bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood Products Wastage in Benghazi Hospitals, Libya: The Rate and Causes
Authors: Abdelmonem M , Mansour N , Dughman N A , Wasim H 
Published: November 2023

Abstract

Introduction/Objective
Introduction: Despite the rising demand for blood and blood products, supplies are limited. Limiting blood wastage may compensate for fewer donors. This study examines blood waste in Benghazi. A close look at blood and blood product distribution can reveal areas of frequent wastage and the primary factors contributing of blood waste. This would aid in the development of waste prevention programs and raise awareness of the issue. Physicians, laboratory professionals and nurses can follow blood transfusion guidelines.
Objectives: This study aimed to determine the rate of blood products wastage and identify the causes of Wastage in Benghazi hospitals in Libya.

Methods/Case Report
Materials and Methods: Data for this retrospective study describes the blood components utilization or waste for two years: 2015 and 2016 were obtained from hospital blood bank records of all public and private hospitals that Benghazi central blood bank supply with blood and blood components. Descriptive statistical methods analyzed the data.

Results (if a Case Study enter NA)
Results: In 2015 and 2016, Benghazi central blood bank supplied hospitals with 73511 units of blood. 35107(47.8%) were transfused. Wasted or discarded 33318(45.4)units. No data was available for 5086 units(6.8%).
The most frequently wasted component was PRBCs(87%) followed by platelets(8%) and FFP(6%).
The major cause of wastage for PRBCs is over-ordering (70.2%) followed by outdated units(18.5%), Returned after 30 minutes of issue (0.6%), Kept more than 3daysand expired(0.6%) and Issued to other hospitals(10.1%).
The main cause of wastage for platelets is over-ordering (89%), and inappropriate ordering is the most common cause of waste of FFP(85%).
PRBCs waste was mostly found in the surgical department, mainly obstetric(24%). For platelets, waste was mostly found in the hematology department(32%). for FFP, waste was mostly found in ER(47.1%).

Conclusion
The main cause of blood and blood component wastage is the unnecessary ordering of blood products. The most blood component discarded is PRBCs. Physicians are the most responsible for blood and blood component wastage. The blood ordering pattern needs to be revised, and the over-ordering of blood and blood component should be minimized. Medical staff must be educated to reduce blood wastage. Every hospital should implement a hospital transfusion committee to develop local guidelines and policies to monitor the rational use of blood and blood component.
Racial Disparity in Antibody Against A rare High Prevalence Antigen; (Anti-Inb)
Authors: Abdelmonem M , Ngo N , Cai W , Yunce M , Papakonstantino K , Jurado C , Virk M S , Lee J , Chang S , Yoshizuka S , Cabungan M 
Published: November 2023

Abstract

Introduction/Objective
Introduction: Ina antigen is very rare except in Iranian and Arab populations (10.6% and 11.8%, respectively). In 1973, Badkere et al. identified this antigen in about 3% of Indians from Bombay. Inb is a very high-prevalence antigen. It is prevalent in 99.9% of Caucasians and blacks, 96% of Indians and South Asians, and 90% of Iranians and Arabs. The Indian blood group system also has two other very high prevalence antigens: INFI and INJA. Indian blood group resides in CD44 glycoprotein that binds to hyaluronate of extracellular matrix. CD44 is an adhesion molecule in lymphocytes, monocytes, and other tumor cells, but its function in RBC is unknown. Ina and Inb are sensitive to proteolytic enzyme treatments and destroyed by disulfide bond-reducing agents 2-aminoethyl isothiouronium bromide (AET) and dithiothreitol (DTT).

Methods/Case Report
Case study: An 11-year-old female of South-East Indian descent with a history of intractable epilepsy was admitted for surgical treatment for epilepsy. Her antibody screen was positive, and her plasma reacted with all cells in PEG AHG except for the auto control. Ficin and DTT-treated cells weakened the reactivity. Suspecting a high-frequency antibody, the patient's plasma was tested against a series of cells in the rare donor cell inventory, including O Bombay cell and Inb-cell considering the patient's ethnicity. With Inb-negative cells, the plasma tested negative. All major alloantibodies from this rare donor cell were ruled out except for anti-C, anti-E, anti-K, and anti-S due to the availability of the rare cell.

