Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study

BACKGROUND

Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics.

OBJECTIVE

We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats.

METHODS

We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs.

RESULTS

A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples.

CONCLUSIONS

Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples.

Novel predictive model of cell survival/death related effects of Extracellular Signal-Regulated kinase protein

Computational modelling is a technique for modelling and solving real-world problems by utilising computing to provide solutions. This paper presents a novel predictive model of cell survival/death-related effects of Extracellular Signal-Regulated Kinase Protein. The computational model was designed using Neural Networks and fuzzy system. Three hundred ERK samples were examined using ten different concentrations of three input proteins: EGF, TNF, and insulin. Based on the different concentrations of input proteins and different samples of ERK protein, adjustment Anderson darling (AD) statistics for multiple distribution functions were computed considering different test such as visual test, Pearson correlation coefficient, and uniformity tests. The results reveal that utilising different concentrations and samples, values such as 7.55 AD and 18.4 AD were obtained using the Weibull distribution function for 0 ng/ml of TNF, 100 ng/ml of EGF, and 0 ng/mL of insulin concentrations. The model was validated by predicting the various ERK protein values that fall within the observed range. The proposed model agrees with the deterministic model, which was developed using difference equations.

The COVID-19 pandemic reveals the wide-ranging role of biobanks

The pandemic of COVID-19 reached an unprecedented scale in terms of spread and deaths, its mitigation required a joint effort of governments, hospitals, private companies and other organizations. One type of organization that could undertake a major role in the process is biobank - a mediator between clinical practice and research. Naturally, biobanks are well equipped to alleviate the burden of a pandemic with their expertise in biospecimen and health information collection, sample preparation and storage, bioethics and project management. Here, we present the participation of Vilnius Santaros Klinikos Biobank (BB VSK), Lithuania in the overall management of the pandemics on the national level. We further discuss the role of biobanks in preparation and management of future pandemics.

Knowledge Among Junior Doctors About the Collection and Transport of Samples for Tuberculosis Diagnosis in a Medical College Hospital in Coastal Karnataka, India

Background The accuracy of the TB diagnosis depends on the quality of the collected and transported samples. Inadequate knowledge and practices regarding the collection and transport of sputum samples can lead to false-negative results and delay the diagnosis and treatment of TB. This study was conducted to assess the knowledge of residents and interns about the collection and transport of sputum and other samples for the diagnosis of tuberculosis in a medical college hospital. Methods This was a cross-sectional study conducted among 120 medical interns and postgraduate residents of a medical college hospital in coastal Karnataka, India. Participants were interviewed using a pre-designed and structured questionnaire. The data was analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Descriptive statistics like the mean, standard deviation, and chi-square test were used. A p-value less than 0.05 was considered statistically significant. Results Most of the study participants (76, 63.3%) belonged to the age group of 22 to 25 years and were interns. Nearly three-quarters of the participants (85, 70.8%) were female. Based on the mean score, 69.2% of the participants exhibited good knowledge. Among the socio-demographic characteristics, being a postgraduate resident was associated with good knowledge about the collection and transport of samples (p-value < 0.05). Conclusion Seven out of ten participants had good knowledge about the collection and transport of sputum and other samples for the diagnosis of tuberculosis. Strengthening the training of this category of health workers needs to be prioritized.

Monitoring and Root Cause Analysis of Clinical Biochemistry Turnaround Time at a Tertiary Care Institute

INTRODUCTION

Most laboratories around the world have focused on improving the analytical quality of laboratory tests. Laboratory turnaround time (TAT) is often left unnoticed and under-recognised in the healthcare setting. Both patients and clinicians are more interested in receiving rapid, reliable, and accurate results. This can be achieved by improving the TAT through the identification of the causes that lead to delayed TAT.

MATERIALS AND METHODS

This prospective study aims to identify the cause of delayed TATs within the outpatient department and implement corrective strategies to overcome them. A total of 214 samples were received. The study was conducted for a period of two years; of all the samples received, 154 were from the outpatient department, and 78 samples exceeded the expected TAT. The samples were analysed in the clinical biochemistry department of the hospital. The time spent at each station was determined using an internal computer system, which was also used to identify the samples that exceeded TATs. The primary outcome of the study was to identify the number of samples exceeding TAT and the causes of it.

