bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Manual and Suction Pump Aspiration Techniques for Performing Bronchoalveolar Lavage in 18 Dogs with Respiratory Tract Disease
Authors: Woods K.S. , Defarges A.M.N. , Abrams‐Ogg A.C.G. , Viel L. , Brisson B.A. , Bienzle D.
Published: July 2014

Background

Different aspiration techniques to retrieve bronchoalveolar lavage fluid (BALF) affect sample quality in healthy dogs. Studies evaluating these techniques in dogs with respiratory disease are lacking.

Objectives

To compare sample quality ofBALFacquired by manual aspiration (MA) and suction pump aspiration (SPA).

Animals

Eighteen client‐owned dogs with respiratory disease.

Methods

Randomized, blinded prospective clinical trial. Manual aspiration was performed with a 35‐mL syringe attached directly to the bronchoscope biopsy channel andSPAwas performed with a maximum of 50 mmHg negative pressure applied to the bronchoscope suction valve using the suction trap connection. Both aspiration techniques were performed in each dog on contralateral lung lobes, utilizing 2 mL/kg lavage volumes per site. Samples ofBALFwere analyzed by percentage of retrieved infusate, total nucleated cell count (TNCC), differential cell count, semiquantitative assessment of slide quality, and diagnosis score. Data were compared by paired Student'st‐test, Wilcoxon signed‐rank test, chi‐squared test, and ANOVA. Cohen's kappa coefficient was used to assess agreement.

Results

The percentage of retrievedBALF(P = .001) was significantly higher forSPAthanMA. Substantial agreement was found between cytologic classification ofBALFobtained withMAandSPA(kappa = 0.615). There was no significant difference in rate of definitive diagnosis achieved with cytologic assessment between techniques (P = .78).

Conclusions and Clinical Importance

Suction pump aspiration, compared toMA, improvedBALFretrieval, but did not significantly affect the rate of diagnostic success of bronchoalveolar lavage (BAL) in dogs with pulmonary disease.
Diagnostic and Predictive Capability of Routine Laboratory Tests for the Diagnosis and Staging of Equine Inflammatory Disease
Authors: Hooijberg E.H. , van den Hoven R. , Tichy A. , Schwendenwein I.
Published: July 2014

Background

A wide spectrum of laboratory tests is available to aid diagnosis and classification of equine inflammatory disease.

Objectives

To compare diagnostic efficacy and combined predictive capability of the myeloperoxidase index (MPXI), and plasma fibrinogen, iron and serum amyloid A (SAA) concentrations for the diagnosis of inflammation.

Animals

Twenty‐six hospitalized horses with systemic inflammation (SI), 114 with local inflammation (LI) and 61 healthy horses or those with noninflammatory disease (NI) were included.

Methods

A retrospective study was performed; clinicopathologic data from horses were compared between groups. Receiver‐operator characteristic (ROC) curves were used to evaluate diagnostic efficacy; classification and regression tree analysis (CART) and logistic regression analysis were used to generate diagnostic algorithms.

Results

Horses with SI had significantly higher SAA than horses with LI (P = .007) and NI (P < .001) and lower iron concentrations than horses with LI (P < .001) and NI (P < .001). Fibrinogen concentration was higher in horses with inflammation than in those without inflammation (P = .002). There was no difference between the SI and LI groups. White blood cell count, neutrophil count and MPXI were similar between groups. SAA had the highest accuracy for diagnosing inflammation (area under ROC curve [AUC], 0.83 ± 0.06) and iron and SAA concentration had the highest accuracy for differentiating SI from LI (AUC, 0.80 ± 0.09 and 0.73 ± 0.10 respectively). Predictive modeling failed to generate useful algorithms and classification of cases was moderate.

Conclusions and Clinical Importance

Very high SAA and low iron concentrations may reflect SI, but diagnostic guidelines based on quantitative results of inflammatory markers could not be formulated.
N‐Terminal Pro‐C‐Natriuretic Peptide and Cytokine Kinetics in Dogs with Endotoxemia
Authors: Floras A.N.K. , Holowaychuk M.K. , Bienzle D. , Bersenas A.M.E. , Sharif S. , Harvey T. , Nordone S.K. , Wood G.A.
Published: July 2014

Background

Serum N‐terminal pro‐C‐natriuretic peptide (NT‐proCNP) concentration at hospital admission has sufficient sensitivity and specificity to differentiate naturally occurring sepsis from nonseptic systemic inflammatory response syndrome (SIRS). However, little is known about serum NT‐proCNP concentrations in dogs during the course of sepsis.

Objective

To determine serum NT‐proCNP and cytokine kinetics in dogs with endotoxemia, a model of canine sepsis.

Samples

Eighty canine serum samples.

Methods

Eight healthy adult Beagles were randomized to receive Escherichia coli lipopolysaccharide (LPS, 5 μg/kg) or placebo (0.9% NaCl) as a single IV dose in a randomized crossover study. Serum collected at 0, 1, 2, 4, and 24 hours was stored at −80°C for batch analysis. Serum NT‐proCNP was measured by ELISA and 13 cytokines and chemokines by multiplex magnetic bead‐based assay.

