Laboratory Implementation Research Articles

Immersive learning of the young generation using a mobile learning lab

In order to counter modern threats, knowledge and ablity to act in the face of emerging dangers are necessary. It is not possible to solve these problems without proper training of the population, including the younger generation, in the field of life safety. The development of the modern education system involves the introduction of modern technologies and innovative educational projects into the educational process, including immersive teaching methods. Immersive learning is the most effective and safe way to develop sustainable skills for safe behavior in various emergency and dangerous situations. The aim of this study is to increase the level of training of the younger generation in the field of life safety. To achieve the aim set, the authors: analyzed the main normative legal acts regulating the issues of training the population in the field of life safety; studied previously completed scientific papers and publications in this field of research; the problematic issues of training the younger generation in the field of life safety are considered; identified the most effective ways of training the younger generation based on the use of modern technologies. To solve the identified problems and achieve the research aim, the authors propose using the latest achievements and trends in the educational environment to develop a unique educational product – the mobile educational laboratory «Country of Safety». The paper substantiates the relevance and effectiveness of the creation and use of a mobile training laboratory in the education system, analyzes the experience of using similar complexes on the topic of road safety in Moscow and the Moscow region. The main emphasis is put on the organization of practical training of the younger generation on the basis of a mobile educational laboratory using game forms of learning, virtual reality technologies and environment modeling using 3D visualization. As conclusions, the planned results of the development and implementation of the mobile training laboratory «Country of Safety» in the activities of both the Ministry of Emergency Situations of Russia and educational organizations are proposed.

Implementation of Volumetric Finger-Prick Self-Sampling for TDM of Immunosuppressants After Kidney Transplantation: Lessons Learned from the Practice.

Home-based hospital services are becoming increasingly popular, and the addition of remote outpatient appointments after kidney transplantation facilitates more practical and closer follow-up. In this context, finger-prick self-sampling is an important aspect of monitoring of immunosuppressants and biomarkers. Nevertheless, several issues must be addressed to ensure the feasibility and quality when implementing microsampling in clinical practice. We summarize our experiences and opinions in this field. This article is based on the authors' experience regarding the laboratory and clinical implementation of finger-prick self-sampling in kidney transplant recipients. The referenced literature is related to the authors' knowledge in this field. We present considerations for the selection of relevant analytes, key characteristics of selected volumetric sampling tools (Mitra and Capitainer), and the associated sampling pitfalls. In addition, we address the requirements for patients performing finger-prick sampling, appropriate design of methods and workflow, critical points for validation, and aspects related to logistics and digital solutions. Volumetric finger-prick self-sampling is suitable for monitoring immunosuppressants and certain biomarkers that are relevant to outpatient follow-up after kidney transplantation. We believe that a carefully designed system for the entire workflow, including patient training, will be beneficial in enabling a safe experience for transplant recipients, as well as ensuring overall efficiency and adequate quality. In the future, a combination of immunosuppressants with a wide range of biomarkers has significant potential for use in at-home self-sampling after kidney transplantation.

The Advantages of Adopting the ISO/IEC 17025: 2017 Lab Management System in Calibration and Testing Laboratories

International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC) standards for testing and calibration laboratories are known as ISO/IEC17025:2017, which is the standard for laboratory certification. The testing laboratory's accreditation, the methods of execution, and the tangible advantages of working with such an organization. This study examined the advantages of ISO/IEC17025:2017 implementation in Chengalpat region's calibration and testing laboratories using a descriptive research design. The advantages of putting ISO/IEC 17025:2017 into practice are the main variable in the current study. The investigator utilized a method called purposive sampling. This research is based on a survey with 180 responses. After the data was gathered, analysis was done using SPSS 20. It has been found that to implement best practices and believe in the benefits, Top Management must fully understand the advantages of enacting the ISO/IEC 17025: 2017 Lab Management System, task and lab managers must fully understand the Lab Management System ISO/IEC 17025: 2017 implementation, the management tools for the Calibration and Testing Labs, the infrastructure that is being developed for the Labs, teams must collaborate, and accountability is linked to the Labs.

