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Objectives Patients and Methods Results Conclusion To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath‐assisted flexible cystoscopy (eFC). EndoSheaths are single‐use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time‐consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced.All adult patients undergoing eFC over a 26‐month period at a single institution were evaluated prospectively. Post‐eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2–4 = mild, 5–7 = moderate, 8–10 = severe). The diagnosis of UTI was broad and based on any one of patient self‐report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi‐squared testing (P < 0.05, two‐tailed).Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post‐eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis.This large, prospective, unselected, real‐world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe. [ABSTRACT FROM AUTHOR]

Current methods for therapeutic drug monitoring (TDM) have a long turnaround time as they involve collecting patients' blood samples followed by transferring the samples to medical laboratories where sample processing and analysis are performed. To enable real‐time and minimally invasive TDM, a microneedle (MN) biosensor to monitor the levels of two important antibiotics, vancomycin (VAN) and gentamicin (GEN) is developed. The MN biosensor is composed of a hydrogel MN (HMN), and an aptamer‐functionalized flexible (Flex) electrode, named HMN‐Flex. The HMN extracts dermal interstitial fluid (ISF) and transfers it to the Flex electrode where sensing of the target antibiotics happens. The HMN‐Flex performance is validated ex vivo using skin models as well as in vivo in live rat animal models. Data is leveraged from the HMN‐Flex system to construct pharmacokinetic profiles for VAN and GEN and compare these profiles with conventional blood‐based measurements. Additionally, to track pH and monitor patient's response during antibiotic treatment, an HMN is developed that employs a colorimetric method to detect changes in the pH, named HMN‐pH assay, whose performance has been validated both in vitro and in vivo. Further, multiplexed antibiotic and pH detection is achieved by simultaneously employing the HMN‐pH and HMN‐Flex on live animals. [ABSTRACT FROM AUTHOR]

Background and Objectives: To develop key performance indicators (KPI) for use in quality assessment of our institutional goal‐directed massive transfusion (GDMT). Materials and Methods: A team comprising our transfusion and emergency medicine departments carried out a cross‐sectional data analysis of GDMT in adult patients from January 2021 to December 2022. The study was rooted in the Define, Measure, Analyse, Improve, Control (DMAIC) approach. Features of KPIs were (a) importance, (b) scientific soundness and (c) feasibility. Study parameters were defined and analysed using measures of central tendencies and benchmark comparison. Results: Ninety‐two massive transfusion events occurred and 1405 blood components were used. Trauma was the leading cause, followed by postpartum haemorrhage and upper gastrointestinal bleeding. Appropriate GDMT activation was observed only in 43.47% of events. The turnaround time (TAT) was within the benchmark in 85.8% of events with an average of 16 ± 10 min. The average utilization of blood components was 20.5 (interquartile range [IQR] = 11.3) in the appropriate group and 5.5 (IQR = 4.25) in the inappropriate group with a wastage rate of 3.5%. Duration of activation was 6.19 ± 4.59 h, and the adherence to thromboelastography was 66.3%. Overall mortality was 45.65%, and the average duration of hospital stay was 6.1 ± 5.9 days. Conclusion: The KPIs developed were easy to capture, and the analysis provided a comprehensive approach to the quality improvement of the GDMT protocol. [ABSTRACT FROM AUTHOR]

Patients discharged from Australian hospitals require a list of current medications at the point of discharge, which is commonly in the form of a Patient Friendly Medication List (PFML). Furthermore, the provision of an Interim Medication Administration Chart (IMAC) reduces the number of medication administration delays and omissions for patients discharged to residential aged‐care facilities. To increase the adoption of PFMLs and IMACs, a new process was developed for creating PFMLs and IMACs directly from the discharge prescription in the Electronic Medical Record (EMR). This retrospective pre‐ and post‐intervention audit aimed to evaluate 1 year of PFML and IMAC generation from three acute metropolitan hospitals, prior to and after transitioning from pharmacy dispensing software to EMR‐generated documents. Despite similar hospital activity, the transition to EMR‐generated PFMLs and IMACs was associated with a 157% increase in PFML provision (7930 vs 20 373), a 220% increase in IMAC provision (1569 vs 5022) and a 99% reduction in the number of items typed into the pharmacy dispensing software that did not require supply (−59 171/year). Discharge dispensary turnaround times were lower in the post‐intervention period (36 min vs 30 min, p < 0.01). In conclusion, the transition to EMR‐generated PFMLs and IMACs was associated with increased provision of these documents, reduced data entry for items not required to be supplied, decreased risk of transcription errors and shortened time taken for the hospital pharmacy to process discharge items. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA21‐094). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities and met local requirements for an audit or quality assurance activity. [ABSTRACT FROM AUTHOR]

Volume 41 of the journal Contemporary Economic Policy, published in 2023, contained 37 articles on various topics in economics. The journal received 196 manuscripts for review, with an acceptance rate of 13%. The refereeing process helped improve the quality of accepted manuscripts, but finding willing referees was a challenge. The journal had a low response rate from referees, impacting turnaround time. The average time to first decision was 69 days. The journal's impact factor increased to 1.7, and an Outstanding Review Service Award was introduced to recognize exceptional referees. Starting with Volume 42, the journal will be published online-only to reduce environmental impact, and its social media presence has been expanded. [Extracted from the article]

Comprehensive biomarker testing for patients with non–small cell lung cancer is critical for selecting appropriate targeted therapy or immunotherapy. Ensuring timely ordering, processing, and reporting is key to optimizing patient outcomes. However, various factors can prevent or delay patients from being offered the option of treatment selection based on comprehensive biomarker testing. These factors include problems with access to testing, tissue adequacy, turnaround time, and health insurance coverage and billing practices. Turnaround time depends on several logistical and tissue handling factors, which involve institutional policies, processes, resources, testing methodology, and testing algorithms that vary across different practices. In this article, the authors identify key factors that prolong biomarker testing turnaround time, propose strategies to reduce it, and present a process map to aid physicians and key organizational stakeholders in improving testing efficiency. [ABSTRACT FROM AUTHOR]

Background Hypothesis/Objectives Animals Materials and Methods Results Conclusions and Clinical Relevance Bacterial identification and antimicrobial susceptibility testing is an important step in timely therapeutic decisions for canine superficial bacterial folliculitis (SBF), commonly caused by Staphylococcus pseudintermedius. Next‐generation sequencing (NGS) offers the appeal of potentially expedited results with complete detection of bacterial organisms and associated resistance genes compared to culture. Limited studies exist comparing the two methodologies for clinical samples.To compare and contrast genotypic and phenotypic methods for bacterial identification and antimicrobial susceptibility from cases of canine SBF.Twenty‐four client‐owned dogs with lesions consistent with SBF were enrolled.A sterile culturette swab was used to sample dogs with SBF lesions. The swab was rinsed in 0.9 mL of sterile phosphate‐buffered saline and vortexed to create a homogenous solution. Two swabs for NGS laboratories (Labs) and one swab for culture (Culture Lab) were randomly sampled from this solution and submitted for bacterial identification and antimicrobial susceptibility.No statistical difference regarding turnaround time for NGS Labs compared to Culture Lab was found. NGS Lab 1 identified more organisms than NGS Lab 2 and Culture Lab, which were both statistically significant. There was no statistical difference in detection frequency for Staphylococcus spp. among all laboratories. There was poor agreement for the presence of meticillin resistance and most antimicrobials among all laboratories.Utilisation of NGS as a replacement for traditional culture when sampling canine SBF lesions is not supported at this time. [ABSTRACT FROM AUTHOR]

