Laboratory Testing Protocols Research Articles

Improved Laboratory Testing Protocol and Full-Scale Evaluation of Rapid-Setting Cementitious Repair Products for Airfield Repairs

Improved Laboratory Testing Protocol and Full-Scale Evaluation of Rapid-Setting Cementitious Repair Products for Airfield Repairs

Characterization of blood bank and transfusion medicine practices for pregnant individuals with fetuses at risk of hemolytic disease in the United States.

Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody-mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well-characterized, the clinical and laboratory monitoring practices are inconsistent. We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell-free fetal DNA testing, and result reporting and documentation practices. The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube-based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell-free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers. There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal-fetal medicine service are needed.

Biodegradation of Water-Soluble Polymers by Wastewater Microorganisms: Challenging Laboratory Testing Protocols.

For water-soluble polymers (WSPs) that enter environmental systems at their end-of-life, biodegradability is a key functionality. For the development and regulation of biodegradable WSPs, testing methods that are both scientifically validated and economically practicable are needed. Here, we used respirometric laboratory tests to study the biodegradation of poly(amino acids), poly(ethylene glycol), and poly(vinyl alcohol), together with appropriate low-molecular-weight reference substrates. We varied key protocol steps of commonly used testing methods, which were originally established for small molecules and tested for effects on WSP biodegradation. We found that avoiding aeration of the wastewater inoculate prior to WSP addition, incubating WSP with filter-sterilized wastewater prior to biodegradation testing, and lowering the WSP concentration can increase biodegradation rates of WSPs. Combining the above-mentioned protocol variations substantially affected the results of the biodegradation testing for the two poly(amino acids) tested herein (i.e., poly(lysine) and poly(aspartic acid)). Our findings were consistent between microbial inocula derived from two municipal wastewater treatment plants. Our study presents promising biodegradation dynamics for poly(amino acids) and highlights the importance, strengths, and limitations of respirometric laboratory methods for WSP biodegradation testing.

Improving Compliance With Evidence-Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes.

A team comprising nursing, medical staff, and administrative leaders at an urban academic orthopedic hospital in the northeastern United States sought to revise a preoperative laboratory testing protocol based on evidence and practice guidelines. The goal was to decrease unnecessary tests by 20% without negatively affecting patient outcomes. After adding the revised protocol to the electronic health record, audits revealed that the target goal was not met and additional strategies were implemented, including educational webinars for surgeon office personnel who ordered tests, additional webinars for advanced practice professionals, and the creation of scorecards to track surgeons' progress. Overall, a downward trend in the ordering of unnecessary laboratory tests for patients without identified risks was observed, but a 20% reduction was not achieved. Surgical complications during the project were not associated with laboratory tests. Clinicians continue to use the revised preoperative laboratory testing protocol at the facility.

TP53 mutations in myeloid neoplasms: implications for accurate laboratory detection, diagnosis, and treatment.

Genetic alterations that affect the function of p53 tumor suppressor have been extensively investigated in myeloid neoplasms, revealing their significant impact on disease progression, treatment response, and patient outcomes. The identification and characterization of TP53 mutations play pivotal roles in subclassifying myeloid neoplasms and guiding treatment decisions. Starting with the presentation of a typical case, this review highlights the complicated nature of genetic alterations involving TP53 and provides a comprehensive analysis of TP53 mutations and other alterations in myeloid neoplasms. Currently available methods used in clinical laboratories to identify TP53 mutations are discussed, focusing on the importance of establishing a robust testing protocol within clinical laboratories to ensure the delivery of accurate and reliable results. The treatment implications of TP53 mutations in myeloid neoplasms and clinical trial options are reviewed. Ultimately, we hope that this review provides valuable insights into the patterns of TP53 alterations in myeloid neoplasms and offers guidance to establish practical laboratory testing protocols to support the best practices of precision oncology.

