Home Laboratory Research Articles

The feasibility and acceptability of home phlebotomy for patients with cancer.

Time toxicity is a considerable burden for oncology patients. This study evaluated the feasibility and acceptability of integrating mobile phlebotomy into standard of care procedures. From September 26, 2022, through December 31, 2023, a total of 345 patients had 1464 home laboratory test collection visits completed. These mobile phlebotomy laboratory collection visits occurred in New York (68.6% of visits), New Jersey (29.9%), Connecticut (1.1%), and Pennsylvania (0.5%). Specimen quality for home laboratory test collection surpassed the Memorial Sloan Kettering Department of Pathology and Laboratory Medicine benchmarks. Acceptability was high, 173 patients were approached, and 149 responded (86% response rate); most respondents (147 of 149, 99%) would use the service again or recommend it to others. This study assessed the integration of mobile phlebotomy into standard of care management for the collection of routine cancer laboratory tests. Mobile phlebotomy results in high patient satisfaction with superior specimen quality, offering a valuable solution to oncology patients for improved efficiency and convenience.

Caregiver encouragement to act on objects is related with crawling infants' receptive language.

The progression from crawling to walking in infancy is associated with changes in infant language development. One possible explanation for such change is the infant's language environment. Prior research indicates that caregivers use more action directives with walking infants compared to crawling infants, but the relations of such parental speech with infant vocabulary is unknown. Here, we present findings from day-long home audio recordings (Study 1) and laboratory observations (Study 2) of same-aged crawling and walking infants to explore how caregiver language, specifically action directives, were associated with parent reported infant vocabulary size. Findings in both studies indicated that caregiver action directives were associated with crawling, but not walking infants' receptive vocabulary sizes. Specifically, action directives about objects occurring when the infant and caregiver were not jointly engaged were associated with higher receptive vocabulary scores for crawling infants, but no such pattern was found for walking infants. The replication of results in distinct samples with different research methodologies strengthens the findings. Taken together, these studies demonstrate that caregiver social engagement specific to infant motoric development is related with infant language learning.

Incorporating hands‐on experiments into an online science course

AbstractBackgroundWith the rapid proliferation of online education, it is incumbent upon teachers to find ways to provide online students with science laboratory experiences. Existing research on online labs focuses heavily on computer‐supported inquiry learning environments, such as virtual laboratories and remote laboratories. There are limited studies on kitchen labs or home labs.ObjectivesThis study investigated the effectiveness of home labs using lab kits from two perspectives: students' perceptions and experiences of labs conducted in a home environment, as well as whether home labs help with students' knowledge acquisition.MethodsThis study employed lab quizzes to assess students' performance and lab reports to evaluate students' ability to interpret the lab results accurately in the authentic home lab contexts. Surveys and semi‐structured interviews were used to collect students' perceptions and experience data regarding these hands‐on experiments at home.Results and ConclusionsWe found that students' perceptions of home labs are similar to that of face‐to‐face labs, but they generally perceive home labs to be less complex. Students' performances on lab quizzes and lab reports indicate that the majority of them were able to apply the key scientific concepts to accurately interpret lab results in authentic home lab contexts. Students perceived that home labs provide flexibility and help in connecting learning to the real world. However, they also face challenges such as unexpected results and ambiguity during the process.ImplicationsBased on the key findings from this study and our reflections, four practice guidelines were provided for teaching hands‐on experiments online.

Raw diffraction data and reproducibility.

In recent years, there has been a major expansion in digital storage capability for hosting raw diffraction datasets. Naturally, the question has now arisen as to the benefits and costs for the preservation of such raw, i.e., experimental diffraction datasets. We describe the consultations made of the global structural chemistry, i.e., chemical crystallography community from the points of view of the International Union of Crystallography (IUCr) Committee on Data, of which JRH was the Chair until very recently, and the IUCrData Raw Data Letters initiative, for which LKB is the Main Editor. The monitoring by the CCDC of CSD depositions which cite the digital object identifiers of raw diffraction datasets provides interesting statistics by probe (x-ray, neutron, or electron) and by home lab vs central facility. Clearly, a better understanding of the reproducibility of current analysis procedures is at hand. Policies for publication requiring raw data have been updated in IUCr Journals for macromolecular crystallography, namely, that raw data should be made available for a new crystal structure or a new method as well as the wwPDB deposition. For chemical crystallography, such a step requiring raw data archiving has not yet been recommended by the IUCr Commission on Structural Chemistry.

