Search

Objectives Monitoring quality indicators (QIs) is an important part of laboratory quality assurance (QA). Here, the Canadian Society of Clinical Chemists (CSCC) Point of Care Testing (POCT) and QI Special Interest Groups describe a process for establishing and monitoring QIs for POCT glucose testing. Methods Key, error prone steps in the POCT glucose testing process were collaboratively mapped out, followed by risk assessment for each step. Steps with the highest risk and ability to detect a non-conformance were chosen for follow-up. These were positive patient identification (PPID) and repeat of critically high glucose measurements. Participating sites were asked to submit aggregate data for these indicators from their site(s) for a one-month period. The PPID QI was also included as part of a national QI monitoring program for which fifty-seven sites submitted data. Results The percentage of POCT glucose tests performed without valid PPID ranged from 0–87%. Sites without Admission-Discharge-Transfer (ADT) connectivity to POCT meters were among those with the highest percentage of POCT glucose tests performed without valid PPID. The percentage repeated critically high glucose measurements ranged from 0–50%, indicating low compliance with this recommendation. A high rate of discordance was also noted when critically high POCT glucose measurements were repeated, demonstrating the importance of repeat testing prior to insulin administration. Conclusions Here, a process for establishing these QIs is described, with preliminary data for two QIs chosen from this process. The findings demonstrate the importance of QIs for identification and comparative performance monitoring of non-conformances to improve POCT quality.

Objectives Ovarian cancer is the most lethal gynecological malignancy in developed countries. One of the key associations with the high mortality rate is diagnosis at late stages. This clinical limitation is primarily due to a lack of distinct symptoms and detection at the early stages. The ovarian cancer biomarker, CA125, is mainly effective for identifying serous ovarian carcinomas, leaving a gap in non-serous ovarian cancer detection. Mucin 13 (MUC13) is a transmembrane, glycosylated protein with aberrant expression in malignancies, including ovarian cancer. We explored the potential of MUC13 to complement CA125 as an ovarian cancer biomarker, by evaluating its ability to discriminate serous and non-serous subtypes of ovarian cancer at FIGO stages I–IV from benign conditions. Methods We used our newly developed, high sensitivity ELISA to measure MUC13 protein in a large, well-defined cohort of 389 serum samples from patients with ovarian cancer and benign conditions. Results MUC13 and CA125 serum levels were elevated in malignant compared to benign cases (p Conclusions We report the novel role of MUC13 as a serum ovarian cancer biomarker, where it could complement CA125 for detecting some subtypes of non-serous ovarian carcinoma and early-stage disease.

Objective The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. Design Cross-sectional survey. Setting Data were collected using an online survey instrument. Participants Three hundred and nine adult combat sport athletes. Main outcome measures Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. Results A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of ‘high’ total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting ‘high’ total symptoms and symptoms severity scores. Conclusion Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.

Tropospheric ozone (O3) is the third most important anthropogenic greenhouse gas. O3 is detrimental to plant productivity, and it has a significant impact on crop yield. Currently, the Joint UK Land Environment Simulator (JULES) land surface model includes a representation of global crops (JULES-crop) but does not have crop-specific O3 damage parameters and applies default C3 grass O3 parameters for soybean that underestimate O3 damage. Physiological parameters for O3 damage in soybean in JULES-crop were calibrated against leaf gas-exchange measurements from the Soybean Free Air Concentration Enrichment (SoyFACE) with O3 experiment in Illinois, USA. Other plant parameters were calibrated using an extensive array of soybean observations such as crop height and leaf carbon and meteorological data from FLUXNET sites near Mead, Nebraska, USA. The yield, aboveground carbon, and leaf area index (LAI) of soybean from the SoyFACE experiment were used to evaluate the newly calibrated parameters. The result shows good performance for yield, with the modelled yield being within the spread of the SoyFACE observations. Although JULES-crop is able to reproduce observed LAI seasonality, its magnitude is underestimated. The newly calibrated version of JULES will be applied regionally and globally in future JULES simulations. This study helps to build a state-of-the-art impact assessment model and contribute to a more complete understanding of the impacts of climate change on food production.