Development of a two-stage thermoacoustic refrigerator prototype

A traveling-wave thermoacoustic refrigerator is a potential cooling option for electronics enclosures. The main advantage of this type of refrigerator is the lack of moving parts, which makes it a maintenance-free application. The design and laboratory implementation of a travelling-wave thermoacoustic refrigerator is studied and presented in this paper. The matching between the thermoacoustic refrigerator and a pair of linear motors is investigated. A model of the refrigerator was first developed via DeltaEC simulations and then validated experimentally. A final configuration comprising of a two-stage refrigerator driven by two linear motors is presented. The model of the refrigerator runs at a frequency of 60 Hz, and it is able to generate a cooling power of 446 W at a cooling temperature of 0 °C. The setup and instrumentation of the apparatus is explained in detail. Experimentally, the refrigerator's maximum cooling load was 298 W, and the lowest cooling temperature achieved was -0.2 °C. At the maximum cooling power, the COP is 2.35.

Untargeted Metabolomics for Inborn Errors of Metabolism: Development and Evaluation of a Sustainable Reference Material for Correcting Inter-Batch Variability.

Untargeted metabolomics has shown promise in expanding screening and diagnostic capabilities for inborn errors of metabolism (IEMs). However, inter-batch variability remains a major barrier to its implementation in the clinical laboratory, despite attempts to address this through normalization techniques. We have developed a sustainable, matrix-matched reference material (RM) using the iterative batch averaging method (IBAT) to correct inter-batch variability in liquid chromatography-high-resolution mass spectrometry-based untargeted metabolomics for IEM screening. The RM was created using pooled batches of remnant plasma specimens. The batch size, number of batch iterations per RM, and stability compared to a conventional pool of specimens were determined. The effectiveness of the RM for correcting inter-batch variability in routine screening was evaluated using plasma collected from a cohort of phenylketonuria (PKU) patients. The RM exhibited lower metabolite variability between iterations over time compared to metabolites from individual batches or individual specimens used for its creation. In addition, the mean variation across amino acid (n = 19) concentrations over 12 weeks was lower for the RM (CVtotal = 8.8%; range 4.7%-25.3%) compared to the specimen pool (CVtotal = 24.6%; range 9.0%-108.3%). When utilized in IEM screening, RM normalization minimized unwanted inter-batch variation and enabled the correct classification of 30 PKU patients analyzed 1 month apart from 146 non-PKU controls. Our RM minimizes inter-batch variability in untargeted metabolomics and demonstrated its potential for routine IEM screening in a cohort of PKU patients. It provides a practical and sustainable solution for data normalization in untargeted metabolomics for clinical laboratories.

B-170 Age-Specific reference intervals for ethanolamine plasmalogen species in red blood cells using liquid chromatography tandem mass spectrometry

Abstract Background Plasmalogens are critical membrane structural components that are mainly generated by de novo synthesis starting in peroxisomes. Hence, patients with defects in peroxisome biogenesis (PBD) exhibit markedly reduced plasmalogen levels. Plasmalogen ratios are traditionally measured by gas chromatography-mass spectrometry (GC-MS); however, this method entails a lengthy sample extraction and derivatization and does not report concentrations of individual plasmalogen species. We have developed a robust and easy-to-implement liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to quantify the 18 most abundant ethanolamine plasmalogen (PlsEtn) species in packed red blood cells (RBCs). However, no reference intervals have been published for individual PlsEtn. Here, we describe the establishment of age-specific reference intervals for individual PlsEtn species and their total values (16:0, 18:0, 18:1 species, and total plasmalogens). Methods Plasmalogens were extracted using methanol containing two labeled internal standards, shaking for one hour at room temperature. Chromatographic separation was performed using an Acquity Premier BEH C18 UPLC column with a binary gradient of 5 mM ammonium acetate in water:methanol (15:85) and 5 mM ammonium acetate in methanol. Analysis was performed using a XEVO TQ-XS Mass Spectrometer with Ultra-High Performance Liquid Chromatography (Waters) in multiple reaction monitoring mode. Eighteen PlsEtn species were quantified using four commercially available standards; additionally, totals were calculated for 16:0, 18:0 or 18:1 species, and for total plasmalogens. Reference intervals were established using 376 RBCs from self-reported healthy volunteers and de-identified clinical samples referred for unrelated testing (182 females and 194 males; range 0 to 88 years). Data was analyzed using the R programming language. The study was approved by the Institutional Review Board of the University of Utah. Results Initial age groups were identified using a model-based clustering algorithm followed by iterative Harris-Boyd analysis. Finally, the adjacent groups were merged if their means differed by less than 10%. Once the final age groups were partitioned, data in each individual age group were analyzed using parametric or non-parametric statistics to determine reference intervals (95%, with 90%confidence intervals). PlsEtn species displayed the lowest concentration in the first few months of life, which increased in childhood until adolescence or adulthood (depending on PlsEtn). For most species, the concentrations increased over time reaching a plateau between 18 and 48 years of age, and then starting to decrease. The total values followed the same trend, with neonates showing significantly lower values compared to other age groups. Conclusions We applied a novel statistical approach to identify age groups and determine age-specific reference intervals for 18 individual PlsEtn in RBC and their totals. Lacking previously published data, this study is critical for supporting test implementation in clinical laboratories.