Assessment of the efficiency of improved cooking stoves and their impact in reducing forest degradation and contaminant emissions in Eastern Rwanda

Biomass is a major source of cooking energy in Rwanda. This high dependence on biomass strongly contributes to forest degradation, biodiversity loss, and atmospheric pollution. Shifting from the traditional three-stone stove (TSS) to improved cooking stoves (ICS) is being promoted to reduce wood consumption and air pollutant emissions. This study assessed the emission reduction of adopted ICS and their impact on forest conservation through a combined laboratory and kitchen performance test (KPT).Out of 940 households surveyed in Eastern Province (EP) of Rwanda, 317 used ICS. Among these users, 180 were selected and revisited for an in-depth interview about the adoption process. The four most popular ICSs were selected for evaluating thermal efficiency and emissions of contaminating gases using laboratory test protocol ISO 19867-1. In addition, the avoided wood consumption of improved cooking stoves compared to the TSS was assessed using a KPT in 100 households.The survey findings indicate that 33.7 % of households use only ICS, 23.1 % only TSS, and 56.4 % ICS and TSS combined. The laboratory results show that the Save80 stove had the highest thermal efficiency (45.8 %) followed by Igisubizo (32.8 %), EcoZoom (32.6 %), and Songa (29.6 %). The emission results showed a significant difference in CO2 (carbon dioxide) emissions (p = 0.001) between the ICS models. However, the emissions of PM2.5 (fine particulate matter) and CO (carbon monoxide) of ICS were high compared to the WHO (World Health Organization) guidelines.The KPT results show that using ICS would result in an estimated annual saving of 149,313 tons of firewood corresponding to 0.7 m3 of wood, leading to an annual equivalent reduction of 0.02 ha of forest per household and 7167 ha of forest in the EP. The KPT results show that using ICS reduced CO2 emissions by 0.372 tons per household per year and by 111,088 tons of CO2 in the EP. ICSs have been shown to enhance fuelwood efficiency, leading to reduced forest degradation.

Response surface methodology-based characterization and optimization of fibre reinforced cemented tailings backfill with Slag

ABSTRACT With the increasing depths of underground mines due to the scarcity of near-surface ores, the introduction of fibre-reinforced cemented paste backfill (F-CPB) has emerged as a novel solution to address the demanding geomechanical conditions in deep mining operations. However, the widespread adoption of F-CPB in mining and industrial backfill operations necessitates a comprehensive understanding of its key engineering properties, including strength, yield stress, modulus of elasticity, and cost. Moreover, it is crucial to investigate the influence of the constituent materials (water, fibres, binders, tailings) and their interactions on these properties. This research paper presents the application of response surface methodology (RSM) to model the effects of binder content (Portland cement/Slag), water content, fibre content, tailings and their interactions on the mechanical and rheological properties, as well as the cost of F-CPB. Central Composite Design (CCD) experiments were conducted, and a high degree of agreement was observed between the experimental and predicted responses. The RSM approach proves suitable for accurately estimating the responses and assessing the interactions between the model parameters and the properties of F-CPB. Furthermore, a combination of RSM and the desirability approach enables the development of an optimisation tool for F-CPB, facilitating the formulation of optimal backfill mixtures. The results obtained from this study highlight the effectiveness of the combined RSM and desirability approach in F-CPB mix proportioning, offering an advanced engineering approach to F-CPB mix design. The proposed design method has the potential to reduce the laboratory testing protocol required for determining the optimal mix composition.

Sampling Strategies in PRRS Elimination in Hungary: An Observational Study Involving Four Farrow-to-Finish Swine Herds.

