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Purpose: To assess associations between sedentary time (ST), physical activity (PA), and cardiovascular health in early childhood. Method: Cross-sectional study including 160 children (age 6.1 y [SD 0.5], 86 boys, 93 maternal body mass index ≥ 30 kg/m2, and 73 gestational diabetes) assessed for pulse wave velocity, echocardiography, ultra-high frequency 48–70 MHz vascular ultrasound, and accelerometery. Results: Boys had 385 (SD 53) minutes per day ST, 305 (SD 44) minutes per day light PA, and 81 (SD 22) minutes per day moderate to vigorous PA (MVPA). Girls had 415 (SD 50) minutes per day ST, 283 (SD 40) minutes per day light PA, and 66 (SD 19) minutes per day MVPA. In adjusted analyses, MVPA was inversely associated with resting heart rate (β = −6.6; 95% confidence interval, −12.5 to −0.7) and positively associated with left ventricular mass (β = 6.8; 1.4–12.3), radial intima-media thickness (β = 11.4; 5.4–17.5), brachial intima-media thickness (β = 8.0; 2.0–14.0), and femoral intima-media thickness (β = 1.3; 0.2–2.3). MVPA was inversely associated with body fat percentage (β = −3.4; −6.6 to −0.2), diastolic blood pressure (β = −0.05; −0.8 to −0.1), and femoral (β = −18.1; −32.4 to −0.8) and radial (β = −13.4; −24.0 to −2.9) circumferential wall stress in boys only. ST and pulse wave velocity showed no significant associations. Conclusions: In young at-risk children, MVPA is associated with cardiovascular remodeling, partly in a sex-dependant way, likely representing physiological adaptation, but ST shows no association with cardiovascular health in early childhood. [ABSTRACT FROM AUTHOR]

Purpose: Neuroimaging is often used in the emergency department (ED) to evaluate for posterior circulation strokes in patients with dizziness, commonly with CT/CTA due to speed and availability. Although MRI offers more sensitive evaluation, it is less commonly used, in part due to slower turnaround times. We assess the potential for abbreviated MRI to improve reporting times and impact on length of stay (LOS) compared to conventional MRI (as well as CT/CTA) in the evaluation of acute dizziness. Materials and methods: We performed a retrospective analysis of length of stay via LASSO regression for patients presenting to the ED with dizziness and discharged directly from the ED over 4 years (1/1/2018-12/31/2021), controlling for numerous patient-level and logistical factors. We additionally assessed turnaround time between order and final report for various imaging modalities. Results: 14,204 patients were included in our analysis. Turnaround time for abbreviated MRI was significantly lower than for conventional MRI (4.40 h vs. 6.14 h, p < 0.001) with decreased impact on LOS (0.58 h vs. 2.02 h). Abbreviated MRI studies had longer turnaround time (4.40 h vs. 1.41 h, p < 0.001) and was associated with greater impact on ED LOS than non-contrast CT head (0.58 h vs. 0.00 h), however there was no significant difference in turnaround time compared to CTA head and neck (4.40 h vs. 3.86 h, p = 0.06) with similar effect on LOS (0.58 h vs. 0.53 h). Ordering both CTA and conventional MRI was associated with a greater-than-linear increase in LOS (additional 0.37 h); the same trend was not seen combining CTA and abbreviated MRI (additional 0.00 h). Conclusions: In the acute settings where MRI is available, abbreviated MRI protocols may improve turnaround times and LOS compared to conventional MRI protocols. Since recent guidelines recommend MRI over CT in the evaluation of dizziness, implementation of abbreviated MRI protocols has the potential to facilitate rapid access to preferred imaging, while minimizing impact on ED workflows. [ABSTRACT FROM AUTHOR]

Microsystems represent an alternative but proficient approach of analysis outside the laboratory, and their use could help in reducing the impact of pre-analytical errors, in particular in challenging newborn samples. The study purpose is to compare the Horiba Microsemi CRP LC-767G system for rapid 3-part complete blood count (CBC) and C-reactive protein (CRP) determination with the laboratory reference systems (respectively Sysmex XN-9100™ and Roche Cobas® c702) in samples of adult patients and newborns hospitalized in the neonatal intensive care unit (NICU) samples. The comparison between the analyzers was performed through Passing-Bablok regression analysis and Bland–Altman plot. One hundred eighty-three blood samples were analyzed. The regression analysis results, performed in the newborn (n = 70) and in adult (n = 113) populations, showed a good agreement between the instruments. The evaluation of the Bland–Altman plots showed comparable values of bias < 10% for most of the parameters, but not for MPV, lymphocyte, and monocyte count. Conclusion: The comparison between the Microsemi CRP LC-767G system and the laboratory instrumentations demonstrated comparable results. The Microsemi CRP LC-767G system provides reliable analytical data and faster turnaround time, particularly useful in NICU. What is Known: • Microsystems for point-of-care testing (POCT) represent an alternative but proficient approach of analysis outside the laboratory, in order to perform a rapid, safe, and exhaustive evaluation for critical patients' management, acting as a valid support for treatment in acute care. What is New: • The Microsemi CRP LC-767G system can represent an alternative but effective testing approach outside the laboratory, particularly in NICU, to reduce the impact of pre-analytical errors on newborn samples. [ABSTRACT FROM AUTHOR]

Purpose: Blood culture (BC) is the gold standard for diagnosing blood stream infections (BSI) but is limited by long turnaround times (TAT) and low detection rate. The T2 Magnetic Resonance method (T2MR) offers a rapid, culture-independent alternative. The objective of this study was to compare the performance of the T2Bacteria assay to BCs in a real-world setting. Methods: Retrospective comparative study consisting of T2Bacteria samples and BCs sampled within 72 h from the T2Bacteria sample. The primary outcome was detections by BC and T2Bacteria, respectively. The secondary outcome was difference in TAT. Results: In total, 640 episodes were included, consisting of 640 T2Bacteria samples and 2,117 BCs. A median of three BCs was collected for each T2Bacteria sample. Overall positivity was 101 (15.8%) by either method. In 29 (28.7%) episodes, both T2Bacteria and BC were concordantly positive. In discordant episodes, 46/101 (45.5%) episodes were T2Bacteria positive/BC negative and 26/101 (25.7%) were T2Bacteria negative/BC positive (McNemar χ2, p < 0,05). In T2Bacteria positive/BC negative episodes, eight had growth of the same microorganism in a non-BC culture. Median (IQR) TAT for BC was 35 h and 30 min (25 h 50 min − 45 h 24 min), compared to 21 h and 3 min (17 h 6 min − 27 h 30 m) for T2Bacteria (p < 0.001), with longer delays for samplings occurring outside work hours. Conclusions: The study highlights a high discordance between T2Bacteria and BC and suggests complementary roles of the methods in BSI diagnostics. Furthermore, it is crucial to improve TAT by reducing preanalytical delays. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a new, less-invasive micro-computed tomography (CT) service on autopsy service provision. We recorded parental consent, type of autopsy performed, autopsy reporting times and time taken for the body to be released from the mortuary. A retrospective, single-centre case series was conducted for all perinatal deaths since the introduction of our micro-CT service in 2016, with a detailed review of records extracted from 2019 and 2021. Fetal demographics (gestational age, weight), type of autopsy conducted, and the time taken from receiving the body to releasing the body and issuing a final report were recorded. Micro-CT imaging uptake increased to over two hundred cases/year by 2021. Overall, invasive autopsies reduced from (45.8%, 196/428; 2019) to (32.1%, 125/390; 2021) with an equivalent rise in less-invasive autopsy from 54.2% (232/428;2019) to 67.9% (265/390;2019). Offering a micro-CT service resulted in an increase in consent to imaging-based autopsies from (76.9%, 329/428;2019) to (87.2%, 340/390;2021). Micro-CT has become the most common post-mortem imaging performed in our institution at 54.4% (212/251;2021), although the body preparation time from the tissue staining required has increased the time to provide an autopsy report to 17 days and release of the body to 18 days. Our study shows that introducing a micro-CT post-mortem imaging service was associated with reduced use of conventional invasive procedures, despite a slight increase in turnaround times. Understanding these factors and continued improvements in micro-CT service delivery will help make this accessible to a wider population in the future. • Micro-CT offers parents an alternative investigation following a pregnancy loss. • Offering micro-CT reduced the usage of conventional autopsies. • Increased less-invasive autopsy availability results in increased demand. • Micro-CT takes slightly longer than conventional autopsy but does not affect uptake. [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]