Introduction: Comprehensive genome profiling (CGP) has revolutionized healthcare by offering personalized medicine opportunities. However, its real‐world utility and impact remain incompletely understood. This study examined the extent to which CGP leads to genomically matched therapy and its effectiveness. Methods: We analyzed data from advanced solid tumor patients who underwent CGP panel between December 2019 and May 2023 at the Osaka International Cancer Institute. Patient demographics, specimen details, and expert panel assessments were collected. Turnaround time (TAT) and genomically matched therapy outcomes were analyzed. Gene alterations and their co‐occurrence patterns were also assessed. Results: Among 1437 patients, 1096 results were available for analysis. The median TAT was 63 [28–182] days. There were 667 (60.9%) cases wherein recommended clinical trials were presented and there were 12 (1.1%) cases that could be enrolled in the trial and 25 (2.3%) cases that could lead to therapies under insurance reimbursement. The median progression free survival of the trial treatment was 1.58 months (95% CI: 0.66–4.37) in clinical trials and 3.66 months (95% CI: 2.14–7.13) in treatment under insurance. Pathologic germline variants were confirmed in 15 patients (1.3%). Co‐alteration of CDKN2A, CDKN2B, and MTAP was significantly observed in overall population. Conclusion: The effectiveness of the genomically matched therapy based on the CGP panel was unsatisfactory. Expansion of clinical trials and utilization of remote clinical trials are required to ensure that the results of the CGP panel can be fully returned to patients. [ABSTRACT FROM AUTHOR]

'Ramping' is a commonly used term in contemporary Australian healthcare. It is also a part of the public and political zeitgeist. However, its precise definition varies among sources. In the published literature, there are distinctions between related terms, such as 'entry overload' and 'Patient Off Stretcher Time Delay'. How ramping is defined and how it came to be defined have significance for policies and procedures relating to the described phenomenon. Through examination of the history of the term, insights are obtained into the underlying issues contributing to ramping and, accordingly, associated possible solutions. [ABSTRACT FROM AUTHOR]

Chinese hamster ovary (CHO) cells are the preferred system for expression of therapeutic proteins and the majority of all biotherapeutics are being expressed by these cell lines. CHO expression systems are readily scalable, resistant to human adventitious agents, and have desirable post‐translational modifications, such as glycosylation. Regardless, drug development as a whole is a very costly, complicated, and time‐consuming process. Therefore, any improvements that result in reducing timelines are valuable and can provide patients with life‐saving drugs earlier. Here we report an effective method (termed SPEED‐MODE, herein) to speed up the Cell line Development (CLD) process in a targeted integration (TI) CHO CLD system. Our findings show that (1) earlier single cell cloning (SCC) of transfection pools, (2) speeding up initial titer screening turnaround time, (3) starting suspension adaptation of cultures sooner, and (4) maximizing the time CHO cultures spend in the exponential growth phase can reduce CLD timelines from ~4 to ~3 months. Interestingly, SPEED‐MODE timelines closely match the theoretical minimum timeline for CHO CLD assuming that CHO cell division is the rate limiting factor. Clones obtained from SPEED‐MODE CLD yielded comparable titer and product quality to those obtained via a standard CLD process. Hence, SPEED‐MODE CLD is advantageous for manufacturing biotherapeutics in an industrial setting as it can significantly reduce CLD timelines without compromising titer or product quality. [ABSTRACT FROM AUTHOR]

Pharmacogenomics (PGx), examining the effect of genetic variation on interpatient variation in drug disposition and response, has been widely studied for several decades. However, as cost, as well as turnaround time associated with PGx testing, has significantly improved, the use of PGx in the clinical setting has been gaining momentum. Nevertheless, challenges have emerged in the broader clinical implementation of PGx. In this review, we will outline current models of PGx delivery and methodologies of evaluation, and discuss clinically relevant PGx tests and associated medications. Additionally, we will describe our approach for the broad implementation of pre‐emptive DPYD genotyping in patients taking fluoropyrimidines in Ontario, Canada, as an example of clinically actionable PGx testing with sufficient clinical evidence of patient benefit that can become a new standard of patient care. We will highlight challenges associated with PGx testing, including a lack of diversity in PGx studies as well as general limitations that impact the broad adoption of PGx testing. Lastly, we examine the future of PGx, discussing new clinical targets, methodologies and analysis approaches. [ABSTRACT FROM AUTHOR]

Background: Kaiser‐Permanente Los Angeles Medical Center (LAMC) is a 560 licensed bed facility that provides regional cardiovascular services, including 1200 open heart surgeries annually. In 2021, LAMC explored alternative therapies to offset the impact of pandemic‐driven cryo AHF shortages, and implemented Pathogen Reduced Cryoprecipitated Fibrinogen Complex (also known as INTERCEPT Fibrinogen Complex or IFC). IFC is approved to treat and control bleeding associated with fibrinogen deficiency. Unlike cryo AHF, IFC has 5‐day post‐thaw shelf life with potential operational and clinical benefits. The implementation steps and the operational advantages to the LAMC Blood Bank are described. Study Design and Methods: Eighteen months post‐implementation, the institution reviewed their product implementation experience and compared IFC with cryo AHF with a retrospective review of transfusion service and cardiac post‐op data. Results: IFC significantly decreased product wastage rates and order‐to‐issue time. It did not significantly impact post‐op product utilization or hospital length of stay (LOS) in cardiac surgery patients when compared with cryo AHF. Discussion: Implementation of IFC provides improved product supply stability, shorter turnaround times, and reduced wastage. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Routine clinical biochemistry tests are crucial for clinical diagnostics and play a key role in enhancing outpatient turnover efficiency and patient satisfaction. This study aimed to implement Lean Six Sigma in the biochemistry laboratory of a hospital in China to improve efficiency and quality by reducing turnaround time.The study was conducted from January to December 2023, using the DMAIC (Define, Measure, Analyze, Improve, Control) framework, and employed tools such as the voice of the customer, Value Stream Mapping, ‘5 whys’ technique, Nominal Group Technique, and Pareto chart.The turnaround time for outpatient routine clinical biochemistry tests was reduced from 139 min to 58 min (p < 0.05), effectively increasing both patient and physician satisfaction.Lean Six Sigma aimed to reduce the turnaround time for biochemical tests have significant advantages. This study confirms the effectiveness of Lean Six Sigma in a Chinese clinical laboratory setting and provides guidance for optimizing efficiency in global clinical laboratories with limited implementation experience, constrained technical and equipment resources, and high demand for medical diagnostics. [ABSTRACT FROM AUTHOR]

One of the most important public health concerns is the increase in antibiotic‐resistant pathogens and corresponding treatment of associated infections. Addressing this challenge requires more efficient use of antibiotics, achievable by the use of evidence‐based, effective antibiotics identified by antibiotic susceptibility testing (AST). However, the current standard method of phenotypic AST used for this purpose requires 48 h or more from sample collection to result. Until results are available, broad‐spectrum antibiotics are used to avoid delaying treatment. The turnaround time must therefore be shortened in order for the results to be available before the second administration of antibiotics. The phenotypic electrochemical AST method presented here identifies effective antibiotics within 5–10 h after sampling. Spiked serum samples, including polymicrobial samples, with clinically relevant pathogens and respective concentrations commonly found in bloodstream infections (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa) are used. Direct loading of the test with diluted serum eliminates the need for a pre‐culture, as required by existing methods. Furthermore, by combining several electrochemical measurement procedures with computational analysis, allowing the method to be used both online and offline, the AST achieves a sensitivity of 94.44% and a specificity of 95.83% considering each replicate individually. [ABSTRACT FROM AUTHOR]