RESULTS

Upon implementation of corrective measures and root cause analysis, the TATs were reduced from 80-88% to 11-33%. After analysing the duration of time for the samples that exceeded TAT, 45.1% and 37.5% exceeded 30 minutes in Year 1 and Year 2, respectively. Only 3.2% and 6.2% exceeded five hours in Year 1 and Year 2, respectively. Furthermore, using root cause analysis, it was found that 12% of the delay was due to increased waiting time or sample collection, 14% included other causes such as outsourcing of samples, and 18% of the delay was due to pre-analytic processing time.

CONCLUSION

Our study concludes that TAT is an important quality assessment tool within the laboratory setting, and with proper identification of causes, it can be improved. Although monitoring TAT is a tedious process that mandates tremendous efforts, with the presence of real-time monitoring, improving TAT is an achievable goal. This, in turn, can improve patient treatment outcomes and clinician satisfaction.

Diagnosing anemia: Challenges selecting methods, addressing underlying causes, and implementing actions at the public health level

Accurate and affordable tools for diagnosing anemia and its main determinants are essential for understanding the magnitude and distribution of the problem and the appropriate interventions needed for its timely prevention and treatment. The objective of this review is to address methods, equipment, and sample-related and quality control aspects of hemoglobin measurement for anemia diagnosis. Also, other iron-, infectious-, and genetic-related causes of anemia are addressed in individuals and populations. The best practice for hemoglobin determination is the use of venous blood, analyzed on automated hematology analyzers, with high-quality control measures in place. The importance of a correct anemia diagnosis is highlighted by the cost of a misdiagnosis. A false-negative diagnosis may result in missing out and not treating anemia, its causes, and its adverse effects. On the other hand, a false-positive diagnosis may result in the provision of unneeded treatment or referral for expensive laboratory tests to determine a cause of anemia, wasting valuable resources and risking causing harm. At the individual level, clinicians must understand the causes of absolute and functional anemia to diagnose and treat anemia at the clinical level. Actions toward anemia diagnosis and control at public health levels require global, regional, and country actions that should cover general and context-specific characteristics.

HIV-1C in-House RNA-Based Genotyping Assay for Detection of Drug Resistance Mutations in Samples with Low-Level Viral Loads

Purpose

Monitoring HIV-1 drug resistance mutations (DRM) in treated patients on combination antiretroviral therapy (cART) with a detectable HIV-1 viral load (VL) is important for the selection of appropriate cART. Currently, there is limited data on HIV DRM at low-level viremia (LLV) (VL 401-999 copies/mL) due to the use of a threshold of VL ≥1000 copies/mL for HIV DRM testing. We here assess the performance of an in-house HIV drug resistance genotyping assay using plasma for the detection of DRM at LLV.

Methods

We used a total of 96 HIV plasma samples from the population-based Botswana Combination Prevention Project (BCPP). The samples were stratified by VL groups: 50 samples had LLV, defined as 401-999 copies/mL, and 46 had ≥1000 copies/mL. HIV pol (PR and RT) region was amplified and sequenced using an in-house genotyping assay with BigDye sequencing chemistry. Known HIV DRMs were identified using the Stanford HIV Drug Resistance Database. Genotyping success rate between the two groups was estimated and compared using the comparison of proportions test.

Results

The overall genotyping success rate was 79% (76/96). For VL groups, the genotyping success was 72% (36/50) at LLV and 87% (40/46) at VL ≥1000 copies/mL. Among generated sequences, the overall prevalence of individuals with at least 1 major or intermediate-associated DRM was 24% (18/76). The proportions of NNRTI-, NRTI- and PI-associated resistance mutations were 28%, 24%, and 0%, respectively. The most predominant mutations detected were K103N (18%) and M184V (12%) in NNRTI- and NRTI-associated mutations, respectively. The prevalence of DRM was 17% (6/36) at LLV and 30% (12/40) at VL ≥1000 copies/mL.

Conclusion

The in-house HIV genotyping assay successfully genotyped 72% of LLV samples and was able to detect 17% of DRM amongst them. Our results highlight the possibility and clinical significance of genotyping HIV among individuals with LLV.