OP173 Estimating The Marginal Productivity Of Health Technology Adoption

IntroductionDecisions to adopt health technologies rely, in part, on judgements about cost effectiveness. Cost effectiveness is commonly assessed against a willingness-to-pay threshold for health gains. Building an evidence base on the marginal productivity of health spending to inform the value of the threshold is increasingly of interest for resource allocation decision-making and technology implementation. We report on an in-progress analysis to inform a threshold for policy purposes in British Columbia, Canada.MethodsWe developed a ten-year panel-data model with instrumental variables, which lessens the degree of time-invariant confounding and addresses biased causal inferences caused by unobserved factors, to provide estimates of the marginal cost per health unit measured using quality-adjusted life-years (QALYs). We use the Johns Hopkins Adjusted Clinical Group (ACG) system and a British Columbia Health System Matrix to classify patients into six resource use bands (RUBs) ranging from ‘healthy’ to ‘very high morbidity’. Patients are also classified by chronic conditions and types of services. Place of residence and geographical region of health authorities are considered. Variables included age, gender, mortality and comorbidity rates, costs of hospitalizations, emergency department and physician visits, residential and home care, laboratory services, diagnosis and medications, and quality of life. Instrumental variables included sociodemographic characteristics as reported in the Canadian census.ResultsThe largest RUB was ‘moderate’ morbidity (39.3%), while the smallest was ‘healthy’ (1.5%). The youngest was the ‘low’ morbidity (mean 31, standard deviation [SD] 21) and the oldest was ‘very high’ (mean 69, SD 17). The healthy group had the smallest mean costs (CND563, SD CND4,121; equivalent to USD421, SD USD3,083). In contrast, the ‘very high’ group had the largest (CND20,398, SD CND36,188; equivalent to USD15,258, SD USD27,069). Age and gender standardized comorbidity index scores ranged from 0.05 to 6.41 (median 0.98). Additional analyses (e.g., costs per QALY) are ongoing and the results will be reported at the conference.ConclusionsOur empirical approach is robust and flexible, allowing estimates of marginal productivity according to factors such as disease, geographical region, service type, and care sector. This work has applications at the provincial and national levels and adds to methodological literature in the field.

How is mental health associated with adolescent alpha-amylase and cortisol reactivity and coordination?

To better understand the role of neuroendocrinological regulation in adolescent mental health, stress reactivity needs to be analyzed through both the autonomic nervous system (ANS) and the hypothalamic–pituitary–adrenal (HPA) axis. Accordingly, this study examined how adolescents’ internalizing and externalizing mental health symptoms are associated with their salivary alpha-amylase and cortisol levels, responses, and coordination (symmetry versus asymmetry). We utilized a developmentally salient stress task of mother–adolescent conflict discussion. Eighty 18–20-year-old late adolescents (55% girls) participated in a home laboratory assessment involving a 10-min conflict discussion with their mothers. Five adolescent saliva samples were collected to measure alpha-amylase and cortisol levels before, immediately after, and in 10-min intervals following the conflict discussion, to indicate stress reactivity. Adolescents had reported their internalizing (depression, anxiety, somatization) and externalizing (inattention, hyperactivity, anger control problems) symptoms 1 year earlier as part of a prospective family study. Internalizing symptoms were associated with adolescents’ high baseline cortisol levels, but not with cortisol responses or alpha-amylase levels or responses. In contrast, externalizing symptoms were associated with blunted alpha-amylase responses. Neither internalizing nor externalizing symptoms were associated with asymmetry between alpha-amylase and cortisol reactivity. The mother–adolescent conflict discussion was relevant as a stress stimulus to induce neuroendocrinological stress responses in adolescents. The nature of mental health problems was important for stress reactivity, yet, we found no evidence about mental health problems being related to endocrinological asymmetry in adolescents.