Results

Serum NT‐proCNP concentrations did not differ significantly between LPS‐ and placebo‐treated dogs at any time. When comparing serum cytokine concentrations, LPS‐treated dogs had higher interleukin‐6 (IL‐6), IL‐10, TNF‐α and KC‐like at 1, 2, and 4 hours; higher CCL2 at 1, 2, 4, and 24 hours; and higher IL‐8 and CXCL10 at 4 hours compared to placebo‐treated dogs. There were no differences in serum GM‐CSF, IFN‐γ, IL‐2, IL‐7, IL‐15 or IL‐18 between LPS‐ and placebo‐treated dogs.

Conclusions and Clinical Importance

Serum NT‐proCNP concentration does not change significantly in response to LPS administration in healthy dogs. Certain serum cytokine and chemokine concentrations are significantly increased within 1–4 hours after LPS administration and warrant further investigation as tools for the detection and management of sepsis in dogs.
From facilitative to competitive interaction between Larrea tridentata and Cylindropuntia leptocaulis in the southern Chihuahuan Desert
Authors: Flores‐Torres A. , Montaña C.
Published: July 2014

Question

Can the co‐existence of the cactus and the shrub in the community be driven by a cyclic succession mechanism?

Location

Mapimí Biosphere Reserve (southern Chihuahuan Desert). The vegetation is scrub, dominated by Larrea tridentata.

Methods

Interspecific spatial association between adult L. tridentata and differently sized Cylindropuntia leptocaulis plants was analysed using Ripley′s K function, exploring the hypothesis that facilitation causes differential recruitment of cactus below the shrub and a subsequent interspecific association, the intensity of which declines with the cactus size due to competitive elimination of the shrub. Competition for water among adult plants was investigated by irrigating solitary and associated plants of both species. The proportion of vigorous (measured by the percentage of dead branches) and dead L. tridentata plants associated with adult cacti was compared to that of solitary L. tridentata plants, testing the hypothesis that competition among associated adults reduces the vigour and increases the proportion of dead shrubs, relative to that of solitary plants.

Results

In 14 out of 16 spatial analyses (four cactus sizes in four plots), C. leptocaulis was found to clump around the L. tridentata adults. Larrea tridentata suffered the effects of interspecific competition for water, but these diminished with increased water provision. In contrast, C. leptocaulis was unaffected by interspecific competition for water. The proportion of vigorous shrubs was higher in solitary than in associated individuals; however, the proportion of dead shrubs was lower in associated than in solitary individuals.

Conclusion

The irrigation experiment and the proportion of dead branches suggest interspecific competition. However, spatial association of the shrubs with every cactus size and the proportion of dead shrubs associated with the cacti both suggest that replacement of the shrub by the cactus is an infrequent event. Cyclic succession therefore appears to be the exception rather than the rule, and does not account for the co‐existence of the species in the community. The possible scenarios in which cyclic succession may occur are discussed.
Reproductive and growth strategies of Idotea balthica basteri (Pallas, 1772) population in the Bizerte lagoon (Tunisia, Southern Mediterranean)
Authors: Zaabar Wahiba , Achouri Mohamed Sghaïer , Charfi‐Cheikhrouha Faouzia
Published: July 2014

We analysed several life history traits of the marine isopod Idotea balthica basteri (Pallas, 1772) from the Bizerte lagoon, Southern Mediterranean Sea. Growth was continuous throughout the life of the animal with a high growth rate in the first life phase, and the growth curve was described according to von Bertalanffy's model. The lowest growth rate (0.23 mm) was recorded in winter (December, January and February) and the maximum rate (2.31 mm) between April and June. The total number of hatched eggs or embryos was positively correlated with the body length of ovigerous females. This population of I. balthica basteri was iteroparous, showing distinct strategies of reproduction. Large ovigerous females with high fecundity were collected during the whole sampling period, while breeding in smaller females with low fecundity was restricted to the period from late spring to early autumn, Manca size increased significantly with increasing female body size and there was also a significant trade‐off between manca size and the number of eggs per brood. Reproductive allocation, ranging between 17.1 ± 1.2% in winter and 23.2 ± 1.8% in summer, was positively correlated with female weight. Accordingly, parental investment in producing a juvenile varied between 1.02% per manca in winter to 3.38% in spring. Evaluated traits show that late summer and autumn cohorts have a K‐strategy, whereas cohorts born in winter and spring, and which exhibit a shorter life time, exhibit faster development, earlier reproduction and a smaller parental investment tending towards an r‐selected strategy.
Assessing Symbiodinium diversity in scleractinian corals via next‐generation sequencing‐based genotyping of the ITS2 rDNA region
Authors: Arif Chatchanit , Daniels Camille , Bayer Till , Banguera‐Hinestroza Eulalia , Barbrook Adrian , Howe Christopher J. , LaJeunesse Todd C. , Voolstra Christian R.
Published: July 2014