PRRS elimination strategies often rely on depopulation-repopulation. However, this approach is accompanied by a long-term loss of production. With adequate control measures, such as well-designed immunization programs and technological changes along with prevalence-based laboratory testing, the virus-free status of the most vulnerable age groups in swine herds can be achieved. The most common reason for acquiring PRRSV at large farrow-to-finish swine farm units is that the previously settled fattening pigs serve as a source of infection for the newly reared PRRS-free animals. Following such unwanted events, PRRSV may persist in an affected establishment for several years. In this observational study, we selected four farrow-to-finish type swine herds. We implemented different laboratory testing protocols to find the most optimal solution for a successful PRRS elimination program. To aid our objectives, we used a DIVA PCR technique. The PRRS DIVA PCR assay is a fast, reliable method to identify sows shedding farm-specific PRRSV strain(s). As a result of elimination efforts at the sentinel pig herds, we found that reliable detection of wild-type PRRSV shedding among sows requires sampling at least three weaned piglets per litter. The strict adherence to this sampling protocol, the systematic use of laboratory methods that quickly detect the presence of wild virulent virus in the herd during the rearing period and the culling of DIVA PCR positive litters and their sows decreased the presence of the resident virus markedly. These procedures at Hungarian farrow-to-finish type farms successfully inhibited the wild-type PRRSV infection of different age groups. The results of this study demonstrate that applying this methodology together with strict biosecurity measures enabled us to reach PRRS-vaccinated-free status in large, farrow-to-finish herds within two years.

Improvement of Ceramic Insulation of Cook Stoves Using Carbonized Organic Waste

Many households and small hotels in Kenya source their energy from biomass; mainly wood and charcoal. For the urban poor, their energy source is basically charcoal. With increasing population, rural urban migration, tough economic times, the use of charcoal must be as efficient as possible. In cognizance of this need, development of energy efficient biomass (charcoal) cook stoves is paramount.
 The main objective of the project was to optimize the insulating properties of ceramic insulation used in ceramic cook stoves using carbonized organic waste as the burnout additive. Carbonized organic waste herein referred to as char was collected and ground to fine dust. The char was used as a burnout medium in the clay to create pores, reduce density and increase porosity thereby improving insulation properties of the fired clay. Optimization was achieved by using different ratios of clay to char. Testing of biomass cook stove is provided for in ISO- 19867-0; the harmonized laboratory test protocol.
 The results showed that the apparent porosity of the sample increased from 34% with no char to 87% when the sample had 50% char. On the other hand, the bulk density reduced from 2.8 g/cm3 with no char to 1.2 g/m3 with 50% char. The prototype thermal efficiency was 33% and 25.8% for the control cook stove. The prototype and control cook stove cooking power were 0.97kW and 0.71kW respectively. The prototype PM2.5 emissions estimated to be 76 mg/MJd and CO emissions at 21 g/MJd which were lower than the Kenya standard KS 1814:2019 maximum emission of 137 mg/MJd and 25 g/MJd respectively
 This study has shown that when clay was mixed with char, there was a significant increase in desirable characteristics, which results in increased efficiency of biomass (charcoal) cook stoves and lower emissions.

Tensile strength of anisotropic rocks from enhanced Brazilian laboratory testing and data analysis protocols

The tensile strength of rock and rock-like materials is a critical material property in rock engineering design and the prediction of rockmass behaviour to mitigate any potential failure that may affect personnel safety or damage property. This study presents new instrumentation guidelines to the Brazilian Tensile Strength (splitting tensile strength) test to enhance the data processing techniques to determine true tensile strength. For this study a total of eighteen (18) specimens of two lithologies (Pointe Du Bois tonalite gneiss and Key Anacon metabasalt) were instrumented, tested, and reviewed to determine the true tensile strength of the material. This paper also identifies three potential failure modes and presents a failure envelope based on the identified potential failure modes.

