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Background: Education, regulation and association (ERA) are the supporting pillars of an enabling environment for midwives to provide quality care. This study explores these three pillars in the 73 low- and middle-income countries who participated in the State of the World's Midwifery (SoWMy) 2014 report. It also examines the progress made since the previous report in 2011.Methods: A self-completion questionnaire collected quantitative and qualitative data on ERA characteristics and organisation in the 73 countries. The countries were grouped according to World Health Organization (WHO) regions. A descriptive analysis was conducted.Results: In 82% of the participating countries, the minimum education level requirement to start midwifery training was grade 12 or above. The average length of training was higher for direct-entry programmes at 3.1 years than for post-nursing/healthcare provider programmes at 1.9 years. The median number of supervised births that must be conducted before graduation was 33 (range 0 to 240). Fewer than half of the countries had legislation recognising midwifery as an independent profession. This legislation was particularly lacking in the Western Pacific and South-East Asia regions. In most (90%) of the participating countries, governments were reported to have a regulatory role, but some reported challenges to the role being performed effectively. Professional associations were widely available to midwives in all regions although not all were exclusive to midwives.Conclusions: Compared with the 2011 SoWMy report, there is evidence of increasing effort in low- and middle-income countries to improve midwifery education, to strengthen the profession and to follow international ERA standards and guidelines. However, not all elements are being implemented equally; some variability persists between and within regions. The education pillar showed more systematic improvement in the type of programme and length of training. The reinforcement of regulation through the development of legislation for midwifery, a recognised definition and the strengthening of midwives' associations would benefit the development of other ERA elements and the profession generally. [ABSTRACT FROM AUTHOR]

The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality. [ABSTRACT FROM AUTHOR]

This paper reports on experience with developing the flood forecasting model for the Upper Danube basin and its operational use since 2006. The model system consists of hydrological and hydrodynamic components, and involves precipitation forecasts. The model parameters were estimated based on the dominant processes concept. Runoff data are assimilated in real time to update modelled soil moisture. An analysis of the model performance indicates 88% of the snow cover in the basin to be modelled correctly on more than 80% of the days. Runoff forecasting errors decrease with catchment area and increase with forecast lead time. The forecast ensemble spread is shown to be a meaningful indicator of the forecast uncertainty. During the 2013 flood, there was a tendency for the precipitation forecasts to underestimate event precipitation and for the runoff model to overestimate runoff generation which resulted in, overall, rather accurate runoff forecasts. It is suggested that the human forecaster plays an essential role in interpreting the model results and, if needed, adjusting them before issuing the forecasts to the general public.

Provides information on the celebration of the International Day of the Midwife (IDM) in 2005. Background on the Campaign for Normal Birth promotion of the Royal College of Midwives; Issuance of an IDM press release by the American College of Nurse-Midwives; Formation of an organization called For Love of Women.

Studies the effect of allogeneic peripheral stem cell transplantation in a patient with job syndrome of hyperimmunoglobulinemia E and recurrent infections. Description of research methodology used; Examination of the patient's medical history; Details on the diagnosis of job syndrome; Medical treatment given to the patient.

Background: Volume-reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out-of-group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD-A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue., Study Design and Methods: This report compares corrected count increments (CCIs) from full-volume and ACD-A acidified volume-reduced human platelets in a retrospective study at a single hospital and in a mouse model., Results: At a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20-month study period. Among all patients, the expected 4-h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full-volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD-acidified volume-reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24-h mean CCI: 6.3 (95% CI: 5.5-7.0) with full-volume platelet, 4.7 (95% CI: 3.6-6.0) with ACD-acidified volume-reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4- and 24-h predicted CCIs, showing lower CCIs in ACD-acidified volume-reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count-adjusted, volume-reduced platelets was significantly lower in mice, suggesting a procedure-related defect., Discussion: ACD-A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4-h and 24-h platelet increments., (© 2024 AABB.)

