Quality Assurance Research Articles

Sustainable application of recycled plastics in asphalt pavement: Case study of a trial in Newtonville, Ontario, Canada

Global research on using plastic waste in asphalt roads highlights its benefits: recycling waste, reducing greenhouse gas emissions, and providing an alternative to non-renewable asphalt binders. This study aims to bridge the gap between laboratory results and field performance of recycled plastic-modified asphalt in cold regions, promoting broader adoption. Laboratory analysis of core samples was performed as part of a quality assurance program. High-temperature rutting resistance was evaluated using the Hamburg wheel tracking test, while low-temperature cracking resistance was assessed through semi-circular bending testing. Results show that the impact of recycled plastics and fibers on rutting resistance varies with temperature, with the greatest benefit at the highest temperatures. For low-temperature cracking resistance, polyethylene terephthalate (PET) fibers outperform mixed plastics by delaying crack propagation. Low-temperature conditioning can induce thermal shrinkage in the asphalt mixture, slightly moderating the effects of recycled plastics and fibers.

Allowable total error in CD34 cell analysis by flow cytometry based on state of the art using Spanish EQAS data.

CD34+ hematopoietic stem cell (HSC) enumeration, crucial for HSC transplantation, is performed by flowcytometry to guide clinical decisions. Variability in enumeration arises from biological factors, assay components, and technology. External quality assurance schemes (EQAS) train participants to minimize inter-laboratory variations. The goal is to estimate total error (TE) values for CD34 cell enumeration using state-of-the-art (SOTA) methods with EQA data and to define quality specifications by comparing TE using different cutoffs. A total of 3,994 results from 40 laboratories were collected over 11 years (2011-2022) as part of the IC-2 Stem Cells Scheme of the GECLID Program that includes absolute numbers of CD34 cells. The data were analyzed in two periods: 2011-2016 and 2017-2022. The TE value achieved by at least 60 %, 70 %, 80 %, and 90 % of laboratories was calculated across the two different periods and at various levels of CD34 cell counts: above 25, 25 to 15, and under 15 cells/μL. A decrease in the SOTA-based TE for CD34 cell enumeration was observed in the most recent period in 2017-2021 compared with 2012-2016. A significant increase of P75 TE values in the low CD34 range (<15 cells/μL) levels was found (p<0.001). Technical advancements contribute to the decrease TE over time. The TE of CD34 cell FC counts is measure-dependent, making it responsive to precision enhancement strategies. The TE measured by EQAS in this study may serve as a quality specification for implementing ISO 15189 standards in clinical laboratories for CD34 cell enumeration.

What Defines a Discipline and How We Teach and Study It? The Changing Scope and Role of the Subject Benchmark Statement for Politics and International Relations (IR) and Its Implications For the Teaching and Study of Politics and IR in Higher Education

The paper asks whether there is a typical Politics and IR curriculum before reviewing the content and design of the revised fifth edition of the Quality Assurance Agency (QAA) Politics and IR Subject Benchmark Statement that was launched in March 2023. The paper examines the manner by which the most recent edition differs from earlier subject benchmark statements and reflects on the implications of the strategic direction taken by the QAA to include new content areas that primarily focus on the development of disciplinary statements on Equality, diversity and inclusion (EDI), Accessibility and sustainability and Enterprise and entrepreneurship education (EED). The paper explores the implications of benchmark statements, given that while they are not a regulatory requirement, they nevertheless seek to define what can be expected of a graduate and are drawn upon by Higher Education Institutions (HEI) to inform the development and revision of Politics and IR undergraduate provision.

Attention 3D UNET for dose distribution prediction of high-dose-rate brachytherapy of cervical cancer: Intracavitary applicators.