The persistence of coral reef ecosystems relies on the symbiotic relationship between scleractinian corals and intracellular, photosynthetic dinoflagellates in the genus Symbiodinium. Genetic evidence indicates that these symbionts are biologically diverse and exhibit discrete patterns of environmental and host distribution. This makes the assessment of Symbiodinium diversity critical to understanding the symbiosis ecology of corals. Here, we applied pyrosequencing to the elucidation of Symbiodinium diversity via analysis of the internal transcribed spacer 2 (ITS2) region, a multicopy genetic marker commonly used to analyse Symbiodinium diversity. Replicated data generated from isoclonal Symbiodinium cultures showed that all genomes contained numerous, yet mostly rare, ITS2 sequence variants. Pyrosequencing data were consistent with more traditional denaturing gradient gel electrophoresis (DGGE) approaches to the screening of ITS2 PCR amplifications, where the most common sequences appeared as the most intense bands. Further, we developed an operational taxonomic unit (OTU)‐based pipeline for Symbiodinium ITS2 diversity typing to provisionally resolve ecologically discrete entities from intragenomic variation. A genetic distance cut‐off of 0.03 collapsed intragenomic ITS2 variants of isoclonal cultures into single OTUs. When applied to the analysis of field‐collected coral samples, our analyses confirm that much of the commonly observed Symbiodinium ITS2 diversity can be attributed to intragenomic variation. We conclude that by analysing Symbiodinium populations in an OTU‐based framework, we can improve objectivity, comparability and simplicity when assessing ITS2 diversity in field‐based studies.
Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence
Authors: Bray Lucy , Snodin Jill , Carter Bernie
Published: July 2014

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised.
Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size
Authors: Singendonk M. M. J. , Kritas S. , Cock C. , Ferris L. , McCall L. , Rommel N. , van Wijk M. P. , Benninga M. A. , Moore D. , Omari T. I.
Published: July 2014

Background

Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult‐derived criteria. As shorter esophageal length and smaller esophago‐gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age‐ and size‐adjustment of diagnostic criteria.

Methods

We evaluated 76 high‐resolution solid state impedance‐manometry recordings in children referred for manometry (32M; mean age 9 ± 1 years) and 25 recordings from healthy adult subjects (7M; mean age 36 ± 2 years). CC metrics; integrated relaxation pressure (IRP4s, mmHg), contractile front velocity (CFV, cm/s), distal contractile integral (DCI, mmHg cm/s), distal latency (DL, s), and peristaltic break size (BS, cm) were derived for 10 liquid swallows using CC analysis software. Effects of age and size were examined using regression analysis.

Key Results

Younger patient age and shorter size correlated significantly with greater IRP4s (p < 0.05), shorter DL (p < 0.001) and smaller BS (p < 0.05). Standard diagnostic CC criteria were adjusted using the slope of the linear regression equation to define the age/size‐related trend. Sixty‐six percent of the pediatric cohort showed abnormal motility when applying standard CC criteria. Adjustment for age and size reduced this to 50% and 53% respectively, with the largest reduction being in the IRP4s‐ and DL‐dependent disorders EGJ outflow obstruction and diffuse esophageal spasm (13% to 7% and 5% and 14% to 1 and 5%, respectively).

Conclusions & Inferences

CC metrics, particularly IRP4s and DL, are age and size dependent, and therefore, require adjustment to improve accuracy of diagnosis of esophageal motility disorders in children.
The Relative Performance of Poisson and Negative Binomial Regression Estimators
Authors: Blackburn Mckinley L.
Published: July 2014

Negative binomial estimators are commonly used in estimating models with count‐data dependent variables. In this paper, sampling experiments are used to evaluate the performance of these estimators relative to the simpler Poisson estimator in finite‐sample situations. The results do not suggest a clear preference for negative binomial estimators in situations in which the underlying dependent variables are overdispersed, unless the researcher is comfortable in assumptions about the precise form of the overdispersion.
Metabolome variations in the Porphyromonas gingivalis vimA mutant during hydrogen peroxide‐induced oxidative stress
Authors: McKenzie R.M.E. , Aruni W. , Johnson N.A. , Robles A. , Dou Y. , Henry L. , Boskovic D.S. , Fletcher H.M.
Published: July 2014

The adaptability and survival of Porphyromonas gingivalis in the oxidative microenvironment of the periodontal pocket are indispensable for survival and virulence, and are modulated by multiple systems. Among the various genes involved in P. gingivalis oxidative stress resistance, vimA gene is a part of the 6.15‐kb locus. To elucidate the role of a P. gingivalis vimA‐defective mutant in oxidative stress resistance, we used a global approach to assess the transcriptional profile, to study the unique metabolome variations affecting survival and virulence in an environment typical of the periodontal pocket. A multilayered protection strategy against oxidative stress was noted in P. gingivalis FLL92 with upregulation of detoxifying genes. The duration of oxidative stress was shown to differentially modulate transcription with 94 (87%) genes upregulated twofold during 10 min and 55 (83.3%) in 15 min. Most of the upregulated genes (55%), fell in the hypothetical/unknown/unassigned functional class. Metabolome variation showed reduction in fumarate and formaldehyde, hence resorting to alternative energy generation and maintenance of a reduced metabolic state. There was upregulation of transposases, genes encoding for the metal ion binding protein transport and secretion system.
Atrial Fibrillation Increases Sympathetic and Parasympathetic Neurons in the Intrinsic Cardiac Nervous System
Authors: YU YANG , WEI CAO , LIU LI , LIAN AI LING , QU XIU FEN , YU GUANG
Published: July 2014

