Test Frequency Research Articles

Routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women in peri-urban areas of Dodoma City, Tanzania: a cross-sectional study

BackgroundThe physiological requirements for iron and folic acid in pregnancy are a significant challenge to achieve through normal dietary intake, especially in low resource settings. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) to prevent maternal anaemia and related adverse effects in community settings where the prevalence of anaemia during pregnancy is > 40%. The objective of this study was to assess the routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women at peri-urban areas of Dodoma City, Tanzania.MethodsA cross-sectional study was conducted in peri-urban areas. Data was collected through face-to-face interviews and review of records from maternal clinic card (RCH 4 card). Routine uptake of iron-folic acid supplementation was defined as pregnant woman who reported taking iron-folic acid supplements at least once within the past seven days prior to data collection. Frequency and percentage were used to report respondents’ characteristics and uptake of prenatal iron-folic acid supplementation. Chi-square test and logistic regression were conducted to determine the relationship and association of routine uptake of iron-folic acid supplementation with respondents’ characteristics.ResultsThe total respondents were 452. Overall routine uptake of iron-folic acid supplementation was 35.6% (161). The majority of the respondents (66.5%) initiated iron-folic acid supplementation during the second trimester of pregnancy. Most of the respondents (86.3%) obtained IFA supplements at the health centers where they were receiving antenatal care. The prevalence of routine uptake of iron-folic acid supplementation was significantly higher among women in the third trimester of pregnancy (54.9%), those with more than a five-year interval since last pregnancy (40.6%), those with at least four antenatal care (ANC) visits (73.7%) and women who had undergone haemoglobin testing in the current pregnancy (63.0%). Factors associated with routine uptake of iron-folic acid supplementation were; frequency of ANC visits (AOR = 1.69) and haemoglobin testing (AOR = 3.02).ConclusionApproximately one third of the pregnant women took iron-folic acid supplementation at least once a week. The current frequency for intake of iron-folic acid supplementation can be described as intermittent. This practise is unacceptable for prevention of maternal anaemia and associated adverse pregnant outcomes. Frequency of ANC visits and haemoglobin testing during pregnancy were found to be associated with routine uptake of iron-folic acid supplements. Stakeholders are urged to consider novel systems for provision of prenatal IFAS in community settings with limited access to health-care professionals to ensure a timely and continuous supply of supplements.

A Compact V-Band Temperature Compensation Low-Noise Amplifier in a 130 nm SiGe BiCMOS Process.

This paper presents a compact V-band low-noise amplifier (LNA) featuring temperature compensation, implemented in a 130 nm SiGe BiCMOS process. A negative temperature coefficient bias circuit generates an adaptive current for temperature compensation, enhancing the LNA's temperature robustness. A T-type inductive network is employed to establish two dominant poles at different frequencies, significantly broadening the amplifier's bandwidth. Over the wide temperature range of -55 °C to 85 °C, the LNA prototype exhibits a gain variation of less than 1.5 dB at test frequencies from 40 GHz to 65 GHz, corresponding to a temperature coefficient of 0.01 dB/°C. At -55 °C, 25 °C, and 85 °C, the measured peak gains are 25.5 dB, 25 dB, and 24.4 dB, respectively, with minimum noise figures (NF) of 3.0 dB, 3.5 dB, and 4.2 dB, and DC power consumptions of 22.3 mW, 27.6 mW, and 34.4 mW. Moreover, the total silicon area of the LNA chip is 0.37 mm2, including all test pads, while the core area is only 0.09 mm2.