Laboratory testing of dispersant effectiveness at high pressures

AbstractOil spills remain a serious environmental problem, and can have significant economic and ecological consequences. Despite the advantages, accidental deep‐sea oil releases during offshore exploration or production activities are of particular concern as the potential for such incidents increases significantly as we move to deeper waters. Dispersants are important mitigation tools as they have the capability to disperse the oil into a cloud of tiny oil droplets that can be readily degraded by hydrocarbon degraders if suitable environmental conditions prevail. In the case of an offshore incident, the dispersant is injected near the point of crude oil release so that dispersion is more effective. Given that our experience with subsea dispersant use is limited, the effect of pressure on the effectiveness of the dispersant has not been established, and hence, the composition and amount of dispersant to be injected has not been optimized. For typical surface oil spills, dispersant effectiveness is experimentally measured under laboratory conditions by the US‐Environmental Protection Agency (EPA) baffled flask test, which was later adapted as ASTM standard method F3251. Despite its extended use, this test cannot be used for testing dispersants at elevated pressures. In order to see whether pressure affects dispersant effectiveness, we developed a simple laboratory test protocol using a high‐pressure reactor (HPR). In addition, the effectiveness of five commercially available dispersants (COREXIT™ EC9500A, COREXIT™ EC9500B and COREXIT™ EC9527A, Marichem™, and Oiler 60) applied to a dead light crude oil has been determined at various pressures for the first time, and these values have been related to the standard baffled flask test (BFT) at atmospheric pressure. It is shown that pressure increase adversely affects dispersant effectiveness; however, the effect varies from a few percent to nearly a 50% decrease for a pressure increase of 100 bar depending on the particular dispersant used.

The effects of modified operation on emissions from a pellet-fed, forced-draft gasifier stove

Traditional solid fuel cookstoves emit gas- and particle-phase pollutants that contribute to household air pollution, human disease, and climate impacts. Forced-draft semi-gasifier stoves are an attractive intermediate step to zero-emitting stoves due to their reported lower emissions in laboratory and field studies, and potential for increased availability in more rural locales. However, emissions from these stoves have been shown to be highly variable and sensitive to stove design, fuel type, secondary air velocity, and operation mode. We measured carbon monoxide (CO), particulate matter (PM2.5), organic and elemental carbon, and particle number (15–685 nm) emissions of the widely adopted Mimi Moto pellet-fed, gasifier stove for different operating conditions under two modified protocols, the Water Boiling Test (WBT) and an updated laboratory testing protocol ISO 19867-1 (ISO). We categorized operating conditions into three approaches: Startup (varying ignition material), Shutdown (varying fan speed during a 45-min burnout period), and Refuel (varying the height of charred pellets added for re-ignition). Refueling led to the largest and most variable emissions, but lab emissions were all lower than high field emissions (e.g., similar to those of traditional solid fuels) and remained primarily in ISO Tiers 5 and 4 for CO and PM2.5, aspirational and second-best, respectively. We find large relative differences in emissions when comparing our results to similar studies conducted with the Mimi Moto and ISO protocol, suggesting small operational differences can have large emissions implications. To minimize emissions, we recommend using kerosene for ignition, turning the fan off when pellets are done burning and flame has extinguished, and reigniting with fresh pellets instead of pellet char. Improved training and maintenance are needed in real-world applications to decrease the frequency of high-emission events. Tightly constrained testing and detection limits remain challenges to fully understanding factors contributing to these events.

Cookstove Emissions and Performance Evaluation Using a New ISO Protocol and Comparison of Results with Previous Test Protocols.

In 2018, the International Organization for Standardization (ISO) 19867-1 "Harmonized laboratory test protocols" were released for establishing improved quality and comparability for data on cookstove air pollutant emissions, efficiency, safety, and durability. This is the first study that compares emissions [carbon dioxide, carbon monoxide, total hydrocarbons, methane, nitrogen oxides, fine particulate matter (PM2.5), organic carbon, elemental carbon, and ultrafine particles] and efficiency data between the ISO protocol and the Water Boiling Test (WBT). The study examines six stove/fuel combinations [liquefied petroleum gas (LPG), pellet, wood fan, wood rocket, three stone fire, and charcoal] tested in the same US EPA laboratory. Evaluation of the ISO protocol shows improvements over previous test protocols and that results are relatively consistent with former WBT data in terms of tier ratings for emissions and efficiency, as defined by the ISO 19867-3 "Voluntary Performance Targets." Most stove types remain similarly ranked using ISO and WBT protocols, except charcoal and LPG are in higher PM2.5 tiers with the ISO protocol. Additionally, emissions data including polycyclic aromatic hydrocarbons are utilized to compare between the ISO and Firepower Sweep Test (FST) protocols. Compared to the FST, the ISO protocol results in generally higher PM2.5 tier ratings.