Background

Chronic atrial fibrillation (AF) leads to heterogeneous autonomic nerve innervation termed neural remodeling. The quantitative changes in neural density as a function of autonomic remodeling and its association with sustained AF has not been previously determined.

Method and Results

Seven dogs (paced group) were chronically paced with electrodes sutured to the epicardium of left atrial appendages. Seven dogs (control animals) were not paced. All paced dogs developed sustained AF by 5 weeks of pacing. The fat pads on the atrial epicardium containing ganglionated plexuses (GP) were separated along with underlying myocardial tissue. Immunocytochemical techniques were used to identify the neurons immunoreactive to anti‐tyrosine hydroxylase (TH) and anti‐acetylcholine antibodies. After chronic AF, sympathetic and parasympathetic neurons in the atrial intrinsic cardiac ganglia increased significantly. In paced dogs, the density of sympathetic neurons was 3,022 ± 507 μm2/mm2 in the right atrial GP (vs control P < 0.01), 8,571 ± 476 μm2/mm2 in the ventral left atrial GP (vs control P < 0.0001)， 6,422 ± 464 μm2/mm2 in the dorsal atrial GP (vs control P < 0.0001) and 5,392 ± 595 μm2/mm2 in the inferior vena cava‐inferior atrial GP (vs control P <0.0001), respectively. The density of parasympathetic neurons was 4,396 ± 877 μm2/mm2 in the right atrial GP, 7,769 ± 465 μm2/mm2 in the ventral left atrial GP， 7,016.47 ± 687 μm2/mm2 in the dorsal atrial GP and 5,485 ± 554 μm2/mm2 in the inferior vena cava‐inferior atrial GP, respectively, which was higher than control cohorts in corresponding GP (P < 0.05).

Conclusions

This study provides evidence for the remodeling in atrial intrinsic cardiac ganglia in the dogs with pacing induced AF. A significant increase of sympathetic and parasympathetic neurons was present in atrial intrinsic cardiac ganglia.
AtMyb7, a subgroup 4 R2R3 Myb, negatively regulates ABA‐induced inhibition of seed germination by blocking the expression of the bZIP transcription factor ABI5
Authors: KIM JUN HYEOK , HYUN WOO YOUNG , NGUYEN HOAI NGUYEN , JEONG CHAN YOUNG , XIONG LIMING , HONG SUK‐WHAN , LEE HOJOUNG
Published: July 2014

Various Myb proteins have been shown to play crucial roles in plants, including primary and secondary metabolism, determination of cell fate and identity, regulation of development and involvement in responses to biotic and abiotic stresses. The 126 R2R3 Myb proteins (with two Myb repeats) have been found in Arabidopsis; however, the functions of most of these proteins remain to be fully elucidated. In the present study, we characterized the function of AtMyb7 using molecular biological and genetic analyses. We used qRT‐PCR to determine the levels of stress‐response gene transcripts in wild‐type and atmyb7 plants. We showed that Arabidopsis AtMyb7 plays a critical role in seed germination. Under abscisic acid (ABA) and high‐salt stress conditions, atmyb7 plants showed a lower germination rate than did wild‐type plants. Furthermore, AtMyb7 promoter:GUS seeds exhibited different expression patterns in response to variations in the seed imbibition period. AtMyb7 negatively controls the expression of the gene encoding bZIP transcription factor, ABI5, which is a key transcription factor in ABA signalling and serves as a crucial regulator of germination inhibition in Arabidopsis.
Historical Overview of Community Health Practitioners in Korea
Authors: Kwak Changyeong , Ko Young
Published: July 2014

The Korean government introduced CHPs (Community Health Practitioners) as front‐line primary health care providers to address the health disparity between urban and rural areas. Through their dedicated contribution over last 30 years, the CHPs have improved Korea's public health through the successful control of high birth rates, a lowered maternal and infant mortality rate in the 1980s, eradication of parasitic infection, and containing many communicable diseases including hepatitis B. However, rapid changes in the health care environment and demands for health care among rural residents have required changes in the roles and functions of the CHPs. They are challenged by fundamental changes in the public health system addressing various health issues due to a rapidly aging society, pandemic of chronic disease, new infectious disease, and climate changes. CHPs should continuously transform their roles and functions to establish a lifelong health management system. This article presents a historical overview of the CHP system and their tasks and activities. Also, recent challenges that CHPs are facing and strategies to overcome those challenges will be discussed. This historical overview will be informative for other developing countries in resolving their own public health problems.
Enhanced Light‐Harvesting Capacity by Micellar Assembly of Free Accessory Chromophores and LH1‐like Antennas
Authors: Harris Michelle A. , Sahin Tuba , Jiang Jianbing , Vairaprakash Pothiappan , Parkes‐Loach Pamela S. , Niedzwiedzki Dariusz M. , Kirmaier Christine , Loach Paul A. , Bocian David F. , Holten Dewey , Lindsey Jonathan S.
Published: July 2014