Formulating a clinically acceptable plan within the time-constrained clinical setting of brachytherapy poses challenges to clinicians. Deep learning based dose prediction methods have shown favorable solutions for enhancing efficiency, but development has primarily been on external beam radiation therapy. Thus, there is a need for translation to brachytherapy. This study proposes a dose prediction model utilizing an attention-gating mechanism and a 3D UNET for cervical cancer high-dose-rate intracavitary brachytherapy treatment planning with tandem-and-ovoid/ring applicators. A multi-institutional data set consisting of 77 retrospective clinical brachytherapy plans was utilized in this study. The data were preprocessed and augmented to increase the number of plans to 252. A 3D UNET architecture with attention gates was constructed and trained for mapping the contour information to dose distribution. The trained model was evaluated on a testing data set using various metrics, including dose statistics and dose-volume indices. We also trained a baseline UNET model for a fair comparison. The attention-gated 3D UNET model exhibited competitive accuracy in predicting dose distributions similar to the ground truth. The average values of the mean absolute errors were 0.46±11.71Gy (vs. 0.47±9.16Gy for a baseline UNET) in CTVHR, 0.55±0.67Gy (vs. 0.70±1.54Gy for a baseline UNET) in bladder, 0.42±0.46Gy (vs. 0.49±1.34Gy for a baseline UNET) in rectum, and 0.31±0.65Gy (vs. 0.20±3.76Gy for a baseline UNET) in sigmoid. Our results showed that the mean individual differences in ΔD2cc for bladder, rectum, and sigmoid were 0.38±1.19 (p=0.50), 0.43±0.71 (p=0.41), and -0.47±0.79 (p=0.30) Gy, respectively. Similarly, the mean individual differences in ΔD1cc for bladder, rectum, and sigmoid were 0.09±1.21 (p=0.36), 0.20±0.95 (p=0.24), and -0.21±0.59 (p=0.30) Gy. The mean individual differences for ΔD90, ΔV100%, ΔV150%, and ΔV200% of the CTVHR were -0.45±2.42 (p=0.26) Gy, 0.55±9.42% (p=0.78), 0.82±4.21% (p=0.81), and -0.80±10.48% (p=0.36), respectively. The model requires less than 5 s to predict a full 3D dose distribution for a new patient plan. Attention-gated 3D UNET revealed a promising capability in predicting voxel-wise dose distributions compared to 3D UNET. This model could be deployed for clinical use to predict 3D dose distributions for near real-time decision-making before planning, quality assurance, and guiding future automated planning, making the current workflow more efficient.

Application of metabolomics in quality control of traditional Chinese medicines: a review

Plant metabolites are the components endowing traditional Chinese medicine (TCM) with therapeutic effects, and, simultaneously, they are the primary targets for quality control. From germplasm selection and origin determination to field management, growth duration, harvesting and processing, and, finally, storage and transportation, each step profoundly influences TCM quality. The complexity of these plant or herb metabolites poses numerous quality control challenges. Metabolomics, as a comprehensive and systematic approach, has demonstrated value in this field. This technique not only meets the requirements for studying the complex mechanisms of TCM but also has significant advantages in identifying the TCM components, including active components. Therefore, in this article, several key factors affecting the chemical characteristics and quality traits of TCM, including their origin, harvesting period, medicinal parts, and processing methods, are researched. Additionally, the current challenges of integrating metabolomics with other omics technologies (transcriptomics, spatial metabolomics, etc.) are discussed. Furthermore, a future development trends and prospects are highlighted. With the continuous deepening of research and ongoing updates in technological capabilities, metabolomics will play an increasingly important role in the quality control of TCM, providing more scientific and robust support for quality assurance and safety evaluation.