The impact of non-structured PSA testing on prostate cancer-specific mortality on New Zealand Māori men

ObjectivesTo assess the impact of differences in Prostate-Specific Antigen (PSA) testing rates on prostate cancer (PCa) diagnosis and PCa-specific mortality among Māori men in a New Zealand (NZ) population.Patients and MethodsMāori men aged 40 years or older, without a history of PCa, with a PSA test between 2006 and 2018 were included. The cohort was divided into two groups; the “screened group” (ScG) consisting of men who had at least one PSA test every four years or less, and the “non-screened group” (non-SG). We measured the rate of cancer diagnoses and used competing risk analysis to assess survival.ResultsThe study cohort included 63,939 Māori men, with 37,048 (58%) in the ScG. PCa was more frequently diagnosed in the ScG (3.7% vs. 3.0%, P < 0.001). A higher proportion of high-grade cancers were found in the non-SG (32.7% vs. 25.6%, P = 0.001). The 10-year cancer-specific survival was significantly higher in the ScG (99.4% vs. 98.5%, P < 0.001). In a multivariable risk model, PSA testing frequency was an independent predictor of PCa mortality. (HR 2.43, [95% CI 1.97–3.01], P < 0.001).ConclusionsIn a cohort of only Māori men, lower PSA testing rates were associated with a higher risk of PCa-related death. Therefore, regular PSA testing for Māori could improve cancer-specific survival among Māori men. Regular PSA testing should be considered a priority area for improving PCa survival in this population.

Adherence to guideline-recommended cardiac screening in Medicaid-enrolled survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

56 Background: Childhood cancer survivors face increased risks of heart failure and myocardial dysfunction associated with cancer treatment exposure. Children’s Oncology Group (COG) guidelines recommend periodic cardiac screening for survivors exposed to anthracycline or radiation. However, the extent of adherence to cardiac screening among Medicaid-enrolled survivors—a group typically characterized by socioeconomic disadvantages—remains unclear. Additionally, as Medicaid expansion under the Affordable Care Act has occurred in most, but not all states, cardiac screening adherence may vary based on survivors' state of residence. Methods: Data from the CCSS were linked to administrative Medicaid insurance claims from 2015 to 2019. We included at-risk survivors (i.e., received radiation to chest or heart, total body irradiation, and/or anthracyclines), aged 18-64 years, continuously covered by Medicaid during 2015-2019, and without a history of grade 3-4 cardiovascular conditions by 2019 to ensure the identified cardiac tests were for screening purposes. Our primary outcome assessed adherence to COG guidelines (V4.0) based on age- and therapy dose-specific frequency of cardiac testing (i.e., echocardiogram, multigated acquisition scan, or magnetic resonance imaging) during the study period. Multivariable logistic models assessed sociodemographic, clinical, and policy-related factors associated with adherence, with adjusted probability differences (i.e., marginal effects [MEs]) reported. Results: We identified 1,062 survivors at risk of cardiovascular conditions, with 57.0% female, 52.8% young adults (ages 18-39 years), and 72.8% non-Hispanic White. During 2015-2019, 285 (26.8%) survivors received any cardiac test, and 102 (9.6%) adhered to COG guideline-based frequency of cardiac testing. In multivariable models, survivors residing in states that expanded Medicaid in 2014 and later has 4.3 percentage points (ppts, 95% CI=0.58.1, p =0.025) and 6.1 ppts (95% CI=0.611.6, p =0.031) increased likelihood of adhering to guideline-based frequency of cardiac testing respectively compared to states that did not. Compared to leukemia survivors, the likelihood of adhering to guideline-based frequency of cardiac testing was higher in survivors of central nervous system tumors (ME=7.6 ppt, 95% CI=2.712.6, p =0.002), Hodgkin lymphoma (ME=10.7 ppt, 95% CI=1.320.1, p =0.026), and non-Hodgkin lymphoma (ME=9.4, 95% CI=1.017.8, p =0.028). Conclusions: Adherence to risk-based cardiac testing is low among Medicaid-enrolled survivors of childhood cancer, and associated with residence in a Medicaid expansion state and cancer type. Policy reforms toward improving affordable, continuous health insurance coverage are important means to increase adherence to guideline-based cardiac tests among survivors.

Improving dihydropyrimidine dehydrogenase genotyping (DPYD) prior to initiation of fluoropyrimidine-based chemotherapy at a community-based hospital: A quality improvement initiative.