In this study, we compared the DiaSorin LiaisonXL IGF-1 immunoassay to both the Roche Elecsys IGF-1 immunoassay and to the liquid chromatography-high resolution mass spectrometry (LC-MS) IGF-1 assay. Our study shows a constant positive bias in DiaSorin compared to the Roche immunoassay (mean 42 μg/L, 24%), and a proportional positive bias in DiaSorin compared to the LC-MS method (mean 49 μg/L, 29%). Further, we demonstrate the potential clinical impact of this bias by evaluating 43 adult samples, collected over a 2-month period, which were shown to be discrepant based on a chart review. Despite the positive analytical bias in the Diasorin assay compared to the LC-MS assay, the Diasorin assay upper reference limits were lower than those of the LC-MS assay. This effect caused nine out of forty-three samples to show falsely elevated results when they were clinically diagnosed as negative for acromegaly. Discussed in the context of previous literature, our findings emphasize the importance of adjusting reference intervals for IGF-1 assays based on the clinical needs of a patient population.

Regional increases in atmospheric O

The diagnosis of tissue samples traditionally has been performed by anatomic pathologists using a combination of cellular staining and light microscopy. With these techniques, pathologists can characterize various tissue features including cell morphology, structure, and composition to subsequently confirm whether a disease process is present. Although the histopathologic “gold-standard” methods are invaluable for routine tissue diagnosis, the results can be subjective, owing to a combination of factors such as variability in staining quality, nature of the sample, and human interpretation, and inconclusive for diseases that present indistinguishable histologic features. There is a need for new technologies that can be used as complementary tools in pathology for objective tissue analysis and disease diagnosis. Mass spectrometry (MS)7 imaging has been heralded as an upcoming advance in tissue analysis. The ability of MS to rapidly identify a variety of biomolecules present in a sample is highly attractive to the clinical laboratory. Indeed, MS coupled to chromatographic separation techniques is currently used to detect and/or quantify small molecules such as pharmacological agents and hormones in blood and urine. The advent of MS techniques that allow direct tissue analysis, including MALDI-MS and secondary ion MS, has allowed laboratories to extend the use of MS beyond biofluids into tissue samples. Using MALDI MS, for example, thin tissue sections can be analyzed in a nontargeted manner for the abundance and spatial distribution of biomolecules. As such, MALDI-MS imaging is being increasingly applied in clinical research, especially in the context of cancer diagnostics based on tissue proteomic and lipidomic signatures. The potential of MS in revolutionizing tissue analysis and diagnosis has driven several advances to accelerate its feasibility and utility in the clinical setting. The development of ambient ionization MS (AIMS), for example, has brought MS-based tissue imaging even closer to routine clinical use. Unlike MALDI and …

With concerns about future catastrophic disasters, elevated CO2 concentration (eCO2), global warming and vegetation changes have received much attention globally. In recent years, studies have suggested controlling climate change should be based on regional impacts. However, regional quantitative assessments of respective and combination influences of CO2, temperature and vegetation variations on water resources remain limited. To address this issue, a comprehensive framework is developed. This framework integrates a dynamic vegetation simulation approach, a biosphere hydrological model and a variance-based sensitivity analysis approach which enables identification of predominant influential factors including their combinations. A medium-sized river basin in northeast China is used to illustrate the application based on different CO2 concentration and temperature rise assumptions. Validation using MODIS products shows the proposed approach can simulate Leaf Area Index (LAI) changes well. Results show sum of the influences of LAI and temperature variations on transpiration are more than 1.6 times higher than physiological effects of eCO2 in growing seasons, which implies more water could be transpired than conserved with eCO2, global warming and LAI changes. Results also show runoff increases with eCO2 and decreases with increasing temperatures, but LAI changes play a dominate role in runoff decrease in hot summer. Therefore, considering LAI changes is of utmost importance in projections of future water resources, and severity of future water shortage could be underestimated if LAI changes are neglected. This research is useful in gaining insights into the complicated impacts of eCO2, global warming and LAI changes on regional water security and sustainability.

Objectives Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment. Design Cross-sectional cohort. Methods 213 male adolescent (13–18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48). Results There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function. Conclusions The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.

Background: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing ( p = 0.002) and less longitudinal tearing ( p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area ( p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.