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]

AbstractObjectiveMethodsResultsConclusionsAccurate and rapid identification of causative pathogens is essential to guide the clinical management of lower respiratory tract infections (LRTIs). Here we conducted a single-centre prospective study in 284 patients suspected of lower respiratory tract infections to evaluate the utility of a nucleic acid test based on highly multiplexed polymerase chain reaction (PCR) and CRISPR-Cas12a.We determined the analytical and diagnostic performance of the CRISPR assay using a combination of reference standards, including conventional microbiological tests (CMTs), metagenomic Next-Generation Sequencing (mNGS), and clinical adjudication by a panel of experts on infectious diseases and microbiology.The CRISPR assay showed a higher detection rate (63.0%) than conventional microbiological tests (38.4%) and was lower than metagenomic Next-Generation Sequencing (72.9%). In detecting polymicrobial infections, the positivity rate of the CRISPR assay (19.4%) was higher than conventional microbiological tests (3.5%) and lower than metagenomic Next-Generation Sequencing (28.9%). The overall diagnostic sensitivity of the CRISPR assay (67.8%) was higher than conventional microbiological tests (41.8%), and lower than metagenomic Next-Generation Sequencing (93.2%).Considering the low cost, ease of operation, short turnaround time, and broad range of pathogens detected in a single test, the CRISPR assay has the potential to be implemented as a screening tool for the aetiological diagnosis of lower respiratory tract infections patients, especially in cases where atypical bacteria or coinfections are suspected. [ABSTRACT FROM AUTHOR]

Background : Metagenomics is a powerful approach for the detection of unknown and novel pathogens. Workflows based on Illumina short-read sequencing are becoming established in diagnostic laboratories. However, high sequencing depth requirements, long turnaround times, and limited sensitivity hinder broader adoption. We investigated whether we could overcome these limitations using protocols based on untargeted sequencing with Oxford Nanopore Technologies (ONT), which offers real-time data acquisition and analysis, or a targeted panel approach, which allows the selective sequencing of known pathogens and could improve sensitivity. Methods: We evaluated detection of viruses with readily available untargeted metagenomic workflows using Illumina and ONT, and an Illumina-based enrichment approach using the Twist Bioscience Comprehensive Viral Research Panel (CVRP), which targets 3153 viruses. We tested samples consisting of a dilution series of a six-virus mock community in a human DNA/RNA background, designed to resemble clinical specimens with low microbial abundance and high host content. Protocols were designed to retain the host transcriptome, since this could help confirm the absence of infectious agents. We further compared the performance of commonly used taxonomic classifiers. Results: Capture with the Twist CVRP increased sensitivity by at least 10–100-fold over untargeted sequencing, making it suitable for the detection of low viral loads (60 genome copies per ml (gc/ml)), but additional methods may be needed in a diagnostic setting to detect untargeted organisms. While untargeted ONT had good sensitivity at high viral loads (60,000 gc/ml), at lower viral loads (600–6000 gc/ml), longer and more costly sequencing runs would be required to achieve sensitivities comparable to the untargeted Illumina protocol. Untargeted ONT provided better specificity than untargeted Illumina sequencing. However, the application of robust thresholds standardized results between taxonomic classifiers. Host gene expression analysis is optimal with untargeted Illumina sequencing but possible with both the CVRP and ONT. Conclusions: Metagenomics has the potential to become standard-of-care in diagnostics and is a powerful tool for the discovery of emerging pathogens. Untargeted Illumina and ONT metagenomics and capture with the Twist CVRP have different advantages with respect to sensitivity, specificity, turnaround time and cost, and the optimal method will depend on the clinical context. [ABSTRACT FROM AUTHOR]

Background and Objectives Materials and Methods Results Conclusion To develop key performance indicators (KPI) for use in quality assessment of our institutional goal‐directed massive transfusion (GDMT).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.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.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]

Antimicrobial susceptibility testing (AST) is a core function of the clinical microbiology laboratory and is critical to the management of patients with bloodstream infections (BSIs) to facilitate optimal antibiotic therapy selection. Recent technological advances have resulted in several rapid methods for determining susceptibility direct from positive blood culture that can provide turnaround times in under 8 h, which is considerably shorter than conventional culture-based methods. As diagnostic results do not directly produce a medical intervention, actionability is a primary determinant of the effect these technologies have on antibiotic use and ultimately patient outcomes. Randomized controlled trials and observational studies consistently show that rapid AST significantly reduces time to results and improves antimicrobial therapy for patients with BSI across various methods, patient populations and organisms. To date, the clinical impact of rapid AST has been demonstrated in some observational studies, but randomized controlled trials have not been sufficiently powered to validate many of these findings. This article reviews various metrics that have been described in the literature to measure the impact of rapid AST on actionability, antibiotic exposure and patient outcomes, as well as highlighting how implementation and workflow processes can affect these metrics. [ABSTRACT FROM AUTHOR]

Background Bloodstream infections are linked to heightened morbidity and mortality rates. The consequences of delayed antibiotic treatment can be detrimental. Effective management of bacteraemia hinges on rapid antimicrobial susceptibility testing. Objectives This retrospective study examined the influence of the VITEK® REVEAL™ Rapid AST system on positive blood culture (PBC) management in a French tertiary hospital. Materials and methods Between November 2021 and March 2022, 79 Gram-negative monomicrobial PBC cases underwent testing with both VITEK®REVEAL™ and VITEK®2 systems. Results The study found that VITEK®REVEAL™ yielded better results than the standard of care, significantly shortening the time to result (7.0 h compared to 9.6 h) as well as the turnaround time (15 h compared to 31.1 h) when applied for all isolates. Conclusions This study implies that the use of VITEK®REVEAL™ enables swift adaptations of antibiotic treatment strategies. By considerably minimizing the turnaround time, healthcare professionals can promptly make necessary adjustments to therapeutic regimens. Notably, these findings underscore the potential of VITEK®REVEAL™ in expediting appropriate antibiotic interventions, even in less ideal conditions. Further studies in varied laboratory contexts are required to validate these encouraging outcomes. [ABSTRACT FROM AUTHOR]