Results (if a Case Study enter NA)
NA

Conclusion
Antigen Inb has a high prevalence in all populations. The rare phenotype In(b–) has been observed in approximately 2 of 700 Indian blood donors. A patient may be advised to undergo an autologous transfusion. Fortunately, the patient's procedures were uncomplicated, so a blood transfusion was unnecessary. Awareness on the part of blood bank staff regarding the variability of the blood group phenotype and the unpredictability of Anti-Inb may aid in improving patient care. To prevent further exposure, it is recommended that patients with rare antibodies carry an Antibody ID card indicating the rare antibody they possess.Inb antigen blood donors are under represented in the general donors pool. It is recommended to develop a systematic recruitment for Inb antigen donors
Financial Analysis of Transfusion Therapy: A Focus on Liquid Plasma and Fresh Frozen Plasma
Authors: Alazawi S , Saad A , Jain D , Alzaiem F , Ballouk C , Nash T 
Published: November 2023

Abstract

Introduction/Objective
Fresh Frozen Plasma (FFP) is widely used in transfusions, but its short shelf life once thawed (5 days) can lead to wastage. Liquid Plasma (LQP), on the other hand, doesn't require thawing and, thus, has a longer shelf life (26 days), but also more expensive. Our project examines the cost-effectiveness of LQP versus FFP, with a focus on the waste resulting from FFP units expiration at our institution.

Methods/Case Report
Our methodology involves a comprehensive review of existing literature, focusing on the utility and advantages of liquid plasma incorporation in transfusion protocols, and strategies to mitigate the wastage of Fresh Frozen Plasma (FFP). We conducted a detailed evaluation of FFP usage and wastage data in 2022 at a level one trauma center in the Detroit metropolitan area, specifically pertaining to trauma and trauma activation cases.

Results (if a Case Study enter NA)
In 2022, our institution collectively consumed 2,595 units of Fresh Frozen Plasma (FFP). Of these, 1,024 units, or 39%, were wasted, and only 1,571 units, or 61%, were actually utilized. The average cost per unit of FFP was $40.8, resulting in a total expenditure of $105,876.
If the hospitals had used liquid plasma (LQP) instead of FFP, and assuming no wastage with LQP, the total cost would have been $88,133 (given the average cost of $56.1 per unit of LQP).
This implies that by switching to LQP from FFP, and by eliminating the wastage, the hospitals could have achieved a combined saving of $17,745 in 2022.

Conclusion
Our findings highlight the urgent need for more efficient plasma usage. Despite the higher cost of LQP per unit, the increased waste associated with FFP contributes to higher overall costs for hospitals, making liquid plasma a potentially more cost-effective option when considering waste reduction.
Phosphatidylethanol as a biomarker to assess alcohol exposure in women of reproductive age using retrospective data from a reference laboratory
Authors: Mathewson Nicole , Johnson-Davis Kamisha 
Published: November 2023

Abstract
Alcohol consumption during pregnancy may cause fetal alcohol spectrum disorder (FASD), which is a preventable disorder. Prenatal alcohol exposure during the first trimester of pregnancy is deemed most disruptive to the developing fetus. Pregnant women may be screened for alcohol use through self-reported measures. These subjective methods are known to underreport drug use. Therefore, a reliable method to detect and monitor alcohol use during pregnancy is needed. Phosphatidylethanol (PEth) is a specific biomarker associated with alcohol consumption that can be used to differentiate social drinking from heavy alcohol use. The predominant PEth homologues are PEth 16:0/18:1 (POPEth) and PEth 16:0/18:2 (PLPEth), which account for 37-46% and 26-28% of the total PEth homologues, respectively. PEth can reflect alcohol intake up to several days to weeks after consumption. The aim of this study is to investigate the prevalence of positive PEth samples in women of reproductive age to determine whether testing for PEth should be assessed in a three-month checkup in pregnant women. The first objective is to perform a retrospective study on the direct alcohol biomarker, PEth, to evaluate the true positivity rates of alcohol use in females and in women of reproductive age (14 - 44 years old) using retrospective data analysis from a reference laboratory. The initial data analysis demonstrated the positivity rate of PEth in females (N = 66,306) to be 32% for POPEth and 28% for PLPEth. Further retrospective data analysis of PEth in women of reproductive age (N = 19,366) was performed and the positivity rate of PEth in this population was quite similar between the ages of 27 to 40 years old, at around 35%. The data shows that the positivity rate of PEth in women of reproductive age (~35%) is slightly above the positivity rate for all females (~30%). These percentages are significantly higher than what is reported in the 2020 National Survey on Drug Use and Health (NSDUH). The NSDUH reported that 10.6% of pregnant women used alcohol in the past month. The second objective is to conduct a laboratory study where we will measure PEth concentrations by mass spectrometry using residual whole blood specimens from females in an OB/GYN clinic and compare the positivity rates to those determined by the retrospective analysis. This study will provide the opportunity to educate women of reproductive age on drinking during pregnancy and the long-term effects of alcohol use.
Caffeine, Lorazepam, and Morphine Use in Neonatal Intensive Care Unit Population and Potential Relevance of Pharmacogenomics
Authors: Falekun Seyi , Mankouski Anastasiya , Solorzano Chelsea , Floyd Ivah , Rau Carrie , Margraf Rebecca , Del Angel Sergio , Brunelli Luca , McMillin Gwendolyn 
Published: November 2023

