Quick Assessment Research Articles

Quick Sequential Organ Failure Assessment (qSOFA) and Performance Status Scoring Systems as Prognostic Predictors in Pneumococcal Community-Acquired Pneumonia

Quick Sequential Organ Failure Assessment (qSOFA) and Performance Status Scoring Systems as Prognostic Predictors in Pneumococcal Community-Acquired Pneumonia

HRMAS NMR for Studying Solvent-Induced Mobility of Polymer Chains and Metallocene Migration Into Low-Density Polyethylene (LDPE).

HRMAS (high-resolution magic angle spinning) nuclear magnetic resonance (NMR) spectroscopy of low-density polyethylene (LDPE) affords 1H and 13C NMR spectra with superior resolution. For acquiring HRMAS NMR spectra, the polymer is first swollen with representative organic solvents. Then, the samples are measured with a conventional solid-state NMR spectrometer in the wideline mode or at the low spinning speed of 2 kHz. Anisotropic interactions like CSA (chemical shift anisotropy) and dipolar interactions are reduced due to the additional mobility of the polymer chains in the presence of the solvent within the polymer network. The combined effect of this mobility and MAS leads to signals with substantially reduced halfwidths as compared to classic MAS of the dry polymer. With HRMAS, all signals of the polymer become visible, and the spectra can be used for a quick and easy assessment of the polymer swelling behavior in diverse solvents. Being able to characterize polymers on the molecular level, and identifying the solvents that penetrate the polymer network best, enables the study of post-synthesis modifications of the polymers. It is demonstrated by paramagnetic HRMAS that the metallocene nickelocene (Cp2Ni) penetrates the LDPE network along with the solvent and is homogeneously dispersed in the polymer. SEM images prove that the structure of the polymer is not altered by the presence of a solvent and Cp2Ni. The impact of the paramagnetic Cp2Ni on the 1H signal halfwidth and T1 time of LDPE is studied. HRMAS allows a quick assessment of metal complexes regarding their ability to penetrate the LDPE network and therefore supports future studies of catalytic polymer degradation.

T1-weighted MRI texture analysis in amyotrophic lateral sclerosis patients stratified by the D50 progression model.

Amyotrophic lateral sclerosis, a progressive neurodegenerative disease, presents challenges in predicting individual disease trajectories due to its heterogeneous nature. This study explores the application of texture analysis on T1-weighted MRI in patients with amyotrophic lateral sclerosis, stratified by the D50 disease progression model. The D50 model, which offers a more nuanced representation of disease progression than traditional linear metrics, calculates the sigmoidal curve of functional decline and provides independent quantifications of disease aggressiveness and accumulation. In this research, a representative cohort of 116 patients with amyotrophic lateral sclerosis was studied using the D50 model and texture analysis on MRI images. Texture analysis, a technique used for quantifying voxel intensity patterns in MRI images, was employed to discern alterations in brain tissue associated with amyotrophic lateral sclerosis. This study examined alterations of the texture feature autocorrelation across sub-groups of patients based on disease accumulation, aggressiveness and the first site of onset, as well as in direct regressions with accumulation/aggressiveness. The findings revealed distinct patterns of the texture-derived autocorrelation in grey and white matter, increase in bilateral corticospinal tract, right hippocampus and left temporal pole as well as widespread decrease within motor and extra-motor brain regions, of patients stratified based on their disease accumulation. Autocorrelation alterations in grey and white matter, in clusters within the left cingulate gyrus white matter, brainstem, left cerebellar tonsil grey matter and right inferior fronto-occipital fasciculus, were also negatively associated with disease accumulation in regression analysis. Otherwise, disease aggressiveness correlated with only two small clusters, within the right superior temporal gyrus and right posterior division of the cingulate gyrus white matter. The findings suggest that texture analysis could serve as a potential biomarker for disease stage in amyotrophic lateral sclerosis, with potential for quick assessment based on using T1-weighted images.

Moving Beyond Systemic Inflammatory Response Syndrome and Bacteremia: Are Modern Critical Care Calculators Useful in Predicting Debridement, Antibiotics, and Implant Retention Treatment Outcomes in Periprosthetic Joint Infection?