Detection of Monkeypox Virus according to The Collection Site of Samples from Confirmed Cases: A Systematic Review

Due to the rapid evolution of the monkeypox virus, the means by which the monkeypox virus is spread is subject to change. Therefore, the present study aims to analyze the detection of the monkeypox virus according to the collection site of samples from confirmed monkeypox cases. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Embase databases until 5 October 2022. A total of 1022 articles were retrieved using the search strategy. After removing duplicates (n = 566) and examining by title, abstract, and full text, 65 studies reporting monkeypox case reports were included with a detailed description of risk factors, sexually transmitted infections (STIs), site of monkeypox virus-positive specimens, location of skin lesions, and diagnostic test. A total of 4537 confirmed monkeypox cases have been reported, of which 98.72% of the cases were male with a mean age of 36 years, 95.72% had a sexual behavior of being men who have sex with men, and 28.1% had human immunodeficiency virus (HIV). The most frequent locations of lesions in patients diagnosed with monkeypox were: 42.85% on the genitalia and 37.1% in the perianal region. All confirmed monkeypox cases were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR), and the most frequent locations of samples collected for diagnosis that tested positive for monkeypox virus were: 91.85% from skin lesions, 20.81% from the oropharynx, 3.19% from blood, and 2.43% from seminal fluid. The disease course of the cases with monkeypox was asynchronous, with no severe complications, and most patients did not report specific treatment but simply followed a symptomatic treatment.

Microfluidic liquid sheets as large-area targets for high repetition XFELs

The high intensity of X-ray free electron lasers (XFELs) can damage solution-phase samples on every scale, ranging from the molecular or electronic structure of a sample to the macroscopic structure of a liquid microjet. By using a large surface area liquid sheet microjet as a sample target instead of a standard cylindrical microjet, the incident X-ray spot size can be increased such that the incident intensity falls below the damage threshold. This capability is becoming particularly important for high repetition rate XFELs, where destroying a target with each pulse would require prohibitively large volumes of sample. We present here a study of microfluidic liquid sheet dimensions as a function of liquid flow rate. Sheet lengths, widths and thickness gradients are shown for three styles of nozzles fabricated from isotropically etched glass. In-vacuum operation and sample recirculation using these nozzles is demonstrated. The effects of intense XFEL pulses on the structure of a liquid sheet are also briefly examined.

Pesticide Residues in Fresh Fruit and Vegetables from Farm to Fork in the Kampala Metropolitan Area, Uganda

This study assessed concentrations of pesticide residues in fruits and vegetables from farm-to-fork in Kampala Metropolitan Area, Uganda. A total of 160 samples of fruit and vegetables collected from farms, markets, streets, restaurants and homes were analysed using liquid chromatography-tandem mass spectrometry; and Gas Chromatograph-Mass Spectrometer for dithiocarbamates. Multiple pesticide residues were detected in majority of the samples (95.6%). The proportions of the most frequently detected pesticides residue classes were organophosphates (91.3%), carbamates (67.5%), pyrethroids (60.0%) dithiocarbamates (48.1%) and neonicotinoids (42.5%). Among organophosphates, propotamophos, acephate, fonofos, monocrotophos and dichlorvos were the most detected active ingredients; aminocarb, methomyl and pirimicarb were the commonly detected carbamates; while imidacloprid, a neonicotinoid and lambda-cyhalothrin, pyrethroid were also highly detected. Twenty-seven pesticide were tested at all stages, of which the concentrations either decreased or increased along the chain. Multiple pesticide residues occurred in commonly consumed fruit and vegetables with decreasing or increasing concentrations from farm-to-fork.

Outbreak investigation of acute watery diarrhea in a village of North India: timely action saved lives

INTRODUCTION

Outbreaks of acute watery diarrhoea are common in developing countries having poor access to safe drinking water and sanitation. An outbreak of acute watery diarrhoea in a village in North India was investigated with the aim to initiate and recommend necessary actions to control it.

METHODOLOGY

A house to house survey using a specially designed case record form was conducted covering all the households. Stool samples of some of the affected individuals and twenty water samples during and after the outbreak from various sites were collected for laboratory analysis.

