placed onto Si substrate. Additionally, the method outlines the steps for mounting the prepared specimen onto SEM sample holder aluminum stubs, followed by coating with an ultrathin gold layer via thermal evaporation to enhance specimen/substrate/stub conductivity. The specimens are then mounted in the SEM sample holder. This step-by-step procedure demonstrates successful morphological analysis of C. albicans, providing a comprehensive and effective specimen preparation for SEM analysis.•Effective preparation of Candida albicans specimens for SEM analysis, preserving cellular structure.•Step-by-step specimen mounting and gold coating for enhanced detailed SEM imaging.•Chemical fixation of yeast cells for electron microscopy visualization.