BackgroundIn critically ill periprosthetic joint infection (PJI) patients, surgeons need to balance the need for aggressive, definitive treatment against the health state of a potentially unstable patient. A clear understanding of the association between treatment outcomes and assessment scores for sepsis would benefit clinical decision-making in these urgent cases. The current study evaluates the effect of critical illness on debridement, antibiotics, and implant retention (DAIR) outcomes, as defined by systemic inflammatory response syndrome (SIRS) and, for the first time, by contemporary markers quick Sequential Organ Failure Assessment (qSOFA) and Modified Early Warning Score (MEWS). MethodsWe retrospectively identified 253 patients who underwent DAIR for PJI at a single institution between 2017 and 2021. The SIRS, qSOFA, and MEWS scores were calculated based on variables on admission. A DAIR treatment failure, defined as reoperation or mortality, was measured at 90 days and two years. Univariate analysis was used to determine the association between elevated critical care scores and DAIR failure. ResultsThe DAIR treatment success was 59% at two years, with hip procedures and Charlson comorbidity index (CCI) ≥ 1 independently associated with higher odds of DAIR failure. There were 43 patients (16%) who presented with SIRS, however, only four (2%) had positive qSOFA scores. Neither SIRS nor qSOFA were predictive of DAIR failure. For knees only, elevated MEWS scores were predictive of 90-day DAIR failure (P = 0.019). ConclusionOver one in six patients undergoing DAIR for PJI presented with SIRS, while only one in 50 had a positive qSOFA. The SIRS and qSOFA scores were not predictive of DAIR failure. Elevated MEWS scores were associated with DAIR failure at 90 days postoperatively in knee PJIs only, and should be confirmed in a larger cohort. Our results suggest that SIRS is not predictive of DAIR outcomes, possibly because it overestimates the proportion of critically ill patients.

Non-palpable contraceptive implants localization: review of imaging techniques and algorithm proposal.

Contraceptive arm implants provide long-acting contraception through a subdermal rod. The device is intended to be placed on the medial side of the non-dominant upper arm. There are two main types of implants: etonogestrel (ENG)-releasing devices, such as Implanon NXT®/Nexplanon®, and levonorgestrel (LNG)-releasing devices, including Sino-implant II® and Jadelle®. Since the rods are not biodegradable, the implants must be removed after the device's licensed duration. When the implant is palpable and located in subcutaneous tissue, it can be removed with a small skin incision, without the need for imaging. If the implant is not palpable, imaging techniques must be used for precise localization. Ultrasound (US) is the first-line imaging modality for non-palpable implants, allowing quick and accurate localization in the vast majority of cases. The patient can usually indicate the implant insertion site, which speeds up the localization process. If the implant cannot be located using US, other imaging techniques should be used. X-ray can also be useful for a quick localization assessment of radiopaque implants. Magnetic resonance imaging (MRI) is valuable for locating deep or migrated implants, especially if the device has not been locatable through US or X-ray. In case of suspected pulmonary migration, a thoracic computed tomography (CT) should be performed for arterial implant detection. In this article, we review the imaging techniques used for implant localization. We also present an algorithm that recommends a sequential approach to implant localization, integrating imaging modalities based on implant characteristics and patient presentation.

A novel approach for microbial activity assessment in bioleaching. Towards to a standardised fast starting up protocol

Biohydrometallurgy is a proven industrial method for extracting base metals from sulfidic ores with low-grade content and as a pre-treatment of Au ores. The lack of study of biological aspects related with microbial activity assessment makes it difficult to control and monitor these processes; and the multitude of experimental procedures described in the literature hinders cross-study comparisons among researchers. Experimental tools that allow a quick and reliable quantitative assessment of the iron oxidising capacity of the cells during the bioleaching process are needed. This work proposes monitoring microbial activity through a simple and reliable method based on the offline measurement of the Oxygen Uptake Rate (OUR). The methodology allows to quantify the microbial activity evolution of a growing culture under no-limiting conditions. By this methodology, the maximum potential bioleaching rate of the culture at any time is determined, assessing the occurrence of a biological or chemical limitation. The results obtained reveals that whether due to Fe2+ or O2 depletion, substrate availability significantly limits microbial activity. This aspect is key to assess a culture suitability for bioleaching bioreactor inoculation, preventing long lag phases. Furthermore, the methodology allows for quick disturbances correction, avoiding process shutdowns and enhances technological reliability of continuous bioleaching.