Xylella fastidiosa is a plant‐pathogenic bacterium that poses a serious threat to the production of economically important plant species including grapes, almonds, olives and a broad range of amenity plants, causing significant economic losses worldwide. While multiple molecular detection assays have been developed for X. fastidiosa, there is a lack of molecular tools available for detection and differentiation of the closely related pear pathogen, Xylella taiwanensis. In this study, we present a novel conventional PCR assay with primers that can amplify both Xylella species. The amplified product could be sequenced and used for discrimination between the two species and the subspecies within the fastidiosa species. This PCR assay was designed using a genome‐informed approach to target the ComEC/Rec2 gene of both Xylella species, ensuring a higher specificity than other previously developed PCR assays. A test performance study across five national plant diagnostic laboratories in Australia and New Zealand demonstrated this assay's high sensitivity and specificity to all known species and subspecies within the Xylella genus. This PCR assay can be used for Xylella identification at the species and subspecies level and is compatible with Sanger sequencing and nanopore sequencing for rapid turnaround time. The newly developed conventional PCR assay presented here offers rapid detection and accurate identification of both Xylella species from plant, insect vector or bacterial samples, enabling timely implementation of biosecurity measures or disease management responses. [ABSTRACT FROM AUTHOR]

The display module process is characterized by having to deal with a wide range of customers and product groups with a short turnaround time (TAT). In this study, a new concept of simulation tool reflecting the characteristic of the module process was developed. This tool reflects the TAT of the equipment using the cumulative distribution function of the process time, and the frequency and time of down of the equipment are modeled using statistical techniques. This tool has confirmed a high accuracy of 92% in comparison with actual production. The tool provides rule‐based operation guidance to manufacturing engineers. However, rule‐based operation is not easy to adequately respond to all manufacturing situations in the actual field. Thus, reinforcement learning (RL) was applied to the module scheduler system for optimal operation. We applied RL algorithm such as deep Q‐Networks (DQN), double DQN, dueling network. Through a test comparing reinforcement learning‐based operations and rule‐based operations under the same conditions, it was found that reinforcement learning‐based operations are better in terms of productivity and efficiency than rule‐based operations. This result shows that the paradigm of module scheduling has shifted from traditional rule‐based operations to reinforcement learning‐based AI operations. [ABSTRACT FROM AUTHOR]

Summary: X‐ray scattering experiments using free electron lasers (XFELs) are a powerful tool to determine the molecular structure and function of unknown samples (such as COVID‐19 viral proteins). XFEL experiments are a challenge to computing in two ways: (i) due to the high cost of running XFELs, a fast turnaround time from data acquisition to data analysis is essential to make informed decisions on experimental protocols; (ii) data‐collection rates are growing exponentially, requiring new scalable algorithms. Here we report our experiences analyzing data from two experiments at the Linac Coherent Light Source (LCLS) during September 2020. Raw data were analyzed on NERSC's Cori XC40 system, using the Superfacility paradigm: our workflow automatically moves raw data between LCLS and NERSC, where it is analyzed using the software package CCTBX. We achieved real time data analysis with a turnaround time from data acquisition to full molecular reconstruction in as little as 10 min—sufficient time for the experiment's operators to make informed decisions. By hosting the data analysis on Cori, and by automating LCLS‐NERSC interoperability, we achieved a data analysis rate which matches the data acquisition rate. Completing data analysis within 10 min is a first for XFEL experiments and an important milestone if we are to keep up with data‐collection trends. [ABSTRACT FROM AUTHOR]

Airport access mode disruptions, such as a subway shutdown, threaten the whole passenger door‐to‐door journey. When such a disruptive event occurs, knowledge of passengers' delays would help the airport operation centre to decide if a departure flight should be delayed. This paper proposes a tactical flight rescheduling at an airport to minimise the number of stranded passengers while considering operational constraints. An integer linear programming formulation of the problem is presented. Constraints such as terminal capacities, maximal runway throughput, minimum turnaround time or minimum transfer time for connecting passengers are considered. An exact and heuristic resolution is proposed and compared to a study case around Paris‐Charles de Gaulle airport. The new schedule satisfies the operational constraints and reduces up to 60% of the number of stranded passengers with moderate deviation from the initial planning. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate the diagnostic value of rapid on‐site evaluation (ROSE) combined with computed tomography‐guided percutaneous needle biopsy (CT‐PNB) or radial endobronchial ultrasound‐guided transbronchial lung biopsy (EBUS‐TBLB) for pulmonary cryptococcosis (PC). Methods: Clinical data of 33 patients diagnosed with PC at the Third Affiliated Hospital of Soochow University between February 2018 and June 2023 were retrospectively analysed. Patients were divided into the CT‐PNB and EBUS‐TBLB groups based on the intervention method, and the diagnostic positivity rate and incidence of complications were compared between the two groups. Results: Compared with the final diagnosis, the positive diagnostic rates of ROSE, histopathology and serum CrAg of all patients were 81.8% (27/33), 72.7% (24/33) and 63.6% (21/33), respectively. The average turnaround times of the three methods were 0.1 (0.1–0.2) h, 96.0 (48.0–120.0) h and 7.8 (4.5–13.6) h, respectively (P < 0.001). The coincidence rate between histopathology and ROSE was 84.8% with a kappa value of 0.574. The positive diagnostic rate for PC was significantly higher in the CT‐PNB group than in the EBUS‐TBLB group (92.9% vs. 57.9%), and the difference was statistically significant (P < 0.05). Combined with the ROSE results, the positive diagnostic rate in the EBUS‐TBLB group increased to 84.2% (16/19). Conclusion: ROSE has commendable accuracy and timeliness, and CT‐PNB offers further advantages in this regard. ROSE enhances the diagnostic efficiency of EBUS‐TBLB for PC and is safe and effective. [ABSTRACT FROM AUTHOR]

Background: We have examined the number and types of stipulations received following the submission of surgical study protocols to the Institutional Review Boards (IRBs) for review, and their effect on turnaround time for approval. This analysis will enable our organization to improve the quality of applications and design of study protocols, which can streamline the approval process and increase efficiency of the startup phase for clinical research. Methods: IRB stipulations for 48 surgical studies were analyzed. Various factors were assessed: surgical specialty, type of study by design, clinical trial phase, type of investigational product, type of IRB utilized (local or centralized), study complexity score, type of review (e.g., exempt, expedited, or full board), turnaround time, and number of stipulations received. Statistical analyses were performed to examine associations between the number/type of stipulations received during the IRB review process and any of the aforementioned study‐related factors. Results: For analyzed surgical studies, the number of stipulations allotted to a study and time taken for approval had moderate association with the complexity of the study. The turnaround time for approval was the highest for randomized, controlled trials and studies undergoing full board review. Conclusion: This study elucidates characteristics that are associated with increased time for IRB approval. Analysis of IRB stipulations can help improve the turnaround time for the approval process, increase efficiency of startup phase, and transition to execution phase faster, which will allow more time for enrollment of research subjects, and increase return on investment made into research and development programs. [ABSTRACT FROM AUTHOR]