347 Background: Dihydropyrimidine dehydrogenase gene (DPYD) testing is crucial in preventing toxicities from fluoropyrimidine chemotherapy. Despite benefits and established guidelines, its adoption within healthcare organizations remains inconsistent and suboptimal. We implemented a quality improvement project to improve DPYD testing prior to fluoropyrimidine chemotherapy at a community-based hospital. We aimed to increase DPYD testing for patients receiving fluoropyrimidine-based chemotherapy from 65% to 95% between July 2023 to July 2024. Balancing measures included DPYD testing turnaround time. Methods: For baseline diagnostics, manual chart review was performed on 126 patients to identify frequency of DPYD testing, and turnaround time (TAT) between May 1, 2023 to August 4, 2023. Patients were excluded if they received fluoropyrimidine-based chemotherapy prior to May 1, 2023. A multidisciplinary team including medical oncology residents and staff, pharmacists, nurses, and clinical informatics specialists worked jointly to identify and address barriers to implementation. Barriers identified included lack of established workflows and awareness of the importance of testing. Diagnostic tools utilized included Ishikawa diagrams and process mapping. The team used Plan-Do-Study-Act (PDSA) cycles to address barriers. A p-chart was used to analyze the results. Results: The baseline DPYD testing rate was 65%. Barriers identified via multidisciplinary sessions included lack of established workflow, awareness and importance of testing. PDSA cycles included education sessions to breast medical oncologists and medical oncology nurses, and development of a best-practice advisory in the electronic medical record. The percentage of eligible patients receiving DPYD testing increased from 65% to 95.8% in the total population. For breast cancer patients, the rate increased from 16.7% to 100%. For gastrointestinal cancer patients, the rate increased from 56.1% to 94.2%. Sustainability was demonstrated two months post-intervention with TAT stable between 7-8 days. Conclusions: Through PDSA cycles, we improved the frequency of DPYD testing for patients receiving fluoropyrimidine chemotherapy from 65% to 95.8%. Future work will assess changes in chemotherapy prescribing behavior in the setting of variant DPYD results, and outcomes of patients with variant DPYD testing.

Analysis and Guideline for Determining Piezoelectric Coefficient for Films With Substrate Constraint.

Piezoelectric films including coatings are widely employed in various electromechanical devices. Precise measurement for piezoelectric film properties is crucial for both piezoelectric material development and design of the piezoelectric devices. However, substrate constraint on the deformation of piezoelectric films could cause significant impacts on the reliability and accuracy of the piezoelectric coefficient measurement. Through both theoretical finite element analysis (FEA) and experimental validation, here we have identified three important factors that strongly affect the measurement results: ratio of Young's modulus of substrate to piezoelectric film, ratio of electrode size to substrate thickness, and test frequency. Our investigations show that a relatively smaller substrate's Young's modulus to film, and a larger ratio of electrode size to substrate thickness would cause a larger substrate bending effect and thus potentially more significant measurement errors. Moreover, intense transversal displacement fluctuation can be excited at excessively high frequencies, leading to unreliable measurements. Various well-established piezoelectric measurement methods are compared with outstanding measurement issues identified for those commonly used piezoelectric films and substrates. We further establish the guidelines for piezoelectric coefficient measurements to achieve high reliability and accuracy, thus important to the wide technical community with interests in electromechanical active materials and devices.

Micronutrient supplementation and frequency of blood testing in vegan adults in Italy

Micronutrient supplementation and frequency of blood testing in vegan adults in Italy

Extrapolating Sentinel Surveillance Information to Estimate National COVID Hospital Admission Rates: A Bayesian Modeling Approach.