A Virtual Simulation Experimental Platform for Smart Home based on Unity3D

Smart home provides people with a more convenient and intelligent way of living and it is one of the most widely used application of Internet of Things (IoT). However, building a smart home laboratory for students to visit and learn is labor intensive and time consuming. In order to meet the demand of experimental teaching in higher education, this paper designed and developed a Virtual Simulation Experimental Platform (VSEP) for smart home. Firstly, we introduced goals, platform architecture and functional modules of the system. Then, the development process was discussed. Specifically, the model of smart home was quickly built in SketchUp and imported into Unity 3D project, and both the scene roaming and interactive functions were achieved by coding C# scripts. Finally, we described the key methods in details and accomplished the development work. The proposed platform provides an immersive virtual environment for students to learn concepts and principles of related theoretical knowledge, and offers a new method for experimental teaching.

Technical note: MR-compatible pedal ergometer with electromechanical pedal resistance and exercise triggering enhanced by visual feedback via video display.

During and after exercise, dynamic 31 P MR parameters are typically measured using an MR-compatible ergometer. Self-built equipment for local condition can be constructed where possible. To develop a pedal resistance ergometer with rocker arm based on a system that combines electric weight displacement, visual self-monitoring, and exercise triggering. The repeatability and reproducibility were tested. The hardware and software for the ergometer were constructed from commercial components in a home laboratory. Twelve volunteers participated in the testing of the ergometer. A fully automated ergometer system was developed, allowing the pedal resistance to be adjusted during the examination. The system includes a self-monitoring and triggering mechanism that enables both the operator and subject to monitor pedal frequency and force. The operator can modify the pedal resistance as desired during the exercise. This self-monitoring solution is simple and cost-effective, requiring only a commercial potentiometer, an Arduino converter, and a conventional video projector with a personal computer (PC). Additionally, all system components are located outside the magnetic resonance (MR) room, avoiding interference with the MR system. Results of several test of the reproducibility/repeatability of power at three pedal resistance values (15%, 24%, 25% maximal voluntary force) were expressed both as a coefficient of variation ranging from 6% to 3.1% and as an intraclass correlation of coefficient ranging from 0.96 to 0.99. Similar values were also found for other dynamic parameters of 31 P MR spectroscopy. These findings are similar to published data obtained on different types of ergometers. Based on more than 1 year of usage, the ergometer proved successful in handling stationary and variable loads, and can be easily operated by a single user.

Nocturnal Polysomnography without Technical Supervision in the Diagnosis of Respiratory Sleep Disorders, Diagnostic Performance of Home and Sleep Laboratory Studies.

Introduction Unattended Polysomnography (type 2 PSG) is a procedure for the diagnosis of sleep-disordered breathing (SDB). Published evidence on its performance and efficacy is limited. Available studies reveal a high rate of lost records that could limit its application. Objective To assess the efficacy of type 2 PSG and the rate of studies that must be repeated due to critical loss of signals. Methods prospective, descriptive study. Adult patients with suspected SDB were included. Unattended PSG was performed using portable equipment. 75 patients were connected at home and another 75 in the laboratory, without subsequent monitoring. Records were evaluated to determine the percentage of the night with adequate quality for each of the signals, considered as an evaluable signal for = 70% of the total recording time (TRT). The need to repeat the studies was also estimated. Results: 150 patients were recruited; 44% women; age 57.3 ± 15.4 years; BMI 29.4 ± 6.5. EEG and EOG signals were adequate in 149 records. Flow signal by pressure cannula was adequate in 146 and by thermistor in 67.8%. In only one study the signal of both effort bands were inadequate. Oximetry was lost in 4 cases. Ten tracings (6%) met the criteria for repetition; 8 hospital and 2 home. Conclusions Acceptable records were obtained in most unattended PSG studies, both at home and in the sleep laboratory. The rate of repetition of studies due to loss of signal was 6%, with failure in SaO2 or in flow signals being the main cause of the indication.

Transitioning Lab Courses to Online Platforms by Higher Education Institutions during COVID-19: Strategies, Learning Outcomes, Perceptions, and Challenges

The COVID-19 pandemic forced universities to shift their in-person lab courses to remote delivery, which presented several challenges for instructors and students. This article analyzed 33 peer-reviewed research articles to identify the various approaches taken by universities to migrate lab courses to remote platforms, as well as the difficulties encountered during the transition. The review revealed that technology and internet issues, workload constraints, academic integrity, and the overall educational experience were among the challenges faced. The authenticity and completeness of online labs were inferior to in-person labs, resulting in mixed opinions on the effectiveness of online labs. Students found labs that incorporated video recordings and simulations on a synchronous platform to be the most engaging. However, home labs provided limited hands-on experience, depending on the circumstances. Further research is required to investigate the cognitive, physical, and temporal demands posed by these technologies to develop a more compelling online lab experience.