SwabExpress: An End-to-End Protocol for Extraction-Free COVID-19 Testing.

BackgroundThe urgent need for massively scaled clinical testing for SARS-CoV-2, along with global shortages of critical reagents and supplies, has necessitated development of streamlined laboratory testing protocols. Conventional nucleic acid testing for SARS-CoV-2 involves collection of a clinical specimen with a nasopharyngeal swab in transport medium, nucleic acid extraction, and quantitative reverse-transcription PCR (RT–qPCR). As testing has scaled across the world, the global supply chain has buckled, rendering testing reagents and materials scarce. To address shortages, we developed SwabExpress, an end-to-end protocol developed to employ mass produced anterior nares swabs and bypass the requirement for transport media and nucleic acid extraction.MethodsWe evaluated anterior nares swabs, transported dry and eluted in low-TE buffer as a direct-to-RT–qPCR alternative to extraction-dependent viral transport media. We validated our protocol of using heat treatment for viral inactivation and added a proteinase K digestion step to reduce amplification interference. We tested this protocol across archived and prospectively collected swab specimens to fine-tune test performance.ResultsAfter optimization, SwabExpress has a low limit of detection at 2–4 molecules/µL, 100% sensitivity, and 99.4% specificity when compared side by side with a traditional RT–qPCR protocol employing extraction. On real-world specimens, SwabExpress outperforms an automated extraction system while simultaneously reducing cost and hands-on time.ConclusionSwabExpress is a simplified workflow that facilitates scaled testing for COVID-19 without sacrificing test performance. It may serve as a template for the simplification of PCR-based clinical laboratory tests, particularly in times of critical shortages during pandemics.

Singapore's efforts to achieve measles elimination in 2018.

The World Health Organization verified that Singapore had eliminated endemic transmission of measles in October 2018. This report summarizes the evidence presented to the Regional Verification Commission for Measles and Rubella Elimination, comprising information about immunization schedules; laboratory testing protocols and the surveillance system; and data on immunization coverage and the epidemiology of cases. Between 2015 and 2017, a total of 246 laboratory confirmed cases of measles were reported. The source or country of infection was unknown for most cases (195; 79.3%). There were 22 clusters, ranging from two to five cases. The most common genotypes detected were D8 and D9. Transmission of B3 was interrupted in 2017, and H1 cases were sporadic and imported. Phylogenetic analyses of the D8 isolates showed the existence of 13 lineages or clusters. Although a few lineages were circulating concurrently, no lineage propagated continuously for a prolonged period, and transmission of each lineage eventually stopped. Although cases and clusters were reported yearly, molecular data showed that none of the lineages resulted in prolonged transmission. There were fewer measles cases in 2017 compared with 2016. The higher number of clusters was likely due to the overall increase in cases because cluster sizes remained small. The occurrence of small clusters is not unexpected since measles is highly infectious. The majority of imported cases did not result in secondary transmission. With the global increase in the number of measles cases, Singapore needs to stay vigilant and continue to promptly test suspected cases; vaccination is the key to preventing infection.

