BACKGROUND: The Ministry of Health in Côte d\'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President\'s Emergency Plan for AIDS Relief, have been collaborating to develop and implement the Open-Source Enterprise-Level Laboratory Information System (OpenELIS). The system is designed to improve HIV-related laboratory data management and strengthen quality management and capacity at clinical laboratories across the nation.
OBJECTIVE: This evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to HIV care and treatment.
METHODS: This evaluation used a quasi-experimental design to perform an interrupted time-series analysis to estimate the changes in the level and slope of 3 data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. We collected paper and electronic records on clusters of differentiation 4 (CD4) testing for 48 weeks before OpenELIS adoption until 72 weeks after. Data collection took place at 21 laboratories in 13 health regions that started using OpenELIS between 2014 and 2020. We analyzed the data at the laboratory level. We estimated odds ratios (ORs) by comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS.
RESULTS: There was an immediate 5-fold increase in timeliness (OR 5.27, 95% CI 4.33-6.41; P<.001) and an immediate 3.6-fold increase in completeness (OR 3.59, 95% CI 2.40-5.37; P<.001). These immediate improvements were observed starting after OpenELIS installation and then maintained until 72 weeks after OpenELIS adoption. The weekly improvement in the postimplementation trend of completeness was significant (OR 1.03, 95% CI 1.02-1.05; P<.001). The improvement in validity was not statistically significant (OR 1.34, 95% CI 0.69-2.60; P=.38), but validity did not fall below pre-OpenELIS levels.
CONCLUSIONS: These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in health care. These findings highlight the importance of OpenELIS in Côte d\'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems.

Cannabinoids regulate analgesia, which has aroused much interest in identifying new pharmacological therapies in the management of refractory pain. Voltage-gated Na+ channels (Navs) play an important role in inflammatory and neuropathic pain. In particular, Nav1.9 is involved in nociception and the understanding of its pharmacology has lagged behind because it is difficult to express in heterologous systems. Here, we utilized the chimeric channel hNav1.9_C4, that comprises the extracellular and transmembrane domains of hNav1.9, co-expressed with the ß1 subunit on CHO-K1 cells to characterize the electrophysiological effects of ACEA, a synthetic surrogate of the endogenous cannabinoid anandamide. ACEA induced a tonic block, decelerated the fast inactivation, markedly shifted steady-state inactivation in the hyperpolarized direction, decreasing the window current and showed use-dependent block, with a high affinity for the inactivated state (ki = 0.84 µM). Thus, we argue that ACEA possess a local anaesthetic-like profile. To provide a mechanistic understanding of its mode of action at the molecular level, we combined induced fit docking with Monte Carlo simulations and electrostatic complementarity. In agreement with the experimental evidence, our computer simulations revealed that ACEA binds Tyr1599 of the local anaesthetics binding site of the hNav1.9, contacting residues that bind cannabinol (CBD) in the NavMs channel. ACEA adopted a conformation remarkably similar to the crystallographic conformation of anandamide on a non-homologous protein, obstructing the Na+ permeation pathway below the selectivity filter to occupy a highly conserved binding pocket at the intracellular side. These results describe a mechanism of action, possibly involved in cannabinoid analgesia.

Although pharmacological treatment of COPD is codified in different guidelines and strategy documents, there is abundant evidence of discrepancy between what they suggest and what health professionals prescribe, especially in low-risk groups where there is widespread overprescription of triple therapy. It is therefore necessary to clarify when the use of triple therapy is indicated in COPD patients and when it is preferable to maintain treatment with dual bronchodilation. In this article, we discuss our views based on our experience and what is reported in the literature and try to give answers to these two questions. The evidence generated by pivotal RCTs supports the use of triple therapy in patients who present for the first time and have severe airway obstruction, are symptomatic, have had frequent moderate or severe exacerbations in the previous year, and have peripheral eosinophilia. However, it is difficult to determine whether step-up is useful in all other cases because the available data are quite conflicting. It is likely that the inconsistency in the information generated by the various available studies may explain the prescribing behaviour of many physicians who do not adhere to recommendations of guidelines and strategies. However, it is necessary to establish whether and when the addition of an ICS to the LAMA/LABA combination is effective, to determine whether triple therapy can induce an additional clinical benefit over dual bronchodilation, irrespective of a preventive effect on COPD exacerbations, to establish its value, and to examine whether cost differences can support the use of triple therapy over combined LAMA/LABA therapy in real life.