Abstract
Medications are critical for managing acutely ill infants in neonatal intensive care unit (NICU). Tailoring therapies to individual differences in response and dose requirements might help improve outcomes. However, tools for optimizing pharmacotherapy remain limited. In this retrospective study, we explored the potential utility of pharmacogenetics for commonly prescribed NICU medications. All patients admitted to our local NICU March-December, 2022 were eligible for inclusion in the study. In infants who received at least three doses of one or more medications, we extracted DNA from residual EDTA blood collected for routine clinical care according to IRB-approved study protocols. Demographic, pharmacy, and clinical information was recorded retrospectively. Targeted pharmacogenetics testing was performed with a custom TaqMan OpenArray and a QuantStudio 12K Flex (ThermoFisher Scientific) with DNA normalized to 50 ng/mL. Results were analyzed using Genotyper Software version 1.3 and allele calls were made based on the combination of variants detected and consensus nomenclature. For drugs administered to at least 30 NICU patients, pharmacogenes were evaluated for variant allele frequency and potential clinical relevance. Of the 132 patients enrolled, 81 were male. Average length of stay was 47 days. Of the 64 different medications prescribed to at least one infant, for 15 of them are described clinical annotations with specific pharmacogenes by the PharmGKB and/or Clinical Pharmacogenetics Implementation Consortium. Of those 15 medications, three were administered at least three times to at least 30 infants: caffeine (n=102), morphine (n=56), and lorazepam (n=31). The associated pharmacogenes were CYP1A2 (caffeine); CYP3A4, OPRM1, COMT, ABCB1 (morphine); and UGT2B15 (lorazepam). Relevant to the rate of clearance of caffeine, rs2069514 (CYP1A2) was heterozygous in 18% of patients, and homozygous in 5%. Relevant to the rate of clearance of morphine, CYP3A4*22 was heterozygous in 5%. The common variants associated with response to morphine, c.472G&gt;A (COMT) and c.118A&gt;G (OPRM1) were heterozygous in 43% and 26%, and were homozygous in 22% and 8%, respectively. The transporter variant ABCB1*2 was heterozygous in 6% and homozygous in 11%. Relevant to the rate of clearance of lorazepam, UGT2B15*2 (rs1902023) was heterozygous in 45%, and homozygous in 31%. Correlation of pharmacogenetic results to specific clinical phenotypes is currently in progress. Pharmacogenetic variants relevant to commonly prescribed medications in the NICU are prevalent. Further clinical correlation of pharmacogenetic results may help inform selection and dosing of medications for critically ill NICU infants. This research may also facilitate detection and definition of new drug-gene associations unique to this patient population.
Comparison of two free light chain assays: performance of the free light chain ratio as risk factor for MGUS progression
Authors: Andress Benjamin , Wang Qian , Pazdernik Vanessa , Kalass Stephanie , Dispenzieri Angela , Murray David , Willrich Maria 
Published: November 2023

Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is the most common plasma cell dyscrasia, present in ~3% of the population over 50yo. MGUS carries a 1% per year risk of malignant transformation for the rest of the affected individual’s life; long-term followup is recommended for all patients with MGUS. Different risk stratification models exist to evaluate potential for progression to malignancy. The Mayo risk model, published in 2005, uses the presence of 3 risk factors (abnormal free light chain (FLC) kappa/lambda ratio (KLr), M-spike ≥1.5 g/dL, non-IgG isotype) to confer a 3% per year risk of progression instead of the average 1%. For many years, the only FDA-approved measurement of FLC was the FreeLite assay (Binding Site), which uses polyclonal sheep antibodies. Recently, other FLC assays have become available in the US, including the Sebia FLC ELISA, which employs rabbit polyclonal antibodies. The assays have similar reference intervals (RI), however differences in analytical performance between the FreeLite and Sebia were previously reported. The objective of this study was to determine the performance of the Sebia FLC assay in the Mayo risk stratification model of MGUS patients for progression in comparison to FreeLite. Cryopreserved serum samples from a cohort of 923 MGUS patients with available long-term clinical followup (median follow-up time: 7.7years, range: 0.0 to 46.9) was used to measure FLC using Sebia ELISA on a DS2 automated platform (Dynex) and FreeLite on a Siemens BNII nephelometer. Passing-Bablok (P-B) regression and Spearman correlation were used to compare the KLr between assays. Cox proportional hazards models for progression to multiple myeloma or a related plasma cell malignancy were used to estimate the prognostic effect and ability to discriminate low and high risk of abnormal KLr for each assay. Analyses were carried out in R software. Correlation between Sebia and FreeLite KLr had a Spearman r = 0.796; P-B fit: Sebia KLr = 0.825*(FreeLite KLr) – 0.048, 95% CI of slope: 0.810-0.839). With FreeLite, 32.9% of patients had a KLr outside RI for the method. For Sebia, 48.0% of patients had a KLr outside the method specific RI. Despite the individual samples analytical disagreement, both assays showed similar clinical performance for risk stratification: Sebia abnormal KLr was associated with a hazard ratio (HR) of 2.77 (95%CI: 1.79-4.28 c-statistic=0.6505) for progression, while FreeLite abnormal KLr was associated with a HR of 3.31 (95%CI: 2.20-5.00, c-statistic=0.6529), and the difference in c-statistics was not statistically significant (p=0.93). The risk assessment is performed only once per patient, at the initial diagnosis of MGUS. The similarity in clinical performance between FreeLite and Sebia assays support the use of either method as a predictor for risk of progression for MGUS patients.
Analysis of daratumumab reporting in type and screen orders to identify opportunities for information system improvement
Authors: Morse Patrick , Thibodeaux Suzanne , Jackups Ronald 
Published: November 2023

Abstract
The rapid growth of monoclonal antibody therapies has resulted in a wide variety of targeted treatments towards malignancies. The presence of these antibodies in patient plasma can interfere with blood bank testing, which in turn can create a delay in the process of pretransfusion testing and provision of blood products to patients. Availability of information regarding particular medications can help guide blood bank processes and testing algorithms. Reporting of patient medications that can interfere with blood bank testing, including targeted therapeutic antibodies (e.g. anti-CD38 therapies such as daratumumab), often relies on the ordering provider to provide that information. At our institution, the type and screen (T&S) order contains a prompt that requests the history of daratumumab administration. Available responses are “yes”, “no”, or “unknown”, with the default answer of “unknown”. The goal of this study was to evaluate the reporting practice of daratumumab history in the T&S order and identify potential areas for process improvement. We retrospectively reviewed T&S orders for patients receiving daratumumab therapy during 2022 at a single institution. Of 370 patients who were receiving daratumumab therapy, 214 (57.8%) had T&S orders. Forty of the 214 patients (18.7%) with T&S orders had at least one order with a “yes” answer indicating daratumumab administration. Of the 40 patients with an answer of “yes”, 16 (40%) were associated with the initial T&S after starting therapy. Of the other answer options, 23 of 40 (57.5%) indicated “unknown” and 1 (2.5%) indicated “no”. The remaining T&S orders ordered after the initial order were evaluated for consistency in response. Of 352 total T&S orders placed after the initial T&S orders, 62 (17.6%) were “yes” answers, 4 (1.1%) were “no” answers, and 286 (81.3%) were “unknown”. These results suggest that manual reporting of daratumumab therapy is not optimized at time of initial T&S orders placed after daratumumab treatment is started and is further misaligned with treatment status with subsequent T&S orders. Development of automated methods may help improve the process of reporting medications to the blood bank to guide testing. Future directions include development of an informatics-based approach to link the patient’s medical administration record (MAR) to the laboratory information system (LIS) to provide history of daratumumab therapy to the blood bank. This approach will prioritize: (1) compatibility with the blood bank’s current workflow for testing, (2) clinical needs for ordering laboratory testing, and (3) adaptability for reporting of other relevant interfering therapies to the blood bank as well as to other clinical laboratories.
Banking Law in Italian Legal Consulting between the Fourteenth and the Fifteenth Centuries
Authors: Conetti Mario 
Published: November 2023