Fostering a food safety culture and strengthening quality assurance at food manufacturers

Fostering a food safety culture and strengthening quality assurance at food manufacturers

Piloting a Diagnostic Foot and Ankle Fracture Sonographic Algorithm with Rural and Adolescent Patients

Background: Foot and ankle injuries are a common presenting complaint to the Emergency Department (ED) and are often assessed with plain radiography. Rural environments may not have access to radiography mandating the referral or transfer patients to regional centers for definitive diagnosis. The Ottawa Foot and Ankle Rules (OFAR) is a clinical decision rule that can assist in ruling out fractures. Point of care ultrasound (POCUS) can augment this decision rule. The objective of this study was to assess both the feasibility and test characteristics of a previously described POCUS augmented clinical assessment, OFAR-POCUS, for adolescent and adult patients with foot and ankle pain in a rural environment. Methods: This was a prospective cohort study from June to August 2022 including patients with chief complaint of foot or ankle injury presenting to a rural clinic. Patients were included if they had positive finding(s) on the OFAR Test and required radiographic imaging. Patients were excluded if they did not consent, speak English, were unable to be scanned, had obvious joint deformities, had altered mental status, were not physiologically stable, had other injuries preventing sonography, were pregnant, or had previous injury with internal fixation, osteomyelitis, or rheumatoid arthritis. POCUS was performed before transport for radiography. POCUS examiners were POCUS novices who underwent a one and a half to two-hour, standardized foot and ankle POCUS training session. All POCUS studies were reviewed by two emergency medicine ultrasound fellowship trained faculty for quality assurance. Standard test characteristics were calculated for bedside clinician and expert POCUS interpretations compared to the radiographic control. Results: Thirteen POCUS examiners performed exams on 20 patients included in analysis; four patients had fractures on radiograph (20%). The bedside clinician POCUS interpretation had sensitivity (SN) = 100% (95% Cl, 40%-100%), specificity (SP) =94% (95% Cl, 70%-100%), and negative likelihood ratio (-LR) = 16.00 (95% Cl, 2.40-106.73). Expert POCUS interpretation had SN=75% (95% Cl, 19%-99%), SP=75% (95% Cl, 48%-93%), and -LR=0.33 (95% Cl, 0.06-1.86). Conclusion: A POCUS enhanced clinical strategy for clinically significant foot and ankle fractures in adolescent and adult patients in a rural setting is feasible. Larger studies are required to further characterize test characteristics and use of foot and ankle POCUS where plain radiography is unavailable.

Assessing the correlation between Gamma passing rate and clinical dosimetric variations in breast cancer IMRT plans with multi-leaf collimator errors: perspectives from the ArcCHECK QA system.

This study aimed to comprehensively investigate the influence of multi-leaf collimator (MLC) position errors on both the clinical absolute dose distribution and Gamma passing rate (%GP) in intensity-modulated radiation therapy (IMRT) plans for breast cancer. Additionally, the correlation between %GP and the clinical absolute dose relative difference (%DE) caused by MLC position errors was analysed. Ten IMRT plans for breast cancer were randomly selected. Systematic and random MLC position errors were introduced into DICOM files representing the investigated treatment plans by modifying the plan files and adjusting the MLC positions. Systematic errors were categorized as MLC opening errors, closing errors, and shift errors. The %DE in the tumour planning target volume (PTV) and organs at risk (OARs) caused by MLC errors were statistically analyzed using dose-volume histogram (DVH) analysis. The ArcCHECK quality assurance (QA) system was used to detect the %GP differences between baseline plans and plans with MLC errors. The correlation between %GP and %DE was obtained using linear regression methods. The results of this study indicate that MLC opening and closing errors have a significant impact on %DE and %GP in IMRT plans for breast cancer. Opening and closing errors can be detected at a gamma level of 3%/2mm, if error values are greater than or equal to 0.5mm, and %GP can predict DVH dosimetric changes caused by MLC opening and closing errors. It is concluded that DVH-based verification of IMRT plans can serve as an adjunct method to Gamma analysis to improve QA accuracy for breast cancer cases. Additionally, it is concluded that greater attention should be given to MLC leaf opening and closing errors in clinical practice.

Assessing veterinarians' opinions of antimicrobial stewardship initiative acceptability for farm practice in Wales.