Modificaciones implementadas a los laboratorios de química debido a la pandemia por COVID-19 a nivel internacional y nacional, el caso de la Universidad Nacional y la Universidad de Costa Rica en 2020-2021 y sus aciertos o deficiencias

This essay addresses the problems faced by chemistry laboratory teachers during the COVID-19 pandemic, the contingency measures used to continue virtual laboratory courses, such as online chemical simulators and the application of home laboratory practices, the recommendations made by experts, as well as some impressions of the student body regarding the measures implemented by their teachers. In addition, some measures taken by two state universities from Costa Rica to deal with this anomalous situation are discussed. Although the studies consulted agree that virtuality loses the essence of a laboratory course, as there is no possibility of handling equipment and instrumentation, it is considered that the use of virtual and technological tools is a good complement to support the learning of students and that their inclusion is important for the development of education in the chemistry laboratory.

Open label single arm study to assess the implementation of home based daratumumab administration in patients being treated for multiple myeloma.

TPS1609 Background: Multiple myeloma (MM) is an incurable hematologic malignancy that has a high burden of care for patients and their caregivers. Over the last two decades, the treatment landscape for MM has changed dramatically. However, treatment burden with frequent visits to offices and the hospital is high. We need innovative care delivery models to alleviate these burdens. Chemotherapy at home remains uncommon in the US, though models for its use exist globally. In these models, home-based chemotherapy is safe, preferred by patients, and can be administered at lower cost. Herein, we propose a home-based subcutaneous daratumumab and hyaluronidase-fihj (dara) program for patients with MM. We hypothesize that this program will be feasible, reduce patient treatment and financial burden, and improve quality of life. Methods: We designed an open label single arm study to assess the implementation of home administration of dara. The primary objective is to evaluate (n=20) treatment satisfaction of patients, using the Cancer Therapy Satisfaction Questionnaire (CTSQ), when they receive care at home as compared to the standard of care (SOC). Secondary outcomes include evaluating adherence to home delivery, quality of life (EORTC QLQ-30), financial burden (COST survey), safety of home administration, and barriers to home administration. At the end of the study, we will conduct semi-structured interviews to assess patient experience with home administration of chemotherapy. Patients will be eligible for study participation if they have a diagnosis of multiple myeloma, are in the monthly phase of dara treatment and are treated with either monotherapy or in combination with oral agents. All participants who are interested and eligible will be on study for 8 cycles of dara (2 cycles of dara in the infusion center (IC) followed by 4 cycles at home and then 2 cycles in the IC). During the home administration phase, 1-3 days prior, patients will go to a local lab or have at home labs. On day of at home dara, the drug will be mixed and packaged by our pharmacy, and then delivered at room temperature to the patient’s home by our home infusion courier. The patient will take pre-medications 1-3 hours prior to nurse arrival. The nurse arrives, confirm pre-medications were taken. Pre-treatment vitals and post treatment vitals will be obtained. Drug will be administered as per label instructions. At the beginning of each cycle, patient reported outcome surveys and quality of life surveys will be collected. During the home administration phase, details on barriers to maintaining adherence (i.e. issues with storage, delivery, disposal of medication) will be collected. The study opened for enrollment on November 8th, 2022. As of February 1stth 2023, 9 patients have consented and 5 patients are on-treatment. Clinical trial information: NCT05511428 .