Introduction A patient presented to hospital with chest pain and shortness of breath on 2 occasions 4 weeks apart. Clinical examination revealed an elevated jugular venous pressure consistent with heart failure or elevated filling pressures. Methods The patient was investigated through various modalities including electrocardiogram (ECG), transthoracic echocardiogram, coronary angiography, MRI, cardiac catheterization, positron emission tomography, and an extensive laboratory workup. Results Serial hs TnI measurements consistently revealed grossly elevated troponin I (>10 000 ng/L). In-lab investigation of increased high sensitivity troponin I (hsTnI) showed evidence of falsely increased troponin due to the presence of heterophilic antibodies. Discussion This case demonstrates a complex patient presentation and the value of involving the laboratory medicine team when dealing with potentially discrepant results. This is a rare report of grossly elevated troponin due to heterophilic antibodies for high-sensitivity troponin Abbott assay.

Acacia spp. are exotic tree species that have been widely planted on man-made slopes in Hong Kong since the 1960s. However, as they become mature and senescent, they may become a concern and cause various problems, including soil constraints for plant growth, decreasing provision of intended ecosystem services, declining syndromes, arrested succession, and high risk of failure. In this perspective paper, we present and discuss these problems using practical examples of Acacia-dominated urban forests on man-made roadside slopes in Hong Kong, based on a cross-disciplinary survey and a literature review. To conclude, we suggest that selective cutting, specific silvicultural operations of Acacia plantations, and the management of plantation edge and soils can be exercised, along with the planting of native species, to potentially alleviate these problems associated with mature Acacia plantations, by promoting the establishment of native forests, enhancing biodiversity, expediting succession, and providing better ecosystem services.

ObjectiveThe objective of this systematic review was to explore the incidence of lower limb injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players who are under 18 years old. The review sought to identify the mechanisms and types of injury sustained and to compare between sports. DesignThis systematic review of the literature focussed on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball (rugby union, rugby league, soccer, Australian Rules and Gaelic football). A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. Prospective cohort studies, retrospective studies, longitudinal studies and epidemiology studies written in English were included. The Standard Quality Assessment Criteria appraisal tool¹ was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers. ResultsSixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1) and these studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55,882 participants, aged 7 – 19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports. Summary Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury.

Tropospheric ozone (O3) is the third most important anthropogenic greenhouse gas. O3 is detrimental to plant productivity, and it has a significant impact on crop yield. Currently, the Joint UK Land Environment Simulator (JULES) land surface model includes a representation of global crops (JULES-crop), but does not have crop-specific O3 damage parameters, and applies default C3 grass O3 parameters for soybean that underestimates O3 damage. Physiological parameters for O3 damage in soybean in JULES-crop were calibrated against leaf gas-exchange measurements from the Soybean Free-Air-Concentration-Enrichment (SoyFACE) with O3 experiment in Illinois, USA. Other plant parameters were calibrated using an extensive array of soybean observations such as crop height, leaf carbon, etc. and meteorological data from FLUXNET sites near Mead, Nebraska, USA. The yield, aboveground carbon and leaf area index (LAI) of soybean from the SoyFACE experiment were used to evaluate the newly calibrated parameters. The result shows good performance for yield, with the modelled yield being within the spread of the SoyFACE observations. Although JULES-crop is able to reproduce observed LAI seasonality, its magnitude is underestimated. The newly calibrated version of JULES will be applied regionally and globally in future JULES simulations. This study helps to build a state-of-the-art impact assessment model and contribute to a more complete understanding of the impacts of climate change on food production.

Introduction We observed discordant sodium results from a patient with severe hypernatremia such that whole-blood analysis produced results up to 9.6 mmol/L higher than plasma sodium obtained on the same collection. We investigated this bias by comparing other patients’ sodium results and performing comparisons of 3 blood gas and 2 chemistry analyzers. Methods First, the laboratory information system was queried for whole-blood sodium results >160 mmol/L, which were used for comparison against plasma results from the same collection. Second, whole blood was collected from a healthy donor, a portion of which was spiked with sodium chloride to generate 8 samples with target concentrations of 140 to 185 mmol/L. Whole-blood sodium was measured in duplicate on the ABL90, RAPIDPoint 500, and GEM 4000. Plasma sodium was then measured in duplicate on the Architect c8000 and Cobas c702. Finally, plasma was injected on the blood gas analyzers to measure sodium in singleton. Results Overall, 53 paired results from patients showed a significant positive bias on the ABL90 relative to Vitros when sodium was >160 mmol/L. The magnitude of difference was insignificant within the reference range but increased proportionately with concentration. The magnitude and pattern of positive bias in ABL90 sodium results were consistent with the observation in patient results. Conclusion In severe hypernatremia, sodium results produced by blood gas and plasma analyzers can differ significantly.