Biohybrid light‐harvesting antennas are an emerging platform technology with versatile tailorability for solar‐energy conversion. These systems combine the proven peptide scaffold unit utilized for light harvesting by purple photosynthetic bacteria with attached synthetic chromophores to extend solar coverage beyond that of the natural systems. Herein, synthetic unattached chromophores are employed that partition into the organized milieu (e.g. detergent micelles) that house the LH1‐like biohybrid architectures. The synthetic chromophores include a hydrophobic boron‐dipyrrin dye (A1) and an amphiphilic bacteriochlorin (A2), which transfer energy with reasonable efficiency to the bacteriochlorophyll acceptor array (B875) of the LH1‐like cyclic oligomers. The energy‐transfer efficiencies are markedly increased upon covalent attachment of a bacteriochlorin (B1 or B2) to the peptide scaffold, where the latter likely acts as an energy‐transfer relay site for the (potentially diffusing) free chromophores. The efficiencies are consistent with a Förster (through‐space) mechanism for energy transfer. The overall energy‐transfer efficiency from the free chromophores via the relay to the target site can approach those obtained previously by relay‐assisted energy transfer from chromophores attached at distant sites on the peptides. Thus, the use of free accessory chromophores affords a simple design to enhance the overall light‐harvesting capacity of biohybrid LH1‐like architectures.
Forecasting inflation using time‐varying Bayesian model averaging
Authors: van der Maas Jordi
Published: July 2014

This paper presents a Bayesian model averaging regression framework for forecasting US inflation, in which the set of predictors included in the model is automatically selected from a large pool of potential predictors and the set of regressors is allowed to change over time. Using real‐time data on the 1960–2011 period, this model is applied to forecast personal consumption expenditures and gross domestic product deflator inflation. The results of this forecasting exercise show that, although it is not able to beat a simple random‐walk model in terms of point forecasts, it does produce superior density forecasts compared with a range of alternative forecasting models. Moreover, a sensitivity analysis shows that the forecasting results are relatively insensitive to prior choices and the forecasting performance is not affected by the inclusion of a very large set of potential predictors.
The Maize TFome – development of a transcription factor open reading frame collection for functional genomics
Authors: Burdo Brett , Gray John , Goetting‐Minesky Mary P. , Wittler Bettina , Hunt Matthew , Li Tai , Velliquette David , Thomas Julie , Gentzel Irene , Brito Michael dos Santos , Mejía‐Guerra Maria Katherine , Connolly Layne N. , Qaisi Dalya , Li Wei , Casas Maria I. , Doseff Andrea I. , Grotewold Erich
Published: July 2014

Establishing the architecture of the gene regulatory networks (GRNs) responsible for controlling the transcription of all genes in an organism is a natural development that follows elucidation of the genome sequence. Reconstruction of the GRN requires the availability of a series of molecular tools and resources that so far have been limited to a few model organisms. One such resource consists of collections of transcription factor (TF) open reading frames (ORFs) cloned into vectors that facilitate easy expression in plants or microorganisms. In this study, we describe the development of a publicly available maize TF ORF collection (TFome) of 2034 clones corresponding to 2017 unique gene models in recombination‐ready vectors that make possible the facile mobilization of the TF sequences into a number of different expression vectors. The collection also includes several hundred co‐regulators (CoREGs), which we classified into well‐defined families, and for which we propose here a standard nomenclature, as we have previously done for TFs. We describe the strategies employed to overcome the limitations associated with cloning ORFs from a genome that remains incompletely annotated, with a partial full‐length cDNA set available, and with many TF/CoREG genes lacking experimental support. In many instances this required the combination of genome‐wide expression data with gene synthesis approaches. The strategies developed will be valuable for developing similar resources for other agriculturally important plants. Information on all the clones generated is available through the GRASSIUS knowledgebase (http://grassius.org/).
Donor selection for blood safety: is it still necessary?
Authors: Lin C. K. , Leung J. N. S. , So B. K. L. , Lee C. K.
Published: July 2014

The strive for zero risk blood transfusion is still an ongoing challenge in many countries despite the application of new laboratory blood testing technologies. Predonation blood donor screening has been playing a crucial role in minimizing the collection of blood from ‘unsafe’ donors. This article aims at reviewing the various approaches to ensure blood safety and the factors that need to be considered in drawing up effective strategies that suit the local need.
Pathogen inactivation – defining ‘adequate’ bacterial protection
Authors: Benjamin R. J.
Published: July 2014

Background and Objectives

Clinical acceptance of pathogen inactivation technologies depends on the demonstration of product safety, a minimal effect on product efficacy and the range and degree of pathogen inactivation. The major rationale for pathogen inactivation of platelets is the prevention of transfusion‐associated bacterial sepsis, a persistent problem despite multiple innovations to minimize and detect contamination.