Estimation of Recovery Efficiency in High‐Temperature Aquifer Thermal Energy Storage Considering Buoyancy Flow

AbstractWith their high storage capacity and energy efficiency as well as the compatibilities with renewable energy sources, high‐temperature aquifer thermal energy storage (HT‐ATES) systems are frequently the target today in the design of temporally and spatially balanced and continuous energy supply systems. The inherent density‐driven buoyancy flow is of greater importance with HT‐ATES, which may lead to a lower thermal recovery efficiency than conventional low‐temperature ATES. In this study, the governing equations for HT‐ATES considering buoyancy flow are nondimensionalized, and four key dimensionless parameters regarding thermal recovery efficiency are determined. Then, using numerical simulations, recovery efficiency for a sweep of the key dimensionless parameters for multiple cycles and storage volumes is examined. Ranges of the key dimensionless parameters for the three displacement regimes, that is, a buoyancy‐dominated regime, a conduction‐dominated regime, and a transition regime, are identified. In the buoyancy‐dominated regime, recovery efficiency is mainly correlated to the ratio between the Rayleigh number and the Peclet number. In the conduction‐dominated regime, recovery efficiency is mainly correlated to the product of a material‐related parameter and the Peclet number. Multivariable regression functions are provided to estimate recovery efficiency using the dimensionless parameters. The recovery efficiency estimated by the regression function shows good agreement with the simulation results. Additionally, well screen designs for optimizing recovery efficiency at various degrees of intensity of buoyancy flow are investigated. The findings of this study can be used for a quick assessment and characterization of the potential HT‐ATES systems based on the geological and operational parameters.

Climate Extremes Walking Together: Evidence from Recent Compounding Climate Hazards after Remal

On May 26, 2024, Tropical Cyclone (TC) Remal made a devastating landfall along the coastal regions of India and Bangladesh. The sequence of devastating events began with prevailing heatwaves, followed by the cyclone’s landfall and subsequent heavy rainfall coupled with early onset of monsoon led to floods, landslides, and the resurgence of hot spells. It illustrates the complexity of managing such cascading effects of compound climate hazards. Multisource Earth Observation (EO) data with Google Earth Engine (GEE) was used to study the dynamics of Remal and its cascading impacts. IbTracks, INSAT-3D, GPM, Sentinel-1, and PlanetScope were involved in analyzing the cyclone's progression and impacts. Remal's slow progression extended the impact of the cyclone as it hovered over Bangladesh for more than 50 hours. As observed from the GPM data, the right side of the cyclone's path experienced more extensive and severe flooding than the left. Flood extent mapping using the Sentinel-1 data and Otsu thresholding depicted Jogipara, Assam in India and Jashore, Narail, and Khulna in Bangladesh as among the worst affected regions. Additionally, the early onset of the monsoon and the triggered cyclonic rainfall in the area led to landslides in Assam and Meghalaya during this period. The present study advocates the usage of multisource EO data and GEE for quick assessment of compound hazards started Remal. The study also highlights the need for a deeper understanding to develop a more robust district disaster management plan integrating EO data for actionable disaster risk reduction strategies for TC.

USABILITY TESTING ANALYSIS ON PROFESSIONAL SOCIAL MEDIA USING THE SYSTEM USABILITY SCALE (SUS) METHOD

Usability is a critical aspect of digital product design, which determines how effective, efficient, and satisfying a product is for its users. This research aims to evaluate the level of usability of digital applications in a professional context using the System Usability Scale (SUS) method. The SUS method was chosen for its ability to provide a quick and accurate assessment of the usability of a product or service. The test results show that the average SUS score of the respondents is 63, which is below the general average of 68. This score indicates that the tested digital product has a poor level of usability and requires improvement to increase user satisfaction.