Objective: To evaluate the performance of the epoc hand-held analyzer against the RAPIDPoint 500 blood gas analyzer and laboratory analyzers where applicable. Methods: Venous or arterial whole blood samples collected in balanced heparinized syringes were obtained from 69 patients (35 females, 34 males) predominantly (77%) from the surgical unit and intensive care unit (ICU). Method comparison was performed for all analytes on the epoc System against the RAPIDPoint 500 Blood gas analyzer or laboratory analyzers where applicable. Results: Mean bias was

Hong Kong is one of the most densely populated cities in the world, with millions of people exposed to severe air pollution. (1) Background: Surface ozone, mostly produced photochemically from anthropogenic precursor gases is harmful to both human and vegetation. The phytotoxicity of ozone has been shown to damage plant photosynthesis, induce early leaf death and retard growth. (2) Methods: We use genotypes of bush bean Phaseolus vulgaris with various degrees of sensitivity to ozone to investigate the impacts of ambient ozone on the morphology and development of the bean. We use ozone-induced foliar injury index and measure the flowerings and fruit production to quantify the ozone stress on the plants. (3) Results: We expected that the ozone-sensitive genotype would suffer from a reduction of yield. Results however show that the ozone-sensitive genotype suffers higher ozone-induced foliar damage as expected but produces more pods and beans and heavier beans than the ozone-resistant genotype. (4) Conclusions: It is postulated that the high ozone sensitivity of the sensitive genotype causes stress-induced flowering and therefore results in higher bean yield. A higher-than-ambient concentration of ozone is needed to negatively impact the yield production of the ozone-sensitive genotype. This study demonstrate the usefulness of bioindicators to monitor the phytotoxic effects of ozone pollution in a subtropical city such as Hong Kong.

We examine the effect of university education on students' non-cognitive skills (NCS) using high-quality Australian longitudinal data. To isolate the skill-building effects of tertiary education, we follow the education decisions and NCS - proxied by the Big Five personality traits - of 575 adolescents over eight years. Estimating a standard skill production function, we demonstrate a robust positive relationship between university education and extraversion, and agreeableness for students from disadvantaged backgrounds. The effects are likely to operate through exposure to university life rather than through degree-specific curricula or university-specific teaching quality. As extraversion and agreeableness are associated with socially beneficial behaviours, we propose that university education may have important non-market returns.

Objectives There is a high incidence of injuries in rugby union due to the physical nature of the game. There is a lack of large-scale injury surveillance data reported for school level rugby players of different ages. Our study aimed to investigate the frequency and nature of injuries being sustained during an Australian school level rugby union season. Design Prospective observational study. Methods Injury surveillance was conducted on 3585 rugby players from all 8 schools participating in an interschool rugby competition in Queensland, Australia. Match injury data were collected using paper-based injury recording forms during the season using a ‘medical-attention’ injury definition for each age group from opens (17 and 18 year olds) through to year 5 teams (9–10 year olds). Results There were 332 injuries recorded over 14,029 player hours during the season. The overall rate of injury was 23.7/1000 player hours (95% CI, 21.2–26.3). The incidence of upper and lower limb injuries were 6.3 and 5.6 injuries/1000 player hours respectively (95% CI, 5.1–7.8 and 4.5–7.0). The incidence of suspected concussion injuries was 4.3/1000 player hours (95% CI, 3.6–5.5). Injuries differed across age groups and tackling was the most common mechanism of injury. Conclusions The injury patterns observed in this large sample of players could be used to guide injury prevention programs in school level rugby union. Injury prevention programs should include age appropriate interventions and focus on improving the techniques used during the contact phase of rugby.