Materials and Methods

Recent reports and an empirical model are used to describe our current understanding of the efficacy of pathogen inactivation in improving platelet transfusion safety.

Results

Optimized in vitro testing evaluated the efficacy of riboflavin/UV light (Mirasol™), amotosalen/UVA (Intercept™) and UVC irradiation (THERAFLEX™ UV platelets) systems to effect a 102‐ >106 fold reduction of a variety of bacterial species. All systems are less effective at inactivating bacterial spores. Reviewing reports on the level of pathogen inactivation at very low and high bacterial concentrations identifies areas for further scrutiny.

Conclusions

Clinical trials of pathogen inactivated platelets have focused on safety and clinical efficacy in terms of count increments and the prevention and treatment of bleeding. Little attention has been paid to efficacy in reducing the risk of bacterial transmission. Pathogen inactivation is expected to significantly reduce transfusion of contaminated platelet units, especially ones that are the result of low initial bacterial titres that are a systemic issue with the current testing methodology. Nevertheless, available data suggest that breakthrough cases of sepsis are likely and that their rates will vary substantially by technology.
Managing bleeding in cardiac surgery
Authors: Ariff M. H.
Published: July 2014

Despite major advances in the management of perioperative blood conservation, transfusion rates in cardiac surgery remain very high, with large variations among individual centres. Significant differences in the approach to allogeneic red cell transfusion have been consistently observed among institutions in particular in cardiac surgery. The concept of blood conservation rests on three main pillars: (i) Increasing preoperative red blood cell mass, (ii) Decreasing peri‐operative blood losses, and (iii) Optimizing transfusion practice. The acceptance of a lower perioperative haematocrit (in IJN the Hct on bypass is 20–25% and post bypass is >25%) could present an important element in current blood conservation practice. Other techniques include pharmacological (tranaxemic acid, aprotinin, desmopressin, rFVII) as well as non pharmacological techniques (PAD, ANH, red cell washing, tissue glue) as well as novel surgical and cardiology techniques (Off Pump surgery, minimal invasive surgery, stenting and other interventions).
How do you solve a problem like transfusion‐related acute lung injury?
Authors: Fung Y. L. , Minchinton R. M. , Tung J. P.
Published: July 2014

Background

The last 20 years have seen substantial international efforts to minimize the incidence and risk of transfusion‐related acute lung injury (TRALI). Nevertheless, TRALI remains a real morbidity and mortality risk to transfusion recipients.

Discussion

This review discusses the current knowledge on antibody‐ and non‐antibody‐mediated TRALI, as well as current and potential mitigation strategies.
Emerging and imported infections in the region – what's bothering us today?
Authors: Teo D.
Published: July 2014

An emerging infection is defined as one that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range. The Asia Pacific region, with 30% of global population, has a reputation as a hot spot for emerging infections. The emergence of severe acute respiratory syndrome exactly 10 years ago dramatically transformed individual and national awareness and capabilities for identifying and responding to regional emerging infectious threats. The impact of emerging infections on the blood supply may be direct through the potential for transmission through transfusion, the effect on blood donor attendance and eligibility and the effect on blood demand. There is a need for constant surveillance and the capacity to identify, assess and manage risks to the blood supply. In recent years, the strengthening of regional and international partnerships and the development of new risk assessment tools has improved our ability to respond to infectious threats. Nonetheless, the volatile and ever‐changing nature of emerging infections will remain a constant challenge to the vigilance and response capabilities of the transfusion medicine community.
Dysregulated negative immune regulators in immune thrombocytopenia
Authors: Kuwana M.
Published: July 2014

Immune thrombocytopenia (ITP) is an autoimmune disease mediated by IgG antiplatelet autoantibodies, resulting in an isolated thrombocytopenia. The mechanism for ongoing antiplatelet antibody production is explained by a ‘pathogenic loop’ model consisting of macrophages in the reticuloendothelial system, platelet‐reactive CD4+ T cells and B cells producing IgG antiplatelet antibodies. In ITP patients, a variety of negative immune regulators including CD4+ T regulatory cells, B regulatory cells and tolerogenic dendritic cells are dysfunctional, resulting in failure to efficiently suppress the pathogenic loop. In addition, Helicobacter pylori infection leads to defective inhibitory FcγRIIB signalling in macrophages and thereby increases susceptibility to ITP. In ITP patients, dysregulation of these negative immune regulators is associated with each other in the impaired immune regulatory network. Thus, strategies that enhance functions of these intrinsic negative immune regulators would be promising future approaches for treating ITP.
Transfusion safety in hospitals
Authors: Murphy M. F. , Yazer M. H.
Published: July 2014

The main challenges for the hospital transfusion laboratory are ensuring patient safety, the effective use of blood, robust methods for documentation and monitoring practice, good blood stock management and low wastage, adequate staff training and the rapid availability of blood for those patients who need it urgently. Patient safety is paramount, but haemovigilance schemes worldwide continue to demonstrate that errors in the transfusion process result in patient morbidity and mortality.