Background Development of rapid bacterial identification from blood cultures has been an area of intense study in diagnostic microbiology. Shortened turnaround time coupled with antimicrobial stewardship interventions have been shown to improve patient outcomes and decrease healthcare-associated costs. Objectives We report the validation of a short incubation method for Gram-positive and Gram-negative bacterial identification utilizing MALDI-TOF MS without additional instrumentation, processing or cost compared with current practice. Methods Prospective, observational, single-centre study in a quaternary care academic hospital encompassing 376 blood cultures subjected to bacterial identification after short incubation periods of 3–4 and 6–8 h. Results There was 97.5% species-level identification agreement with tests undertaken after 3–4 h incubation with 83.6% isolates identified, and 99.7% species-level identification agreement after 6–8 h incubation with 96.7% isolates identified. Conclusions The short incubation method provides a rapid MALDI-TOF MS bacterial identification method, reducing turnaround time by 10–18 h compared with standard practice without additional cost, processing or instrumentation. [ABSTRACT FROM AUTHOR]

Summary Imagine if we could simultaneously predict spatial protein expression in tissues from their routine Hematoxylin and Eosin (H&E) stained images, and create tissue images given protein expression profiles thus enabling virtual simulations of how protein expression alterations impact histology in complex diseases like cancer. Such an approach could lead to more informed diagnostic and therapeutic decisions for precision medicine at lower costs and shorter turnaround times, more detailed insights into underlying disease pathology as well as improvement in predictive and generative performance. In this study, we investigate the intricate correlation between protein expressions obtained from Hyperion mass cytometry and histopathological microstructures in conventional H&E stained glioblastoma (GBM) samples, unveiling morphological patterns and cellular-level spatial alterations associated with protein expression changes. To model these complex relationships, we propose a novel generative-predictive framework called Ouroboros for producing H&E images from protein expressions and simultaneously predicting protein expressions from H&E images. Our comprehensive sample-independent validation over 9920 tissue spots from 4 GBM samples encompassing visual image analysis, quantitative analysis, subspace alignment and perturbation experiments shows that the proposed generative-predictive approach offers significant improvements in predicting protein expression from images in comparison to baseline methods as well as accurate generation of virtual GBM sample images. This proof of concept study can contribute to advancing our understanding of histological responses to protein expression perturbations and lays the foundations for further developments in this area. Availability and implementation Implementation and associated data for the proposed approach are available at the URL: https://github.com/Srijay/Ouroboros. [ABSTRACT FROM AUTHOR]

Current malaria diagnostic methods require blood collection, which may be associated with pain and the risk of transmitting blood-borne pathogens, and often create poor compliance when repeated sampling is needed. This study determined the potential use of non-invasive methods (saliva and urine specimens) as alternative sample sources for the diagnosis of malaria infection using real-time polymerase Chain Reaction (qPCR) among children below five years in Nnewi, Anambra State, Nigeria. Biomarkers (18S rRNA) were captured and concentrated from saliva and urine samples using a magnetic bead-based method. DNA recovered from the saliva and urine samples was amplified using qPCR. The results revealed that, out of the 552 participants recruited in this study, the malaria prevalence based on blood microscopy was 55.1%. The prevalence of malaria among children based on the qPCR of saliva specimens was 343 (62.1%), out of which 301 (87.7%) were true positives (TP) and 42 (12.3%) were false positives (FP) when compared with microscopy. Moreover, the prevalence of malaria among children based on qPCR of urine specimens was 269 (48.7%), of which 237 (88.1%) were true positive (TP) and 32 (11.9%) were false positive (FP). When the qPCR method was compared to thick blood film-microscopy as the reference standard, saliva qPCR had a sensitivity of 98.7%, specificity of 80.0%, positive predictive value (PPV) of 87.2%, and negative predictive value (NPV) of 97.8%; urine qPCR had a sensitivity of 88.1%, specificity of 84.3%, PPV of 88.5%, and NPV of 83.8%. Saliva and urine samples are therefore promising non-invasive approaches for malaria diagnosis, and their qPCR has a sensitivity comparable to that of blood microscopy, despite the limitations of cost and turnaround time. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic decisions in early breast cancer are based on clinico-pathological features which are subject to intra- and inter-observer variability. This single-center decision impact study aimed to evaluate the effects of the Prosigna assay on physicians' adjuvant treatment choices. Methods: Between 09/2017 and 02/2018, formalin-fixed tumor samples from 52 newly diagnosed, postmenopausal, hormone receptor-positive, HER2-negative breast cancer (T1–T2; pN0-N1a) patients were analyzed. Pre-test clinical judgements and Prosigna test results were compared. Results: The mean age was 59 (42–77). Invasive ductal carcinoma (79.2%), grade 2 (52.8%) and T1c-N0 tumors (43.4%) were represented. There was 40.4% discordance between the pre- and post-test risk of recurrences. No significant change was observed in the clinical intermediate risk category, while there was a net reclassification of low-risk patients into a high Prosigna recurrence risk group. In addition, clinically determined intrinsic subtypes were 34.6% discordant with the Prosigna results, which is largely driven by the reclassification of the luminal A tumors into the Prosigna-assessed luminal B group. Before the Prosigna test, endocrine treatment was the primary choice in 20 patients (39.2%), and chemotherapy was recommended to 31 patients (60.8%). Overall, the Prosigna assay led to a change in treatment choice for one patient. Conclusions: Although conventional risk assessment methods are relatively inexpensive with shorter turnaround times, their accuracy and value for risk reduction are suboptimal. According to our results, the Prosigna assay was found to be a relevant tool for the clinical decision making process. Long-term follow-up of these patients will elucidate the potential benefits of using multigene molecular tests as biomarkers for treatment. [ABSTRACT FROM AUTHOR]

Managing neonatal sepsis is challenging due to nonspecific clinical signs, hematological markers with poor accuracy, and a lengthy turnaround time for the identification of microorganisms. Delaying the initiation of antibiotics in truly infected infants can lead to severe morbidity and mortality. Therefore, decisions regarding empiric antibiotic treatment are risk stratified, which exposes many uninfected infants to antibiotics. This causes gut microbiota perturbation, unnecessary hospital admissions, and the generation of multi-resistant organisms. High-speed diagnostic assays could expedite discontinuation or avert the initiation of antibiotics in uninfected infants. This study will evaluate the diagnostic performance of molecular culture (MC), a rapid broad-range PCR-based bacterial profiling technique, for diagnosing neonatal sepsis in infants below 90 days old. A multi-center prospective observational cohort study will include infants evaluated for early and late-onset sepsis. Routine evaluation for suspected sepsis includes microbiological cultures of blood. Additionally, blood for MC will be collected. For early-onset sepsis, umbilical cord blood may be used alternatively. Primary outcome is the agreement between MC and conventional blood culture results. Secondary outcome is the agreement of both assays with clinical sepsis using four different, commonly used definitions. Faster diagnostic pathways for sepsis may reduce antibiotic exposure time. Broad-range molecular assays may identify pathogens undetectable by conventional methods. Employment of umbilical cord blood samples for early-onset sepsis diagnosis can resolve challenges in collecting adequate blood volume and could further expedite treatment decisions. [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]