The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) was established in March 2020 to monitor trends in hospitalizations associated with SARS-CoV-2 infection. COVID-NET is a geographically diverse population-based surveillance system for laboratory-confirmed COVID-19-associated hospitalizations with a combined catchment area covering approximately 10% of the US population. Data collected in COVID-NET includes monthly counts of hospitalizations for persons with confirmed SARS-CoV-2 infection who reside within the defined catchment area. A Bayesian modeling approach is proposed to estimate US national COVID-associated hospital admission rates based on information reported in the COVID-NET system. A key component of the approach is the ability to estimate uncertainty resulting from extrapolation of hospitalization rates observed within COVID-NET to the US population. In addition, the proposed model enables estimation of other contributors to uncertainty including temporal dependence among reported COVID-NET admission counts, the impact of unmeasured site-specific factors, and the frequency and accuracy of testing for SARS-CoV-2 infection. Based on the proposed model, an estimated 6.3 million (95% uncertainty interval (UI) 5.4-7.3 million) COVID-19-associated hospital admissions occurred in the United States from September 2020 through December 2023. Between April 2020 and December 2023, model-based monthly admission rate estimates ranged from a minimum of 1 per 10,000 population (95% UI 0.7-1.2) in June of 2023 to a highest monthly level of 16 per 10,000 (95% UI 13-19) in January 2022.

Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic

ObjectiveTo evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) due to the COVID-19 pandemic. MethodsWe performed a cross-sectional study using the Pediatric Health Information System. Eligible subjects were children (90 days-18 years) who were discharged from a pediatric ED included in PHIS from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across three study periods: pre-pandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024). ResultsWe included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least one viral respiratory test was performed for 460,826 of 7,311,177 pre-pandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive pre-pandemic slope in viral testing (0.17% encounters/month; 95% confidence interval [CI] 0.17, 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90, 5.07) and positive slope (0.54% encounters/month; 95% CI 0.54, 0.55). The late pandemic period was associated with a negative shift (-17.80%, 95% CI -17.90, -17.70) and positive slope (0.42% encounters/month; 95% CI 0.41, 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200, 5,700) to $33,000/month (95% CI $32,000, $34,000) during the early pandemic. ConclusionRespiratory testing and associated costs increased during the COVID-19 pandemic and were sustained, despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.

Defining the Optimal Frequency of Dialysis Adequacy Test for Patients on Peritoneal Dialysis

Defining the Optimal Frequency of Dialysis Adequacy Test for Patients on Peritoneal Dialysis

Leveraging HIV self-testing to achieve the UNAIDS 2025 targets in the South and Southeast Asia region.

The South and Southeast Asia region has the second-highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS-related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95-95-95 HIV testing, treatment and viral suppression targets. HIV self-testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow-up HIV services among key populations. Key factors influencing the implementation and scale-up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost-effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. It is crucial to accelerate the implementation and scale-up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial-and-error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95-95-95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic.

Real-world molecular testing patterns in primary advanced or recurrent endometrial cancer (pA/rEC) in the US.