Laboratory Evaluation of the Measuring Capabilities of an Innovative Pressuremeter Probe in Dry Sand

Abstract This article presents the experimental procedures performed in a laboratory to evaluate the measuring capabilities of an innovative monocellular pressuremeter probe. This probe takes advantage of recent technological developments in the domain of inflatable membranes currently applied in the so-called Francis Cour standard tricellular probes, which allow covering an expansion range up to large cavity strains. Those improvements were found to enable increasing the accuracy in the assessment of radial expansion through volume injection in the probe measuring cell at relatively small strain levels without the need of sophisticated punctual measuring arms. Assessing this domain via in situ tests makes up a major contribution to the design of geotechnical structures under cyclic loads, for which the current design practice is mainly developed through laboratory soil tests. To reach this final objective, the probe’s validation program was launched based on pressuremeter tests with unload-reload loops performed in a laboratory calibration chamber and in situ on reference testing sites. This paper focuses on the laboratory testing protocols performed in dry Fontainebleau sand specimens. Shear moduli obtained with the pressuremeter are compared with the expected elementary values for this sand, and it is shown that it was possible to assess sand stiffness at a small strain level using this probe under controlled conditions in a laboratory.

Novel Protocol for Acute In Situ Ecotoxicity Test Using Native Crustaceans Applied to Groundwater Ecosystems

Current standardized laboratory test protocols use model species that have limitations to accurately assess native species responses to stressors. We developed and tested a novel acute in situ protocol for testing field-collected organisms. We used Asellus aquaticus and NaCl as a reference toxicant to test for the effects of location (laboratory vs. in situ), medium (synthetic vs. field water), substrate (presence vs. absence), and protocol replicability. We further tested the protocol using groundwater-adapted isopods: Proasellus assaforensis for the effect of location, P. cavaticus of medium and P.lusitanicus of substrate. Our results showed that A.aquaticus’ lethality obtained with the novel acute in situ protocol did not significantly differ from those from laboratory testing. However, laboratory tested P.assaforensis showed a higher sensitivity, suggesting that its acclimation to laboratory conditions might have pernicious effects. A. aquaticus and P. cavaticus showed a higher mortality using synthetic medium in situ and under laboratory conditions, which overestimated the stressor’s effect. Besides, substrate use had no significant effect. The novel acute in situ protocol allows the use of native species under realistic scenarios. It is particularly well adapted for assessing the risk of groundwater ecosystems but it can be applied to a wide range of ecosystems.

Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Health Care System.

Guidelines recommend evaluating the risk of opioid-related adverse events prior to initiating opioid therapy. The orthopedic service at San Francisco Veterans Affairs Health Care System (SFVHCS) has not routinely used risk assessment tools such as the Stratification Tool for Opioid Risk Mitigation, prescription drug monitoring program data, and urine drug screening prior to opioid prescribing. A quality improvement project was conducted to evaluate the number of pharmacist-provided opioid risk mitigation recommendations implemented by orthopedic providers for patients who underwent total hip or knee arthroplasty at SFVHCS. A pharmacist-led workflow for completing risk mitigation reviews was developed in collaboration with orthopedic providers, and urine drug screening was added to the preoperative laboratory testing protocol. The following recommendations were communicated via electronic medical record: limit postoperative opioids to a 7- or 14-day supply based on risk of suicide and/or overdose, offer naloxone and a medication disposal bag, and order a urine drug screen if not already completed. Risk reviews were completed for 75 patients. Among 64 patients with 2-month postdischarge data available, 88% (7 of 8) of 7-day and 79% (44 of 56) of 14-day opioid supply recommendations were implemented; 41% (26 of 59) of recommendations to issue a medication disposal bag, 17% (2 of 12) recommendations to order a missing urine drug screen, and 9% (5 of 55) of recommendations to offer naloxone were implemented. Pharmacist-performed risk mitigation reviews paired with individualized recommendations led to high rates of orthopedic provider acceptance of limiting postdischarge opioid day supplies for patients who had total hip or knee arthroplasty. Alternative strategies may increase access to naloxone. Future research should examine the impact of risk mitigation tools in reducing prescribing of long-term opioid therapy and adverse events among orthopedic surgical patients.

Heart Failure With Preserved Ejection Fraction in Hypertension Patients: A Myocardial MR Strain Study.