RESULTS

Out of 624 inhabitants surveyed, 118 were found to be suffering from acute watery diarrhoea (Overall attack rate of 18.9%) with two suspected deaths following diarrhoea. Males and females were affected equally and the age group of 15-44 years was affected predominantly. A peculiar epidemic curve with single peak was noted. One of the stool samples collected during the outbreak grew Vibrio Cholera O1(Ogawa) and twelve out of the twenty water samples including the samples from both the tube wells had high coliform counts indicating fecal contamination. Chlorine levels in all the water samples were found to be inadequate.

CONCLUSIONS

Local cultural practices such as indiscriminate defecation in public places, using tullu pumps to extract water from the public supply line, poor engineering design and maintenance of the water supply system having leakages at many sites along with inadequate chlorination of the supply water from the tube wells were the risk factors that could have contributed to this outbreak.

Daily Practice Assessment of KRAS Status in NSCLC Patients: A New Challenge for the Thoracic Pathologist Is Right around the Corner

Simple Summary

RAS mutation is the most frequent oncogenic alteration in human cancers and KRAS is the most frequently mutated, notably in non-small cell lung carcinomas (NSCLC). Various attempts to inhibit KRAS in the past were unsuccessful in these latter tumors. However, recently, several small molecules (AMG510, MRTX849, JNJ-74699157, and LY3499446) have been developed to specifically target KRAS G12C-mutated tumors, which seems promising for patient treatment and should soon be administered in daily practice for non-squamous (NS)-NSCLC. In this context, it will be mandatory to systematically assess the KRAS status in routine clinical practice, at least in advanced NS-NSCLC, leading to new challenges for thoracic oncologists.

Abstract

KRAS mutations are among the most frequent genomic alterations identified in non-squamous non-small cell lung carcinomas (NS-NSCLC), notably in lung adenocarcinomas. In most cases, these mutations are mutually exclusive, with different genomic alterations currently known to be sensitive to therapies targeting EGFR, ALK, BRAF, ROS1, and NTRK. Recently, several promising clinical trials targeting KRAS mutations, particularly for KRAS G12C-mutated NSCLC, have established new hope for better treatment of patients. In parallel, other studies have shown that NSCLC harboring co-mutations in KRAS and STK11 or KEAP1 have demonstrated primary resistance to immune checkpoint inhibitors. Thus, the assessment of the KRAS status in advanced-stage NS-NSCLC has become essential to setting up an optimal therapeutic strategy in these patients. This stimulated the development of new algorithms for the management of NSCLC samples in pathology laboratories and conditioned reorganization of optimal health care of lung cancer patients by the thoracic pathologists. This review addresses the recent data concerning the detection of KRAS mutations in NSCLC and focuses on the new challenges facing pathologists in daily practice for KRAS status assessment.

Diagnostic histologique et moléculaire des cancers de l'ovaire - recommandations pour la pratique clinique Saint-Paul 2021: Histological and molecular diagnosis of ovarian

Oncogenetic testing is now part of standard management in high grade ovarian cancer, including at least mutational status of BRCA1/BRCA2 genes. If necessary, tumor genetic testing is followed by constitutional testing to either confirm the constitutional origin of variants identified in BRCA1/2 genes or detect variants in other predisposition genes. The whole process including prescription of tumoral testing, retrieval of analysis report and communication of results must be formalized, as well as information on possible consequences of the results for the patient and her family. Tumor material must meet criteria of size and cellularity to allow high-quality analysis. These samples are processed during the preanalytical phase with two major steps : time of cold ischemia and fixation. Only pathogenic (Class V) and likely pathogenic (Class IV) variants shown in tumor tissue are mentioned in the report. Currently, only BRCA1 and BRCA2 genes are routinely studied but, in the future, analysis will be extended to other genes involved in homologous recombination repair. In patients without BRCA mutation, other biomarkers reflecting sensitivity to PARP inhibitors, such as HRD scores (homologous recombination deficiency) that appeared recently, will have to be implemented in routine practice in order to better select patients for these treatments and choose optimal therapy.