Using HIS administrative data for initial assessment of comorbid patients’ status (Covid-19 case)

Abstract Background Despite numerous published articles, most of the studies on COVID-19 focused on influence of clinical characteristics and treatments on severity. Yet, the epidemiological viewpoint was rarely discussed. Based on our experience with comorbid hospitalized COVID-19 patients, we aim to show that HIS administrative data can be used to identify individuals that are more prone to worse outcome thus improving patient management not only during pandemics. Methods A retrospective single-center study was conducted using archived anonymized HIS administrative data for all 8319 COVID-19 patients in the university hospital ‘Saint Marina’-Varna, Bulgaria, in the period 14/06/2020-31/12/2021. Up to 7 comorbidities per patient were registered in HIS with ICD-10 codes, used for our analyses. Non-parametric tests and logistic regression were used at α=.05, 95%CI. Results Comorbid patients were 5741(69%), 50.3% ≥69y, 52% male; 1602(27.9%) died, 64% ≥69y, 54.4% male. Deceased were older (p< .01) and had more comorbidities (p< .01). Multimorbid patients (OR = 4.43; 3.80-5.17), male (OR = 4.72; 3.83-5.82) and older ones (OR = 1.91; 1.57-2.34) had higher odds of dying. The odds of dying increased with the number of comorbidities from OR=.635; .559-.721 for 1 to OR = 4.23; 3.28-5.46 for 7. From 4967 comorbid diseases (451 ICD-10 codes), only those from code groups A, J, N, E, I, Z were suitable for analysis. Patients with A41.9 (OR = 213.69; 52.88-863.43), J80 (OR = 52.88; 32.58-85.56), N17 (OR = 18.63; 10.24-33.87), E11.7 (OR = 4.72; 3.09-7.19), I13.2 (OR = 4.67; 3.151-6.93), Z95 (OR = 3.81; 2.74-5.31), I63 (OR = 3.56; 2.25-5.61), E66 (OR = 3.12; 2.10-4.64) died more often. Conclusions Our findings match the results based on EMR data: death with COVID-19 was associated with comorbidities (sepsis, acute RDS and kidney, heart and renal failure, diabetes, cerebral infarction, obesity, implants and grafts), age, gender, i.e. HIS administrative data can be used for quick assessment of comorbid patients’ status. Key messages • HIS administrative data can be used for quick assessment of multimorbidity and following personalized treatment is highly recommended to decrease hospital mortality not only in times of pandemic. • Older Bulgarians have many comorbidities from ICD code groups A, J, N, E, I, Z, and are more prone to death, especially in times of pandemic. Public health measures are needed to prevent comorbidity.

Factors Associated With Death at 30 Days and Evaluation of Clinical Risk Scores Among Patients With Cancer Admitted With Postchemotherapy Infection in Uganda: A Prospective Cohort Study

Abstract Background Little is known about outcomes from cancer chemotherapy–-associated infections in sub-Saharan Africa. Accordingly, among patients with cancer admitted with postchemotherapy infection in Mbarara, Uganda, we aimed to determine (1) the 30-day case fatality rate, (2) factors associated with mortality rate, and (3) clinical risk score performance. Methods We enrolled participants aged ≥18 years if they (1) received cancer chemotherapy within the past 30 days, (2) were admitted to the oncology ward, and (3) were prescribed intravenous antibiotics. We used Cox proportional hazards regression to determine predictors of death at 30 days and calculated the area under the receiver operating characteristic curve (AUC) for each clinical risk score. Results Among 150 participants, 67 (45%) were female, and the median (interquartile range) age was 56 (43–66) years. Esophageal cancer (18%) and pneumonia (42%) were the most common cancer and infection, respectively. Death occurred within 30 days in 63 participants (42%). Quick Sequential Organ Failure Assessment (qSOFA) score ≥2 (adjusted hazard ratio, 2.51 [95% confidence interval, 1.42–4.44]; P = .001), and Universal Vital Assessment (UVA) score >4 (2.13 [.08–4.18, P = .03) were independently associated with death at 30 days. An Eastern Cooperative Oncology Group (ECOG) score ≥3 was similarly independently associated with death at 30 days in the qSOFA and UVA models. The AUCs for qSOFA and UVA scores were 0.70 (95% confidence interval, .63–.79) and 0.72 (.64–.80), respectively. Conclusions In participants with postchemotherapy infection in Mbarara, Uganda, the case fatality rate was high. ECOG, qSOFA, and UVA scores were associated with death at 30 days.