A-161 Diagnosis of Lupus Anticoagulant Cases using Deep Neural Networks

Abstract Background Laboratory identification of lupus anticoagulant (LAC) is critical for diagnosing antiphospholipid antibody syndrome, a common cause of unprovoked thromboembolic events and pregnancy morbidity. Commonly used clot-based assays for LAC include the dilute Russell’s viper venom time (DRVVT) and activated partial thromboplastin time (APTT), but these are susceptible to anticoagulant interferences. Despite standardization efforts, LAC interpretation remains challenging due to pre- and post-analytical complexity and limited expertise. This study explored the use of deep neural networks (DNN) to facilitate LAC diagnosis. Methods Retrospective data for LAC profiling with 13 features performed at Mayo Clinic between 2021 and 2022 was collected. The profiles of 7,202 patients were randomly divided into training (n=4608), validation (n=1153), and test cohorts (n=1441). Diagnostic outputs including LAC positivity (determined by DRVVT or APTT) and the presence of warfarin (WAR) and heparin (HEP), were confirmed by expert assessment. Three DNN architectures were developed and evaluated (Figure 1): (1) four single output DNN models with a domain knowledge driven selection of input features, (2) four single output DNN models using the same 13 inputs across all models, and (3) a multi-output DNN model. Model performance was evaluated using the F1 score and the index of balanced accuracy (IBA) for each output label. Results Architecture 1 achieved high diagnostic accuracy with IBA values of 0.989-1.000 for all four outputs and F1 scores of 0.945-0.991. Architecture 2 exhibited F1 scores of 0.902-0.973 and IBA values of 0.935-0.992. Architecture 3 achieved F1 scores of 0.933-0.967 and IBA values of 0.941-0.983. Conclusions All three architectures accurately classify LAC and common anticoagulation effects. The comparable performance of architectures 1 and 2 suggests that manual feature extraction is unnecessary. Given its relative simplicity and versatility, architecture 3 is the preferred choice for implementation in a clinical laboratory to standardize LAC diagnosis.

B-080 Development and Validation of a GQ1b IgG ELISA as a Diagnostic Aid for Subacute Demyelinating Polyneuropathies