Timing cues such as interaural time differences (ITDs) and temporal pitch are pivotal for sound localization and source segregation, but their perception is degraded in cochlear-implant (CI) listeners as compared to normal-hearing listeners. In multi-electrode stimulation, intra-aural channel interactions between electrodes are assumed to be an important factor limiting access to those cues. The monaural asynchrony of stimulation timing across electrodes is assumed to mediate the amount of these interactions. This study investigated the effect of the monaural temporal electrode asynchrony (mTEA) between two electrodes, applied similarly in both ears, on ITD-based left/right discrimination sensitivity in five CI listeners, using pulse trains with 100 pulses per second and per electrode. Forward-masked spatial tuning curves were measured at both ears to find electrode separations evoking controlled degrees of across-electrode masking. For electrode separations smaller than 3 mm, results showed an effect of mTEA. Patterns were u/v-shaped, consistent with an explanation in terms of the effective pulse rate that appears to be subject to the well-known rate limitation in electric hearing. For separations larger than 7 mm, no mTEA effects were observed. A comparison to monaural rate-pitch discrimination in a separate set of listeners and in a matched setup showed no systematic differences between percepts. Overall, an important role of the mTEA in both binaural and monaural dual-electrode stimulation is consistent with a monaural pulse-rate limitation whose effect is mediated by channel interactions. Future CI stimulation strategies aiming at improved timing-cue encoding should minimize the stimulation delay between nearby electrodes that need to be stimulated successively. [ABSTRACT FROM AUTHOR]

The increasing prevalence of gut colonization with CTX-M extended-spectrum β-lactamase- and/or DHA plasmid-mediated AmpC-producing Escherichia coli is a concern. Here, we evaluate Nanopore-shotgun metagenomic sequencing (Nanopore-SMS) latest V14 chemistry to detect blaCTX-M and blaDHA genes from healthy stools. We test 25 paired samples characterized with culture-based methods (native and pre-enriched). Antimicrobial resistant genes (ARGs) are detected from reads and meta-assembled genomes (MAGs) to determine their associated genetic environments (AGEs). Sensitivity and specificity of native Nanopore-SMS are 61.1% and 100%, compared to 81.5% and 75% for pre-enriched Nanopore-SMS, respectively. Native Nanopore-SMS identifies only one sample with an AGE, whereas pre-enriched Nanopore-SMS recognizes 9/18 plasmids and 5/9 E. coli chromosomes. Pre-enriched Nanopore-SMS identifies more ARGs than native Nanopore-SMS (p < 0.001). Notably, blaCTX-Ms and blaDHAs AGEs (plasmid and chromosomes) are identified within 1 hour of sequencing. Furthermore, microbiota analyses show that pre-enriched Nanopore-SMS results in more E. coli classified reads (47% vs. 3.1%), higher differential abundance (5.69 log2 fold) and lower Shannon diversity index (p < 0.0001). Nanopore-SMS has the potential to be used for intestinal colonization screening. However, sample pre-enrichment is necessary to increase sensitivity. Further computational improvements are needed to reduce the turnaround time for clinical applications. In this work, authors employ Nanopore-based shotgun metagenomic sequencing for the screening of antimicrobial resistance genes (blaCTX-M/blaDHA) in human stool samples. [ABSTRACT FROM AUTHOR]

Cloud computing is a popular, flexible, scalable, and cost-effective technology in the modern world that provides on-demand services dynamically. The dynamic execution of user requests and resource-sharing facilities require proper task scheduling among the available virtual machines, which is a significant issue and plays a crucial role in developing an optimal cloud computing environment. Round Robin is a prevalent scheduling algorithm for fair distribution of resources with a balanced contribution in minimized response time and turnaround time. This paper introduced a new enhanced round-robin approach for task scheduling in cloud computing systems. The proposed algorithm generates and keeps updating a dynamic quantum time for process execution, considering the available number of process in the system and their burst length. Since our method dynamically runs processes, it is appropriate for a real-time environment like cloud computing. The notable part of this approach is the capability of scheduling tasks with asymmetric distribution of burst time, avoiding the convoy effect. The experimental result indicates that the proposed algorithm has outperformed the existing improved round-robin task scheduling approaches in terms of minimized average waiting time, average turnaround time, and number of context switches. Comparing the method against five other enhanced round robin approaches, it reduced average waiting times by 15.77% and context switching by 20.68% on average. After executing the experiment and comparative study, it can be concluded that the proposed enhanced round-robin scheduling algorithm is optimal, acceptable, and relatively better suited for cloud computing environments. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal (GI) tract. Fecal calprotectin (fCAL) is a noninvasive laboratory test used in the diagnosis and monitoring of IBDs such as Crohn's disease and ulcerative colitis. The fCAL send-out test that our facility has been offering so far uses an ELISA-based method. In the current study, we sought to validate the performance of a Buhlmann fCAL turbo assay in an automated Abbott Alinity C analyzer (AFCAL) in our core laboratory. Five-day imprecision studies showed good performance for both within-run (5.3%) and between-day (2.5%) measurements. The reportable range was verified as 30–20,000 µg/g. Deming regression and Bland–Altman analysis indicated a strong correlation of r = 0.99 with a low, acceptable bias of 1.8% for AFCAL relative to the predicate Buhlmann fCAL ELISA results. AFCAL's clinical performance was determined retrospectively in 62 patients with ICD codes for IBD. Overall, the implementation of AFCAL in our routine clinical testing has improved our turnaround time, reduced the cost per test, and significantly increased our clinician satisfaction. [ABSTRACT FROM AUTHOR]

The escalation of Internet of Things (IoT) devices has led to increased data generation at the network edge that has burdened the cloud infrastructure in terms of handling and processing of data. This has led to the rapid adoption of fog computing because of its ability to bring computation and storage closer to the edge and support for real-time applications and services by reducing latency. One of the foremost challenges in the fog computing arena is minimizing turnaround time. This research paper proposes a Modified Levy Flight Firefly Algorithm (MLFFA) to optimize task scheduling for fog computing environments. Specifically, the objective is to minimize the turnaround time of tasks. Moreover, genetic operators like crossover and mutation are also employed to achieve an optimal balance between exploration and exploitation. Experimental observations undertaken show that the proposed method improves the average turnaround time by 55%, 22%, and 13%, average waiting time by 59%, 45%, and 37%, average energy consumption by 19%, 7%, and 4%, and average failure rate by 50%, 28%, and 7% compared to the existing studies, namely Load Balancing and Optimization Strategy (LBOS), Technique for Resource Allocation and Management (TRAM), and Fuzzy Golden Eagle Load Balancing (FGELB), respectively. [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis and successful treatment of drug-resistant tuberculosis (TB) demands rapid, precise, and consistent diagnostic methods to minimise the development of resistance. Therefore, this comparative study was designed to evaluate the diagnostic performance of Xpert (MTB/RIF) and Line probe assay (LPA) for detecting drug-resistant TB. Methodology: This study comprised 389 (279 pulmonary and 110 extrapulmonary) samples from patients suspected of having TB. All samples were subjected to Xpert (MTB/RIF), LPA, solid culture, and drug-susceptibility testing. Out of 320 samples, only 180 culture (gold standard) positive were included in the final evaluation. The diagnostic characteristics for methods used were determined by calculating diagnostic sensitivity, specificity, and predictive values. The agreement between all methods was determined by calculating the kappa coefficient. Results: The sensitivity and specificity for Xpert (MTB/RIF) for detecting TB were 88.5% and 96.4%, respectively, against the solid culture. On the other hand, LPA showed sensitivity and specificity at 94.3% and 100%, respectively. Xpert (MTB/RIF) showed moderate agreement (kappa 0.65, p < 0.01) – (73.3% sensitivity; 97.6% specificity) for the detection of rifampicin resistance. However, LPA achieved better diagnostic accuracy (kappa 0.80, p < 0.01) – (84.6% sensitivity; 98.4% specificity) against drug-resistant TB. Conclusions: Xpert (MTB/RIF) and LPA have outstanding diagnostic sensitivity and specificity against RIF resistance with a shorter turnaround time, which could result in a substantial therapeutic outcome. Our findings showed LPA superiority over Xpert (MTB/RIF) for drug resistance. However, due to operational challenges, the requirement of technical expertise and infrastructure issues, LPA cannot be used as point-of-care testing in resource-limited countries. [ABSTRACT FROM AUTHOR]

