bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prognostic Significance of Established Hematological Parameters and Inflammatory Biomarkers in Assessing Dengue Infection Severity and Progression among Patients Ages 5 to 14 in a Tertiary Government Hospital in Pampanga, Philippines
Authors: Cai J R , Camacho I B , Caras E M , Carayugan J A , Carmona K H , Castillo C O , Castillo E D , Nieto X A , Sison R G 
Published: October 2021

Abstract

Introduction/Objective
Dengue virus (DENV) is an arthropod-borne virus which imposes a significant burden on the health system in most tropical and subtropical countries. In 2009, WHO classified Dengue into Dengue Without Warning Signs (DNWS), Dengue With Warning Signs (DWWS), and Severe Dengue (SD). This study aims to establish the prognostic value of predetermined hematological parameters and inflammatory biomarkers in assessing severity and progression of dengue infection among ages 5-14.

Methods/Case Report
A retrospective study was conducted to evaluate the Complete Blood Count, Inflammation biomarkers, and severity of dengue patients (5-14 of age). The diagnosis must be serologically confirmed by a positive NS1/IgM.

Results (if a Case Study enter NA)
A total of 36 patients participated in the study, having 18 from each groups of DWWS and SD. The mean age of Dengue cohort was 13.9 years with 59% (19/36) being male. Laboratory findings reveal SD to have lower platelet count (&lt;100.00x109/L) during day 1-3 (p&lt;0.001). Low WBC count (&lt;4.00x109/L), Relative Eosinophil (&lt;2.00%), and Absolute Lymphocyte count (&lt;1.52x109/L) were evident on days 1-3 among DWWS and SD cases (p=0.023; p=0.045; p=0.033). Low relative neutrophil (&lt;0.45%) was a constant finding in both clinical types throughout disease progression. SD group had significantly higher Neutrophil to Lymphocyte ratio (NLR) values among SD cases on days 4-6 (p&lt;0.001). In contrast, Platelet to Lymphocyte ratio (PLR) was significantly lower among DWWS cases on days 4-6 (p=0.020). Monocyte to Lymphocyte (MLR) ratio had poor discriminative power (p=0.560).

Conclusion
The findings highlight decreased platelet, WBC, relative eosinophil, and absolute lymphocyte count to be common among Dengue patients. NLR and PLR were found to be good predictors of dengue severity during the initial phase of infection. Evaluating these values may aid clinicians in early diagnosis of severe dengue. However, larger samples are needed to further validate the predictive values of these parameters.
Coping with the COVID-19 Pandemic: An adapted approach to preclinical teaching of Pathology- Pathophysiology
Authors: Huq Ronny F M , Mares A , Harris Petersen K , Risucci D , Catano D , Lento P 
Published: October 2021

Abstract

Introduction/Objective
The COVID-19 pandemic affected all aspects of medicine, from patient care to medical education. Pandemic-related restrictions regarding in-person teaching activities at our medical college required adoption of an online, live, virtual format for all activities in our preclinical Pathology-Pathophysiology (PP) courses. Adaptation of teaching approaches using available technology allowed for uninterrupted learning and may serve to contribute to future innovations in medical education.

Methods/Case Report
Using Zoom as a platform, all lectures and interactive group exercises were converted to a live virtual format. Live Zoom lectures were also recorded and, subsequently, made available to students, in order to provide additional opportunities for engaged learning. Interactive, case-based and self-directed exercises, and gross specimen reviews were also held using the live virtual format. Fourth year students enrolled in our education concentration helped provide intermittent virtual peer reviews for the 2nd year students. All exams were administered via an electronically monitored virtual format.

Results (if a Case Study enter NA)
Overall, performance of the 2020-2021 class on in-house, multiple choice question (MCQ) exams in our PP courses was typically at or above the performance of prior classes, while class performance on a standardized national subject exam (NBME) in Pathology was above the national average, which was consistent with prior class performances, and significantly higher (p = 0.01) on average in 2021 than in 2019 (2.28 points) and 2020 (2.27 points). Additional analyses are being conducted on demographic subgroups within each cohort (sex, MCAT score, socioeconomic status, underrepresented in medicine, registered for disability accommodations) to determine if any particular group’s performance was impacted by this change of format.