Antimicrobial stewardship (AMS) initiatives are imperative to safeguard antimicrobials and reduce resistance. Across the UK, AMS relies in part on the self-regulation of the veterinary profession, particularly in farm animal practice, alongside voluntary schemes and quality assurance systems. In Europe, AMS initiatives are often statutory and require responsibility from several sectors. Consideration of broader AMS initiatives, potentially unfamiliar to the Welsh veterinary profession, could optimise future policy and align it with the requirements of Welsh veterinarians. AMS initiatives were collated from nations with long-standing low antimicrobial use. A survey was constructed permitting veterinarians'evaluation of initiative feasibility and effectiveness (collectively, 'acceptability') within Welsh farm animal practice. Veterinarian-directed AMS initiatives, particularly those implemented within individual practices, were considered most acceptable. Initiatives that demanded cooperation from entities outside practices, or those regarded as punitive, were less acceptable. The findings of this voluntary survey may be biased towards particularly motivated respondents in the veterinary sector. Additionally, the cause or effect of the recorded professional behaviour is not known in this study. Future antimicrobial policy should consider AMS acceptability by veterinarians, alongside farmers and other stakeholders, to promote compliance and attainment. The study data suggest that veterinarians may perceive continuous professional development/knowledge exchange as being most acceptable, alongside activities allied to a strong veterinarian‒client prescribing relationship. Continued support should focus on expanding these areas. Decoupling (ie, abolishing the professional licence for veterinarians to both prescribe and dispense medicines) was viewed as least acceptable by veterinarians in this study.

Validation of Service-Learning Outcomes Measurement Scale-Short Version (S-LOMS-SV) With New Samples and Cross-Cultural Comparisons

Background: The Service-Learning Outcomes Measurement Scale (S-LOMS) with 56 items is an established tool for evaluating student developmental outcomes arising from service-learning in Hong Kong. However, its length may have deterred potential users. Hence, the current study used a shortened version (S-LOMS-SV) with 21 items for validation in Hong Kong and Singapore. Purpose: The purpose of the current study is to validate S-LOM-SV with new samples, as is required for shortened scales. Methodology/Approach: We recruited 970 respondents from Hong Kong and Singapore universities. They answered the 21-item S-LOMS-SV before and after service-learning, along with a service-learning experience questionnaire. We tested scale validity and reliability and used multisample analyses to examine factor stability and cross-cultural validity. In addition, we employed structural equation modeling to establish the relationship between service-learning experience and developmental outcomes. Findings/Conclusions: The current study established the scale validity and reliability and preliminary cross-cultural validity of the S-LOMS-SV. Results revealed developmental differences between traditional undergraduate students and adult learners and reaffirmed the positive relationships between service-learning experience and student development. Implications: The validated S-LOMS-SV provides a succinct and reliable tool for academic research and quality assurance purposes and paves the way for developing a centralized database for cross-cultural and cross-institutional comparisons.

Revision of a self-assessment tool for research ethics committees in low- and middle-income countries: Incorporation of elements that safeguard participants' rights and welfare.

Evaluating the quality of research ethics committees (RECs) is crucial but challenging due to the difficulty of developing meaningful quality measures. Recently, commentators assessed ten quality instruments for RECs, including the Research Ethics Committee Quality Assurance Self-Assessment Tool developed for RECs in the Arab Middle East. They identified several missing items in this tool regarding safeguarding participants' rights and welfare. To address these gaps, we aimed to redesign the tool. Using the Delphi method, we involved 15 REC chairs to provide feedback and recommendations for a revised tool. This process led to a modified instrument that incorporated the missing items and additional elements regarding the monitoring of research conduct (an essential oversight function of RECs), and the independence of the RECs from institutional and external influences. We conclude that the revised tool effectively addresses the quality of RECs by including elements relevant to participant outcomes, board deliberations, and participant protection. The added focus on ethics oversight enhances its robustness, significantly impacting participants' rights and welfare.