Evaluation of Culture Top transport systems for assessing the bacterial diversity of microbiota by culturomics as compared to a routine transport system

In recent years, metagenomics and then culturomics, which consists of the multiplication of media and culture conditions and the rapid identification of all bacterial colonies, have generated renewed interest in the human microbiota, and diseases associated with modifications in its composition in particular. The sample transport media included in diverse swab transport systems and the storage conditions are among the factors that influence the results of the culturomics. In this study, we compared the results of culturomics from paired skin, oral and rectal swabs from intensive care unit (ICU) patients using Culture Top sample transport medium as compared to our routine one. From 152 clinical samples, we were able to isolate and identify 45 600 colonies, belonging to 338 different bacterial species. The transport system Culture Top identified 282 different bacterial species, while 244 were identified by our routine system. Of these, 188 different bacterial species were commonly identified using both transport systems, while 94 (27.8 %) and 56 (16.5 %) were only identified using Culture Top and our routine system, respectively (P<0.001), but there was no significant difference in bacterial diversity at the genus or phylum level, or in terms of their type of respiration and cell wall. In conclusion, the Culture Top transport system appears to be complementary to our routine system, although it seems slightly superior in terms of isolated bacterial species.

Multicentre study of the burden of multidrug-resistant bacteria in the aetiology of infected diabetic foot ulcers

Background

Infected diabetic foot ulcer (IDFU) is a public health issue and the leading cause of non-traumatic limb amputation. Very few published data on IDFU exist in most West African countries.

Objective

The study investigated the aetiology and antibacterial drug resistance burden of IDFU in tertiary hospitals in Osun state, Nigeria, between July 2016 and April 2017.

Methods

Isolates were cultured from tissue biopsies or aspirates collected from patients with IDFU. Bacterial identification, antibiotic susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase and carbapenemase production were done by established protocols. Specific resistance genes were detected by polymerase chain reaction.

Results

There were 218 microorganisms isolated from 93 IDFUs, comprising 129 (59.2%) Gram-negative bacilli (GNB), 59 (27.1%) Gram-positive cocci and 29 (13.3%) anaerobic bacteria. The top five facultative anaerobic bacteria isolated were: Staphylococcus aureus (34; 15.6%), Escherichia coli (23; 10.6%), Pseudomonas aeruginosa (20; 9.2%), Klebsiella pneumoniae (19; 8.7%) and Citrobacter spp. (19; 8.7%). The most common anaerobes were Bacteroides spp. (7; 3.2%) and Peptostreptococcus anaerobius (6; 2.8%). Seventy-four IDFUs (80%) were infected by multidrug-resistant bacteria, predominantly methicillin-resistant S. aureus and GNB producing extended-spectrum β-lactamases, mainly of the CTX-M variety. Only 4 (3.1%) GNB produced carbapenemases encoded predominantly by bla _VIM. Factors associated with presence of multidrug-resistant bacteria were peripheral neuropathy (adjusted odds ratio [AOR] = 4.05, p = 0.04) and duration of foot infection of more than 1 month (AOR = 7.63, p = 0.02).

Conclusion

Multidrug-resistant facultative anaerobic bacteria are overrepresented as agents of IDFU. A relatively low proportion of the aetiological agents were anaerobic bacteria.

Depolarization Characteristics of Different Reflective Interfaces Indicated by Indices of Polarimetric Purity (IPPs)

Compared with the standard depolarization index, indices of polarimetric purity (IPPs) have better performances to describe depolarization characteristics of targets with different roughnesses of interfaces under different incident angles, which allow us a further analysis of the depolarizing properties of samples. Here, we use IPPs obtained from different reflective interfaces as a criterion of depolarization property to characterize and classify targets covered by organic paint layers with different roughness. We select point-light source as radiation source with wavelength as 632.8 nm, and four samples, including Cu, Au, Al and Al₂O₃, covered by an organic paint layer with refractive index of n = 1.46 and Gaussian roughness of α = 0.05~0.25. Under different incident angles, the values of P₁, P₂, P₃ at divided 90 × 360 grid points and their mean values in upper hemisphere have been obtained and discussed in the IPPs space. The results show that the depolarization performances of the different reflective interfaces (materials, incident angles and surface roughness) are unique in IPPs space, providing us with a new avenue to analyze and characterize different targets.