395 Background: Targeted therapy can improve outcomes in women with pA/rEC, but real-world biomarker testing rates are unknown. This study estimated the real-world proportion of patients receiving biomarker testing (within ≤6 months of advanced/recurrent diagnosis) and characterized testing according to sociodemographic and clinical characteristics. Methods: We used the US Flatiron Health electronic health record–derived deidentified database. Records from 1/1/2013 to 8/31/2023 for women ≥18 years old with advanced/recurrent EC were searched to identify testing for DNA mismatch repair/microsatellite instability (MMR/MSI), HER2, and estrogen or progesterone receptors (ER/PR); a subsample dataset from 4/1/2013 to 11/30/2022 was analyzed for additional biomarkers. The subsample has information on additional biomarker testing and was used to evaluate the frequency of testing for these biomarkers. Testing rates were evaluated using descriptive statistics; characteristics associated with testing were identified by multivariate logistic regression. Results: Among persons meeting eligibility criteria (n=2982), the mean age was 65 years; the majority were non-Hispanic White (56%), had commercial insurance (79%), and received care in a community setting (73%). The subsample (n=509) had similar characteristics to the full cohort. Between 2013-2022, 73% (n=2165) of patients received testing for any biomarker. Testing rates for individual biomarkers are shown in the Table. From 2013 to 2021, testing increased for MMR/MSI (17% to 81%), ER/PR (45% to 62%), and HER2 (15% to 43%). The likelihood of testing was higher among patients with primary advanced EC (OR, 1.45; 95% CI, 1.03-2.06), endometrioid carcinoma histology (1.39; 1.01-1.93), commercial insurance (1.51; 1.18-1.93), at an academic facility (1.70; 1.37-2.11), and with no prior surgery (2.29; 1.83-2.86) relative to other attributes. Conclusions: Molecular testing has increased over time, indicating a continuous trend toward personalized treatment decisions. Several factors associated with an increased likelihood of biomarker testing were identified. Understanding these factors can inform approaches to increase access to molecular testing and increase testing rates. Biomarker testing rates, 2013-2022. Biomarker, n (%) 2013 2021 Overall MMR/MSI a 35 (15) 238 (80) 1604 (54) HER2 a 31 (14) 121 (41) 612 (21) ER/PR a 99 (43) 177 (59) 1465 (49) p53/ TP53 b 13 (36) 31 (74) 260 (51) TMB b 3 (8) 14 (33) 91 (18) CTNNB1 b 4 (11) 12 (29) 88 (17) ARID1A b 4 (11) 15 (36) 91 (18) CDK4/6 b 5 (14) 14 (33) 110 (22) POLE b 4 (11) 17 (40) 110 (22) ARID1A, AT-rich interactive domain-containing protein 1A; CDK4/6, cyclin-dependent kinases 4 and 6; CTNNB1, catenin beta-1; POLE, polymerase-epsilon; TMB, tumor mutation burden. a 2013, n=228; 2021, n=298; overall, n=2982. b Rates from subsample dataset (4/1/2013 to 11/30/2022); 2013, n=36; 2021, n=42; overall, n=509.

Sub-Optimal Disease Control and Low Blood Eosinophil Testing Frequency in Chinese Adult Patients with Asthma Receiving GINA Step 4/5 Treatment: A Real-World Study.

To inform effective management strategies for severe asthma in China, this study aimed to comprehensively characterize clinical characteristics, treatment patterns, disease control status, and healthcare resource utilization among patients on GINA Step 4/5 therapies by analyzing data from the Adelphi Asthma Disease Specific Program conducted in China. All information was retrieved from medical records or collected from physicians and patients on the survey date (August-December 2018); no follow-up was conducted. Results were summarized descriptively for patients on GINA Step 4/5 therapies, who were pooled from a consecutive sample (comprising three or more consecutive patients with physician-diagnosed asthma from each participating physician) and an oversample (comprising the next two patients with physician-perceived severe asthma from each participating physician). Of the included patients (n=754), 51.5% had ever had a blood eosinophil measurement taken, 22.1% had available records for their most recent blood eosinophil measurements (68.9% of them had an elevated level ≥150 cells/µL), 39.9% had ever been tested for specific immunoglobulin E or radioallergosorbent, and 8.0% were prescribed maintenance oral corticosteroids. Asthma was not well controlled in 69.2% of patients. In the prior year, 27.1% experienced at least one severe exacerbation and 22.8% experienced at least one hospitalization (emergency visit or overnight stay) due to asthma. In Chinese patients with asthma on GINA Step 4/5 therapies, biomarker testing was underutilized, asthma was not well controlled, and severe exacerbations were not infrequent. These findings highlight the urgent need for optimized asthma management for patients on GINA Step 4/5 therapies in China.

