bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathogen inactivation – defining ‘adequate’ bacterial protection
Authors: Benjamin R. J. 
Published: July 2014

Background and ObjectivesClinical 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 MethodsRecent reports and an empirical model are used to describe our current understanding of the efficacy of pathogen inactivation in improving platelet transfusion safety.ResultsOptimized 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.ConclusionsClinical 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.
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

BackgroundThe 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.DiscussionThis 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.
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.
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

IntroductionDespite 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.AimsReview 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.MethodsSummarize 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.ResultsImplementation 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.ConclusionThese 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

BackgroundThe 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.AimThe 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.MethodsThe 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.ResultsThe 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/ConclusionThe 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

AbstractBackground and ObjectivesIn 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.AimThe 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.MethodsTo 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.ResultsResults 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.
Development of a stepwise accreditation programme from the perspective of the Africa Society for Blood Transfusion
Authors: M'baya B. 
Published: July 2014

BackgroundBlood 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 StandardsThe 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 ImplementationThere 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.ConclusionStepwise 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.
The International Society of Blood Transfusion Library of Guidelines, Standards and regulatory documents
Authors: Chapman J. F. , Prinsze F. 
Published: July 2014

AimA survey identified that members of the International Society of Blood Transfusion (ISBT) expected the Society to offer more educational material than was already available. As a result of the survey the ISBT Board of Directors decided to invest in increasing the availability of educational material. Webcasts from plenary sessions and the Academy day programme at congresses were made available, and the Board agreed to the development of a library of published guidelines, standards and regulatory documents.MethodsThe library project was established, and a temporary staff member recruited to undertake the work of searching for available guidelines and standards documents, identifying those suitable for inclusion in the library and organizing them into various topic headings. The ISBT Academy e‐portal was identified as the ‘home’ for the library.ResultsTwo hundred and ninety‐three documents were found and have been placed in the library under seven topic headings; these are further sub divided into 27 sub categories. There are currently guidelines available from 25 countries. There are two books one from Italy and one from the Netherlands, which cover all of the topics found in the library.
Detection of clinically relevant platelet antibodies in the Asian population
Authors: Wu G.‐G. 
Published: July 2014

BackgroundThe detection and identification of the clinically relevant platelet antibodies are important for the diagnosis and management of the affected patients with immune thrombocytopenia.AimsThe aim of this study was to investigate the characteristic of clinically relevant platelet antibodies in the Asian population, and to evaluate the ability of platelet immunology laboratories in Asia to detect and identify these platelet antibodies.MethodsTotal of 635 cases that were diagnosed and studied as NAITP, PTR and PTP by Asian platelet laboratories were reviewed for the clinical and experimental data from the publications.ResultsExcept the anti‐HLA and unknown‐specificity antibody, the most frequently identified platelet antibody was anti‐CD36 (18/635, 18·35%), and then anti‐HPA‐3 and anti‐HPA‐4 (each 5/635, 0·78%), and anti‐HPA‐5 (4/635, 0·62%). Only two cases of anti‐HPA‐1 antibodies (2/635, 0·31%) were reported. In 274 cases, including four cases contained anti‐HLA antibody, the laboratories could not identify the specificity of platelet antibodies. The methods of detection and identification of antiplatelet antibody, such as monoclonal antibody immobilization of platelet antigens (MAIPA), mixed passive hemagglutination assay (MPHA), platelet immunofluorescence test (PIFT), modified antigen‐capture ELISA (MACE) and solid‐phase red‐cell adherence (SPAA), have been used in Asian laboratories.ConclusionWith an increasingly heterogeneous patient population in Asia, diagnostic laboratories should be aware of the ethnic origin of a particular patient to consider the possibility of immunization to antigens. The most important clinical relevant platelet antibodies implicated in immune‐mediated thrombocytopenia among the Asian population are anti‐CD36, then anti‐HPA‐3, anti‐HPA‐4 and others.
Dry-Cooled Supercritical CO2 Power for Advanced Nuclear
Reactors
Authors: Conboy T. M. , Carlson M. D. , Rochau G. E. 
Published: July 2014