Over the past century, human activities have contributed to the release of 226Ra (t½ = 1,600 y) in the environment, increasing the potential risks for human exposure and thus prompting scientists to monitor it. Inductively coupled plasma mass spectrometry (ICP‐MS) is an alternative to alpha‐spectrometry for the quantification of 226Ra. However, the performances of radioanalytical procedures are rarely compared in a rigorous framework, which means that researchers may choose one on subjective factors or guesses. This article compares five published methods for the separation and preconcentration of 226Ra in drinking waters based on chromatographic and extraction resins prior to its analysis by ICP‐MS. We evaluated the turnaround time, generated wastes, and final cost of each protocol as the economic aspect can be an important criterion when selecting a method, particularly for sustainable environmental monitoring. Our results showed that 226Ra was successfully separated and preconcentrated, yielding recoveries ranging between 84% and 105%. Method detection and quantification limits of respectively 2–7 fg L−1 (0.1–0.3 mBq L−1) and 6–24 fg L−1 (0.2–0.9 mBq L−1) were achieved when the separation method was coupled with ICP‐MS. The turnaround times ranged between 6 and 21 hours, whereas the cost of the methods varied between 40 and 132 USD. This study highlights for the first time that methodologies recently published on the evaluation of 226Ra levels in drinking water by ICP‐MS have comparable figures of merit. Our results offer essential insights into the selection of the most suitable separation method. [ABSTRACT FROM AUTHOR]

Background: Molecular testing is critical to guiding treatment approaches in patients with metastatic non‐small cell lung cancer (mNSCLC), with testing delays adversely impacting the timeliness of treatment decisions. Here, we aimed to evaluate the time from initial mNSCLC diagnosis to treatment decision (TTD) following implementation of in‐house EGFR, ALK, and PD‐L1 testing at our institution. Methods: We conducted a retrospective chart review of 165 patients (send‐out testing, n = 92; in‐house testing, n = 73) with newly diagnosed mNSCLC treated at our institution. Data were compared during the send‐out (March 2017–May 2019) and in‐house (July 2019–March 2021) testing periods. We performed a detailed workflow analysis to provide insight on the pre‐analytic, analytic, and post‐analytic intervals that constituted the total TTD. Results: TTD was significantly shorter with in‐house testing (10 days vs. 18 days, p < 0.0001), driven largely by decreased internal handling and specimen transit times (2 days vs. 3 days, p < 0.0001) and laboratory turnaround times (TAT, 3 days vs. 8 days, p < 0.0001), with 96% of in‐house cases meeting the international guideline of a ≤ 10‐day intra‐laboratory TAT (vs. 74% send‐out, p < 0.001). Eighty‐eight percent of patients with in‐house testing had results available at their first oncology consultation (vs. 52% send‐out, p < 0.0001), and all patients with in‐house testing had results available at the time of treatment decision (vs. 86% send‐out, p = 0.57). Conclusion: Our results demonstrate the advantages of in‐house biomarker testing for mNSCLC at a tertiary oncology center. Incorporation of in‐house testing may reduce barriers to offering personalized medicine by improving the time to optimal systemic therapy decision. [ABSTRACT FROM AUTHOR]

Objectives: Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower‐cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value‐based, guideline‐concordant ordering practices in primary care (PC) and cardiology clinics. Methods: Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019–February 2020); Period 1 with reduced stress ECG report turnaround time + PC‐targeted education (began June 2020); and Period 2 with the addition of electronic health record‐based alternative alert (AA) providing point‐of‐care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2. Results: Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value‐based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001). Conclusions: This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change. [ABSTRACT FROM AUTHOR]

We set out to demonstrate the feasibility of pharmacogenetic testing of DPYD and UGT1A1 and explore the clinical benefits in a community‐based cancer center. We conducted a retrospective review of 280 patients who underwent pharmacogenetic testing between November 2020 and May 2023. The primary end points included the percentage of patients with results prior to chemotherapy initiation, percentage of DPYD‐ and UGT1A1‐guided interventions implemented before chemotherapy initiation, and the turnaround time (TAT) for the pharmacogenetics results. Exploratory end points included a comparison of unplanned hospitalizations and treatment interruptions among (1) DPD phenotypes in patients who received fluoropyrimidines and (2) UGT1A1 phenotypes in patients who received irinotecan ± fluoropyrimidines. We evaluated cancer progression among patients who received DPYD‐guided dose reductions in the curative setting. More than 75% of patients had results prior to initiation of chemotherapy and 61.5% of the actionable interventions were implemented before chemotherapy, with a median TAT of 7 calendar days (IQR 5–8 calendar days). A non‐significant higher percentage of unplanned hospitalizations and treatment interruptions occurred among patients with normal DPYD compared with patients with DPYD‐guided dose reductions. A non‐significant higher frequency of treatment interruptions and dose reductions were observed in UGT1A1 intermediate metabolizer (IM) compared with UGT1A1 normal metabolizer (NM). None of the patients who received DPYD‐guided dose reductions in the curative setting experienced progression after a median follow‐up of 342 days. The real‐world evidence generated from this study demonstrates the feasibility of pre‐chemotherapy pharmacogenetic testing of DPYD and UGT1A1 in a community‐based cancer center. [ABSTRACT FROM AUTHOR]

Rapid identification of pathogens is critical for early and appropriate treatment of bloodstream infections. The various culture‐independent assays that have been developed often have long turnaround times, low sensitivity and narrow pathogen coverage. Here, we propose a new multiplex PCR assay, MeltArray, which uses intact microbial cells as the source of genomic DNA (gDNA). The successive steps of the MeltArray assay, including selective lysis of human cells, microbial cell sedimentation, microbial cellular DNA extraction, target‐specific pre‐amplification and multiplex PCR detection, allowed the detection of 35 major bloodstream infectious pathogens in whole blood within 5.5 h. The limits of detection varied depending on the pathogen and ranged from 1 to 5 CFU/mL. Of 443 blood culture samples, including 373 positive blood culture samples and 70 negative blood culture samples, the MeltArray assay showed a sensitivity of 93.8% (350/373, 95% confidence interval [CI] = 90.7%–96.0%), specificity of 98.6% (69/70, 95% CI = 91.2%–99.9%), positive predictive value of 99.7% (95% CI = 98.1%–99.9%), and negative predictive value of 75.0% (95% CI = 64.7%–83.2%). The MeltArray detection results of 16 samples differed from MALDI–TOF and were confirmed by Sanger sequencing. Further testing of 110 whole blood samples from patients with suspected bloodstream infections using blood culture results revealed that the MeltArray assay had a clinical sensitivity of 100% (9/9, 95% CI = 62.8%–100.0%), clinical specificity of 74.5% (70/94, 95% CI = 64.2%–82.7%), positive predictive value of 27.3% (95% CI = 13.9%–45.8%), and negative predictive value of 100.0% (95% CI = 93.5%–100.0%). Compared with metagenomic next‐generation sequencing, the MeltArray assay displayed a positive agreement of 85.7% (6/7, 95% CI = 42.0%–99.2%) and negative agreement of 100.0% (4/4, 95% CI = 39.6%–100.0%). We conclude that the MeltArray assay can be used as a rapid and reliable tool for direct identification of pathogens in bloodstream infections. [ABSTRACT FROM AUTHOR]

Background: In superficial fungal infections, prompt diagnosis and treatment are essential to prevent the spread of infection and minimise the impact on patients' quality of life. Traditional diagnostic methods, such as KOH smear and fungal culture, have limitations in terms of sensitivity and turnaround time. Recently, the PCR-reverse blot hybridization assay (PCR-REBA) has been developed for the direct detection of dermatophyte DNA. However, there is a lack of information assessing the diagnostic accuracy of PCR-REBA. Objectives: This systematic review aimed to evaluate the diagnostic accuracy of PCR-REBA in superficial fungal infections compared to conventional and molecular methods. Methods: The comprehensive search containing Ovid MEDLINE and Embase databases was conducted on 7 August 2022. Two reviewers independently reviewed the included articles. Quality assessment was performed using the Newcastle-Ottawa Scale tool. Results: The included studies were conducted in Korea (five studies) and the Netherlands (two studies), all of which were conducted in a single institution. The quality assessment of these studies indicated low risk of bias. When compared to the potassium hydroxide (KOH) smear and fungus culture, the sensitivity of PCR-REBA ranged from 85% to 100%, and the positive predictive values ranged from 58.9% to 100%. When compared to the RT-PCR, the sensitivity of PCR-REBA ranged from 93.3% to 100%, and the positive and negative predictive values were 91.6%-99.6% and 81.0%-89.1%, respectively. Conclusions: The PCR-REBA shows promise as a valuable diagnostic tool for dermatophytosis, offering practical and cost-effective benefits. [ABSTRACT FROM AUTHOR]