The Colorado Twin Registry: 2019 Update

The Colorado Twin Registry (CTR) is a population-based registry formed from birth and school records including twins born between 1968 and the present. Two previous reports on the CTR [Rhea et al., (2006). Twin Research and Human Genetics, 9, 941-949; Rhea et al., (2013).Twin Research and Human Genetics, 16, 351-357] covered developments in the CTR through 2012. This report briefly summarizes previously presented material on ascertainment and recruitment and the relationships between samples and studies, discusses developments since 2012 for four previously described twin samples, describes two new samples and their complementary studies and expands on two subjects briefly mentioned in the last report: a history of genotyping efforts involving CTR samples, and a survey of collaborations and consortia in which CTR twins have been included. The CTR remains an active resource for both ongoing, longitudinal research and the recruitment of new twin samples for newly identified research opportunities.

Strategies of blood collection in Cote d'Ivoire: impact of mobile collection methods on the production of the National Blood Transfusion Service, 2014-2016

Blood product suppliers have two options for blood collection: at fixed sites and mobile collection sites. Those preferring voluntary, unpaid donations must move ever closer to the population by organizing mobile collection. The objective of this study was to analyze the impact of mobile collection in the production of the Côte d'Ivoire's CNTS. Our results, based on data from the CNTS from 2014 through 2016 and interviews with 22 managers of blood transfusion centers, confirm the increasing preponderance of this approach. Thus, our results raise the problem of blood safety in a context where the prevalence of transfusion-transmissible infections is higher in mobile collections, where most donors are giving blood for the first time.

Investigating populations via penguins and their poo!

We describe an activity that introduces students to population modelling, enables them to use estimates obtained from a sample to infer back to the population, and understands how the findings are translatable via penguins and their poo!

Evaluation of a rapid immunochromatographic diagnostic test (RIDT) for diagnosis of rabies in samples from Argentina

INTRODUCTION

Rabies is a globally widespread zoonosis of viral origin that causes fatal encephalitis in humans and animals. In countries where rabies is endemic and there is a lack of well-equipped diagnostic laboratories, a rapid immunochromatographic diagnostic test (RIDT) for detection of rabies could be an indispensable tool. In this study we evaluated the limit of detection, as well as specificity and sensitivity of RIDT, compared to the standard fluorescent antibody test (FAT).

METHODOLOGY

A total of 174 samples were diagnosed by both RIDT and FAT. Fresh clinical samples, poorly conserved samples and brains in advanced state of decomposition generated under laboratory conditions were used to resemble field conditions. The sensitivity of RIDT was evaluated with CVS fixed strain of rabies virus (RABV), previously titrated in 21-day old albino mice and compared with the Reverse Transcription - Polimerase Chain Reaction (RT-PCR) technique in parallel. Additionally, the Mouse Inoculation Test (MIT) was used to perform the antigenic characterization of Rabies virus variants.

RESULTS

The limit of detection of RIDT was 100 LD50 / 0.03 mL and its performance, as compared to that of FAT, showed a sensitivity of 97.96%, a specificity of 100% and a concordance by the Kappa test of 0.98 with 95% CI.

CONCLUSIONS

RIDT provides results comparable to those of FAT and this test can be considered as an appropriate method under the field conditions, even in samples that are not suitable for FAT due to their state of decomposition.

10KP: A phylodiverse genome sequencing plan

Understanding plant evolution and diversity in a phylogenomic context is an enormous challenge due, in part, to limited availability of genome-scale data across phylodiverse species. The 10KP (10,000 Plants) Genome Sequencing Project will sequence and characterize representative genomes from every major clade of embryophytes, green algae, and protists (excluding fungi) within the next 5 years. By implementing and continuously improving leading-edge sequencing technologies and bioinformatics tools, 10KP will catalogue the genome content of plant and protist diversity and make these data freely available as an enduring foundation for future scientific discoveries and applications. 10KP is structured as an international consortium, open to the global community, including botanical gardens, plant research institutes, universities, and private industry. Our immediate goal is to establish a policy framework for this endeavor, the principles of which are outlined here.