Despite current recommendations for heart failure with preserved ejection fraction (HFpEF), few studies have demonstrated the ability of MRI to identify subtle functional differences between HFpEF with essential hypertension (HFpEF-HTN) patients and hypertension patients (HTN). This study aimed to detect and evaluate HFpEF in patients with HTN using feature-tracking (FT) and to ascertain optimal strain cutoffs for the diagnosis of HFpEF-HTN. Retrospective study. Three groups (84 with HFpEF-HTN; 72 with HTN; and 70 healthy controls). 1.5T, steady-state free precession (SSFP), and half-Fourier single-shot turbo spin-echo (HASTE) sequences. All patients underwent laboratory testing and imaging protocols (echocardiography and MRI). FT-derived left ventricular (LV) strain and strain rate (SR) were measured and compared among the three groups with adjustment for confounding factors. Kolmogorov-Smirnov's test, independent-sample t-tests, one-way analysis of variance (ANOVA), Pearson's correlation coefficient, area under the receiver-operator characteristic (ROC) curve (AUC), and logistic regression. Compared to 72 HTN patients and 70 healthy controls, HFpEF-HTN patients (84 patients) demonstrated significantly impaired LV strains (except for global peak systolic radial strain, GRS, P < 0.05 for all). Only LV global peak systolic longitudinal strain (GLS) was significantly impaired in HTN patients vs. controls (P < 0.05). The global peak systolic circumferential SR (sGCSR) showed the highest diagnostic value for the differentiation of HFpEF-HTN patients from HTN patients (AUC, 0.731; cutoff value, -1.11/s; sensitivity, 56.0%; specificity, 84.7%). Only global peak early diastolic longitudinal SR (eGLSR) remained independently associated with a diagnosis of HFpEF-HTN in multilogistic analysis. The major strain parameters significantly correlated with LV ejection fraction, end-systolic volume index, and N-terminal pro-brain natriuretic peptide (P < 0.05 for all) and also demonstrated differences between NYHA functional class. HFpEF-HTN patients suffer from both systolic and diastolic cardiac dysfunction. FT-derived strain parameters have potential value for the diagnosis and risk stratification of HFpEF-HTN patients. Level of Evidence 3. Technical Efficacy Stage 2.

Effect of emergency department fibrinogen testing on survival of trauma patients receiving blood transfusions.

: Fibrinogen is the first clotting factor to reach critically low levels during blood loss and its depletion is associated with coagulopathy, increased blood loss, transfusion requirements and mortality after trauma. However, direct measurements of fibrinogen concentration or function are not included in many Emergency Department (ED) trauma laboratory testing protocols. We hypothesized that including a test of fibrinogen concentration in the ED would be associated with increased survival for trauma patients requiring blood transfusions.To test this hypothesis, we performed a single-centre retrospective study of the effect of a resulted fibrinogen concentration measurement performed in the ED on survival of trauma patients receiving blood transfusions within the first 4 h of their hospital arrival. Multivariate logistic regression was used test the effect of a fibrinogen test on hospital survival after adjusting for the influence of INR, injury severity, lowest recorded blood pressure and blood transfusion intensity defined as the number of red blood cell units transfused in the first 4 h or care.Of 11 404 trauma registry individuals from 2016 to 2017, 843 (7.4%) received any blood transfusions within the first 4 h of ED care, of whom 635 (75.3%) had a documented fibrinogen concentration ordered and resulted. Multivariate logistic regression for hospital survival demonstrated a significant interaction effect between the presence of a fibrinogen test and transfusion intensity (Whole Model P < 0.0001, Interaction P = 0.035). Repeat analysis after stratifying for those individuals receiving more than 4 units of red blood cell units within 4 h of care found that the presence of a fibrinogen test was independently associated with survival only for those receiving more than 4 units [FIB test odds ratio for survival = 3.5 (1.0, 10.8), P = 0.03].Fibrinogen testing in the ED may be a valuable addition to resuscitation of the trauma patient receiving significant blood transfusions.