Background and Aims: Assuring laboratory quality by minimizing the magnitude of errors is essential. Therefore, this study aimed to assess hematology laboratory performance in the total testing process using quality indicators and sigma metrics. Methods: A cross‐sectional study was conducted from April to June 2022. The study included a total of 13,546 samples. Data on included variables were collected using a checklist. Descriptive statistics were used to present the overall distribution of errors. Binary logistic regression models were applied. Furthermore, using a Sigma scale, the percentage of errors was converted to defects per million opportunities to assess laboratory performance. Finally, the defect per million opportunities was converted to a sigma value using a sigma calculator. Results: Of the 13,546 samples and corresponding requests, the overall error rate was 123,296/474,234 (26%): 93,412/47,234 (19.7%) pre‐analytical, 2364/474,234 (0.5%) analytical, and 27,520/474,234 (5.8%) post‐analytical. Of the overall errors, 93,412/123,296 (75.8%), 2364/123,296 (1.9%), and 27,520/123,296 (22.3%) were pre‐analytical, analytical, and post‐analytical errors, respectively. The overall sigma value of the laboratory was 2.2. The sigma values of the pre‐analytical, analytical, and post‐analytical phases were 2.4, 4.1, and 3.1, respectively. The sample from the inpatient department and collected without adherence to the standard operating procedures (SOPs) had a significantly higher (p < 0.05) rejection rate as compared to the outpatient department and collected with adherence to SOPs, respectively. In addition, an association between prolonged turnaround times and manual recording, inpatient departments, and morning work shifts was observed. Conclusion: The current study found that the overall performance of the laboratory was very poor (less than three sigma). Therefore, the hospital leadership should change the manual system of ordering tests and release of results to a computerized system and give need‐based training for all professionals involved in hematology laboratory sample collection and processing. [ABSTRACT FROM AUTHOR]

The recent development of LA‐ICP‐MS/MS techniques enables in situ Rb‐Sr dating of micas, but there is not yet a matrix‐matched reference material (RM). In this contribution we optimised laser conditions and developed a new data reduction approach for Rb‐Sr dating of micas with non‐matrix‐matched RMs Mica‐Mg‐NP and NIST SRM 612. This was achieved by systematically investigating the effects of laser ablation settings, data reduction methods and the selection of the RMs on the Rb‐Sr dating quality of a 306 ± 1 Ma hydrothermal muscovite. We then tested this approach using twelve mica samples with known ages from 306 to 1.4 Ma. The results show that this technique can achieve accuracy of 2.5% or better, and precision of ~1–3% for micas > 15 Ma. The dating accuracy (> 9%) and precision (> 21%) decrease for micas younger than 5 Ma due to the short radiogenic accumulation time. This technique provides a way to date many types of mineral deposits and rocks, with a relatively high spatial resolution (down to 38 μm), a fast turnaround time and a higher closure temperature for muscovite than the Ar‐Ar system, which makes it a powerful tool in geochronological studies. [ABSTRACT FROM AUTHOR]

This article discusses the benefits of submitting scientific articles to journals published by scientific societies, specifically focusing on the partnership between the Association for the Sciences of Limnology and Oceanography (ASLO) and Wiley. The author highlights three main benefits of the society-publisher model: the expansion of society capacities to serve authors and members, the financial support provided by publication fees for various programs and initiatives, and the stature and recognition of scientific-society journals. The article also provides examples of transformative science published in ASLO's journal, Limnology and Oceanography, over the past decades. The article discusses the importance of the ASLO brand in the field of aquatic sciences and highlights the rigorous and constructive peer review process employed by ASLO's journals. The article emphasizes the value of citations as an indicator of scientific impact and mentions that ASLO's research journals, L&O and L&O Letters, have ranked highly in their respective fields. The article also provides data on the median turnaround times for editorial decisions and includes testimonials from authors who have submitted manuscripts to ASLO's journals. Overall, the article aims to assure authors that their articles will be read, cited, and impactful if published in ASLO's journals. [Extracted from the article]

This study explored the acceptability of a novel pharmacist‐led pharmacogenetics (PGx) screening program among patients with cancer and healthcare professionals (HCPs) taking part in a multicenter clinical trial of PGx testing (PACIFIC‐PGx ANZCTR:12621000251820). Medical oncologists, oncology pharmacists, and patients with cancer from across four sites (metropolitan/regional), took part in an observational, cross‐sectional survey. Participants were recruited from the multicenter trial. Two study‐specific surveys were developed to inform implementation strategies for scaled and sustainable translation into routine clinical care: one consisting of 21 questions targeting HCPs and one consisting of 17 questions targeting patients. Responses were collected from 24 HCPs and 288 patients. The 5‐to‐7‐day PGx results turnaround time was acceptable to HCP (100%) and patients (69%). Most HCPs (92%) indicated that it was appropriate for the PGx clinical pharmacist to provide results to patients. Patients reported equal preference for receiving PGx results from a doctor/pharmacist. Patients and HCPs highly rated the pharmacist‐led PGx service. HCPs were overall accepting of the program, with the majority (96%) willing to offer PGx testing to their patients beyond the trial. HCPs identified that lack of financial reimbursements (62%) and lack of infrastructure (38%) were the main reasons likely to prevent/slow the implementation of PGx screening program into routine clinical care. Survey data have shown overall acceptability from patients and HCPs participating in the PGx Program. Barriers to implementation of PGx testing in routine care have been identified, providing opportunity to develop targeted implementation strategies for scaled translation into routine practice. [ABSTRACT FROM AUTHOR]

We study the potential negative impact of imbalanced compensation schemes on firm performance. We analyze data from a radiology workflow platform that connects off‐site radiologists with hospitals. These radiologists select tasks from a common pool, while service level is defined by priority‐specific turnaround time targets. However, imbalances between pay and workload of different tasks could result in higher priority tasks with low pay‐to‐workload ratio receiving poorer service. We investigate this hypothesis, showing turnaround time is decreasing in pay‐to‐workload for lower priority tasks, whereas it is increasing in workload for high‐priority tasks. Crucially, we find evidence of an externality effect: Having many economically attractive tasks with low priority can lead to longer turnaround times for higher priority tasks, increasing their likelihood of delay, thus partially defeating the purpose of the priority classes. Highlights: It has been studied that salaried hospital radiologists working on emergency images tend to sequence images to minimize their work queue. However, the advent of new radiology workflow platforms that aggregate images from multiple hospitals, where independent radiologists choose which emergency and nonemergency images to read, creates novel operational challenges that are becoming pervasive in the sharing economy.We find that independent radiologists behave as previously established when reading emergency images. However, for nonemergency images, they prefer to process images that provide a higher bang‐for‐the‐buck, meaning they lead to a higher monetary payout for the time spent on processing.Crucially, we also find that this preference exerts a negative externality on nonemergency images with high‐operational priority (for example, that can generate bed‐blocking), resulting in longer turnaround times and a higher frequency of delay.The delayed processing exerts a bed‐blocking and patient dissatisfaction cost on client hospitals. We suggest radiology workflow platforms use their information systems capabilities to hide nonemergency, high bang‐for‐the‐buck images from radiologists until the higher priority studies are cleared out. [ABSTRACT FROM AUTHOR]