Combined X-ray diffraction tomography imaging of tension and opposite wood tissues in young hybrid aspen saplings

Combining spatially localized X-ray diffraction (XRD) with X-ray microtomography (XMT) enables the mapping of the micro- and nanoscale structures simultaneously. The combination of these methods results in a powerful tool when considering the structural studies of hierarchical materials, allowing one to couple the relationships and connections of the structures at various scales. In this study, XMT was used to map the anatomy and cellular structures in 3D in tension and opposite wood with 1.5 µm resolution, while XRD was used to determine the cellulose crystallite widths and microfibril orientations with 100 µm spatial resolution within the same tissues. Tension wood (TW) has an important biological function with clearly distinct properties to opposite (OW) and normal wood, e.g. differing cellular structures with a higher cellulose content. This is the first study of very young hybrid aspen saplings (1-month-old) using the combined diffraction tomography method. The TW tissues could be identified from the OW tissues based on both the XMT and XRD results: TW had a higher average size of the cellulose crystallites and smaller mean microfibril angles (mMFA) than those in OW. With the XRD data, we were able to reconstruct the images of the cross sections of the saplings using the structural parameters (cellulose crystallite width and mMFA) as contrast mechanisms. As far as the authors know, there are no previous studies with images on any TW samples using the XRD-based contrast. Home laboratory bench-top set-up offers its advantages for these studies, considering the number of samples characterized, time-dependent studies and larger field of views.

Extreme weather events and HIV: development of a conceptual framework through qualitative interviews with people with HIV impacted by the California wildfires and their clinicians

BackgroundPeople with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH.MethodsFrom October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts.ResultsWe interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing).ConclusionsBased on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness.Trial registrationN/A.

EVALUATION OF TRACHEAL ASPIRATE CULTURES IN PATIENTS FOLLOWED WITH HOME MECHANICAL VENTILATORS

Introduction: In recent years, there has been an increase in the use of mechanical ventilators at home. In this study, we aimed to investigate the underlying diseases, admission complaints, microorganisms that isolated in samples taken from tracheal aspirate (TA) cultures and their resistance to antibiotics in patients followed up with mechanical ventilators at home.
 Methods: Between January 1, 2020 and January 1, 2021, TA cultures, identification of bacteria and their antibiotic susceptibilities were evaluated by VITEK 2 (bioMeriux, France) automated identification system. The patients' age, gender, underlying diseases, duration of home ventilator use, complaints, and laboratory data were reviewed retrospectively from the patient files.
 Results: Of the 91 prediagnosed ventilator-associated pneumonia (VAP) patients examined in the study, 72 (79%) were male and 19 (21%) were female. The ages of the patients ranged from 5 to 212 month, with a mean age of 91,64 ± 64,07 month. The most common reason for referral was fever and dyspnea and 43.76% of the patients were diagnosed with cerebral palsy/epilepsy and 10.4% with syndromes.
 Of the samples; 12 (13.3%) were defined as Gram-positive and 79 (86.7%) as Gram-negative. Pseudomonas aeruginosa was detected in 44 (48.4%) samples, S. marcescens in 9 (9.9%) and Klebsiella in 8 (8.8%) samples. Staph aureus was detected in 12 (13.3%) samples. Carbapenem resistance was 18.75% for P. auriginosa, 16% for Klebsiella, 12.5 for E.coli and 12% for Acinetobacter baumani.
 Conclusion: TA culture should be taken from patients with home mechanic ventilator (HMV) who admitted with signs of infection such as fever and respiratory distress and treatment should be arranged according to the result. It was observed that the TA culture antibiotic resistance rates of the patients followed up with HMV at home was lower than the TA cultures sent from the patients hospitalized in the intensive care unit.

Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke.

Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.

Real-time energy management in an off-grid smart home: Flexible demand side control with electric vehicle and green hydrogen production

A real-time energy management system for an off-grid smart home is presented in this paper. The primary energy sources for the system are wind turbine and photovoltaics, with a fuel cell serving as a supporting energy source. Surplus power is used to generate hydrogen through an electrolyzer. Data on renewable energy and load demand is gathered from a real smart home located in the Yildiz Technical University Smart Home Laboratory. The aim of the study is to reduce hydrogen consumption and effectively utilize surplus renewable energy by managing controllable loads with fuzzy logic controller, all while maintaining the user's comfort level. Load shifting and tuning are used to increase the demand supplied by renewable energy sources by 10.8% and 13.65% from wind turbines and photovoltaics, respectively. As a result, annual hydrogen consumption is reduced by 7.03%, and the average annual efficiency of the fuel cell increases by 4.6%

The three facets of the SARS-CoV-2 pandemic during the first two waves in the northern, central, and southern Italy