Effect of abnormally oriented grains on the ferroelectric properties of Al0.65Sc0.35N thin films

The wide bandgap wurtzite Al1-xScxN ferroelectric material is compatible with semiconductor processes and offers advantages such as high remanent polarization (Pr) and high-temperature stability. To clear the relationship between the structure zone model (SZM), abnormally oriented grains (AOGs) and the ferroelectric properties, the Al0.65Sc0.35N films were prepared at various sputtering pressures (0.32–0.90 Pa) and substrate temperatures (200–500 ℃) on low resistance n+-(111) Si substrate by the radio frequency dual-source reactive magnetron sputtering method using Al and Sc targets under pure N2 gas. The introduction of AOGs facilitates compressive stress reduction and promotes ferroelectric switching. However, excessive AOGs will damage the (002) orientation, leading to loss of ferroelectricity. The Al0.65Sc0.35N films synthesized under a sputtering pressure of 0.52 Pa and a substrate temperature of 400 ℃ exhibited a lower leakage current at high electric field, with a Pr value of 154.3 μC/cm2 and a negative coercive field (Ec-) of 3.1 MV/cm at a testing frequency of 1 kHz. The outstanding comprehensive properties support the large potential of Al1-xScxN ferroelectric material for high-performance FeRAM devices.

Bending fatigue behavior of metastable and stable austenitic stainless steels with different surface morphologies

AbstractThe surface morphology has a significant influence on the fatigue behavior of components. For austenitic stainless steels (ASSs), this issue is even more pronounced due to their metastability. Based on the complex deformation mechanisms of metastable ASSs, which include dislocation slip, deformation twinning, and deformation‐induced martensitic phase transformation, the metastable stainless steel AISI 347 was investigated in this study together with the stable AISI 904L as a reference material. Four‐point bending fatigue tests with load ratio R = 0.1 and testing frequency f = 10 Hz at ambient temperature were carried out on specimens with five technically relevant surface morphologies: mechanical polished, milled, microshot peened, laser shock‐peened, and ultrasonic modified. Systematic material characterizations were carried out to elucidate the crucial role of surface roughness and deformation‐induced α′‐martensite in the fatigue behavior of both metastable and stable materials. While surface roughness is a well‐known key factor in conventional fatigue cases, deformation‐induced martensite layers implemented by various surface modification methods were proven to improve the fatigue life in metastable austenitic steels, opening new perspectives to extend the lifetime of ASS components.

Occurrence and predictors of laboratory abnormalities during outpatient parenteral antimicrobial therapy – A multicenter cohort study to inform laboratory test monitoring

ObjectivesEvidence on the optimal frequency of laboratory testing during outpatient parenteral antimicrobial therapy (OPAT) is lacking. Therefore, we investigated how often and when laboratory abnormalities occur during OPAT and which factors are associated with these abnormalities. MethodsWe performed a multicenter cohort study in four Dutch hospitals among adult patients receiving OPAT and collected routinely obtained laboratory test results. Incidence and incidence rates were calculated for various laboratory abnormalities. Survival analysis was performed to visualize the time to the first occurrence of laboratory abnormalities and Poisson regression analysis to compare the number of abnormalities in the first and second 30 OPAT days among patients receiving OPAT for ≥60 days. Predictors were identified using a multivariable Cox proportional hazard regression model. Results45.1% of 1152 included patients developed laboratory abnormalities, but only 2% led to OPAT discontinuation. Hepatotoxicity was most common (33.9 events/1000 OPAT days), with a time-dependent decrease in the occurrence of the first hepatotoxic event, while hypokalemia was rare (1.7 events/1000 OPAT days). In the subgroup of patients receiving ≥60 days of OPAT, nephrotoxicity was more common in days 31-60. We observed partly toxicity-specific associations between antibiotic type, concomitant medication, baseline laboratory values, patient characteristics, and the occurrence of laboratory abnormalities. ConclusionsWhile laboratory abnormalities are frequently observed during OPAT, they rarely lead to discontinuation of OPAT. Specific patient, treatment and laboratory characteristics were associated with the occurrence of laboratory abnormalities. Based on our results, we recommend a more personalized laboratory monitoring policy with less blood sampling.

Frequency and Determinants of Levothyroxine Therapy Initiation for Veterans with Subclinical Hypothyroidism.