The 36-Item Yoni Task: Normative Data for the Clinical Assessment of Theory of Mind.

Background: The evaluation of Theory of Mind (ToM) in the clinical setting remains limited due to the lack of valid instruments for a quick and reliable assessment. In this study, the psychometric properties of the Yoni-36 task were tested, and correction grids, equivalence scores, and normative data were computed. Methods: In total, 318 healthy subjects (169 females; mean age = 42.22 ± 18.11 years; mean education = 15.01 ± 3.43 years) were enrolled and administered the Yoni-36 task. Results: Statistical analysis showed good-to-high internal consistency, split-half reliability, and discrimination ability (especially for the second-order items) of the Yoni-36 task. Regression models highlighted the predictive role of age and education on second-order, affective, cognitive accuracy, and response time scores. Education influenced the first-order ToM response time score as well. Based on β values of the regressions, raw scores of the Yoni task were adjusted for sex, age, and education, and correction grids were computed. The equivalent scores indicated an accuracy index score < 0.69 and a response time index score < 0.83 as cut-off points for ToM competence. Normative data reported a mean accuracy and response time index score of 0.90 ± 0.11 and 0.91 ± 0.05 in the Italian population, respectively. Conclusions: The Yoni-36 proved to be a valid instrument for a quick and reliable ToM assessment, suitable to be included in neuropsychological batteries and to be used in routine clinical practice.

Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India.

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Scoring model for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation.

Distinguishing colorectal from gastroduodenal perforations is clinically important and challenging. We aimed to establish a scoring model based on objective findings (excluding computed tomography findings) for the diagnosis of colorectal perforation and its differentiation from gastroduodenal perforation. Patients diagnosed with colorectal or gastroduodenal perforations between January 2014 and December 2021 were retrospectively studied. Univariate and multivariate analyses were performed to identify independent variables, and a scoring model was developed based on these variables. Among 131 eligible patients, 64 (48.9%) were in the colorectal group and 67 (51.1%) were in the gastroduodenal group. White blood cell count, C-reactive protein, and quick Sequential Organ Failure Assessment score were identified as independent clinical variables associated with the diagnosis of colorectal perforation, which differentiated colorectal perforation from gastroduodenal perforation, and were used to develop a new scoring model. The scores ranged from 0 to 5, with an area under the receiver operating characteristic curve of 0.846. The probabilities of colorectal perforation with scores of 0, 1.5, 2, 3, 3.5, and 5 were 3.2, 20, 55.6, 81.8, 73.9, and 82.4%, respectively. The new scoring model may help in treatment selection and perioperative management of patients with gastrointestinal perforation.

CD64 Expression on Neutrophils (nCD64) as a Biomarker in Adult Patients With Sepsis: A Cross-Sectional Study.