Background The World Health Organization–approved Xpert MTB/XDR test detects Mycobacterium tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and injectable drugs directly in specimens. This pragmatic, laboratory-based study assessed the diagnostic accuracy and feasibility of a reflex testing approach, where Xpert MTB/XDR was performed on residual specimens previously processed for Xpert MTB/RIF Ultra. Methods Routine respiratory specimens, processed for Xpert MTB/RIF Ultra, were stored in sample reagent buffer at 2°C–8°C. If rifampicin resistant, the residual specimen was assessed for adequate volume (≥2 mL) and tested with Xpert MTB/XDR, with storage time recorded. A second specimen was used for routine and reference standard testing (culture and sequencing). Results Specimens (99% sputum) from 763 participants submitted to 2 large routine laboratories were included. Xpert MTB/XDR yielded valid resistance detection results in 639 (84%), compared with 507 (66%) for routine testing (difference [95% CI], 18% [13%–22%]). The median turnaround time for results was 23 hours for Xpert MTB/XDR and 15 days for routine testing. While 748 specimens (98%) were ≥2 mL, only 102 (13%) were stored for ≤4 hours. By the reference standard, 284 of 394 (72%) were isoniazid resistant, and 57 of 380 (15%) were fluroquinolone resistant. The sensitivities of Xpert MTB/XDR were 94% (95% CI, 91%–97%) for isoniazid and 91% (81%–97%) for fluoroquinolone resistance detection. The specificities were 98% (94%–100%) and 100% (98%–100%), respectively. Conclusions Xpert MTB/XDR performed favorably compared with the reference, and the reflex testing approach increased results availability over routine testing, while dramatically decreasing turnaround time from weeks to hours. Laboratory workflow precluded testing within the manufacturer-recommended 4-hour storage time, but longer storage did not appear detrimental. [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: Liver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient's recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient's post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery. Methods: Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery. Results: This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien–Dindo grade III or above complications, no 30-day readmission and 90-day mortalities. Conclusion: This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner. [ABSTRACT FROM AUTHOR]

Objectives Complete blood count and differential (CBC diff) is a common laboratory test that may be overused or misordered, particularly in an inpatient setting. We assessed the ability of a clinical decision support (CDS) alert to decrease unnecessary orders for CBC diff and analyzed its impact in the laboratory. Methods We designed 3 CDS alerts to provide guidance to providers ordering CBC diff on inpatients at frequencies of daily, greater than once daily, or as needed. Results The 3 alerts were highly effective in reducing orders for CBC diff at the frequencies targeted by the alert. Overall, test volume for CBC diff decreased by 32% (mean of 5257 tests per month) after implementation of the alerts, with a corresponding decrease of 22% in manual differentials performed (mean of 898 per month). Turnaround time for manual differentials decreased by a mean of 41.5 minutes, with a mean decrease of up to 90 minutes during peak morning hours. Conclusions The 3 CDS alerts successfully decreased inpatient orders for CBC diff and improved the quality of patient care by decreasing turnaround time for manual differentials. [ABSTRACT FROM AUTHOR]

The next-generation magnetic recoil spectrometer (MRSnext) is being designed to replace the current MRS at the National Ignition Facility and OMEGA for measurements of the neutron spectrum from an inertial confinement fusion implosion. The MRSnext will provide a far-superior performance and faster data turnaround than the current MRS systems, i.e., a 2× and 6× improvement in energy resolution at the NIF and OMEGA, respectively, and 20× improvement in data turnaround time. The substantially improved performance of the MRSnext is enabled by using electromagnets that provide a short focal plane (12–16 cm) and unprecedented flexibility for a wide range of applications. In addition to being able to measure neutron yield, apparent ion temperature, areal density, and plasma-flow velocity over a wide range of yields, the NIF MRSnext will be able to directly, uniquely assess the alpha heating of the fuel ions through measurements of the alpha knock-on tail in the neutron spectrum. The goal is to implement a radiation-hard electronic detection system capable of providing rapid data acquisition and analysis. The development of the MRSnext will also set the foundation for the more advanced, time-resolving MRSt and serve as a testbed for its implementation on the NIF. [ABSTRACT FROM AUTHOR]

Background: Next-generation sequencing (NGS) is the most commonly used method for determining BRAF mutational status in patients with advanced melanoma. Automated PCR-based methods, such as the IdyllaTM system, are increasingly used for mutation diagnostics, but it is unclear what impact the choice of diagnostic method has on the management of melanoma. Objectives: To compare the concordance rate of BRAF V600 mutational analysis using IdyllaTM and NGS and to analyze the technical and clinical turnaround time. The clinical relevance is compared by analyzing the impact on the treatment decision. Methods: In this monocentric prospective cohort study, the BRAF mutation status of 51 patients was determined using both methods in parallel. Results: BRAF V600 mutation was detected in 23/51 cases (45%). IdyllaTM showed a 100% concordant result with a faster turnaround time (0.2 days) compared to NGS (12.2 days). In general, less tumor material was required for IdyllaTM than for NGS. Most patients received immunotherapy as a first-line therapy regardless of the BRAF V600 status. Conclusions: IdyllaTM testing proved to be a reliable and rapid alternative to NGS in the determination of BRAF V600 mutation. Although BRAF. status was available earlier, this had no influence on the treatment decision in most cases. [ABSTRACT FROM AUTHOR]

Timely pathogen identification in bloodstream infections is crucial for patient care. A comparison is made between positive blood culture (BC) pellets from serum separator tubes using a direct identification (DI) method and colonies on agar plates from a short-term incubation (STI) method with a matrix-assisted laser desorption/ionization Biotyper for the evaluation of 354 monomicrobial BCs. Both the DI and STI methods exhibited similar identification rates for different types of bacteria, except for Gram-positive and anaerobic bacteria. The DI method's results aligned closely with the STI method's results for Enterobacterales, glucose-non-fermenting Gram-negative bacilli (GNB), and carbapenem-resistant Enterobacterales. The DI method exhibited high concordance with the conventional method for GNB identification, achieving 88.2 and 87.5% accuracy at the genus and species levels, respectively. Compared with the STI method, the DI method showed a less successful performance for Gram-positive bacterial identification (50.5 vs. 71.3%; p < 0.01). The DI method was useful for anaerobic bacterial identification of slow-growing microorganisms without any need for colony growth, unlike in the STI method (46.7 vs. 13.3%; p = 0.04). However, both methods could not identify yeast in positive BCs. Overall, the DI method provided reliable results for GNB identification, offering many advantages over the STI method by significantly reducing the turnaround time and enabling quicker pathogen identification in positive BCs. [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]