Background The diagnostic utility of laboratory tests in paediatric medicine relies heavily on the availability of appropriate reference intervals (RIs). The Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) has established a comprehensive database of covariate-stratified RIs for many paediatric laboratory tests using a large, healthy reference population. Several automated analysers in widespread use in clinical laboratories have already been studied. Here, we extend the testing to Roche immunoassays and report, for the first time, comprehensive paediatric RIs for 17 endocrine and special chemistry markers. Methods A total of 741 healthy children and adolescents (1 day to Results Reference values for all analytes measured required age partitioning, particularly during early life and throughout adolescence. Of the 17 analytes measured, eight required sex partitioning, including ferritin, thyroid stimulating hormone (TSH), total triiodothyronine (TT3) and all fertility/sex hormones, except prolactin. Conclusions This is the first study to determine accurate paediatric RIs for Roche immunoassays. RIs were generally similar to those previously published by CALIPER on other analytical platforms, highlighting the reproducibility of age- and sex-specific trends in reference values observed across the paediatric age range. The RIs established in this study will improve the accuracy of test result interpretation and clinical decision-making in clinical laboratories utilising Roche immunoassays.

There is a high incidence of injuries in rugby union due to the physical nature of the game. In youth rugby union, there are large variations in injury rates reported. Our study investigated the rates of injuries in school-level rugby union players in Australia using the consensus statement for rugby union injuries. Injury surveillance was conducted on 480 rugby players from 1 school in Queensland, Australia. Injury data were collected using paper-based injury recording forms during the 8-week rugby season using a "medical-attention" injury definition. In total, 76 players sustained one or more injuries, with a total of 80 injuries recorded. The overall injury rate was 31.8 injuries/1000 match player hours (95% CI, 25.4-39.4). Concussion had an incidence rate of 6.0/1000 match player hours (95% CI, 3.5-9.6). The incidence of upper limb and lower limb injuries were 9.1 and 9.9/1000 match player hours, respectively (95% CI, 5.9-13.5 and 6.6-14.5). The older age divisions had higher injury rates and most injuries occurred while tackling or being tackled. The injury rates observed in this sample of Australian school rugby union players provides direction for future studies to enable informed decisions relating to development of injury prevention programmes at this level of rugby.

It is widely believed that work-related training increases a worker's probability of moving up the job-quality ladder. This is usually couched in terms of effects on wages, but it has also been argued that training increases the probability of moving from non-permanent forms of employment to more permanent employment. This hypothesis is tested using nationally representative panel data for Australia, a country where the incidence of non-permanent employment, and especially casual employment, is high by international standards. While a positive association between participation in work-related training and the subsequent probability of moving from either casual or fixed-term contract employment to permanent employment is observed among men, this is shown to be driven not by a causal impact of training on transitions but by differences between those who do and do not receive training, that is selection bias.

(1) Background: Hong Kong is one of the most densely populated cities in the world, with millions of people exposed to severe air pollution. Surface ozone, mostly produced photochemically from anthropogenic precursor gases, is harmful to both humans and vegetation. The phytotoxicity of ozone has been shown to damage plant photosynthesis, induce early leaf death, and retard growth. (2) Methods: We use genotypes of bush bean Phaseolus vulgaris with various degrees of sensitivity to ozone to investigate the impacts of ambient ozone on the morphology and development of the beans. We use ozone-induced foliar injury index and measure the flowering and fruit production to quantify the ozone stress on the plants. (3) Results: We expected that the ozone-sensitive genotype would suffer from a reduction of yield. Results, however, show that the ozone-sensitive genotype suffers higher ozone-induced foliar damage as expected but produces more pods and beans and heavier beans than the ozone-resistant genotype. (4) Conclusions: It is postulated that the high ozone sensitivity of the sensitive genotype causes stress-induced flowering, and therefore results in higher bean yield. A higher than ambient concentration of ozone is needed to negatively impact the yield production of the ozone-sensitive genotype. Meanwhile, ozone-induced foliar damage shows a graduated scale of damage pattern that can be useful for indicating ozone levels. This study demonstrates the usefulness of bioindicators to monitor the phytotoxic effects of ozone pollution in a subtropical city such as Hong Kong.