Conclusion
Despite the restrictions imposed by the pandemic, student performance on in-house and standardized national exams in the NYMC Pathology-Pathophysiology courses were similar to recent pre-pandemic years. Our endeavors to provide a strong preclinical educational experience in Pathology-Pathophysiology during the pandemic resulted in learning outcomes on a par with those in recent years, despite the rapid transition to a completely online, live virtual format.Our data suggest that continued use of virtual teaching methods is a viable option in on-going medical curricula
SATB2 expression in human tumors: A tissue microarray study on more than 15,000 tumors
Authors: Dum D , Krech T 
Published: October 2021

Abstract

Introduction/Objective
Introduction: Special AT-rich sequence-binding protein 2 (SATB2) binds to DNA in specific nuclear matrix attachment regions and facilitates chromatin remodeling. SATB2 immunostaining is commonly used as a marker for colorectal adenocarcinoma and osteosarcoma.

Methods/Case Report
Methods: To comprehensively evaluate SATB2 expression in normal and tumor tissues, a tissue microarray containing 15,012 samples from 120 different tumor types and subtypes and 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry.

Results (if a Case Study enter NA)
Result: SATB2 positivity was found in 89 different tumor types including 59 with at least one moderately positive and 38 tumor types with at least one strongly positive tumor. Most frequent and strongest expression were found in adenomas (94-96%), adenocarcinomas (86%) and various subtypes of neuroendocrine neoplasms (43-100%) of the colorectum and appendix, Merkel cell carcinoma (74%), osteosarcomas (60%), and papillary renal cell carcinoma (RCC) (52%). In colorectal cancer, weak SATB2 expression was linked to high pT (p&lt;0.0001), nodal metastasis (p&lt;0.0001), right-sided tumor location (p&lt;0.0001), microsatellite instability (p=0.0004), and BRAF mutations (p&lt;0.0224). In papillary RCC, low SATB2 was associated with high pT (p=0.0197), distant metastasis (p=0.042), and reduced tumor specific survival (p=0.0395). In clear cell RCC, low SATB2 was linked to high pT (p&lt;0.0001), high UICC stage (p&lt;0.0001), high Thoenes grade (p=0.0178), and reduced recurrence free survival (p=0.0216).

Conclusion
SATB2 expression can occur in many different tumor entities. Strong SATB2 expression argues for a colorectal tumor origin within adenocarcinomas and neuroendocrine neoplasms. Weak SATB2 expression reflects cancer progression and poor prognosis in colorectal and kidney cancer.
Mobilizing COVID-19 Testing: Impact and Challenges
Authors: Odenbrett R , Ingemansen D , Baumgart T , Hieb V , Ross A , McDowell J , Chang R , Strouts F 
Published: October 2021

Abstract

Introduction/Objective
In response to the rapidly evolving COVID-19 pandemic, Sanford Health developed a mobile diagnostic testing program capable of reaching geographically dispersed sites and communities. These mobile laboratories provided on-site testing and sensitive detection of SARS-CoV-2 by leveraging Cepheid’s GeneXpert platform, enabling rapid reporting of results directly to the patient and physician. Aggregation of these results allowed monitoring population infection rates and public health reporting.

Methods/Case Report
Within 3 weeks of conception, the first mobile unit was designed, engineered and deployed. Key requirements for successful implementation included mobile lab licensure, CLIA certification, COLA enrollment, Quality and Risk assessments, inventory management, lab maintenance and ongoing monitoring. Testing was performed using the Xpert Xpress SARS-CoV-2 test and the population tested were primarily asymptomatic individuals.

Results (if a Case Study enter NA)
Between May 3rd, 2020 and June 23rd, 2021, a total of 31,148 Xpert Xpress SARS-CoV-2 tests were run across 3 mobile laboratories, with an average of 600 tests performed per week. The percent positivity ranged from 0% to 5.8%, reaching highest positivity in week beginning May 10th, 2020. The average turnaround time from sample collection to result verification was 2.0 hours, and the average time from sample receipt to result verification was under 1 hour.