Objective This study aimed to describe our experience with universal urine drug screening (UDS) with rapid confirmation (RC) via liquid chromatography mass spectrometry (LC-MS) before infant's discharge, in efforts to increase detection of neonates at risk of neonatal opioid withdrawal syndrome (NOWS) while reducing patient burden related to false positive results. Study Design Two-phase retrospective study of all pregnant women admitted to our labor and delivery (L&D) unit before (phase 1, April 2018–March 2019) and after (phase 2, October 2019–September 2020) RC of UDS was initiated. Urine samples were obtained on admission and screened for drugs using an enzyme immunoassay with positive results reflexed to confirmation via LC-MS. The turnaround time for LC-MS was 1 week in phase 1 and 24 hours in phase 2. For mothers with positive LC-MS confirmation, the infant's meconium was sent for drug screening. Positive results were determined to be true or false positive based on urinary LC-MS results. The primary outcome was the rate of opioid-positive mothers who were unanticipated. The secondary outcome was the difference in rate of neonates who were observed for NOWS, before and after implementation of RC with LC-MS. Results In phase 2, a total of 2,395 deliveries occurred of which 2,122 (88.6%) had available UDS results. Fifty-two (2.5%) women had a positive UDS for at least one drug with LC-MS confirmation. Of those, 25 were true positive and 27 were false positive. Twenty-one (84%) true positive mothers were taking opioids and 8 (37%) of them were unanticipated positives. Among mothers with positive UDS for opioids, the neonatal observation rate for development of NOWS was 100% (22/22) and 48% (21/44) before and after implementation of LC-MS RC, respectively. Conclusion Universal UDS and LC-MS RC in L&D may improve detection of unanticipated positive mothers whose infants are at risk of NOWS. RC of positive results allows intervention only for confirmed cases. Key Points Universal UDS can detect more infants at risk of NOWS. Rapid confirmation of positive UDS reduces burden. Only confirmed infants should be observed in the neonatal intensive care unit. Child Protective Services should only be notified of confirmed opioid-positive results. [ABSTRACT FROM AUTHOR]

Efficient vessel arrivals and departures are crucial for the smooth functioning of port operations and global supply chains. Nonetheless, the emergence of the Coronavirus disease (COVID-19) at the end of 2019 has presented unprecedented challenges to the shipping industry worldwide, disrupting vessel schedules and operations due to measures aimed at minimizing in-person interactions and restricting the movement of goods and people. The influence of the COVID-19 on vessel arrivals at ports around the world has been significant and far-reaching, with many ports struggling to maintain their efficiency and effectiveness. This study takes the Hong Kong port (HKP) as an example to evaluate the impact of the COVID-19 pandemic on vessel arrivals and port operations. Data from 2019 to 2022 on vessel arrivals and port operations are collected to examine whether, how, and why the pandemic has affected these arrivals and the related port operations. Specifically, we use four general indicators, namely the number of vessel calls, vessel total net tonnage (NT), vessel average gross tonnage (GT), and port total throughput, to comparatively evaluate the COVID-19 impact on vessel arrival. Additionally, we quantitatively assess the effects of COVID-19 on vessel arrival punctuality and vessel turnaround time at the HKP. Our analysis reveals that the COVID-19 and associated restrictions have led to fewer vessel calls across various vessel types, a decrease in overall port throughput, and consequently, reductions in total vessel NT and average GT. Furthermore, the pandemic-related restrictions have exacerbated vessel arrival delays and increased vessel turnaround time during the pandemic, further reducing the efficiency of port operations. To address these challenges, our study also proposes policy recommendations and management guidance for the port to enhance its resilience and efficiency in the post COVID-19 pandemic era. By shedding light on effects of the COVID-19 pandemic on vessel arrival and port operations, our study contributes to a deeper understanding of the challenges faced by the shipping industry and provides insights and recommendations for the future development of port operations in the post COVID-19 era. • Comparative analysis of Hong Kong port vessel arrival patterns and operational performance before and after the COVID-19 outbreak. • Quantitatively evaluate the effects of COVID-19 on vessel arrival punctuality and vessel turnaround time. • Analyze the correlation between vessel arrival delay and turnaround time at the HKP with global container rates. • Explore emerging approaches for efficient port operations in the post-COVID-19 era. • Propose policy suggestions and guidance on port operation and management in the post-COVID-19 era. [ABSTRACT FROM AUTHOR]

Background: The temperature changes, chemical agents, and brushing activity that resin composite restorations are exposed to in the oral environment can cause changes in surface roughness. In this study, the aim was to investigate in vitro the clinical one-year surface roughness changes of different types of composites (flowable or conventional) from the same companies by subjecting them to immersion in solutions, brushing, and thermal cycling procedures to simulate intraoral conditions. Methods: Four different resin composite brands were included in the study using both their conventional (Charisma Smart, 3M Filtek Ultimate Universal, Omnichroma, Beautifil II) and flowable resin composites (Charisma Flow, 3M Filtek Ultimate Flowable, Omnichroma Flow, Beautifil Flow Plus F00), giving 4 groups with 2 types of resin composite in each. 40 samples were prepared for each group/resin type, for a total of 320 samples. After initial surface roughness measurements by a mechanical profilometer, the samples were divided into 4 subgroups (n = 10) and immersed in solutions (distilled water, tea, coffee, or wine) for 12 days. The samples were then subjected to 10,000 cycles of brushing simulation and 10,000 cycles of thermal aging. Surface roughness measurements were repeated after the procedures. For statistical analysis, the 3-way analysis of variance and the Tukey test were used (p < 0.05). Results: It was concluded that composite groups and types had an effect on surface roughness at time t0 (p < 0.001). At time t1, the highest surface roughness value was obtained in the Beautifil-conventional interaction. When the surface roughness values between time t0 and t1 were compared, an increase was observed in the Beautifil II and Beautifil Flow Plus F00, while a decrease was observed in the other composite groups. Conclusion: Composite groups, types, and solutions had an effect on the surface roughness of resin composites. After aging procedures, it was concluded that the Beautifil group could not maintain the surface structure as it exceeded the threshold value of 0.2 μm for bacterial adhesion. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, ambulance divert in our EMS system reached critical levels. We hypothesized that eliminating ambulance divert would not be associated with an increase in the average number of daily ambulance arrivals. Our study objective was to quantify the EMS and emergency department (ED) effects of eliminating ambulance divert during the COVID-19 pandemic. Regional hospital divert data were obtained for the 10-county Twin Cities metro from MNTrac, a state-supported online system designed to allow hospitals to indicate their divert status to EMS. ED metrics are reported for a single Level I trauma center and were obtained by a deidentified data pull from our electronic medical record covering the 12 months prior to the elimination of divert (2021) and the 12 months after divert elimination (2022). The decision to eliminate divert occurred in November 2021, based on data available through October, with an implementation date of January 2022. The primary study outcome was to quantify the effect of the elimination of divert on the number of ambulances arriving per day at the study hospital. Regional utilization of ambulance divert increased steadily by 859% from January to October 2021 when 355 individual divert events occurred, totaling 809 h (34 days). There was no significant difference in the number of ambulances that arrived to the study hospital in 2021 (30,774) vs 2022 (30,421) p = 0.15. As compared to 2021, in 2022 there was no significant increase in mean ambulance arrivals per day (84/day vs 83/day, p = 0.08), time to room Emergency Severity Index level 2 (ESI) patients (28 min vs 28 min, p = 0.90), or time to obtain emergent head CT in acute "code stroke" patients (12 min vs 12 min, p = 0.15). Ambulance turnaround interval in the ED did not appreciably increase (16 min vs 17 min, p = 0.15). Elimination of ambulance divert was not associated with increases in the number of mean daily ambulance arrivals or EMS turnaround intervals, delays in ESI 2 patients being placed in beds, or prolonged time to head CT in stroke code patients. [ABSTRACT FROM AUTHOR]