Key points: The peer review system is viewed by many as being flawed and antiquated.While it is unlikely that the system will be overhauled completely, some changes seem to be warranted.Our proposal is to change the incentives to do peer review by making reviews a part of the tenure criteria and valuing reviews as a contribution to the literature.The proposal would require more transparency than is currently the industry norm to prevent unwanted effects.We believe these changes would not only increase willingness to review, but also lead to shorter turnaround times and increase the quality of reviews. [ABSTRACT FROM AUTHOR]

Precision cancer medicine is a multidisciplinary team effort that requires involvement and commitment of many stakeholders including the society at large. Building on the success of significant advances in precision therapy for oncological patients over the last two decades, future developments will be significantly shaped by improvements in scalable molecular diagnostics in which increasingly complex multilayered datasets require transformation into clinically useful information guiding patient management at fast turnaround times. Adaptive profiling strategies involving tissue‐ and liquid‐based testing that account for the immense plasticity of cancer during the patient's journey and also include early detection approaches are already finding their way into clinical routine and will become paramount. A second major driver is the development of smart clinical trials and trial concepts which, complemented by real‐world evidence, rapidly broaden the spectrum of therapeutic options. Tight coordination with regulatory agencies and health technology assessment bodies is crucial in this context. Multicentric networks operating nationally and internationally are key in implementing precision oncology in clinical practice and support developing and improving the ecosystem and framework needed to turn invocation into benefits for patients. The review provides an overview of the diagnostic tools, innovative clinical studies, and collaborative efforts needed to realize precision cancer medicine. [ABSTRACT FROM AUTHOR]

Introduction: Younger donor age in hematopoietic cell transplantation has been associated with improved overall and disease‐free survival. Safety data on peripheral blood stem cell (PBSC) and bone marrow (BM) donation is well established, including in the <18‐year old age group in the related setting. In response, Anthony Nolan became the first stem cell donor registry to lower the minimum age for unrelated donors to 16‐years. Materials and Methods: This retrospective study reviewed unrelated donors donating PBSC or BM for the first time between April 2015 and October 2017 since adoption of the lowered recruitment age. Data were collected from registry electronic database and structured follow‐up questionnaires. Primary outcomes were turnaround time from VT to donation, optimal cell yield achievement, and physical and emotional recovery. Results: Out of a total of 1013 donors, there were no differences between the different age groups in proportion of donors achieving optimal CD34+ or TNC (PBSC and BM, respectively). There was no increased central line requirement for younger donors or increased emergency telephone support. Youngest donors were more likely to report physical recovery 2 and 7 days post‐PBSC (P =.024 and P =.015, respectively) as well as an earlier emotional recovery (P =.001) and fewer physical symptoms 1 week BM donation (P =.04). Conclusion: This study shows that younger donors are as reliable as older donors, and have favorable recovery profiles without need for increased support at any stage of the donation, supporting Anthony Nolan recruitment strategy and offering reassurance to donor registries considering the same. [ABSTRACT FROM AUTHOR]

Background: To compare the performance of conventional, semi‐nested and real‐time panfungal ITS PCRs for diagnosing fungal keratitis (FK) and develop genus‐specific real‐time PCR for the most common aetiology of FK. Methods: This multicentric study includes 232 corneal samples from suspected FK patients from four centres across India between November 2019 through August 2021. A total of 87 corneal buttons were included for the comparison of conventional, semi‐nested and real‐time ITS PCRs, of which 68 were from confirmed FK patients. Of these 87 samples, 44 (microscopy and culture positive for Aspergillus sp. and/or Fusarium sp.) were used for the standardisation of genus‐specific real‐time primers/probes. Subsequently, the best method showing highest sensitivity and specificity was validated in 188 samples. Results: On Bayesian comparison, conventional ITS2 PCR showed best performance (sensitivity and specificity of 55.88% and 100%, respectively). Since, real‐time ITS2 PCR was also considerably efficient (sensitivity and specificity of 51.47% and 84.21%, respectively) in comparison with the conventional PCR but faster, cost‐effective, and less labor‐intensive, ITS‐2 real‐time PCR is a suitable method that can be applied along with culture and microscopy. During validation, real‐time PCR with genus‐specific primers showed 61.76% and 91.18% sensitivity with specificity of 98.05% and 79.22%, respectively, for Aspergillus sp. and Fusarium sp. Aspergillus probe, Fusarium probe and duplex PCR showed sensitivity of 52.94%, 50% and 54.41% with specificity of 92.86%, 82.47% and 75%, respectively. No cross‐reactivity of genus‐specific PCRs was observed during standardisation. Conclusions: ITS‐2 real‐time PCR can be applied as an adjunct with conventional methods for the diagnosis of FK. The genus‐specific duplex real‐time PCRs are rapid which reduces the turnaround time (TAT) avoiding the need for sequencing. [ABSTRACT FROM AUTHOR]

Spherotech (SPT) microparticles capture non‐specific binding materials present in test serum, and EDTA removes the so called" prozone effect". This study presents a novel approach of combined SPT‐EDTA serum treatment prior to Luminex HLA antibody testing to remove high background, and prozone effect in a single step process, and compared the efficacy of SPT‐EDTA serum pre‐treatment with AdsorbOut (ADS) and Serum Cleaner (SC) to reduce background in solid phase immunoassays (SPI). A total of 21 serum samples with a history of elevated negative control (NC) values ≥500, and 20 samples with normal NC values were included to assess the potential adverse effects. A problem of high background was noted in 25% of our samples in SPI. We observed 80% effectiveness in reducing NC values <500 with SPT‐EDTA serum pre‐treatment compared to 72%, and 67% for ADS and SC‐treated sera, respectively. Interestingly, we found a strong correlation in antibody‐binding levels between SPT versus ADS; and ADS versus SC‐treated sera for both phenotype and single antigen bead assays (p < 0.001). No adverse effect was noted on NC, positive control (PC) values, PC/NC ratios in the upfront use of SPT‐EDTA as compared to EDTA alone. Our data revealed that combined SPT‐EDTA treated sera is more effective than ADS, and SC in reducing high background in SPI. Taken together, SPT‐EDTA serum treatment prior to Luminex HLA Ab testing is cost‐effective, our laboratory saves nearly 30% of the annual total cost for Ab testing and improved test turnaround time by two business days. [ABSTRACT FROM AUTHOR]

While Mpox virus (MPXV) diagnostics were performed in specialized laboratories only, the global emergence of Mpox cases in 2022 revealed the need for a more readily available diagnostic. Automated random‐access platforms with fast nucleic acid extraction and PCR have become established in many laboratories, providing faster and more accessible testing. In this study, we adapted a previously published generic MPXV‐PCR as a lab‐developed test (LDT) on a NeuMoDx Molecular System and isolated MPXV clones from patient materials. To reduce the handling of infectious material, we evaluated a viral lysis buffer (VLB) for sample pretreatment. We further compared the MPXV‐LDT‐PCR to conventional real‐time PCR, determined its sensitivity and specificity using positive swabs, and assessed its performance using external quality assessment samples. Pretreatment of samples with 50% VLB reduced MPXV infectivity by approximately 200‐fold while maintaining PCR sensitivity. The assay demonstrated a sensitivity and specificity of 100% with no cross‐reactivity in the samples tested and performed with a limit of detection of 262 GE/mL. In summary, the assay had a turnaround time of fewer than 2 h and can easily be transferred to other automated PCR platforms, providing a basis for developing rapid assays for upcoming pandemics. [ABSTRACT FROM AUTHOR]