Conclusion
Sanford Health’s mobile testing program brings SARS-CoV-2 PCR testing to the community and dramatically reduces the time from sample collection to result reporting compared with traditional testing labs, enabling rapid intervention following a positive result. The flexibility of the GeneXpert platform, including the instrument’s robustness, the independently functioning analyzers, and the wide range of tests available, makes it particularly well suited to mobile laboratories. This program demonstrates the impact of on-site testing and highlights the challenges that were overcome for successful implementation, providing a blueprint to support the development of other mobile laboratories in the US.
Assessment of Clinical Laboratory Personnel Protective Equipment Inventory Management During COVID-19 Pandemic in the Philippines
Authors: Pingol M 
Published: October 2021

Abstract

Introduction/Objective
COVID-19 pandemic has brought a worldwide scarcity of personal protective equipment, which prompted medical technologists to explore the inventory management strategies, specifically the maintenance, conservation, and alternative use of personal protective equipment. The study aimed to assess the impact of these strategies on the personal protective equipment shortage in laboratories, as well as identify and describe the clinical laboratory supply and demand of personal protective equipment during the outbreak.

Methods/Case Report
The researchers utilized a quantitative survey involving one hundred thirty-six medical technologists working in an institution-based laboratory of Makati and Taguig City. The collated data were encoded in Microsoft Excel for descriptive statistics containing frequency distribution.

Results (if a Case Study enter NA)
27.9% of the respondents affirmed that they experienced a shortage of personal protective equipment in their workplace but most were unsure whether the contributing factors caused it. The respondents resorted to inventory management strategies to alleviate their lack of personal protective equipment. However, 41.9% and 38.2% of the respondents were undecided whether the efforts to conserve personal protective equipment and the supply management strategies were effective, respectively. Meanwhile, 40.4% of the respondents agreed that personal protective equipment alternatives can help in mitigating the demand for traditionally manufactured personal protective equipment.

Conclusion
Nonetheless, they were able to utilize inventory management strategies in which they were unsure if conservation and maintenance of personal protective equipment were effective but affirmed with the competency of an alternative use for alleviation.
Histology Slide Quality Improvement Project Utilizing DMAIC principle of Six Sigma Quality Improvement Methodology
Authors: Wang Y , Loboda A , Chitsaz M , Ganesan S 
Published: October 2021

Abstract

Introduction/Objective
DMAIC (an acronym for Define, Measure, Analyze, Improve and Control) refers to a data- driven improvement cycle used for improving, optimizing, and stabilizing business processes and designs. Our goal was to utilize DMAIC principle of six sigma quality to improve histology slide quality.

Methods/Case Report
We “defined” the problem as suboptimal quality in endometrial biopsy slides (defects). Utilizing the DMAIC principle and adhering to a strict timeline, the defects found during baseline slide quality review were “measured” by linking the defects to specific histology competencies, which were addressed systematically for process improvement (PI). After PI, a follow up review (“improve” and “control” phases) was carried out to identify measurable outcomes as a testament to quality.

Results (if a Case Study enter NA)
During the problem “measurement” phase, the defects found in the baseline review of 175 slides were linked to four specific histology competencies (fixation, embedding, cutting, and staining). Processing was excluded as it is completely automated and standardized. Our analysis showed that 83.3 % of defects were linked to embedding (“tissue too dispersed”). As embedding competency depends on the size and nature of the tissue (e.g. mucus and blood admixed with tissue), grossing competency was also addressed along with embedding at the respective workstations. Recommendations were offered to the grosser, embedder, and cutter to reduce variables during the “improvement” phase. Follow up review was done on 196 slides. The number of defective slides decreased and the defects that linked to “tissue too dispersed” had an overall improvement of 91.3%. Once the PI is proven to be effective, in service to histotechnology personnel biannually were also offered during “control” phase.

Conclusion
We have demonstrated successful methods for improving histology slide quality utilizing DMAIC principle of quality improvement by six sigma methodology DMAIC principle can be creatively adapted in laboratory practice management to enhance quality.
Impacts of the Virtual Landscape During the COVID-19 Pandemic on the 2020 Application Cycle
Authors: Cutshall H , Amerson C , Singh N , Hattaway R , Rais-Bahrami S , McCleskey B 
Published: October 2021

Abstract

Introduction/Objective
In response to the COVID-19 pandemic, the 2020 application cycle adapted to a mostly virtual setting. This project focused on the impact of these changes on the 2020 application cycle with the elimination of in- person away rotations and interviews, as well as the implementation of new virtual opportunities for learning and interacting with residents and programs.