Abstract Background Autoimmunity targeting GQ1b is associated with group of disorders that includes Miller-Fisher Syndrome (MFS), Bickerstaff Brainstem Encephalitis (BBE) and classic Guillain Barre Syndrome (GBS) with ophthalmoplegia. Collectively these are referred to as GQ1B-IgG related syndromes. The prevalence of GQ1b-IgG in this population of patients is high and has been reported to be >80% in well-defined clinical cohorts. Clinical phenotypic presentation is diverse and requires highly accurate antibody testing. The objective of this study was to evaluate a newly developed custom GQ1b-IgG assay, using a semi-quantitative ELISA-based method. Methods A GQ1b-IgG ELISA was developed and validated. Patient sera along with assay controls and a single-point calibrator are diluted and incubated in duplicate wells in a 96-well plate coated with GQ1b antigen. The plate is washed and incubated with anti-human-IgG secondary antibody conjugated with HRP. After a colorimetric reaction, optical densities (OD) are read. The OD of patient samples are compared against the calibrator, generating a cut-off index (COI). Samples ≥1.0 COI are considered positive. During the validation phase, analytical and clinical performance characteristics were evaluated. Studies included assessment of imprecision at multiple concentrations of GQ1b-IgG, accuracy using method comparison, analytical sensitivity and specificity, reference range, common interferences, plate drift, and clinical performance in relevant disease and control cohorts. Results Intra-assay imprecision (coefficient of variation; %CV) ranged from 1.0 - 16% across all concentrations of GQ1b-IgG. Inter-assay imprecision (%CV) ranged from 12.4 - 44.5% but was <20% at or above the assay cut-off. We found perfect qualitative agreement with an independent ELISA reference method (20 positive and 20 negative samples selected based on reference method results [reference interval <1:100]). Limit of detection (LOD) was calculated at a COI of 0.22. To assess analytical specificity, 40 samples with high concentrations of immunoglobulins (hypergammaglobulinemia [N=15], IgG M-protein [N=15] and systemic lupus erythematosus [N=10] were tested and all were negative. A reference interval study was performed on 140 healthy donor serums, all were negative. Interference studies were conducted on 2 positive and 2 negative serum samples, spiked for highly hemolytic (1000 mg/dL), lipemic (2000 mg/dL) and icteric (60 mg/dL) conditions. There was no impact on the assay even with high levels of a given interferent. Plate drift on 2 distinct patient pools tested across the plate (COI range 0.7 - 1.3) had overall plate CV’s ≤10%. ROC analysis was performed on a cohort of 278 patient samples (15 MFS cases and 263 controls [suspected demyelinating neuropathy or disease mimics]). A cut-off value of 1.0 (COI) was selected based on the Youden index. At this cut-off, clinical sensitivity for MFS was 87% while clinical specificity was 99.2%. Conclusions The observed performance of the GQ1b-IgG ELISA was acceptable for clinical laboratory implementation. A COI of ≥ 1.0 was selected for clinical use.

Development and Validation of a High-Performance Liquid Chromatography-Ultraviolet Spectrometry Method for Ampicillin and its Application in Routine Therapeutic Drug Monitoring of Intensive Care Patients.

Ampicillin/sulbactam, a combination of a β-lactam and β-lactamase inhibitor, is widely used in clinical settings. However, therapeutic drug monitoring (TDM) of ampicillin is not commonly performed, particularly in intensive care units (ICUs). The purpose of this study was to develop and validate a rapid and cost-effective high-performance liquid chromatography (HPLC)-ultraviolet spectrometry method to quantify ampicillin in human serum and evaluate its clinical application in ICU patients. Sample cleanup included a protein precipitation protocol, followed by chromatographic separation on a C18 reverse-phase HPLC column within 12.5 minutes using gradient elution of the mobile phase. The assay was validated according to the German Society of Toxicology and Forensic Chemistry criteria. Clinical applications involved the retrospective analysis of TDM data from ICU patients receiving continuous infusion of ampicillin/sulbactam, including the attainment of target ranges and individual predicted and observed pharmacokinetics. The method was robust, with linear relations between the peak area responses and drug concentrations in the range of 2-128 mg/L. The coefficient of variation for precision and the bias for accuracy (both interday and intraday) were less than 10%. Clinical application revealed variable pharmacokinetics of ampicillin in ICU patients (clearance of 0.5-31.2 L/h). TDM-guided dose adjustments achieved good therapeutic drug exposure, with 92.9% of the samples being within the optimal (16-32 mg/L) or quasioptimal (8-48 mg/L) range. This method provides a practical solution for the routine TDM of ampicillin, facilitating individualized dosing strategies to ensure adequate therapeutic drug exposure. Given its simplicity, cost-effectiveness, and clinical relevance, HPLC-ultraviolet spectrometry holds promise for broad implementation in hospital pharmacies and clinical laboratories.

Quantification of Urinary Exosomal Prostate-Specific Antigen for the Diagnosis of Prostate Cancer Using Clinical Laboratory-Based Techniques: Protocol for a Case-Control Study.