Background: Recent studies and consensus statements in veterinary and human medicine recommend more judicious use of antimicrobials. While guidelines have been provided for some veterinary diseases, others have poorly elucidated guidelines. Postoperative treatment of canine pyometra is a condition with minimal guidelines regarding antimicrobial use. Objective: To identify and investigate patterns of antimicrobial use following surgically treated canine pyometra. Methods: A 23‐question survey, sent to 863 small and mixed animal practitioners, investigated demographics, patterns of antibiotic use, rate of culture submission and participant's recollection of outcomes of surgically treated pyometra cases. Responses were analysed for relationships between demographics, patterns of antibiotic use and culture results to better understand reasoning for antibiotic protocols. Results: One hundred and fifty‐two responses were received. Overall, 76% of veterinarians stated they always use preoperative and perioperative antibiotics, and 74% stated they always use postoperative antibiotics. A total of 16 different antibiotics were reported. Twelve per cent of respondents regularly submitted a culture. Culture submission was impacted by cost, prior experience, poor owner compliance, result turnaround time and anticipated results. Conclusions: Most respondents always used antibiotics and rarely or never submitted a culture. To optimise patient care, future clinical studies are needed to determine specific guidelines for the use of culture and antibiotics in the treatment of canine pyometra following ovariohysterectomy. [ABSTRACT FROM AUTHOR]

The utility of big data in spontaneous adverse drug reactions (ADRs) reporting systems has improved the pharmacovigilance process. However, identifying culprit drugs in ADRs remains challenging, although it is one of the foremost steps to managing ADRs. Aiming to estimate the likelihood of prescribed drugs being culprit drugs for given ADRs, we devised a Bayesian estimation model based on the Japanese Adverse Drug Events Reports database. After developing the model, a validation study was conducted with 67 ADR reports with a gross of 1,387 drugs (67 culprit drugs and 1,320 concomitant drugs) prescribed and recorded at Yamaguchi University Hospital. As a result, the model estimated a culprit drug of ADRs with acceptable accuracy (area under the receiver operating characteristic curve 0.93 (95% confidence interval 0.88–0.97)). The estimation results provided by the model to healthcare practitioners can be used as one clue to determine the culprit drugs for various ADRs, which will improve the management of ADRs by shortening the treatment turnaround time and increasing the precision of diagnosis, leading to minimizing the adverse effects on patients. [ABSTRACT FROM AUTHOR]

Background: In Japan, microsatellite instability (MSI) testing for solid tumors was introduced in clinical practice in December 2018. Although immune checkpoint inhibitors (ICIs) are established standards of care for patients with MSI‐high tumors, the status of implementing MSI testing in clinical practice remains unclear. Methods: We retrospectively reviewed the medical records of patients with solid tumors who underwent MSI testing between January 2019 and December 2020 at our institution. Results: In total, 1,052 MSI tests were performed in 1,047 patients. Regardless of specimen volume and condition, the MSI status was successfully determined in 1,041 (99.0%) tests, encompassing 27 tumor types (microsatellite stable [MSS] or MSI‐low: n = 991 [95.2%] and MSI‐high: n = 50 [4.8%]). Patients whose specimens were fixed with 20% neutral buffered formalin (NBF) and who had specimens with prolonged storage (98.4% and 95.4%) showed lower success rates than those whose specimens were fixed with 10% NBF and who had specimens with nonprolonged storage (100.0% and 99.6%), respectively. The prolonged turnaround time (TAT) in MSI‐high cases (median TAT: 24 days) was a critical issue that directly resulted in treatment delay. Of the 50 patients with MSI‐high tumors, 24 (48.0%) received ICIs and 34 (68.0%) were referred to the Department of Clinical Genetic Oncology where 6 (12.0%) patients were diagnosed with Lynch syndrome. Conclusions: MSI testing was successfully performed for various types of tumors and specimens in clinical practice. Our study results identified certain issues associated with the clinical implementation of MSI testing, including optimal specimen selection, extended TAT in MSI‐high cases, and awareness of hereditary tumors. [ABSTRACT FROM AUTHOR]

This paper explores cardiac electrophysiological simulations of the monodomain equations and introduces a novel subcycling time integration algorithm to exploit the structure of the ionic model. The aim of this work is to improve upon the efficiency of parallel cardiac monodomain simulations by using our subcycling algorithm in the computation of the ionic model to handle the local sharp changes of the solution. This will reduce the turnaround time for the simulation of basic cardiac electrical function on both idealized and patient‐specific geometry. Numerical experiments show that the proposed approach is accurate and also has close to linear parallel scalability on a computer with more than 1000 processor cores. Ultimately, the reduction in simulation time can be beneficial in clinical applications, where multiple simulations are often required to tune a model to match clinical measurements. [ABSTRACT FROM AUTHOR]

Traditional microbiological methodology has limited sensitivity, detection range, and turnaround times in diagnosis of bloodstream infection in Febrile Neutropenia (FN) patients. A more rapid and sensitive detection technology is urgently needed. Here we used the newly developed Nanapore targeted sequencing (NTS) to diagnose the pathogens in blood samples. The diagnostic performance (sensitivity, specificity and turnaround time) of NTS detection of 202 blood samples from FN patients with hematologic disease was evaluated in comparison to blood culture and nested Polymerase Chain Reaction (PCR) followed by sanger sequence. The impact of NTS results on antibiotic treatment modification, the effectivity and mortality of the patients under the guidance of NTS results were assessed. The data showed that NTS had clinical sensitivity of 92.11%, clinical specificity of 78.41% compared with the blood culture and PCR combination. Importantly, the turnaround time for NTS was <24 h for all specimens, and the pre‐report time within 6 h in emergency cases was possible in clinical practice. Among 118 NTS positive patients, 98.3% patients' antibiotic regimens were guided according to NTS results. There was no significant difference in effectivity and mortality rate between Antibiotic regimen switched according to NTS group and Antibiotic regimen covering pathogens detected by NTS group. Therefore, NTS could yield a higher sensitivity, specificity and shorter turnaround time for broad‐spectrum pathogens identification in blood samples detection compared with traditional tests. It's also a good guidance in clinical targeted antibiotic treatment for FN patients with hematologic disease, thereby emerging as a promising technology for detecting infectious disease. [ABSTRACT FROM AUTHOR]

Background: Cell‐free next‐generation sequencing (cfNGS) may have a unique role in the diagnosis of infectious complications in immunocompromised hosts. The rapid turnaround time and non‐invasive nature make it a promising supplement to standard of care. Methods: This retrospective, observational single‐center study at a tertiary care medical center in Virginia investigated the use of cfNGS in clinical practice. Patients over age 18 years with cfNGS performed for any indication were included. The primary outcome was detection of bacteria and/or fungi on cfNGS. The secondary outcomes were concordance, and abundance of fungal and bacterial organism concentration detected over time from symptom onset, and clinical impact. Results: Thirty‐six patients (92% immunosuppressed) were identified and included. Twenty‐one (58%) tests detected one to five organisms (14/21 bacteria, 8/21 fungi, and 6/21 viruses). The clinical impact of cfNGS was positive in 52.8% of cases, negative in 2.8%, and negligible in 44.4%. Positive tests prompted therapy changes in 12 of 21 patients; six of 20 bacteria and seven of eight fungi identified were considered clinically pathogenic. Three bacteria identifications and six fungi identifications prompted targeted treatment. When fungal species were not identified by cNFGS, antifungal de‐escalation occurred in seven patients. Conclusion: cfNGS assisted in critical management changes, including initiation of treatment for identified organisms and antimicrobial de‐escalation. Its non‐invasive nature and rapid turnaround time make this an important adjunct to standard of care testing that may assist in providing earlier, targeted therapy, especially when opportunistic pathogens remain high on the differential diagnosis. [ABSTRACT FROM AUTHOR]