Methods/Case Report
This study was conducted through an anonymous survey sent out to programs that engaged in social media usage in the 2020 application cycle. The survey was made available to program directors, faculty, residents and the matched applicants and focused on their usage and opinion of impact of virtual opportunities, virtual interviews and social media encounters.

Results (if a Case Study enter NA)
A total of 17 program directors/faculty, 17 residents and 19 matched applicants completed the survey across 91 programs surveyed. Virtual opportunities that were offered across these programs include: open houses, sub-internships, didactic lectures, grand rounds, Q&A sessions, and virtual facility tours. Responses showed that 4 programs (16%) moved applicants up on their rank list based on pre-interview virtual interactions. From the applicant perspective, 13 (76.5%) said virtual opportunities impacted the way they evaluated programs with 13 (68.4%) ranking programs higher and 3 (15.7%) ranking programs they otherwise would not have ranked. On the other hand, 21 faculty/residents (80.7%) felt that applicants missed out on fully experiencing the program due to lack of in person interviews and away rotations. However, 14 programs (56%) interviewed more candidates and offered more interview days during the 2020 application cycle. Applicants also applied to a greater number of programs with 42% of surveyed applicants applying to more than 50 programs, however none attended more than 30 interviews.

Conclusion
In conclusion, adaptations in response to the COVID-19 pandemic have provided an unexpected opportunity to explore the impact of the virtual landscape on residency recruitment.
Reducing IV-contaminated blood specimens in the clinical laboratory: A Quality Improvement Project
Authors: Harrington A , Kroft S H , Wells T , Gannon V 
Published: October 2021

Abstract

Introduction/Objective
Preanalytical errors constitute the most common errors in the laboratory, with improper specimen collection accounting for many errors. In our laboratory, we had a sentinel event related to repeated deletions of suspected IV-contaminated draws, and herein report our quality improvement project (QIP) to reduce deleted test results and IV-contaminated specimens.

Methods/Case Report
Our QIP initiated with creating a core-lab task force. Several interventions were launched: (A) policy/definition standardization, (B) nursing IV-line/cathedar in-services, (C) in-services on deleting test results and identifying IV-contamination, (D) policy updates to reflect no deletions without evidence of IV-contamination, and (E) mitigation steps requiring supervisory approval for result deletions. We measured: patient safety events (PSRs); RECOLLECTION comment usage and efficacy (disclaimer attached to results thought to be IV-contaminated, requesting recollection); and mitigation failures. Efficacy of the comment usage was measured by comparing subsequent collections to the original and determining likelihood of IV-contamination (contaminated, not contaminated, and unsure). Prior to the QIP, lab practice was to delete suspected IV-contaminated results and those requested by the care team.

Results (if a Case Study enter NA)
PSRs attributable to IV-contamination dropped from 47/mo. (time 0) to 18/mo. over an 11-month period (min-8/mo.; max-64/mo.), with the greatest decrement seen following intervention C. The RECOLLECTION comment was attached to 38 results (0.06% of total accessions) at the start and 73 results (0.12% of total accessions) at time 11 mos. and showed greatest increase in use immediately prior to interventions C and D (approximately 3-fold increase). At time 0, 54% of RECOLLECTION comments were deemed contaminated and 31% were not; at time 11mos., 74% (50/68) were contaminated and 24% (16/68) were not. Mitigation failures numbered 5/mo. initially and 1/mo. at time 11 mos.

Conclusion
With multiple educational and supervisory interventions, we demonstrate a reduction in PSRs attributable to IV-contamination collections at our hospital. Use of cautionary disclaimers was overall minimal and appropriately used.
Adherence to Choosing Wisely Campaign Guidelines at Three Health Systems
Authors: Windham A K , Whitted M , Brimhall B , Buckley J , Nichols G , Weddell B , Thomas D , Leung B 
Published: October 2021

Abstract

Introduction/Objective
With rising healthcare costs in the United States, there has been a push for lab stewardship to improve the quality of patient care while reducing costs. To optimize the use of clinical laboratory testing, the ASCP working with other medical specialty organizations, developed the Choosing Wisely Campaign to promulgate evidence-based guidelines to optimize clinical laboratory testing.