Purpose: Utilization of technology-assisted workflow (TAWF) systems has gained popularity in the sterile compounding setting. This study was designed to evaluate whether safety and efficiency could be seen when preparing oral controlled substance doses gravimetrically vs volumetrically., Methods: This 2-phase observational study combined manual data collection with automated logs generated by a single TAWF. During phase I, oral controlled substance solutions were prepared volumetrically. In phase II, the same subset of medications was to be prepared gravimetrically via the same TAWF. Findings from phases I and II were compared against each another to determine safety, efficiency, and documentation differences between the volumetric and gravimetric workflows., Results: Thirteen different medications were evaluated during phase I (1,495 preparations) and phase II (1,781 preparations) of this study. Mean compounding time (min:sec) increased in phase II when compared to phase I (1:49 vs 1:28; P < 0.01), with the deviation detection rate also increasing (7.9% vs 4.7%; P < 0.01). Despite a target in phase II of utilizing gravimetric analysis for more than 80% of preparations, only 45.5% (811 preparations) were prepared with this workflow, as adoption challenges and dose size limitations prevented compliance. Doses that were prepared gravimetrically had a mean accuracy rate of 100.6% (the mean achieved dose was 0.6% higher than the mean prescribed dose) and a rejection rate of 0.99% (compared to the phase I rejection rate of 1.07%; P = 0.67)., Conclusion: The gravimetric workflow provided accuracy and additional safety checks when compared to the volumetric alternative, all while providing users with greater access to data. Health systems should consider staffing, product sourcing, patient populations, and medication safety when determining the balance between volumetric and gravimetric workflows., (© American Society of Health-System Pharmacists 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Presymptomatic plasma samples from 1596 donors reporting coronavirus disease 2019 infection or symptoms after blood donation were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA and anti-S and anti-N antibodies. Prior infection and vaccination both protected from developing SARS-CoV-2 RNAemia and from symptomatic infection. RNAemia rates did not differ in the Delta and Omicron variant eras., Competing Interests: Potential conflicts of interest. All authors: no reported conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Respiratory viruses such as influenza do not typically cause viremia; however, SARS-CoV-2 has been detected in the blood of COVID-19 patients with mild and severe symptoms. Detection of SARS-CoV-2 in blood raises questions about its role in pathogenesis as well as transfusion safety concerns. Blood donor reports of symptoms or a diagnosis of COVID-19 after donation (post-donation information, PDI) preceded or coincided with increased general population COVID-19 mortality. Plasma samples from 2,250 blood donors who reported possible COVID-19-related PDI were tested for the presence of SARS-CoV-2 RNA. Detection of RNAemia peaked at 9%-15% of PDI donors in late 2020 to early 2021 and fell to approximately 4% after implementation of widespread vaccination in the population. RNAemic donors were 1.2- to 1.4-fold more likely to report cough or shortness of breath and 1.8-fold more likely to report change in taste or smell compared with infected donors without detectable RNAemia. No infectious virus was detected in plasma from RNAemic donors; inoculation of permissive cell lines produced less than 0.7-7 plaque-forming units (PFU)/mL and in susceptible mice less than 100 PFU/mL in RNA-positive plasma based on limits of detection in these models. These findings suggest that blood transfusions are highly unlikely to transmit SARS-CoV-2 infection.

Objectives: The first coronavirus disease 2019 (COVID-19) case in the United States was reported in Washington State. The pandemic caused drastic disruptions to medical institutions, including medical education. The Department of Laboratory Medicine at the University of Washington responded by rapidly implementing substantial changes to medical student clerkships., Methods: In real time, we converted one ongoing case- and didactic-based course, LabM 685, to remote learning., Results: Fifteen of 17 scheduled sessions proceeded as planned, including two sessions for student presentations. Two didactics were canceled as the functions of the teleconferencing platform were not sufficient to proceed. One grand rounds speaker canceled due to COVID-19 precautions. Elements of an immersive clinical laboratory clerkship, LabM 680, were repurposed to accommodate 40 medical students per class via remote learning, highlighting clinical laboratory activities that continue throughout the outbreak. A new remote clerkship, MedSci 585C, was developed incorporating distance learning and guided small-group sessions. This coincided with parallel efforts to make resident and fellow service work, conferences, and didactics available remotely to comply with social distancing., Conclusions: The changes in medical education described reflect the dynamic interplay of current events affecting the world of clinical pathology. Throughout this, technology-while with some limitations-has provided the platform for innovative learning., (© American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The first coronavirus (COVID-19) case was reported in United States in the state of Washington, approximately 3 months after the outbreak in Wuhan, China. Three weeks later, the US federal government declared the pandemic a national emergency. The number of confirmed COVID-19 positive cases increased rather rapidly and changed routine daily activities of the community., Study Design and Methods: This brief report describes the response from the hospital, the regional blood center, and the hospital-based transfusion services to the events that took place in the community during the initial phases of the pandemic., Results: In Washington State, the first week of March started with four confirmed cases and ended with 150; by the end of the second week of March there were more than 700 cases of confirmed COVID-19. During the first week, blood donations dropped significantly. Blood units provided from blood centers of nonaffected areas of the country helped keep inventory stable and allow for routine hospital operations. The hospital-based transfusion service began prospective triaging of blood orders to monitor and prioritize blood usage. In the second week, blood donations recovered, and the hospital postponed elective procedures to ensure staff and personal protective equipment were appropriate for the care of critical patients., Conclusion: As community activities are disrupted and hospital activities switch from routine operations to pandemic focused and urgent care oriented, the blood supply and usage requires a number of transformations., (© 2020 AABB.)