The rapid rise in increasingly resistant bacteria has become a major threat to public health. Antimicrobial susceptibility testing (AST) is crucial in guiding appropriate therapeutic decisions and infection prevention practices for patient care. However, conventional culture-based AST methods are time-consuming and labor-intensive. Therefore, rapid AST approaches exist to address the delayed gap in time to actionable results. There are two main types of rapid AST technologies— phenotypic and genotypic approaches. In this review, we provide a summary of all commercially available rapid AST platforms for use in clinical microbiology laboratories. We describe the technologies utilized, performance characteristics, acceptable specimen types, types of resistance detected, turnaround times, limitations, and clinical outcomes driven by these rapid tests. We also discuss crucial factors to consider for the implementation of rapid AST technologies in a clinical laboratory and what the future of rapid AST holds. [ABSTRACT FROM AUTHOR]

The wound-healing process is a physiological response that begins after a disruption to the integrity of tissues present in the skin. To understand the intricacies involved in this process, many groups have tried to develop different in vitro models; however, the lack of a systemic response has, until this day, been the major barrier to the establishment of these models as the main study platform. Therefore, in vivo models are still the most common system for studying healing responses following different treatments, especially porcine models, which share several morphological similarities to the human skin. In this work, we developed a porcine excisional wound model and used semi-automated software as a strategy to generate quantitative morphometric results of healing responses by specific tissues and compartments. Our aim was to extract the most information from the model while producing reliable, reproducible, and standardized results. In order to achieve this, we established a 7-day treatment using a bacterial cellulose dressing as our standard for all the analyzed wounds. The thickness of the residual dermis under the wound (DUtW) bed was shown to influence the healing outcome, especially for the regeneration of epidermal tissue, including the wound closure rate. The analysis of the DUtW throughout the entire dorsal region of the animals opened up the possibility of establishing a map that will facilitate the experimental design of future works, increasing their standardization and reproducibility and ultimately reducing the number of animals needed. Thus, the developed model, together with the automated morphometric analysis approach used, offers the possibility to generate robust quantitative results with a rapid turnaround time while allowing the study of multiple extra morphometric parameters, creating a more holistic analysis. [ABSTRACT FROM AUTHOR]

A glioma is a solid brain tumor which originates in the brain or brain stem area. The diagnosis of gliomas based on standard-of-care (SOC) techniques includes karyotyping, fluorescence in situ hybridization (FISH), and chromosomal microarray (CMA), for detecting the pathogenic variants and chromosomal abnormalities. But these techniques do not reveal the complete picture of genetic complexity, thus requiring an alternative technology for better characterization of these tumors. The present study aimed to evaluate the clinical performance and feasibility of using optical genome mapping (OGM) for chromosomal characterization of gliomas. Herein, we evaluated 10 cases of gliomas that were previously characterized by CMA. OGM analysis showed concordance with the results of CMA in identifying the characterized Structural Variants (SVs) in these cases. More notably, it also revealed additional clinically relevant aberrations, demonstrating a higher resolution and sensitivity. These clinically relevant SVs included cryptic translocation, and SVs which are beyond the detection capabilities of CMA. Our analysis highlights the unique capability of OGM to detect all classes of SVs within a single assay, thereby unveiling clinically significant data with a shorter turnaround time. Adopting this diagnostic tool as a standard of care for solid tumors like gliomas shows potential for improving therapeutic management, potentially leading to more personalized and timely interventions for patients. [ABSTRACT FROM AUTHOR]

Exercise-induced muscle injury is one of the most common types of sports injuries. Skeletal muscle troponin I (skTnI) serves as an ideal biomarker in assessing such injuries, facilitating timely detection and evaluation. In this study, we develop a fluorescent sandwich lateral flow immunoassay (LFIA) combined with a desktop analyzer for rapid detection of skTnI. Through optimizing the reaction system, the assay achieves a satisfying detection performance, reaching a limit of detection (LOD) of 0.5 ng/mL with a turnaround time of 15 min. The proposed detection platform offers portability, ease of use, and high sensitivity, which facilitates the monitoring of exercise-induced muscle injuries at the point of care. This feature is particularly advantageous for end users, enabling timely detection of sports-related injuries and ultimately enhancing prognosis and sports life. [ABSTRACT FROM AUTHOR]

Power estimation has a major impact on the reliability of very-large-scale integration (VLSI) circuits. As a results power estimation is highly needed in VLSI circuits at the early stages. One of the evident challenges in integrated circuit (IC) industry is development and investigation of techniques for the reduction of design complexity due to the growing process variations and reduction of chip manufacturing turnaround time. Under these conditions, the higher design levels of average power estimation before the chip manufacturing process is highly essential for the calculation of power budget and to take the necessary steps for the reduction of power consumption. Over the years, most of the approaches were designed to estimate the power usage, however, most of the conventional techniques are time consuming, resource-intensive and largely manual. Machine learning techniques have received much attention in many of the engineering applications and are capable for modelling the complex systems through historical data. Hence, in this work on chip-based power estimation for complementary metaloxide-semiconductor (CMOS) VLSI using support-vector machine (SVM) is presented to estimate the power. The SVM is employed to estimate the usage of power at runtime. The performance of this model is evaluated in terms of Power usage, delay, data accuracy and error rate. [ABSTRACT FROM AUTHOR]

Surgical pathology of the head and neck is one of the more challenging areas in all of diagnostic pathology. Its unparalleled diversity and complexity renders it highly vulnerable to diagnostic error compelling unconstrained access to specialized diagnostic expertise. Digital pathology (DP) is a state-of-the-art tool that could facilitate access to specialized expertise, but it is relatively untested in the context of pathology consultations. In a collaboration between Labcorp Dianon and a large academic hospital with subspecialized surgical pathology, DP was implemented to provide the pathology community access to head and neck pathology expertise. From this collaborative experience, glass slides from consecutive consult cases that had been previously diagnosed using DP were reviewed by an expert consultant in a blinded manner following an extended wash-out period. The intraobserver discrepancy rate was recorded. Major discrepancies were defined as those resulting in significant impact on clinical management and/or prognosis, whereas minor discrepancies were those with no impact on care or prognosis. Slides from 57 cases were available for review. The average wash-out period was 19 months. Five discrepancies were recorded (intraobserver concordance rate of 91%). All discrepancies were minor (major discrepancy rate, 0%; minor discrepancy rate, 9%). On appraisal of the discrepant cases, discordant diagnoses were attributed to subjective differences in interpretation rather than objective differences related to the inferiority of DP. DP decreased the median turnaround time by 97% (from 70 h 26 min to 2 h 25 min). DP provides efficient and fast access to expert consultants. The speed of case delivery does not compromise diagnostic precision. Discrepancies are uncommon, minor, and reflect subjective interpretative differences inherent to difficult and ambiguous head and neck cases, and not the inferiority of DP as a diagnostic platform. High concordance can be achieved even for those difficult and complex cases that are concentrated in the consultation practice. This observation carries profound implications regarding universal health care access to specialized diagnostic expertise. [ABSTRACT FROM AUTHOR]