There are considerable barriers to improving the safety of transfusion practice in hospitals, but they can be overcome by ‘re‐engineering’ the process with the support of a multidisciplinary team with shared, achievable and measurable objectives, engaging with senior hospital management and having a determination to see the development of a new process through to completion and its implementation as routine practice.

This review will highlight where progress has been made in improving transfusion safety in hospitals, and use the implementation of electronic transfusion management systems in Oxford, UK, and the hospitals of the University of Pittsburgh Medical Centre (UPMC) in western Pennsylvania, USA, as examples of improving patient safety and to support and educate clinical staff when the decision to transfuse is being made.
Understanding the current and future contribution of psychology to blood donor recruitment
Authors: Masser B. , Bagot K.
Published: July 2014

Understanding our future donors is of importance to blood collection agencies (BCAs) worldwide. For effective panel management, we need to know both who they are and also why they do or do not engage in blood (product) donation. The recent surge in psychological research into blood donation has provided significant insight into understanding the psychological factors underpinning the commencement of blood donation, that is, answering the why questions. This review will summarize our current understanding of the psychology of blood donor recruitment while outlining the complexities that may lie ahead. From the systematic application of various psychological theories to blood donation, certain psychological elements (e.g. self‐efficacy) have emerged as key determinants of donor recruitment. Drawing on this, research psychologists have worked with BCAs to develop and evaluate recruitment materials designed to target these constructs. Both laboratory and in‐field trials have consistently shown positive effects in recruiting new donors. This collaboration of researchers and BCAs has furthered understanding and recruitment efficacy generating measurable, operational deliverables. However, such collaborative research also highlights the challenges that lie ahead both in terms of the diversity of nondonors as well as the limitations of current theoretical models. Further, there is an increasing need for large‐scale randomized controlled field trials to systematically evaluate interventions designed on the basis of psychological research. Although such trials provide substantial challenges, the promise of psychology in providing the ‘who’ and ‘how’ to successfully recruit donor panel members efficiently is great.
Infectious risks of blood transfusions: Recent advances in testing technologies and new approaches to surveillance and decision‐making
Authors: Busch M. P.
Published: July 2014

Introduction

Despite impressive progress in reducing risk of established transfusion‐transmitted infectious diseases (TTIDs), new emerging infectious disease (EID) threats continue to be identified and cause pressure to expand deferrals and testing in order to maintain the safety of transfusions.

Aims

Review recent progress in developing approaches for estimation of residual risk and test efficacy for established TTIDs, as well as new approaches for systematic surveillance and assessment of EIDs that may threaten the blood supply.

Methods

Summarize recent publications and initiatives of the global blood banking community directed at reducing risk of traditional TTIDs as well as recent responses to EID threats.

Results

Implementation of enhanced serological assays and nucleic acid amplification technologies (NAT) has virtually eliminated risks of major TTIDs. Formal approaches have recently been developed to monitor and respond to EIDs by examining their properties with respect to transmissibility and potential for causing significant disease in transfusion recipients. New tools for quantitative risk assessment are under development to facilitate rigorous evaluation of scientific evidence, while also formally soliciting and considering public perception and fear and health economic realities.

Conclusion

These ongoing efforts at refining our risk surveillance, assessment and decision analysis tools, coupled with focused research to quantify risks and evaluate interventions, presage an era of sustained safety and enhanced public trust in the blood supply.
Meeting clinical demand for blood and blood products
Authors: Caulfield J.
Published: July 2014

Background

The Australian Red Cross Blood Service (the Blood Service) is supported by circa 600 000 voluntary nonremunerated blood donors. The ongoing challenge is to influence donor behaviours to best match the collections received to the product demand.

Aim

The aim has been to develop a suite of tools and a framework of processes that result in a close alignment of supply and demand, ensuring that customer service and efficiency are balanced for optimal outcome.

Methods

The Blood Service implemented S&OP in 2010, and this has been the basis for integrated, iterative planning that establishes a single set of monthly numbers that aim to align supply and demand. These plans are disaggregated to the lowest level of daily collection plans by blood type in order to drive or pull appointments only as needed to meet demand. Previously, collection targets were not ABO specific, so there was no assurance of correct proportions by ABO.

Results

The average interval since last donation for returning donors by blood group has adjusted to better meet inventory targets. In January 2008, the gap between the lowest and highest average interval period was 33 days, and this has risen to 166 days by June 2013. This has resulted in more appropriate inventory holdings by ABO, enabling demand to be met and expiry to be reduced.