Prostate cancer is the most common cancer in men and represents a major public health problem. The current method for the diagnosis or screening of prostate cancer is invasive and costly. There have been renewed and innovative studies searching for urinary biomarkers to aid in the diagnosis of prostate cancer, especially with technologies based on urinary exosomes. However, technologies based on urine exosomes usually need expensive machines such as an ultracentrifuge and they are difficult to standardize, which hinder their application in clinical laboratories. We have optimized and standardized the isolation of urinary exosomes with the precipitation method. We have found that urinary exosomal prostate-specific antigen (PSA) can be quantified by automatic Elecsys total PSA technique. In this study, our objective is to utilize urinary exosomes from prostate cancer for the development of a test to aid in its diagnosis. Exosomes from the prostate cancer cell line LNCaP was used to set up the technique. To analyze urine samples from patients, the methods include the collection of first-void urine using the Colli-Pee device, the isolation of urine exosomes using the optimized precipitation method, and the quantification of exosomal PSA by Elecsys total PSA. This will be a 2-year study. We will start including patients and controls in the last quarter of 2024. We expect the results to be published in the second quarter of 2027. This is the first study to quantify urinary exosomal PSA using the Elecsys total PSA technique for the diagnosis of prostate cancer. This study emphasizes techniques that are suitable for implementation in clinical laboratories, which will facilitate the application of urinary exosomes to simplify and improve the diagnosis and screening of prostate cancer. PRR1-10.2196/63551.

California's Recovery Incentives Program: Implementation strategies

IntroductionDue to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit. MethodsThe Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch. ResultsThe present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program. ConclusionThe California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

Evaluating the accuracy of the MBT Lipid Xtract Kit for assessing colistin resistance in comparison to broth microdilution.

Colistin resistance testing methods such as broth microdilution (BMD) are time-consuming and labour intensive for clinical laboratories. MBT Lipid Xtract Kit on MALDI Biotyper Sirius System (Bruker, Billerica, MA, USA) utilizes lipidomic analysis to identify specific cell wall modifications associated with colistin resistance. We compared MBT to BMD (ComASP Colistin, Liofilchem) across 36 Gram-negative isolates (non-resistant MIC ≤2 µg ml-1, resistant MIC ≥4 µg ml-1). All samples were tested twice on MBT with discrepant results repeated before assessing categorical agreement between MBT and BMD. 44.4% (16/36) of isolates were colistin resistant via BMD. MBT Lipid Xtract had 80.6% agreement (29/36) with BMD, with 5/7 discrepancies corrected to match upon repeat testing. There was 100% agreement for Escherichia coli isolates (n=16). The whole-genome sequencing was completed on the two discrepant Klebsiella pneumoniae isolates, with variants within colistin resistance-associated loci identified (MIC 0.5 µg ml-1: arnC S30T, pmrB T246A, lapB N212T, lpxM S253G, crrB Q287K and MIC >16 µg ml-1: arnC S30T, pmrB R90insRN, pmrB T246A, pmrA E57G, lpxM S253G). Further evaluation, particularly for non-E. coli, of MBT is required prior to implementation in clinical laboratories.

Development of Virtual Geography Laboratory to Improve Cognitive Learning Outcomes and Spatial Capabilities Social Sciences Education

This project aims to develop a website that functions as a virtual laboratory for studying geography topics that is suitable for use, as well as testing its effectiveness on cognitive learning outcomes and spatial abilities. The research uses the Borg and Gall development model, which is then summarized and divided into three main activities: introduction, development, and testing. Subject selection was based on the cluster random sampling technique. The subjects consisted of Class Learning outcome data was collected using questionnaires, interviews, pretests and posttest, analyzed using descriptive statistical tests and Mancova inferential statistics. Research Results: 1) the development of a geographic virtual laboratory is suitable for use according to material experts and received the "very good" category, while according to media experts it received the "good" category; 2) students gave a strong response to the implementation of the virtual geography laboratory; 3) there is a significant difference between initial abilities and cognitive learning outcomes and spatial abilities; and 4) there are no significant differences between two schools that implement virtual geography laboratories with cognitive learning outcomes and spatial abilities.

Physicochemical Analysis of Historical Ordu Taşbaşı Church Mortars and Recommendations for Restoration

Throughout history, the architecture of worship structures has been shaped based on different cultures and belief systems during the Roman, Seljuk, Anatolian Principalities, and Ottoman periods. Additionally, it is understood that the sociocultural and ritual structure in which the worship place is built plays a significant role in church architecture. In province of Ordu, rich in historical and cultural heritage, historical structures outside the city center have not been well preserved. In recent years, neglected historical structures have been restored through various methods with public investments, aiming to reintegrate them into urban life. Through chemical and mineralogical (by microscopy) examinations aimed at determining the types of historical structural materials used for this purpose, the preservation of historical structures in Ordu province and their transfer to future generations is targeted. Church structures, holding a distinct significance in the region’s history, exhibit various characteristics in terms of location, climate, and sociocultural and ritual aspects in the Black Sea region. In this regard, the restoration of the historical Taşbaşı Church in the Altınordu district of Ordu province has been carried out considering scientific techniques and methods, serving as a guide for similar studies in the region in terms of laboratory analysis, studies, planning, project development, and implementation stages.