Methods/Case Report
We examined adherence to three Choosing Wisely guidelines over a four-year period (2017- 2020), through queries of internal cost accounting databases to return aggregate volumes as well as variable and total costs at three large academic health systems. We measured concurrent orders for: 1) erythrocyte sedimentation rate (ESR) with C-reactive protein (CRP), 2) serum/plasma amylase with lipase, and 3) free thyroxine (FT4) and/or total triiodothyronine (TT3) with thyroid stimulating hormone (TSH) when the TSH is within the reference range (using an frequency estimate of 85% based on other studies). We also examined another guideline for concurrent orders for serum aldolase with creatine kinase (CK). We also quantified aggregate variable costs for the non-recommended test in each Choosing Wisely guideline (amylase, ESR, FT4 and/or TT3), and for serum aldolase when ordered with CK.

Results (if a Case Study enter NA)
Over the four-year period, there were 322,853 unnecessary tests based on these four guidelines (120,587 ESR and CRP, 30,444 amylase and lipase, 164,818 FT4 and/or TT3 with TSH, and 7,004 aldolase). Overall, unnecessary testing decreased between 2017 and 2020 for amylase with lipase, remained essentially unchanged for aldolase, and increased for the other two test guideline scenarios. The largest changes were concurrent orders for amylase and lipase at one health system (38% decrease), and orders for TT3 with a normal TSH result at another health system (324% increase). The four-year variable cost of these unnecessary tests was $1,215,309 ($303,827 mean annual cost), resulting in potential annual variable cost savings of $101,276 for each health system for the four guidelines we examined. Variable costs for unnecessary testing increased by 16.5% ($45,571) over the four-year period.

Conclusion
Guideline-based unnecessary testing remains as a target to improve laboratory diagnostic testing. There is potential to realize significant achievable cost savings if guidelines are implemented and maintained.
Addressing Opportunities & Misunderstandings of ASCP International Certification in the Philippines
Authors: Finnegan K , Tanabe P , Baker J 
Published: October 2021

Abstract

Introduction/Objective
The objective of this study is to identify the positive viewpoints and misunderstandings Filipino applicants have about the BOC’s international credential and credential maintenance programs. With a total of 10,836 MLS(ASCPi) certificants, the Philippines is the BOC’s largest and most successful international certification market. However, despite the Philippines being the BOC’s largest international certification market, the BOC only certifies about a third of eligible Filipino graduates each year.
Therefore, to encourage additional interest in achieving BOC credentials and to eliminate misunderstanding surrounding the BOC’s Credential Maintenance Program (CMP), the ASCP BOC International Credentialing Committee created and deployed a survey.
The purpose of the survey was to learn as much as possible about the medical laboratory scientist certification market in the Philippines, as well as determine what opportunities Filipino‘s were afforded after they earned their credential. The resulting report based on analysis of the survey results showed there are a number of issues affecting Filipino participation in the BOC’s credential and CMP offerings.

Methods/Case Report
422 individuals from 44 countries of education participated in the survey. This study is a summary of results from the 265 Filipino respondents.

Results (if a Case Study enter NA)
This study confirmed a number of assertions the BOC had about the Filipino credential market. The most important of these assertions is MLS(ASCPi) certification is appealing to Philippine- educated individuals due to its portability (i.e., work eligibility, emigration, etc.).

Conclusion
The BOC should continue leaning into the portability of MLS(ASCPi) certification, but also needs to do a better job of promoting our other international certifications for which Filipinos may be eligible. The BOC needs to place greater emphasis on educating Filipinos on the importance of CMP and on what can be used for CE towards CMP. For example, the BOC needs to create an outreach campaign that helps Filipino credential holders understand CE earned for their PRC (i.e., Philippines-licensure requirements) can also be used for their CMP. Finally, considering the popularity of BOC certification in the Philippines, the BOC should work on creating more content that focuses on promoting the usefulness of pursing an advanced credential, the portability of certification, and the overall demystification of CMP.