Next generation tissue biobanking: quality assured, financed, and integrated?

Biobanks are essential for biomedical research, particularly in the era of personalized medicine. In Germany, 36biobanks have been established over the past decade that are connected under the German Biobank Alliance (GBA). These biobanks store high-quality biological samples along with clinical data to support research projects. Biobanks can be integrated, handling both tissue and liquid samples, or set up as separate entities depending on specific requirements.Tissue biobanking is especially complex due to the invasive nature of tissue collection and the non-replicability of the samples. Close collaboration between clinics, pathologists, IT specialists, and biobank managers is crucial to ensure the quality of samples and promote interdisciplinary research.The integration of pathology and biobanking is key, both organizationally and technically. Shared IT systems, standardized protocols, and collaborative governance structures are vital for efficient data management. Quality assurance, ethical guidelines, and data protection are critical to maintaining public trust and legal compliance.Long-term financial models are needed to ensure the sustainability of biobanks. The GBA supports emerging biobanks through its "Starterkit" initiative, offering guidance and best practices to help new biobanks develop.Tissue biobanks are indispensable for advancing the understanding of diseases and developing new therapies. However, they must adhere to strict ethical and legal standards to maximize their scientific and societal value.

How to Measure the Productivity of a Software Quality Engineer

This paper critically examines COBOL85 compiler software quality assurance project from the unintentional perspective of Total Quality. In 1988, when this project occurred, the author was not associated with TQM in any way or had any training in, or knowledge about, Total Quality. The project took place 36 years ago. The company Prime Computer, Inc. no longer exists, and the individuals involved have long since gone their separate ways. An unquestionable comfort can be derived from discussing a project that does not violate confidentiality in any way whatsoever. In 1988, this author was hired as a consultant to manage the software quality assurance effort. The charge was to significantly increase productivity in a relatively short period so that the COBOL85 compiler could be released to Prime’s customers on time. This author was directly responsible for increasing the project's productivity by 40 percent over 14 weeks, while the association with the project lasted a little over a year. Unfortunately, MAI Basic Four attempted a hostile takeover of Prime, approximately three-fourths of the way through the project. Due to financial considerations and because Prime management decided to abandon their mini-computer business entirely, the quality assurance effort finished not with a bang but with a whimper. The author was then relieved of management responsibilities so that the company could save money. The last remaining software quality assurance consultant completed his work, and the COBOL85 compiler finally went to market. Because of the lack of managerial commitment, the compiler never met the expectations of the individuals dedicated to bringing to market a quality product. At the time, the author had no formal or informal training or knowledge of TQM whatsoever but did have an understanding of how a process works. The author was convinced that the process he was hired to oversee could experience dramatic improvements in productivity in a relatively short period, which could be construed as a matter of faith or possibly overconfidence. He achieved what he set out to do.

Effectiveness of Teachers Training Program in Enhancing Teaching Competence of Public Primary School Teachers in Ilemela Municipality, Tanzania

The study aims to investigate the Effectiveness of Teachers Training Program in Enhancing Teaching Competence of Public Primary School Teachers in Ilemela Municipality, Tanzania. The problem of this study was answered by the one research questions; TCPD training programs in enhancing teaching competence. The study was guided by the Social Cognitive Theory. The current study employed convergent design under mixed research methods approach. The target population consisted of various stakeholders, including 81 public primary schools, 1,047 teachers, 19 Ward Education Officers, 81 head teachers, and 8 District quality assurers making total number of 1155 population. The sample size for the current study consisted of 16 public primary schools, 192 teachers, 16 head teachers, 6 Ward Education Officers (WEO), and 2 District School Quality Assurers (DSQA), totaling 216 respondents. Questionnaires, interview guides, and document analysis guides were used to collect data from respondents. Data collection instruments were validated by MWECAU research experts. A pilot study was conducted in two public primary schools. The reliability of questionnaires for Likert-type items was estimated using Cronbach's Alpha Coefficient whereby r= 0.889 for teachers while that of qualitative established through peer debriefing and triangulation. The study adhered to ethical considerations throughout the research process. Descriptive statistics were analyzed quantitative data using SPSS version 26. Qualitative data was analyzed thematically. The study found that the TCPD is highly effective in improving teaching competence through focused training on classroom management, instructional design, differentiated instruction, student engagement, and technology integration significantly improved their teaching skills. The study concluded that Continuing Professional Development (CPD) effectively Enhanced Teaching Competence of Public Primary School Teachers in Ilemela Municipality to the high extent. The study recommended that a similar training program should be implemented regularly to equip teachers with up-date skills and knowledge.