Background: Here we report a case of acute hemolytic transfusion reaction (HTR) due to anti-P1 and review our institutional database for prevalence of anti-P1 antibodies and frequency of anti-P1-mediated HTR. Anti-P1 antibodies, reported to be present in up to two-thirds of P 2 individuals, are usually clinically insignificant. However, rare cases of acute HTR due to anti-P1 are reported. Case Report: We report the clinical and laboratory features of a mild acute HTR due to an IgM anti-P1 not detected by a routinely used antibody screening method. We reviewed our institutional database to investigate prevalence of anti-P1 antibodies identified in our patient population and frequency of HTR in patients with anti-P1., Results: Analysis of RBC transfusion recipient data over the 10-year period from 2006 to 2015 showed prevalence of anti-P1 identified in our laboratory of 174 per 100,000 individuals. Frequency of HTR in patients with anti-P1 identified in our laboratory over a 10-year period was 1 in 1,429 RBC transfusions (0.07%). Conclusion: Our reported case of HTR mediated by IgM anti-P1 reactive at 37 °C confirms the potential of antibody screening methods designed to detect IgG antibodies to miss rare clinically significant IgM antibodies., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2018 by S. Karger AG, Basel.)

Changes in the river flood regime may be due to atmospheric processes (e.g., increasing precipitation), catchment processes (e.g., soil compaction associated with land use change), and river system processes (e.g., loss of retention volume in the floodplains). This paper proposes a new framework for attributing flood changes to these drivers based on a regional analysis. We exploit the scaling characteristics (i.e., fingerprints) with catchment area of the effects of the drivers on flood changes. The estimation of their relative contributions is framed in Bayesian terms. Analysis of a synthetic, controlled case suggests that the accuracy of the regional attribution increases with increasing number of sites and record lengths, decreases with increasing regional heterogeneity, increases with increasing difference of the scaling fingerprints, and decreases with an increase of their prior uncertainty. The applicability of the framework is illustrated for a case study set in Austria, where positive flood trends have been observed at many sites in the past decades. The individual scaling fingerprints related to the atmospheric, catchment, and river system processes are estimated from rainfall data and simple hydrological modeling. Although the distributions of the contributions are rather wide, the attribution identifies precipitation change as the main driver of flood change in the study region. Overall, it is suggested that the extension from local attribution to a regional framework, including multiple drivers and explicit estimation of uncertainty, could constitute a similar shift in flood change attribution as the extension from local to regional flood frequency analysis.

There has been a surprisingly large number of major floods in the last years around the world, which suggests that floods may have increased and will continue to increase in the next decades. However, the realism of such changes is still hotly discussed in the literature. This overview article examines whether floods have changed in the past and explores the driving processes of such changes in the atmosphere, the catchments and the river system based on examples from Europe. Methods are reviewed for assessing whether floods may increase in the future. Accounting for feedbacks within the human-water system is important when assessing flood changes over lead times of decades or centuries. It is argued that an integrated flood risk management approach is needed for dealing with future flood risk with a focus on reducing the vulnerability of the societal system. WIREs Water 2015, 2:329-344. doi: 10.1002/wat2.1079 For further resources related to this article, please visit the WIREs website.