BACKGROUND: Teleradiology has become an important tool in emergency medicine, particularly in the interpretation of emergency ultrasonography. In emergency situations, where time is essential, rapid diagnosis and treatment can mean the difference between life and death. Teleradiology is an innovative alternative to augment the staffing and fill the gaps of onsite radiology personnel in emergency departments or during off-hours. AIM: To assess the effectiveness/impact of teleradiology in emergency ultrasound interpretation. MATERIALS AND METHODS: A retrospective study was performed in a cohort of 33,616 patients from 86 hospitals across the USA between January and December 2022. The study involved radiological interpretations of 37,253 ultrasound images acquired in the emergency setting by American Board Certified Radiologists empaneled by a teleradiology service provider, headquartered in Bangalore, India. RESULTS: The proposed telehealth model provided timely and quality reporting of 37,253 scans of patients with a mean turnaround time of 35.71 min (95% confidence interval 35.50–35.91). CONCLUSION: This study demonstrates that a structured telesonography program with defined protocols for image capture, transmission, and clinical communication can allow for successful immediate reporting of ultrasound data in the emergency care setting.

Introduction: Bloodstream infection is a major cause of mortality and morbidity worldwide. Timely reporting of blood culture results is of utmost importance for better patient outcomes. The recently introduced Rapid Antimicrobial Susceptibility Testing (RAST) method is poised to profoundly influence clinical outcomes. Aim: To compare the results of RAST with Standard Antimicrobial Susceptibility Testing (SAST) and evaluate the impact of RAST reporting on the clinical management of septicaemia patients. Materials and Methods: This prospective, observational study was conducted in the Department of Microbiology, Government Medical College, Kurnool, Andhra Pradesh, India from May 2021 to September 2022. All positive blood culture bottles with only a single morphotype in gram staining were further processed using the RAST method, followed by conventional identification and SAST. Categorical agreement and disagreement between the RAST and SAST results were compared, along with the difference in the time at which results were available. Results: Out of a total of 1,146 blood cultures received, 228 were flagged as positive. A total of 514 isolate and antimicrobial agent combinations were evaluated, of which 496 (96.5%) showed categorical agreement. Only 18 (3.5%) showed categorical disagreement, with the majority being Major Errors (ME) (1.56%), followed by Very Major Errors (VME) (0.97%) and minor Errors (mE) (0.97%). Conclusion: RAST results demonstrated strong concurrence with SAST results. RAST is affordable, fast, and flexible and can potentially lead to a considerably shortened time for AST results to reach the bedside of the patient. This enables rapid modifications and adjustments in antibiotic therapy, including both escalation and de-escalation.

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]

Whole genome analysis for microbial genomics is critical to studying and monitoring antimicrobial resistance strains. The exponential growth of microbial sequencing data necessitates a fast and scalable computational pipeline to generate the desired outputs in a timely and cost-effective manner. Recent methods have been implemented to integrate individual genomes into large collections of specific bacterial populations and are widely employed for systematic genomic surveillance. However, they do not scale well when the population expands and turnaround time remains the main issue for this type of analysis. Here, we introduce AMRomics, an optimized microbial genomics pipeline that can work efficiently with big datasets. We use different bacterial data collections to compare AMRomics against competitive tools and show that our pipeline can generate similar results of interest but with better performance. The software is open source and is publicly available at https://github.com/amromics/amromics under an MIT license. [ABSTRACT FROM AUTHOR]

In oncology drug development, using biomarkers to select a study population more likely to benefit from a therapeutic effect is critical to increase the efficiency of a clinical trial in demonstrating effectiveness. This perspective delves into therapeutic product approvals that were tested in pivotal trials with all-comers populations, but ultimately received US Food and Drug Administration approval for use within specific patient subgroups identified by biomarkers. Despite initial designs for efficacy and safety assessments in overall populations, a favorable benefit-risk assessment was primarily established in biomarker-positive subgroups. Analyzing these cases, we summarize key considerations pivotal to totality of evidence for regulatory benefit-risk assessments for biomarker-defined subgroup versus all-comers approvals, including biological and clinical rationales, biomarker prevalence, safety data, overall trial design, and subgroup efficacy characterization. Furthermore, a decision tree is proposed to guide optimal clinical trial design, delineating between patient enrichment and stratification, accounting for key factors including biological and clinical rationale, marker type (discreate or continuous), prevalence, assay readiness, and turnaround times for marker assessment. Finally, a recommended approach for subgroup characterization involves prespecifying magnitude of improvement that would be considered clinically meaningful in the biomarker-negative subgroup, which can be supplemented with methodologies such as Bayesian to incorporate evidence from similar studies when available. In summary, this perspective underscores the importance of clinical trial innovations, statistical methodologies and regulatory considerations, to optimize biomarker-driven drug development for patients with cancer. Biomarker-driven oncology trial design and subgroup characterization: Challenges and potential solutions. [ABSTRACT FROM AUTHOR]

Point-of-care testing of "sample in, answer out" is urgently needed for communicable diseases. Recently, rapid nucleic acid tests for infectious diseases have been developed for use in resource-limited areas, but they require types of equipment in central laboratories and are poorly integrated. In this work, a portable centrifugal microfluidic testing system is developed, integrated with magnetic bead-based nucleic acid extraction, recombinase-assisted amplification and CRISPR–Cas13a detection. The system, with the advantage of its power-supplied active rotating chip and highly programable flow control through integrated addressable active thermally-triggered wax valves, has a rapid turnaround time within 45 min, requiring only one user step. All reagents are preloaded into the chip and can be automatically released. By exploiting a multichannel chip, it is capable of simultaneously detecting 10 infectious viruses with limits of detection of 1 copy per reaction and 5 copies per reaction in plasmid samples and mock plasma samples, respectively. The system was used to analyse clinical plasma samples with good consistency compared to laboratory-based molecular testing. Moreover, the generalizability of our device is reported by successfully testing nasopharyngeal swabs and whole blood samples. The portable device does not require the operation of professional technicians, making it an excellent assay for on-site testing. [ABSTRACT FROM AUTHOR]

Accurate aircraft turnaround time prediction is an important way to coordinate the operation time of airport ground service and improve the efficiency of airport operation. In this paper, by analyzing the aircraft turnaround operation process, a description model based on Time Transition Petri Net is proposed. The model describes the flight turnaround operation process and the logical relationship of the operation. According to the model, a dynamic prediction method of turnaround time based on Bayesian theorem is designed. According to the actual landing time of the flight, the aircraft turnaround time is predicted. The specific method is to obtain the prior probability distribution and joint distribution law of each operation link according to the flight history data, and use Shapiro-Wilke to test the prior probability distribution of each link. Based on the analysis and comparison between the actual turnaround data of a large airport in China and the forecast data proposed in this paper, the root-mean-square error 3.75 minutes and the mean absolute error 3.40 minutes can be calculated. This paper contributes to the improvement of flight punctuality rate and airport clearance level. [ABSTRACT FROM AUTHOR]