Introduction Neutrophils that are at rest exhibit very low expression of CD64, the high-affinity immunoglobulin fragment crystallizable γ receptor I, which is also found in monocytes. Neutrophils that have been exposed to endotoxins or are infected express more CD64. Objectives The aim of this study was to assess the CD64 biomarker expression on neutrophils using the flow cytometry method and its comparison with total leukocyte count, C-reactive protein (CRP) level, and blood culture sensitivity test in the diagnosis of sepsis in adults. Materials and methods Using the quick Sequential Organ Failure Assessment (qSOFA) scoring criteria, 94 blood samples from individuals with clinical indications of sepsis were included in this investigation. Samples were collected in K2 EDTA (ethylenediaminetetraacetic acid) vacutainers and analyzed for neutrophil CD64 (nCD64) levels using BD FACSLyricTM flow cytometer (BD, Franklin Lakes, NJ) within 24 hours of collection. Total leukocyte count, CRP levels, and blood culture sensitivity tests were also assessed simultaneously. Results Majority of the patients, i.e., 29 (30.9%), belonged to the age group of 19 to 35 years, with a female preponderance. The mean total leukocyte count was 19.49 ± 8.12 x 103/µL, mean CRP level was 81.19 ± 56.33 mg/dL, and the mean nCD64 expression - median fluorescence intensity was 197.26 ± 79.56. A positive blood culture was found in 59 (62.8%) cases. Neutrophils showed bright expression of nCD64 in 39 (41.5%) patients, dim expression in 35 (37.2%) patients, and moderate expression in 20 (21.3%) patients in the present study. The correlation between nCD64 expression with CRP, total leukocyte count, and blood culture sensitivity test was statistically significant (p=0.001). nCD64 expression showed a sensitivity of 93.2% and specificity of 91.4% for diagnosing sepsis, with an area under the curve (AUC) of 0.973. This proves nCD64 to be a highly effective biomarker compared to conventional methods. Conclusion nCD64 has a higher sensitivity and specificity as compared to total leukocyte count, CRP levels, and blood culture sensitivity test in the diagnosis of sepsis. It is an effective and rapid test that can enhance sepsis diagnostic accuracy, when combined with other biomarkers. Multicentric research needs to be conducted to validate these findings.

A GIS Based Quick Assessment Method of Flood Vulnerability: Susurluk Basin Case

A GIS Based Quick Assessment Method of Flood Vulnerability: Susurluk Basin Case

Enhancing Sepsis Care at an Academic Emergency Department in a Resource-Constrained Setting: A Quality Improvement Initiative.

The early recognition of sepsis and septic shock is crucial for improved patient outcomes. Quality improvement programs have ameliorated processes and outcomes in the care of patients with sepsis and septic shock. This study aimed to improve the proportion of patients receiving antibiotics within 1 hour of triage and compliance with sepsis bundles. A multidisciplinary sepsis task force was created to monitor and improve sepsis care. The program lasted 24 months from January 1, 2018, to December 31, 2019. A unique screening criterion was created by combining items from the systemic inflammatory response syndrome, quick sequential organ failure assessment, and National Early Warning Score systems. Thereafter, a sepsis flowsheet was implemented in the emergency department for monitoring. The measures between the first 12 months and the last 12 months were compared. The proportion of patients receiving antibiotics within 1 hour of triage improved from 44% to 84%, intravenous crystalloid administration within 3 hours improved from 62% to 94%, serum lactic acid measurement within 3 hours improved from 62% to 94%, and vasopressor initiation within 6 hours improved from 76% to 94%. The mortality rates decreased from 32% to 21% between the 2 study periods. This program emphasizes the impact of a structured quality improvement program on the process and outcomes of care.

The Value of Sysmex White Precursor Cell Channel in Distinguishing Circulating Large Blastoid Lymphoma Cells from Blasts