BackgroundThere is a scarcity of information in literature regarding the clinical differences and comorbidities of patients affected by Coronavirus disease 2019 (COVID-19), which could clarify the different prevalence of the outcomes (composite and only death) between several Italian regions. ObjectiveThis study aimed to assess the heterogeneity of clinical features of patients with COVID-19 upon hospital admission and disease outcomes in the northern, central, and southern Italian regions. MethodsAn observational cohort multicenter retrospective study including 1210 patients who were admitted for COVID-19 in Infectious diseases, Pulmonology, Endocrinology, Geriatrics and Internal Medicine Units in Italian cities stratified between north (263 patients); center (320 patients); and south (627 patients), during the first and second pandemic waves of SARS-CoV-2 (from February 1, 2020 to January 31, 2021). The data, obtained from clinical charts and collected in a single database, comprehended demographic characteristics, comorbidities, hospital and home pharmacological therapies, oxygen therapy, laboratory values, discharge, death and Intensive care Unit (ICU) transfer. Death or ICU transfer were defined as composite outcomes. ResultsMale patients were more frequent in the northern Italian region than in the central and southern regions. Diabetes mellitus, arterial hypertension, chronic pulmonary and chronic kidney diseases were the comorbidities more frequent in the southern region; cancer, heart failure, stroke and atrial fibrillation were more frequent in the central region. The prevalence of the composite outcome was recorded more frequently in the southern region. Multivariable analysis showed a direct association between the combined event and age, ischemic cardiac disease, and chronic kidney disease, in addition to the geographical area. ConclusionsStatistically significant heterogeneity was observed in patients with COVID-19 characteristics at admission and outcomes from northern to southern Italy. The higher frequency of ICU transfer and death in the southern region may depend on the wider hospital admission of frail patients for the availability of more beds since the burden of COVID-19 on the healthcare system was less intense in southern region. In any case, predictive analysis of clinical outcomes should consider that the geographical differences that may reflect clinical differences in patient characteristics, are also related to access to health-care facilities and care modalities. Overall, the present results caution against generalizability of prognostic scores in COVID-19 patients derived from hospital cohorts in different settings.

Determining biomolecular structures near room temperature using X-ray crystallography: concepts, methods and future optimization.

For roughly two decades, cryocrystallography has been the overwhelmingly dominant method for determining high-resolution biomolecular structures. Competition from single-particle cryo-electron microscopy and micro-electron diffraction, increased interest in functionally relevant information that may be missing or corrupted in structures determined at cryogenic temperature, and interest in time-resolved studies of the biomolecular response to chemical and optical stimuli have driven renewed interest in data collection at room temperature and, more generally, at temperatures from the protein-solvent glass transition near 200 K to ∼350 K. Fischer has recently reviewed practical methods for room-temperature data collection and analysis [Fischer (2021), Q. Rev. Biophys. 54, e1]. Here, the key advantages and physical principles of, and methods for, crystallographic data collection at noncryogenic temperatures and some factors relevant to interpreting the resulting data are discussed. For room-temperature data collection to realize its potential within the structural biology toolkit, streamlined and standardized methods for delivering crystals prepared in the home laboratory to the synchrotron and for automated handling and data collection, similar to those for cryocrystallography, should be implemented.

Multielectron ionization contributions in valence‐to‐core x‐ray emission spectra of third‐row elements

AbstractThe valence‐to‐core (VtC) K x‐ray emission spectroscopy (XES) in the tender x‐ray range is emerging as a powerful analytical technique used to study the electronic structure of third‐row elements within complex bulk materials. With dedicated tender x‐ray emission spectrometer coupled with laboratory excitation source, such analysis can be successfully performed also in a smaller lab. In this work, we have gathered VtC x‐ray emission spectra of several sulfur and chlorine compounds measured previously in our home lab using Johansson type tender x‐ray emission spectrometer and MeV proton excitation. Measured spectra are compared to the results of one‐electron density functional theory (DFT) calculations. Theoretical spectra were found in good agreement with the experimental data with few exceptions where systematic discrepancies were observed. The latter was attributed to the simultaneous K and M shell ionization induced by MeV protons, which is not included in the one‐electron DFT theoretical framework. In order to confirm this also experimentally, VtC x‐ray emission spectra of few selected S and Cl compounds induced with three different proton energies were recorded yielding characteristic KM ionization satellite lines, confirmed by their emission energies as well as the dependence of their relative intensity on proton energy.