Research on the Challenges and Countermeasures of Undergraduate Vocational Education in China

Undergraduate vocational education represents a significant innovation within China’s education system, aimed at cultivating high-level technical and skilled talents to meet the modern economy demand for skilled and application-oriented professionals. Drawing on a review of domestic and international literature on undergraduate vocational education, this paper analyzes the issues and challenges in curriculum design, school-enterprise cooperation, faculty development, and quality assurance, proposing corresponding optimization strategies.

Envisioning doctoral education as research hubs in Latin America (2011–2021): waves of evolution

ABSTRACT This study analyses 70 scholarly articles on doctoral education in Latin America from 2011 to 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. The research identifies key trends, themes, and defining characteristics within the literature. We propose a three-wave evolution model for doctoral education in Latin America based on the findings. The results show the consolidation of doctoral education in several countries, the ‘second wave’, with themes such as quality assurance policy, program development, learning, curriculum, and advising. The study also highlights the emergence of research hubs as a ‘third wave’, in which doctoral programs attract individuals from different backgrounds and locations who mobilise knowledge and ideas within and across regions. Our three-wave model of evolution for doctoral education offers a way to articulate research and policy around doctoral education in Latin America, a critical step towards significant research hubs and pertinent programs.

Next-Generation Data Pipeline Designs for Modern Analytics : A Comprehensive Review

This comprehensive article examines the transformative evolution of data pipeline architectures in modern analytics, focusing on the integration of real-time and batch-processing methodologies to meet contemporary data processing demands. The article investigates how advanced frameworks like Apache Spark and Databricks, coupled with innovative technologies such as Delta Lake, are reshaping traditional data processing paradigms to accommodate increasing data volumes and complexity. Through a detailed article of hybrid pipeline architectures, data quality mechanisms, and observability practices, this paper demonstrates the critical role of next-generation pipeline designs in enabling organizations to build scalable, reliable, and maintainable data infrastructures. The article explores the implementation of ACID-compliant data lake technologies, automated monitoring systems, and sophisticated quality assurance methods that collectively ensure data integrity and processing efficiency. Key findings highlight the significance of emerging technologies, including edge computing and serverless architectures, in shaping future data pipeline designs. The article provides valuable insights into architectural patterns, best practices, and future trends that organizations can leverage to optimize their data processing capabilities and maintain competitive advantage in an increasingly data-driven business landscape.

Existing operational standards for field deployments of rapid response mobile laboratories: a scoping review