Opportunities to preserve forensic evidence in emergency departments

Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

Effect of colesevelam on faecal bile acids and bowel functions in diarrhoea-predominant irritable bowel syndrome

BACKGROUND

About one-third of patients with IBS-diarrhoea (irritable bowel syndrome-D) have evidence of increased bile acid synthesis or excretion.

AIMS

To assess effects of the bile acid sequestrant, colesevelam, on faecal excretion of BAs, hepatic BA synthesis and diarrhoea in IBS-D; to appraise whether individual or random stool samples accurately reflect 48-h total faecal bile acid excretion and proportions of the main bile acids excreted and to study the faecal fat excretion in response to colesevelam.

METHODS

A single-centre, unblinded, single-dose trial of effects of colesevelam, 1875 mg [3 tablets (625 mg tablets)] orally, twice daily, for 10 days on total 48-h faecal bile acid excretion and fasting serum C4 (7α-hydroxy-4-cholesten-3-one; surrogate of hepatic bile acid synthesis). Stool diaries documented bowel functions for 8 days prior and 8 days during colesevelam treatment. Stool 48-h samples and fasting serum were collected for faecal fat, faecal bile acid and serum C4.

RESULTS

Colesevelam was associated with significantly increased faecal total bile acid excretion and deoxycholic acid excretion, increased serum C4 and more solid stool consistency. There was a significant inverse correlation between number of bowel movements per week and the total bile acid sequestered into stool during the last 48 h of treatment. Random stool samples did not accurately reflect 48-h total or individual faecal bile acid excretion. Sequestration of bile acids by colesevelam did not increase faecal fat.

CONCLUSIONS

Colesevelam increases delivery of bile acids to stool while improving stool consistency, and increases hepatic bile acid synthesis, avoiding steatorrhoea in patients with IBS-D. Overall effects are consistent with luminal bile acid sequestration by colesevelam.

Commutability of food microbiology proficiency testing samples

AIM

Food microbiology proficiency testing (PT) is a useful tool to assess the analytical performances among laboratories. PT items should be close to routine samples to accurately evaluate the acceptability of the methods. However, most PT providers distribute exclusively artificial samples such as reference materials or irradiated foods. This raises the issue of the suitability of these samples because the equivalence-or 'commutability'-between results obtained on artificial vs. authentic food samples has not been demonstrated. In the clinical field, the use of noncommutable PT samples has led to erroneous evaluation of the performances when different analytical methods were used. This study aimed to provide a first assessment of the commutability of samples distributed in food microbiology PT.

METHODS AND RESULTS

REQUASUD and IPH organized 13 food microbiology PTs including 10-28 participants. Three types of PT items were used: genuine food samples, sterile food samples and reference materials. The commutability of the artificial samples (reference material or sterile samples) was assessed by plotting the distribution of the results on natural and artificial PT samples. This comparison highlighted matrix-correlated issues when nonfood matrices, such as reference materials, were used. Artificially inoculated food samples, on the other hand, raised only isolated commutability issues.

CONCLUSIONS

In the organization of a PT-scheme, authentic or artificially inoculated food samples are necessary to accurately evaluate the analytical performances. Reference materials, used as PT items because of their convenience, may present commutability issues leading to inaccurate penalizing conclusions for methods that would have provided accurate results on food samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

For the first time, the commutability of food microbiology PT samples was investigated. The nature of the samples provided by the organizer turned out to be an important factor because matrix effects can impact on the analytical results.

The Big Census Data Revolution: IPUMS-International. Trans-Border Access to Decades of Census Samples for Three-Fourths of the World and more

Over the past decade a revolution has occurred in the dissemination and analysis of census microdata. This paper discusses the IPUMS-International initiative to liberate census data for researchers world-wide without cost. As of June 2013, academic researchers and policy makers may access, 234 anonymized samples representing 74 countries and totaling over one-half billion person records. The database expands with the addition of 20-30 samples each year. Data are downloadable as extracts from the project website: www.ipums.org/international. To facilitate good use, both metadata and microdata are integrated. The analysis of 450 citations in the project bibliography reveals patterns in publications by country and topic.