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, nearly universally fatal complication from transfusion of nonirradiated cellular blood components, occurring when a recipient's immune system is unable to recognize and destroy transfused T lymphocytes. Irradiation of cellular components eliminates this risk. We present an unusual case of a liver transplant recipient developing TA-GVHD 13 weeks after transfusion of a random unit of nonirradiated red blood cells (RBCs) that happened to be from a donor homozygous for an HLA haplotype shared by the patient., Study Design and Methods: This study was a single case review of a liver transplant recipient who developed skin GVHD and marrow aplasia. Clinical course and the chimerism studies involving the patient, the liver donor, and the blood donor are detailed., Results: The patient presented 3 months posttransplant with GVHD of his skin and marrow aplasia. In addition to standard antigraft immunosuppression, this patient had started the interleukin-1 receptor antagonist anakinra on Posttransplant Day 13 for an acute gout flare. Chimerism studies on the patient's peripheral blood identified a population of CD3 cells that did not originate with either the patient or his liver donor. HLA studies and microsatellite profiling of the unknown CD3 population identified the source of the patient's TA-GVHD, a unit of nonirradiated, nonleukoreduced apheresis RBCs., Conclusion: Use of an immunomodulating agent may have contributed to the development of TA-GVHD in a liver transplant patient who received a random unit of nonirradiated RBCs by chance from an unrelated haploidentical donor., (© 2012 American Association of Blood Banks.)

The metropolitan Seattle area has utilized a centralized transfusion service model throughout the modern era of blood banking. This approach has used four laboratories to serve over 20 hospitals and clinics, providing greater capabilities for all at a lower consumption of resources than if each depended on its own laboratory and staff for these functions. In addition, this centralized model has facilitated wider use of the medical capabilities of the blood center's physicians, and a county-wide network of transfusion safety officers is now being developed to increase the impact of the blood center's transfusion expertise at the patient's bedside. Medical expectations and traffic have led the blood center to evolve the centralized model to include on-site laboratories at facilities with complex transfusion requirements (e.g., a children's hospital) and to implement in all the others a system of remote allocation. This new capability places a refrigerator stocked with uncrossmatched units in the hospital but retains control over the dispensing of these through the blood center's computer system; the correct unit can be electronically cross-matched and released on demand, obviating the need for transportation to the hospital and thus speeding transfusion. This centralized transfusion model has withstood the test of time and continues to evolve to meet new situations and ensure optimal patient care., (© 2011 American Association of Blood Banks.)

Drug-induced immune hemolytic anemia is considered to be rare but is likely underrecognized. The consulting pathologist plays a critical role in integrating serologic findings with the clinical history, as drug-induced antibodies should be distinguished as either drug-dependent or drug-independent for appropriate clinical management. Drug-dependent antibodies (DDABs) are most commonly associated with cefotetan, ceftriaxone, and piperacillin, whereas fludarabine, methyldopa, β-lactamase inhibitors, and platinum-based chemotherapeutics are frequent causes of drug-independent antibodies (DIABs). DDABs usually demonstrate a positive direct antiglobulin test and a negative elution, while DIABs are serologically indistinguishable from warm autoantibodies and are similarly steroid-responsive. Drug cessation is always recommended.

Allogeneic packed red blood cells (PRBCs) suppress immunity and influence outcomes. The influence of blood on the risk of infection and death may be related to the duration of storage. We sought to determine whether blood storage duration was associated with infection or death in a large cohort of injury victims. We reviewed a cohort of trauma patients transfused at least 1 U of PRBCs within 24 h of admission to a level 1 trauma center. The outcomes of interest were complicated sepsis and mortality. We compared the amount of older blood (>14 days storage) given to patients who did or did not develop the outcomes of interest using univariate and multivariate methods. A total of 820 patients were included. Patients who died (n = 117) received more units of older blood than those who lived (5 U [inter quartile range {IQR}, 2-9] vs. 3 U [IQR, 2-6]; P < 0.001). Patients with complicated sepsis (n = 244) received a greater volume of older blood than those without complicated sepsis (6 U [IQR, 2-10] vs. 3 U [IQR, 1-5]; P < 0.001). After adjusting for clinical factors, including the total amount of blood transfused, patients receiving greater than or equal to 7 U of older blood had a higher risk of complicated sepsis than patients receiving 1 or fewer units (odds ratio, 1.9; P = 0.03). The risk for complicated sepsis and death in trauma victims who are transfused blood is high. The amount of older blood transfused is associated with complicated sepsis. Although the best strategy to minimize the effects of allogeneic blood is to avoid unnecessary transfusions, it may be particularly important to avoid transfusing multiple units of older blood.