Summary/Conclusion

The Blood Service has been effective in managing donation patterns at the blood group level, which has enabled the organization to improve performance in relation to meeting clinical demand for blood and blood products, especially red cells.
Can we manage blood inventory effectively?
Authors: Caulfield J.
Published: July 2014

Background and Objectives

In Australia, we rely on voluntary, non‐remunerated donors to provide sufficient blood to meet patients’ needs. For fresh components, the Australian Red Cross Blood Service (Blood Service) is 100% self‐sufficient, with only rare phenotypes imported as required. Hospitals and pathology laboratories, as well as the Blood Service, are under increasing pressure from Government/s to improve value for money for blood and blood products, which is resulting in extra demands being placed on the Blood Service. There is also some pressure, in relation to lower age at issue for red cells, and a continuing trend to hold more Group O stock and less of the other groups, especially AB where demand is low. With a typically seasonal inventory pattern for red cells, the Blood Service has focussed on closer management of Blood Inventory. The Blood Service is fully funded by Australian Governments.

Aim

The aim of the inventory programme was to improve reliability of blood coming into the supply chain and therefore to improve reliability of delivery to customers. This is measured by average variance in the number of whole blood collection packs being receipted at the Blood Service processing centre. The aim was to reduce the variability in this metric, which would naturally lead to decreased inventory holding requirements, greater control and efficiency, and increased reliability and service to the customers. Order fulfilment is another measure used to demonstrate improvement.

Methods

To manage blood inventory effectively, the first step was to introduce a minimum and maximum inventory level, by blood type and by state. This provided a common and visible target to aim for. The bands were calculated by firstly setting a minimum inventory level using traditional supply chain safety stock calculations. The next step was to develop a 12‐week inventory forecast, using a number of planning assumptions. One of the core assumptions is the number of appointments booked in the lead up to a donation. To improve reliability, minimum targets were agreed at 3 months out (re‐booking time) through to 1 week out. A ‘traffic light’ style appointments portal was developed to provide improved visibility of appointment levels for each collection mode and by state.

Results

Results show that the quarterly standard deviation of blood coming in to the Blood Service inventory has improved from 1711 units to 1285 units in the last four financial years – a 25% reduction. In addition, order fulfilment has improved from 82% to 95%, demonstrating that, with improved planning systems and processes, it is possible to manage inventory effectively. The Blood Service in Australia set a goal to improve reliability of fresh components, in particular, red cells entering finished goods inventory, to improve order fulfilment and provide service excellence to customers. By implementing robust and disciplined planning and reporting systems, reliability has improved, demonstrating that there are methods available to improve the effectiveness of inventory management for blood components.
The diagnosis and management of heparin‐induced thrombocytopenia in Japan
Authors: Kaneko M. , Wanaka K. , Tsuno N. H. , Kanno N. , Nonobe R. , Takahashi C. , Matsuo T. , Okazaki H. , Yatomi Y.
Published: July 2014

Heparin‐induced thrombocytopenia (HIT) is one of the most important complications of heparin, and results in thrombosis despite its use as an anticoagulation therapy. Although the clinical information is helpful, laboratory tests are essential for diagnosing HIT; two principles of assays detecting anti‐PF4/heparin antibody (HIT Ab) exist, i.e., an immunoassay and a functional assay. 14C serotonin release assay (14C‐SRA), a representative functional HIT Ab assay, is established to be a golden standard test for HIT, the usage of radioisotope hampers its wide spread, especially in Japan. Although immunological HIT Ab can be assayed by commercially available kits, whether this HIT Ab activates platelets cannot be assessed by this method. Recently in Japan, the automated immunoassay for HIT Ab detection has been approved as a clinical laboratory test in the national medical insurance system; only the latex agglutination test is now widely used clinically because of its simplicity, convenience and cost‐effectiveness. In this review, we describe the present status of the diagnosis and management of patients with suspected HIT in Japan.
Development of a stepwise accreditation programme from the perspective of the Africa Society for Blood Transfusion
Authors: M'baya B.
Published: July 2014

Background

Blood services in Africa operate at different levels of development from those comparable to the developed world to those operating at a basic level. In recent years, countries have improved their blood services but have found many international quality standards too stringent for most economies in the region. To address these challenges, the Africa Society for Blood Transfusion (AfSBT) has developed blood transfusion standards relevant for Africa.

The AfSBT Stepwise Accreditation Standards

The Standards were drafted by an AfSBT Task Team with guidance from the AABB and input from a team of experts. There is one Standard with three progressively more rigorous steps of achievement. The Standards apply to facilities that perform any or all of the blood transfusion process chain activities from vein to vein. There is a guidance document that clarifies and enhances understanding of the requirements of some of the standards.

Training and Implementation

There is a training committee, tasked with supporting training for blood services. Piloting of the Standards was done in Namibia and Malawi. Next implementation steps include licensing, translation into French and Portuguese and development of the capacity of the AfSBT to become an accrediting body.

Conclusion

Stepwise accreditation programme is relevant in encouraging improvements for developing blood transfusion services. Accreditation standards need to be commensurate with local needs while safeguarding patient and blood donor safety. Training is important in helping blood services to become accredited.