Analytical and operational considerations of measuring glucose 6-phosphate dehydrogenase (G6PD) activity using a fully automated assay.

This study determined the performance characteristics of a quantitative glucose-6-phosphate dehydrogenase (G6PD) assay with automated lysis and evaluated the robustness of the operational workflow following implementation in a hospital laboratory. The G6PD activity was measured in whole blood using an enzymatic quantitative test on a Roche cobas c501 analyzer with onboard lysis configuration and normalized to hemoglobin (Hb). The performance characteristics of the method and stability of G6PD in whole blood collected in EDTA-containing tubes were evaluated, and the reference interval was established on a population of healthy individuals (n = 279). The robustness of this automated workflow for sample lysis was evaluated during validation and after implementation for routine clinical use for 18 months and in 2,181 patients. The G6PD assay was linear from 0.7 to 16.5 U/g Hb. Inter- and intra-assay precision using control and patient samples was below 12%. The G6PD results correlated well with a reference laboratory method (r = 0.96, y = 0.9615x - 1.222). The reference interval in our population was 9.8 to 15.5 U/g Hb. There were no interferences by lipemia and icteria, although grossly hemolyzed specimens may be affected. The testing workflow requires analyzing samples within minutes from mixing and loading into the instrument to avoid sample sedimentation. Measures to repeat samples with Hb 8.0g/dL or less identified sedimented samples. In our patient population, 10.6% and 5.8% of the total males and females tested were G6PD deficient, respectively. The G6PD assay with automated lysis is acceptable for patient testing. Several measures ensured the robustness of this workflow in a hospital laboratory.

Utilizing Virtual Laboratories (V-Labs) to Facilitate Learning in Vocational High Schools: A Systematic Literature Review

The digital learning resources are diverse and have the potential to be optimally utilized by educators. However, only a few are aware of the opportunities for utilization. Therefore, the purpose of this research is to describe the implementation of virtual laboratories (v-labs) as one of the learning resources in various educational levels. This research is conducted using the Literature Review method, with data sources consisting of 13 selected articles based on keyword analysis and publication year from scientific articles, as well as other publications sourced from databases such as Google Scholar and Scopus.com. The data analysis technique used in this research is descriptive analysis technique, so that the findings of the articles can be analyzed descriptively in terms of the implementation of virtual laboratory technology in learning activities. The review of several literatures shows that virtual laboratories can be applied and integrated into the learning process, becoming one of the learning resource options for practical learning. It is known that through the implementation of virtual laboratories, interactive elements are included, allowing students to actively participate and access learning resources without time constraints. Through this research, it is hoped that virtual laboratories can be adopted by teachers in vocational education considering the great opportunities and potential they have to facilitate learning.

Retrospective analysis of serologic test requests in the diagnosis of viral hepatitis: Inappropriate test requests and cost.

The rational laboratory use and implementation of test ordering procedures aim to reduce unnecessary test requests. This study aimed to determine the financial burden caused by inappropriate serological test requests for viral hepatitis and to investigate physicians' reasons for making unnecessary test requests. We performed a retrospective evaluation of inappropriate requests for hepatitis serology testing and the financial burden they caused at a tertiary care hospital over a 1-year period. The study found 2183 (3.84%) inappropriate test requests, costing $3309.00. Of these, 357 were same-day repeat requests and 1826 were requests not following diagnostic algorithms. In the logistic regression analysis of the factors affecting unnecessary test requests, a statistically significant difference was found between whether the unit was internal or surgical, whether the request came from inpatient services or outpatient clinics, and the professional titles (P < .05). Both types of inappropriate requests were more common among male physicians (P < .05). The highest rates of inappropriate test requesting were in physical therapy and rehabilitation, pediatrics, and adult emergency units. To identify the reasons behind unnecessary test requests, 135 physicians from 23 different departments participated in the survey. The main reasons for requesting tests were identified as protecting against malpractice and fears of misdiagnosis or overlooking a diagnosis. It has been observed that physicians often order tests routinely, without being fully familiar with standard test ordering procedures based on diagnostic algorithms, and lacking knowledge about rational laboratory use. The cost of tests is mostly unknown to clinicians. The study concludes that there are laboratory tests that incur much higher costs. When this assessment is applied to the entire laboratory, it becomes clear how significant a financial burden, unnecessary workload, and loss of time this situation can cause. Identifying the presence of unnecessary test requests is the first step in preventing them. Appropriate measures include highlighting these issues, providing necessary information, and offering in-service training.