IntroductionRapid response mobile laboratories (RRML) play an important role in responding to emergencies such as outbreaks and humanitarian crises, working in coordination with national authorities. This scoping review aims to provide evidence to support the development of minimum operational standards for the deployment of RRMLs across the five key workstreams: operational support and logistics, biosafety and biosecurity, laboratory information management system, quality management systems and interoperability and coordination.MethodsWe searched PubMed, MEDLINE, EMBASE and the grey literature focusing on RRML deployment missions. Study characteristics such as year, country, objectives, methods, and findings were extracted and summarized to identify common themes, gaps, and patterns. The results were presented in a narrative format. We ensured methodological rigor by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines throughout the review process.ResultsOut of 163 full-text studies assessed for eligibility, 46 met the inclusion criteria and were analyzed. Six studies addressed the five RRML workstreams. Operational support and logistics are most commonly addressed during pre-deployment phases with a focus on personnel, transport and cold chain management. The application of biosafety and biosecurity protocols is most addressed during the mission execution phase, particularly in the use of personal protective equipment and the implementation of decontamination and disinfection procedures. The laboratory information management system procedures most frequently reported include sample identification and result dissemination protocols. The quality management system workstream overlaps significantly with the other four workstreams, with a strong emphasis on internal and external quality assurance measures. Coordination and interoperability aspects involve maintaining multiple collaborations, ranging from coordinating with local authorities to establishing international partnerships. Common field challenges included interrupted data transfer in areas characterized by poor connectivity and difficulties caused by extreme weather conditions.DiscussionThis review highlights RRML deployment procedures and addresses some critical challenges concerning their deployment. It suggests the provision of a pre-deployment logistics checklist, the use of a pre-determined standardized dataset for inputs to reduce data entry errors and the application of standardized internal and external quality assurance measures.

MS O01 - HPB Outcomes following Cholecystostomy Insertion for Acute Cholecystitis: A National Registry-based Study

Abstract Background Acute cholecystitis (AC) is a commonly encountered surgical emergency. In cases of severe AC or cholangitis, or in patients with significant comorbidities, percutaneous cholecystostomy (PC) may be employed. International data suggest PC is associated with significantly worse patient outcomes, but limited data exist in the Irish context. Method All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics including age, co-morbidities, length of stay/LOS, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. All patients managed with PC were identified, and their outcomes compared to patients managed without PC. Results In total, 20,886 patients were admitted with AC. 975 (5%) patients underwent PC and 19,911 patients (95%) were managed without percutaneous cholecystostomy. In comparison to non-cholecystostomy cohort, the PC cohort was older (median 72 v 58 years, p&amp;lt;0.001), less likely to be female (39% v 57% p&amp;lt;0.001), had proportionally longer LOS (&amp;lt;0.001), higher mortality rates (&amp;lt;0.001), were more likely to be admitted to critical care (&amp;lt;0.001), and more likely to be re-admitted to hospital within 30 days (&amp;lt;0.001). Conclusion Cholecystostomy insertion occurs in older patients with more comorbidities. These patients have higher in-hospital mortality rates, higher rates of critical care admission, longer LOS, and increased 30-day readmission rates.

Integrating DNA Barcoding Within an Orthogonal Approach for Herbal Product Authentication: A Narrative Review.

Existing methods for morphological, organoleptic, and chemical authentication may not adequately ensure the accurate identification of plant species or guarantee safety. Herbal raw material authentication remains a major challenge in herbal medicine. Over the past decade, DNA barcoding, combined with an orthogonal approach integrating various testing methods for quality assurance, has emerged as a new trend in plant authentication. The review evaluates DNA barcoding and common alternative testing in plant-related sectors to enhance quality assurance and accurate authentication. Studies were selected based on their relevance to the identification, quality assurance, and safety of herbal products. Inclusion criteria were peer-reviewed articles, systematic reviews, and relevant case studies from the last two decades focused on DNA barcoding, identification methods, and their applications. Exclusion criteria involved studies lacking empirical data, those not peer-reviewed, or those unrelated to the main focus. This ensured the inclusion of high-quality, pertinent sources while excluding less relevant studies. An orthogonal approach refers to the use of multiple, independent methods that provide complementary information for more accurate plant identification and quality assurance. This reduces false positives or negatives by confirming results through different techniques, combining DNA barcoding with morphological analysis or chemical profiling. It enhances confidence in results, particularly in cases of potential adulteration or misidentification of plant materials. This study highlights the persistent challenges in assuring the quality, purity, and safety of plant materials. Additionally, it stresses the importance of incorporating DNA-based authentication alongside traditional methods, to enhance plant material identification.