Abstract
Banking operations in northern and central Italy between late fourteenth and early fifteenth century were very sophisticated and often gave rise to disputes involving the expertise only law professors could provide. To provide solutions which were at the same time viable and grounded in legal culture, lawyers went beyond merely practical considerations to work out legal institutions as a framework to banking activities. In doing so, they developed a proper banking law, a peculiar legal system.
Upper Extremity Functional Outcomes After Breast Cancer Treatment: An Analysis of DASH Score in Breast Reconstruction Patients
Authors: Humar Pooja , Moroni Elizabeth , Raghuram Anjali , Balogun Zainab , Nguyen Xuan-Mai , Zhang Casey , De La Cruz Carolyn 
Published: November 2023

Abstract

Background
Patients undergoing postoncologic breast reconstruction can experience upper extremity (UE) functional deficits.

Objectives
In this study, we utilized the disabilities of the arm, shoulder, and hand (DASH) questionnaire to identify patient factors that impacted UE functional recovery.

Methods
Patients who underwent oncologic followed by reconstructive surgery by a single surgeon from 2014 to 2019 and completed the DASH survey were included. A DASH score was calculated for each patient, with values ranging from 0 (no impairment) to 100 (severe impairment). Regression analysis was conducted to identify significant predictors for DASH score with a significance level for entry and stay set at P = .15.

Results
Among 289 patients who underwent breast reconstruction, 157 completed the questionnaire. The average patient age was 52.6yrs ± 8.6 at the time of reconstruction. A total of 111 had implant-based reconstruction, 15 had autologous reconstruction, and 24 had a combination of both. Average DASH score was 7.7 (range 0.0-52.5), with 74.1% of patients having a score greater than 0. Regression analysis showed 5 variables associated with significantly higher DASH scores: age between 50 and 60 years (P = .13), history of radiation (P = .01), placement of a subpectoral implant (P = .06), postoperative complications (P = .10), and lymphedema (P &lt; .01). Autologous breast reconstruction (P = .04) was associated with a significantly lower DASH score.

Conclusions
Implant-based reconstruction, radiation history, postoperative complications, and age at reconstruction were associated with increased UE functional impairment in patients who underwent breast reconstructive surgery. Identification of these factors can inform areas for potential practice changes and improve patient counseling regarding postoperative expectations.

Level of Evidence: 3
Identifying the potential miRNA biomarkers based on multi-view networks and reinforcement learning for diseases
Authors: Su Benzhe , Wang Weiwei , Lin Xiaohui , Liu Shenglan , Huang Xin 
Published: November 2023

Abstract
MicroRNAs (miRNAs) play important roles in the occurrence and development of diseases. However, it is still challenging to identify the effective miRNA biomarkers for improving the disease diagnosis and prognosis. In this study, we proposed the miRNA data analysis method based on multi-view miRNA networks and reinforcement learning, miRMarker, to define the potential miRNA disease biomarkers. miRMarker constructs the cooperative regulation network and functional similarity network based on the expression data and known miRNA–disease relations, respectively. The cooperative regulation of miRNAs was evaluated by measuring the changes of relative expression. Natural language processing was introduced for calculating the miRNA functional similarity. Then, miRMarker integrates the multi-view miRNA networks and defines the informative miRNA modules through a reinforcement learning strategy. We compared miRMarker with eight efficient data analysis methods on nine transcriptomics datasets to show its superiority in disease sample discrimination. The comparison results suggested that miRMarker outperformed other data analysis methods in receiver operating characteristic analysis. Furthermore, the defined miRNA modules of miRMarker on colorectal cancer data not only show the excellent performance of cancer sample discrimination but also play significant roles in the cancer-related pathway disturbances. The experimental results indicate that miRMarker can build the robust miRNA interaction network by integrating the multi-view networks. Besides, exploring the miRNA interaction network using reinforcement learning favors defining the important miRNA modules. In summary, miRMarker can be a hopeful tool in biomarker identification for human diseases.