Background/Objectives: There is evidence of overtreatment in patients with subclinical hypothyroidism (SCH). We aimed to identify the proportion of patients treated for SCH and the determinants of thyroid hormone therapy initiation. Methods: We included a random sample of adult Veterans diagnosed with SCH from 1 January 2016 to 31 December 2018 and conducted univariate and multivariable logistic regression to identify factors associated with levothyroxine initiation. Results: Out of 229 Veterans with SCH [90.0% male, 87.2% White, 99.1% non-Hispanic, median age (interquartile range; IQR) 68 (17) years], 27.5% were treated with levothyroxine. The treated group had a higher proportion of White patients (95.2% vs. 84.2%, p = 0.039), a higher thyrotropin level [median (IQR), 6.98 (2.06) mIU/L vs. 6.14 (1.10) mIU/L, p = 0.0002], a higher proportion of patients with thyrotropin level ≥ 10 mIU/L (11.1% vs. 3.0%, p = 0.021), a lower frequency of confirmatory thyroid testing before initiating levothyroxine (49.2% vs. 97.0%, p < 0.0001), and a similar frequency of thyroid autoimmunity testing (3.2% vs. 0.6%, p = 0.18) compared to the untreated group. In a multivariable logistic regression analysis, White race (OR = 4.50, 95% CI 1.19 to 17.08, p = 0.026) and index thyrotropin level [OR = 1.71, 95% CI 1.24 to 2.35, p = 0.001; for every SD increase (1.6 mIU/L)] were associated with higher odds of treatment. Conclusions: Three in 10 Veterans with SCH received levothyroxine, often based on a single abnormal thyroid test without autoimmunity assessment. White race and higher thyrotropin level were linked to increased odds of starting treatment, indicating potential disparities and the influence of SCH severity on decision-making.

Evaluation of wastewater surveillance results for SARS-CoV-2 at the national scale in the Slovak Republic

As the COVID-19 transits to endemicity, the frequency of clinical testing and its utility for determining lineage prevalence has declined. This situation is not unique to Slovakia but reflects a global trend, as attention shifts from COVID-19 to other post-pandemic issues and emerging global health challenges. Nevertheless, the pandemic itself has spurred advancements in monitoring the epidemiological situation. At the beginning of the pandemic, genomic surveillance was carried out through sequencing of individual COVID-19 cases. Subsequently, many countries implemented wastewater surveillance to monitor the prevalence of SARS-CoV-2 variants in the community. In the present study, we collected and analysed 1715 virus-positive samples from 64 wastewater treatment plants across Slovakia, serving 69 % of the population connected to the wastewater treatment pipelines. Here, we show that wastewater sequencing is effective in detecting the emergence of new virus lineages. Additionally, we can assume that wastewater surveillance provides results that are approximately consistent when compared with clinical testing at both national and city levels, concurrently providing information on variant lineages which have not been detected in clinical cases due to reduced clinical testing. Our study demonstrates and concludes the value of wastewater-based surveillance strategies in the Slovakia, establishing it as an important and supportive tool for monitoring public health and serving as an early warning system in times when clinical testing is either declining or unavailable.

Assessment of the Effective Sensitivity of SARS-CoV-2 Sample Pooling Based on a Large-Scale Screening Experience: Retrospective Analysis.