Abstract Background There are rare cases of lymphoma presenting with circulating large blastoid cells mimicking blasts. These abnormal cells usually are medium to large in size with high nucleus-to-cytoplasmic ratio, fine to slightly condensed chromatin, prominent nucleoli, and scant to moderate amount of cytoplasm. Distinguishing them from real blasts is challenging, and although flow cytometry provides a definitive answer, pathologists may feel compelled to offer a quick preliminary assessment to the clinical team, particularly during weekends when flow cytometry is not accessible. We have recently replaced the old CBC instrument with Sysmex XN-9100 which incorporates a new white precursor cell channel (WPC). WPC channel is triggered only when Sysmex differential channels (WDF+WNR) produce a combined flag of “blasts/abnormal lymphocytes?”. The WPC will then separate this into a specific flag for either cell type or remove the flag if it is normal. Our study aims to explore the effectiveness of the WPC Channel in distinguishing blastoid lymphoma cells from true blasts. Method Between October 2023 and January 2024, we identified four lymphoma cases exhibiting circulating large blastoid cells. For comparative analysis, we included the most recent seven cases of acute myeloid leukemia (AML) and one case of acute lymphoblastic leukemia (ALL), all featuring medium to large-sized blasts. We collected results from initial testing (WDF+WNR) and WPC reflex testing. The reference for our analysis included manual differentials assisted by CellaVision, pathologist reviews, and immunophenotyping results. Results Within four blastoid lymphoma cases, two were diagnosed as blastoid high-grade B-cell lymphomas, one as diffuse large B-cell lymphoma, and another as chronic lymphocytic leukemia with many blast-like cells observed on the cytospin slide (no smear available). Pathologists reviewed the smears and slides of all four cases, categorizing them as blasts or blast-like cells before flow was run. All cases were initially flagged with “Blasts/Abnormal Lymphocyte?” on Sysmex differential channels but were subsequently flagged only with abnormal lymphocytes after the WPC reflex. For comparison, in 7 AML and 1 ALL cases, the WPC channel flagged blasts in 7 out of the 8 cases following the reflex of initial “Blasts/Abnormal Lymphocyte?” flag. The only case flagged with abnormal lymphocytes but not blasts was a case of AML with monocytic differentiation, characterized by many promonocytes and rare blasts. Conclusion The WPC channel accurately characterized the challenging large blastoid lymphoma cells as abnormal lymphocytes in all four cases, where morphology characterization was difficult. The study’s limitation lies in its small sample size. We are actively accumulating additional cases with circulating blastoid lymphoma cells, alongside control leukemia cases, to further assess the efficacy of the WPC channel.

Outcome of patients with solid malignancies considered for intensive care unit admission: a single-center prospective cohort study.

To identify the predictors and outcomes of ICU triage decisions in patients with solid malignancies (SM) and to investigate the usefulness of the National Early Warning Score (NEWS) and quick Sequential Organ Failure Assessment (qSOFA) score at triage. All patients with SM for whom ICU admission was requested between July 2019 and December 2021 in a French university-affiliated hospital were included prospectively. Of the 6262 patients considered for ICU admission, 410 (6.5%) had SM (age, 66 [58-73] years; metastases, 60.1%; and performance status 0-2, 81%). Of these 410 patients, 176 (42.9%) were admitted to the ICU, including 141 (80.1%) subsequently discharged alive. Breast cancer, hemoptysis, and pneumothorax were associated with ICU admission; whereas older age, performance status 3-4, metastatic disease, and request at night were associated with denial of ICU admission. The NEWS, and the qSOFA score in patients with suspected infection, determined at triage performed poorly for predicting hospital mortality (area under the receiver operating characteristics curve, 0.52 and 0.62, respectively). Performance status 3-4 was independently associated with higher 6-month mortality and first-line anticancer treatment with lower 6-month mortality. Hospital mortality was 33.3% in patients admitted to the ICU after refusal of the first request. Patients with SM were frequently denied ICU admission despite excellent in-ICU survival. Poor performance status was associated with ICU admission denial and higher 6-month mortality, but none of the other reasons for denying ICU admission predicted 6-month mortality. Physiological scores had limited usefulness in this setting.

Dehydration by Pervaporation of an Organic Solution for the Direct Synthesis of Diethyl Carbonate

Pervaporation has been a central subject in the research community within the scope of the further development of energy- and cost-efficient alternatives to conventional liquid–liquid separation technologies. The potential eligibility of four commercial membranes (ZEBREX ZX0, PERVAPTM 4155-80, PERVAPTM 4100, PERVAPTM 4101) for use in an integrated dehydration application of a diethyl carbonate/water/ethanol mixture by pervaporation was assessed experimentally. The impact of feed concentration, operating temperature, pressure, and sweep gas flow rate on membrane separation performance, including permeation flux, permeate quality, selectivity, and permeance, was thoroughly investigated. Applying the ZX0 membrane delivered the best qualities of all tested membranes of the permeate stream, with a water concentration of mostly &gt;98%. In comparing the water flux, the ZX0 membrane remained reasonably competitive with the polymer membranes. Furthermore, the sweep gas volume flow rate and the operating temperature were identified as influencing the flux significantly but not the product composition. At the same time, the feed concentration of water also influenced the water purity within the permeate. The experiments were monitored with a partial least squares model, allowing a quick assessment of obtained samples while delivering accurate results.