An enhanced 13‐level triple voltage gain switched capacitor inverter with lower power electronics devices

AbstractIn this study, a 13‐level switched‐capacitor inverter with triple voltage gain is proposed. The proposed structure generates 13‐level output voltage using only one DC source, eleven switches, and three capacitors. The capacitors have the capability of self‐balancing without the use of additional circuits or complex control methods. Additionally, the inrush current of the capacitors has been reduced using a soft charging method. The proposed structure has been compared with different 13‐level structures presented in recent studies in terms of various parameters such as the number of semiconductor devices, the number of DC sources, voltage gain, Maximum Blocking Voltage (MBV), and Total standing Voltage (TSV). Another advantage of the proposed structure is the non‐use of any diode and its cost‐effectiveness. In addition, the power losses of the proposed structure have been evaluated, and its efficiency has been calculated for various output powers. Finally, the performance of the proposed structure has been verified through simulation and laboratory implementation under both stable and various dynamic conditions.

Performance Validation of the NeoBase 2 Non-Derivatized MSMS Assay Kit and Cutoff Values Establishment of Term and Preterm Neonates

Objective NeoBase 2 Non-derivatized MSMS assay kit (NeoBase 2 kit) was used for newborn screening, the performance of the NeoBase 2 kit should be validated before its implementation in clinical diagnostic laboratories. Methods Leftover dried blood spot samples, quality control materials in the NeoBase 2 kit, and proficiency testing materials received from the NSQAP were used. Precision, accuracy, LOD, LLOQ, recovery, and stability were carried out to verify the performance of the Waters ACQUITY TQD MS/MS system with the NeoBase 2 kit for newborn screening. Cutoffs were determined and analytes requiring different cutoffs in preterm neonates were investigated. Results Within-run and between-run precisions ranged from 3.95% to 14.41%. The accuracy and stability were within 15%. All analytes demonstrated acceptable LOD, LLOQ, and recoveries. Cutoffs for term and preterm neonates were established. Conclusions The performance of the NeoBase 2 kit is acceptable and can be implemented in clinical diagnostic laboratories.

Rapid detection of imipenem/relebactam susceptibility/resistance in Pseudomonas aeruginosa

ObjectivesImipenem-relebactam (IPR) has been reported to exhibit a good activity against non-metallo-ß-lactamase carbapenem-resistant Pseudomonas aeruginosa (CRPA), and the rapid detection of susceptibility/resistance to this new therapeutic alternative may be crucial. Therefore, the Rapid IPR Pseudomonas NP test was developed to quickly identify IPR susceptibility/resistance among multidrug-resistant P. aeruginosa. MethodsThe principle of the Rapid IPR Pseudomonas NP test is based on visually detecting glucose metabolization by observing (or not) a color change from yellow to red or orange of the red phenol pH indicator in the presence of imipenem at 2 mg/L and relebactam at 4 mg/L A total of 80 clinical Pseudomonas aeruginosa isolates were analyzed, among which 42 isolates were IPR resistant according to EUCAST guidelines (MICs, susceptible ≤2 mg/L, resistant >2 mg/L). Results obtained with the Rapid IPR Pseudomonas NP test were compared with the reference broth microdilution (BMD). ResultsThe sensitivity, specificity and accuracy of the test were found to be 100 %, 89.5 % and 95 %, respectively, using the BMD reference method as a comparator. Moreover, five out of the IPR-susceptible isolates (n = 38) exhibiting an MIC of IPR close to the breakpoint (MIC = 1 mg/L, n = 2; MIC = 2 mg/L, n = 3) yielded to a major error result, namely a positive result with the rapid IPR Pseudomonas NP test (resistance). By contrast, all IPR-resistant isolates (n = 42) were all correctly categorized. ConclusionsThe Rapid IPR Pseudomonas NP test is sensitive, specific, and easy to perform and interpret. Therefore, it is suitable for implementation in routine clinical laboratories.