The development of new large-scale saliva pooling detection strategies can significantly enhance testing capacity and frequency for asymptomatic individuals, which is crucial for containing SARS-CoV-2. This study aims to implement and scale-up a SARS-CoV-2 screening method using pooled saliva samples to control the virus in critical areas and assess its effectiveness in detecting asymptomatic infections. Between August 2020 and February 2022, our laboratory received a total of 928,357 samples. Participants collected at least 1 mL of saliva using a self-sampling kit and registered their samples via a smartphone app. All samples were directly processed using AutoMate 2550 for preanalytical steps and then transferred to Microlab STAR, managed with the HAMILTON Pooling software for pooling. The standard pool preset size was 20 samples but was adjusted to 5 when the prevalence exceeded 2% in any group. Real-time polymerase chain reaction (RT-PCR) was conducted using the Allplex SARS-CoV-2 Assay until July 2021, followed by the Allplex SARS-CoV-2 FluA/FluB/RSV assay for the remainder of the study period. Of the 928,357 samples received, 887,926 (95.64%) were fully processed into 56,126 pools. Of these pools, 4863 tested positive, detecting 5720 asymptomatic infections. This allowed for a comprehensive analysis of pooling's impact on RT-PCR sensitivity and false-negative rate (FNR), including data on positive samples per pool (PPP). We defined Ctref as the minimum cycle threshold (Ct) of each data set from a sample or pool and compared these Ctref results from pooled samples with those of the individual tests (ΔCtP). We then examined their deviation from the expected offset due to dilution [ΔΔCtP = ΔCtP - log2]. In this work, the ΔCtP and ΔΔCtP were 2.23 versus 3.33 and -0.89 versus 0.23, respectively, comparing global results with results for pools with 1 positive sample per pool. Therefore, depending on the number of genes used in the test and the size of the pool, we can evaluate the FNR and effective sensitivity (1 - FNR) of the test configuration. In our scenario, with a maximum of 20 samples per pool and 3 target genes, statistical observations indicated an effective sensitivity exceeding 99%. From an economic perspective, the focus is on pooling efficiency, measured by the effective number of persons that can be tested with 1 test, referred to as persons per test (PPT). In this study, the global PPT was 8.66, reflecting savings of over 20 million euros (US $22 million) based on our reagent prices. Our results demonstrate that, as expected, pooling reduces the sensitivity of RT-PCR. However, with the appropriate pool size and the use of multiple target genes, effective sensitivity can remain above 99%. Saliva pooling may be a valuable tool for screening and surveillance in asymptomatic individuals and can aid in controlling SARS-CoV-2 transmission. Further studies are needed to assess the effectiveness of these strategies for SARS-CoV-2 and their application to other microorganisms or biomarkers detected by PCR.

Cobalt-doped graphitic carbon nitride: A multifunctional material for humidity sensing, electrochemical water splitting and environmental remediation applications

Graphitic carbon nitride (g-C3N4) has emerged as a promising eco-friendly material for catalysis and sensing applications due to their unique properties. However, limitations like low specific surface area, insufficient light absorption, and poor conductivity hinder their broader usability. Elemental doping has been established as an effective approach to modify the electronic structure and bandgap of g-C3N4 thus significantly expanding its light-responsive range for enhanced charge separation. This work reports on the fabrication of cost-effective and stable g-C3N4 and cobalt-doped g-C3N4 (Co@g-C3N4) via a simple one-step calcination process. The humidity sensing performance of both g-C3N4 and Co@g-C3N4 was evaluated across a broad humidity range (7 % - 94 % RH) at various testing frequencies. The results demonstrated good reversibility with Co@g-C3N4 exhibiting superior performance compared to pristine g-C3N4. Furthermore, the synthesized materials were assessed for their suitability as photoelectrochemical water splitting catalysts for hydrogen production, representing a step towards energy-efficient fuel cells. Notably, Co@g-C3N4 displayed enhanced performance with a lower onset potential (420 mV) and a lower Tafel slope (65.4 mV dec-1) for the hydrogen evolution reaction (HER) compared to undoped counterparts. Additionally, Co@g-C3N4 nanorods exhibited remarkable performance for the oxygen evolution reaction (OER), showcasing a lower onset potential (1.505 V) and a considerably low overpotential (270 mV), surpassing numerous reported electrocatalysts and even rivaling precious-metal-based ones. Finally, enhanced photocatalytic activities for organic dyes degradation were recorded for the mentioned materials. Therefore, g-C3N4 and related materials have great potential for their industrial electrochemcial applications.