The following abstracts are compiled from Check Sample exercises published in 2008. These peer-reviewed case studies assist laboratory professionals with continuing medical education and are developed in the areas of clinical chemistry, cytopathology, forensic pathology, hematology, microbiology, surgical pathology, and transfusion medicine. Abstracts for all exercises published in the program will appear annually in AJCP.

Antimutagenic activity of 20 and 40% ethanol extracts from the biomass of Rhodiola rosea, Polyscias filicifolia, Panax ginseng and Ungernia victoris cultured cells have been studied. DDDTDP, ethidium bromide, benz(a)pyrene, benzidine served as model mutagens for Salmonella typhimurium TA 98 strain (the latter two were tested in presence of metabolic activation system); for S. typhimurium TA 100 strain these were tio-tefa, bichromate potassium and sodium azide and heavy metal compounds (chlorides of manganese, zinc, cadmium, lead acetate) for both strains. Higher capacity of the extracts from the biomass of R. rosea and P. filicifolia to counteract gene mutations induced by various mutagens was demonstrated (ca. 90% inhibition in isolated cases). In the experiment with the metabolic activation most effective proved to be the extracts from the P. ginseng biomass (up to 34% and 47% mutagenicity inhibition).

Background and Objectives: Malignant cartilage tumors demonstrate chemotherapeutic resistance through undetermined mechanisms. P-glycoprotein is the protein product of the multiple drug resistance gene 1 (MDR-1) and confers multidrug chemotherapeutic resistance in a variety of malignancies., Methods: MDR-1 expression was examined in 55 benign and malignant cartilage tumor specimens by immunohistochemistry using C219, C494, and JSB-1 antibodies, and by in situ hybridization with an MDR-1 specific oligonucleotide cDNA probe., Results: Constitutive expression of P-glycoprotein was observed in all benign and malignant cartilage tumor specimens with a similar pattern of immunohistochemical staining present with all three antibodies. In benign tumors and low grade chondrosarcomas, the staining pattern was weak to intermediate and localized to clusters of cells. However, higher grade-tumors (Grade II and III) expressed P-glycoprotein in a higher percentage of cells and with more intense staining. P-glycoprotein expression was absent in normal human articular cartilage, but was focally present in costal and growth plate cartilage. The immunohistochemistry results were confirmed by in situ hybridization in 10 cases., Conclusions: P-glycoprotein is expressed constitutively in cartilaginous tumors, with greatest expression in high grade malignancies. The findings may account for the resistance of cartilage tumors to chemotherapeutic agents.

Four methods of predicting steady-state trough serum procainamide concentrations (SPC) were compared in 15 patients receiving sustained-release procainamide (Procan-SR) therapy. All methods were based on a one-compartment pharmacokinetic model. Method 1 utilized nine initial measured SPC and individualized pharmacokinetic parameters for prediction of the steady-state SPC. Method 2 utilized three SPC and individualized pharmacokinetic parameters. Method 3 utilized two SPC and an individualized apparent elimination rate constant plus other average pharmacokinetic parameters. Method 4 utilized all averaged pharmacokinetic parameters (required no initial SPC). The predicted and measured SPCs for each method were analyzed by linear regression. Regression equations and correlation coefficients (r) for Methods 1, 2, 3, and 4 were as follows: predicted SPC = 0.72 measured SPC + 1.60 (r = 0.86), predicted SPC = 0.67 measured SPC + 1.74 (r = 0.82), predicted SPC = 0.13 measured SPC + 2.57 (r = 0.58), and predicted SPC = 0.15 measured SPC + 2.47 (r = 0.52), respectively. The precision, as measured by the mean squared prediction error (95% confidence interval) for Methods 1, 2, 3, and 4 was 1.44 (0.61, 2.27), 1.75 (0.93, 2.57), 2.81 (1.3, 4.49), and 3.68 (1.12, 6.26), respectively. (Eighty-five percent of the predictions were within +/- 1.5 micrograms/ml of the measured SPC by Methods 1 and 2, as compared with 69% by Methods 3 and 4.) Bias, as measured by the mean prediction error (95% confidence interval) for Methods 1, 2, 3, and 4 were -0.44 (-0.90, 0.03), -0.34 (-0.87, 0.18), -0.43 (-1.09, 0.24), and -0.98 (-1.66, -0.31).(ABSTRACT TRUNCATED AT 250 WORDS)