Abstract
Currently, waste heat rejection from electrical power systems accounts for the largest fraction of water withdrawals from the U.S. fresh water table. Siting of nuclear power plants is limited to areas with access to a large natural supply of fresh or sea water. Due to a rise in energy needs and increased concern over environmental impact, dry air cooling systems are poised to play a large role in the future energy economy. In practice, the implementation of dry air-cooled condensing systems at steam plants has proven to be capital-intensive and requires the power cycle to take a significant efficiency penalty. These shortcomings are fundamental to dry-air steam condensation, which must occur at a fixed temperature. Closed-cycle gas turbines are an alternative to the conventional steam Rankine plant that allows for much improved dry heat rejection compatibility. Recent research into advanced nuclear energy systems has identified the supercritical CO2 (s-CO2) Brayton cycle in particular as a viable candidate for many proposed reactor types. The s-CO2 Brayton cycle can maintain superior thermal efficiency over a wide range of ambient temperatures, making these power systems ideally suited for dry air cooling, even in warm climates. For a sodium fast reactor (SFR) operating at 550 °C, thermal efficiency is calculated to be 43% with a 50 °C compressor inlet temperature. This is achieved by raising CO2 compressor inlet pressure in response to rising ambient temperatures. Preliminary design studies have shown that s-CO2 power cycle hardware will be compact and therefore well-matched to near-term and advanced integral small modular reactor (SMR) designs. These advantages also extend to the cooling plant, where it is estimated that dry cooling towers for an SFR-coupled s-CO2 power cycle will be similar in cost and scale to the evaporative cooling tower for a light-water reactor (LWR). The projected benefits of the s-CO2 power cycle coupled to dry air heat rejection may enable the long-awaited rise of next-generation nuclear energy systems, while redrawing the map for siting of small and large nuclear energy systems.
On the suitability of ultrathin detectors for absorbed dose assessment in the presence of high‐density heterogeneities
Authors: Bueno M. , Carrasco P. , Jornet N. , Muñoz‐Montplet C. , Duch M. A. 
Published: July 2014

Purpose:The aim of this study was to evaluate the suitability of several detectors for the determination of absorbed dose in bone.Methods:Three types of ultrathin LiF‐based thermoluminescent dosimeters (TLDs)—two LiF:Mg,Cu,P‐based (MCP‐Ns and TLD‐2000F) and a7Li‐enriched LiF:Mg,Ti‐based (MTS‐7s)—as well as EBT2 Gafchromic films were used to measure percentage depth‐dose distributions (PDDs) in a water‐equivalent phantom with a bone‐equivalent heterogeneity for 6 and 18 MV and a set of field sizes ranging from to . MCP‐Ns, TLD‐2000F, MTS‐7s, and EBT2 have active layers of 50, 20, 50, and 30 μm, respectively. Monte Carlo (MC) dose calculations (PENELOPE code) were used as the reference and helped to understand the experimental results and to evaluate the potential perturbation of the fluence in bone caused by the presence of the detectors. The energy dependence and linearity of the TLDs’ response was evaluated.Results:TLDs exhibited flat energy responses (within 2.5%) and linearity with dose (within 1.1%) within the range of interest for the selected beams. The results revealed that all considered detectors perturb the electron fluence with respect to the energy inside the bone‐equivalent material. MCP‐Ns and MTS‐7s underestimated the absorbed dose in bone by 4%–5%. EBT2 exhibited comparable accuracy to MTS‐7s and MCP‐Ns. TLD‐2000F was able to determine the dose within 2% accuracy. No dependence on the beam energy or field size was observed. The MC calculations showed that a thick detector can provide reliable dose estimations in bone regardless of whether it is made of LiF, water or EBT's active layer material.Conclusions:TLD‐2000F was found to be suitable for providing reliable absorbed dose measurements in the presence of bone for high‐energy x‐ray beams.
A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas
Authors: Thompson Reid F. , Mayekar Sonal U. , Zhai Huifang , Both Stefan , Apisarnthanarax Smith , Metz James M. , Plastaras John P. , Ben‐Josef Edgar 
Published: July 2014

Purpose:Uncontrolled local growth is the cause of death in ∼30% of patients with unresectable pancreatic cancers. The addition of standard‐dose radiotherapy to gemcitabine has been shown to confer a modest survival benefit in this population. Radiation dose escalation with three‐dimensional planning is not feasible, but high‐dose intensity‐modulated radiation therapy (IMRT) has been shown to improve local control. Still, dose‐escalation remains limited by gastrointestinal toxicity. In this study, the authors investigate the potential use of double scattering (DS) and pencil beam scanning (PBS) proton therapy in limiting dose to critical organs at risk.Methods:The authors compared DS, PBS, and IMRT plans in 13 patients with unresectable cancer of the pancreatic head, paying particular attention to duodenum, small intestine, stomach, liver, kidney, and cord constraints in addition to target volume coverage. All plans were calculated to 5500 cGy in 25 fractions with equivalent constraints and normalized to prescription dose. All statistics were by two‐tailed paired t‐test.Results:Both DS and PBS decreased stomach, duodenum, and small bowel dose in low‐dose regions compared to IMRT (p < 0.01). However, protons yielded increased doses in the mid to high dose regions (e.g., 23.6–53.8 and 34.9–52.4 Gy for duodenum using DS and PBS, respectively; p < 0.05). Protons also increased generalized equivalent uniform dose to duodenum and stomach, however these differences were small (<5% and 10%, respectively; p < 0.01). Doses to other organs‐at‐risk were within institutional constraints and placed no obvious limitations on treatment planning.Conclusions:Proton therapy does not appear to reduce OAR volumes receiving high dose. Protons are able to reduce the treated volume receiving low‐intermediate doses, however the clinical significance of this remains to be determined in future investigations.