Summary: Artificial intelligence empowered Chatbots are altering the nature of service interfaces which has further resulted in raised expectations from Chatbots to understand customer's social interactions and respond them within the turnaround time. To close this research gap, we conduct an exploratory study in two phases‐industry's perspective and B2B customer's perspective and analyze results with the help of NVIVO 12 plus and Leximancer. The findings reveal perceived risk with respect to Chatbots is high, complex pricing structure along with nonavailability of testing options makes the pre purchase more complex. Moreover, interactive speed, customization especially with respect to language issues, integration with other platforms is some of the major themes which influence customer experience. Advancements in AI, natural language processing and more testing at all phases will bring efficiency, automation first strategies. Further, our findings suggest Chatbots must provide more personalization, scalability and omni channel engagement and focus on delivering more enhanced customer experience. Chatbots must offer a grievance management dashboard where the customer can see live queries, resolved queries, present queries status and so on to get transparency. Chatbots streamline the lead qualification process, greatly improve, and speed up the data collection therefore, enhancing customer experience. [ABSTRACT FROM AUTHOR]

Background: Health librarians have traditionally provided mediated searches to support patient care, education and research. Objectives: This study aims to discover the types of search result formats used by health science libraries, determine current practice among health science libraries (types of requesters served, fees, deduplication, turnaround time and citation manager use) and uncover innovative methods for providing search results. Methods: An online survey was distributed to the MEDLIB‐L, ExpertSearching, MidContinental Chapter of the Medical Library Association and ICON listservs and through direct email to selected Association of Academic Health Sciences Libraries reference and education librarians. Results: Librarians affiliated with 127 institutions from 11 countries (including the USS) and 36 USS states and territories responded. One hundred and forty‐two of the total 150 analysed responses provided information on full‐text access, and 81 of those 142 responses (57%) indicated that the institutions' link‐resolver links were included in search results provided to the requester. The survey responses provide information on literature search services regarding turnaround time, use of a citation managers, fees and deduplication. Conclusion: With the developing landscape of citation managers and the tools offered, these data can be used as a benchmark for librarians who are considering evaluating or modifying their search service delivery. [ABSTRACT FROM AUTHOR]

This article, titled "EP07.16: Rapid prenatal diagnosis of fetal short femur using trio clinical exome sequencing," explores the use of trio clinical exome sequencing as a detection strategy for prenatal diagnosis of fetal short femur. The study collected data from 43 pregnancies with fetal short femur and found that trio clinical exome sequencing achieved a molecular diagnostic rate of 60.4% with a turnaround time of 2 weeks. The study also identified incidental molecular findings in two fetuses, which helped parents avoid adverse pregnancy outcomes. The findings of this study contribute to genetic counseling during the prenatal diagnosis of fetal short femur length. [Extracted from the article]

Background: Medications often constitute a significant percentage of health care budgets; therefore ensuring rational medication use is essential. In December 2017, the Saudi Ministry of Health (MOH) introduced a national clinical review process for nonformulary medications (NFMs) requests across 284 MOH institutions to standardize review and approval process under the governance of Pharmacy and Therapeutics Committee (PTC). Objectives: This study aims to describe the effectiveness of implementing a national clinical review process for NFMs on the approval rate, decision turnaround time, and potential cost savings within MOH institutions. Methods: This was a retrospective, observational cohort study undertaken over 36 months. All NFM requests were received through an electronic system, linking all the ministry's regions and departments with a single coding system. Quantitative descriptive statistics: frequency, percentage, median, and interquartile range were used to present the results of this study. A P value ≤.05 was considered statistically significant. Results: The approval rate among a total of 2388 NFM requests was 1733 (74%). The median submission turnaround time for NFM requests in 2018 to 2020 were 12.5 (interquartile range [IQR]: 5‐24), 7 (IQR: 3‐15), and 7 (IQR: 4‐14) working days, respectively (P ≤.001). The median decision turnaround time for NFM requests in 2018 to 2020 were 7 (IQR: 4‐10), 5 (IQR: 3‐9), and 5 (IQR: 4‐8) working days, respectively (P =.019). Of the 615 disapproved requests, 514 (83.6%) were disapproved for a single reason. Moreover, disapproval of requests equated to a potential cost savings which exceeded 14.8 million United States dollars. Conclusions: This initial study showed that implementing a structured, systematic review process for NFM requests resulted in potential cost savings and acceptable turnaround times for nonurgent requests. However, further studies are needed to examine the actual cost savings and clinical impact on patient outcomes. [ABSTRACT FROM AUTHOR]

The current increase in number and diversity of targeted anticancer agents poses challenges to the logistics and timeliness of molecular diagnostics (MolDx), resulting in underdiagnosis and treatment. Whole‐genome sequencing (WGS) may provide a sustainable solution for addressing current as well as future diagnostic challenges. The present study therefore aimed to prospectively assess feasibility, validity, and value of WGS in routine clinical practice. WGS was conducted independently of, and in parallel with, standard of care (SOC) diagnostics on routinely obtained tumor samples from 1,200 consecutive patients with metastatic cancer. Results from both tests were compared and discussed in a dedicated tumor board. From 1,200 patients, 1,302 samples were obtained, of which 1,216 contained tumor cells. WGS was successful in 70% (854/1,216) of samples with a median turnaround time of 11 days. Low tumor purity (<20%) was the main reason for not completing WGS. WGS identified 99.2% and SOC MolDx 99.7% of the total of 896 biomarkers found in genomic regions covered by both tests. Actionable biomarkers were found in 603/848 patients (71%). Of the 936 associated therapy options identified by WGS, 343 were identified with SOC MolDx (36.6%). Biomarker‐based therapy was started in 147 patients. WGS revealed 49 not previously identified pathogenic germline variants. Fresh‐frozen, instead of formalin‐fixed and paraffin‐embedded, sample logistics were easily adopted as experienced by the professionals involved. WGS for patients with metastatic cancer is well feasible in routine clinical practice, successfully yielding comprehensive genomic profiling for the vast majority of patients. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Traditional detection of aquatic invasive species via morphological identification is often time‐consuming and can require a high level of taxonomic expertise, leading to delayed mitigation responses. Environmental DNA (eDNA) detection approaches of multiple species using Illumina‐based sequencing technology have been used to overcome these hindrances, but sample processing is often lengthy. More recently, portable nanopore sequencing technology has become available, which has the potential to make molecular detection of invasive species more widely accessible and substantially decrease sample turnaround times. However, nanopore‐sequenced reads have a much higher error rate than those produced by Illumina platforms, which has so far hindered the adoption of this technology. We provide a detailed laboratory protocol and bioinformatic tools (msi package) to increase the reliability of nanopore sequencing to detect invasive species, and we test its application using invasive bivalves while comparing it with Illumina‐based sequencing. We sampled water from sites with pre‐existing bivalve occurrence and abundance data, and contrasting bivalve communities, in Italy and Portugal. Samples were extracted, amplified, and sequenced by the two platforms. The mean agreement between sequencing methods was 69% and the difference between methods was nonsignificant. The lack of detections of some species at some sites could be explained by their known low abundances. This is the first reported use of MinION to detect aquatic invasive species from eDNA samples. [ABSTRACT FROM AUTHOR]