BACKGROUND: Pain and obesity are frequently co-morbid health conditions; thus, it is unsurprising that pain is commonly experienced by individuals seeking bariatric surgery. While pain is generally reduced in the short-term after surgery, there is also variability in pain outcomes and less is known about how unresolved or recurring pain may relate to long-term weight loss and weight loss maintenance.
OBJECTIVE: This study evaluated trajectories of pain scores through 7 years following bariatric surgery and whether higher pain levels related to poorer weight loss and greater weight regain.
METHODS: Data were collected from 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital.
METHODS: Self-report measures of pain and weight change data were utilized for 1702 adults seeking Roux-en-Y gastric bypass surgery from the Longitudinal Assessment for Bariatric Surgery (LABS) cohort. A series of linear mixed models examined trajectories of pain scores and the concurrent predictive relationship between pain and weight outcomes from pre-surgery through 7 years post-surgery.
RESULTS: Overall bodily-, hip-, and knee-pain improved through 2 years, deteriorated from 2-5 years, and then slightly improved from 5-7 years following surgery (P < .001). Greater pain was concurrently associated with less weight loss and greater weight regain over time (P ≤ .006).
CONCLUSIONS: Pain is evident in the long-term following bariatric surgery and associated with suboptimal weight outcomes. More research is needed to identify mechanisms underlying this relationship, which may ultimately help develop appropriate pain assessment and treatment strategies to ensure optimal post-surgery outcomes.

We present here an evidence-based review of the utility, timing, and indications for laboratory test use in the domains of inflammation, cardiology, hematology, nephrology and co-infection for clinicians managing the care of hospitalized COVID-19 patients. Levels of IL-6, CRP, absolute lymphocyte count, neutrophils and neutrophil-to-lymphocyte ratio obtained upon admission may help predict the severity of COVID-19. Elevated LDH, ferritin, AST, and d-dimer are associated with severe illness and mortality. Elevated cardiac troponin at hospital admission can alert clinicians to patients at risk for cardiac complications. Elevated proBNP may help distinguish a cardiac complication from noncardiac etiologies. Evaluation for co-infection is typically unnecessary in nonsevere cases but is essential in severe COVID-19, intensive care unit patients, and immunocompromised patients.

The current study aimed to develop a suitable molecular marker [Linear alkylbenzenes (LABs)] approach for pollution determination in mangrove oysters of peninsular Malaysia. C. belcheri species were collected from rivers of Merbok, Perai, Klang, Muar and PulauMerambong (An Island). The LABs were extracted from C. belcheri and determined using GC-MS. The LABs indices which included I/E, L/S and C13/C12 were applied to describe the sources and biodegradation of LABs. The results revealed that the maximum concentrations were detected in oysters from Klang (27.91 ng g-1dw), while the lowest concentrations were detected in oysters from Merbok (8.12 ng g-1dw). Moreover, I/E ratios varied between 2.83 and 6.40, indicating the secondary treatment effluents being discharged to coastal zones. The results of this study suggested that the oysters absorbed LABs mainly in dissolved phase. Therefore, mangrove oysters are a good biosensor for LABs contamination in the aquatic environment.

This is a retrospective cohort study via a single surgeon, two-hospital database.
PSF in NMS patients is a high-risk surgery, with rates of SSI up to 24%. There is conflicting evidence in the literature regarding a possible association between low preoperative nutritional lab values and heightened risk of SSI after PSF. A retrospective analysis of a 20-year cohort of 111 pediatric neuromuscular scoliosis (NMS) patients that underwent posterior spinal fusion (PSF) with instrumentation was performed. Overall, seven patients (6.3%) developed a postoperative surgical site infection (SSI). With the possible exception of transferrin, low preoperative lab values (prealbumin, Hgb/Hct, WBC, TLC, total protein, albumin) were not associated with SSI. These findings question the utility of the current methodology of preoperative laboratory evaluation in identifying patients at elevated risk for SSI following PSF.
A single-surgeon, two-hospital database was reviewed to identify all patients who underwent PSF for NMS. Diagnoses included cerebral palsy (n = 82), myelomeningocele (n = 13), spinal muscular atrophy (n = 4), and other (n = 12). Medical records for 117 patients were examined; 6 were excluded due to missing lab values. SSI was defined as an infection necessitating a return to the operating room for irrigation and debridement of the surgical site. Demographic information, preoperative lab values, spinal deformity magnitude, and surgical procedure data were recorded.
There were 50 males and 61 females with a mean age of 14 years and 2.5 months (8-20 years). Seven patients (6.3%) experienced postoperative SSI. SSI rate for PSF to pelvis was 7.7% vs. PSF to lumbar spine, 3.0% (NS; p = 0.672). Length of PSF was not statistically associated with SSI (p = 0.172). SSI due to gram positives and polymicrobial gram negatives occurred with equal incidence. Preoperative lab values of transferrin, prealbumin, albumin, WBC count, total lymphocyte count, and total protein were not associated with SSI. Patients with postoperative SSI had higher mean Hct compared to controls (p = 0.041). While 40.6% of controls had low Hgb (< 13.8 g/dl), all patients who developed SSI had Hgb within the normal range (p = 0.043). Similarly, while 37.6% of controls had low Hct (< 40.7%), all patients who developed SSI had Hct within the normal range (p = 0.05).
Low preoperative nutritional labs, Hgb/Hct, and TLC values were not found to be associated with an increased incidence of SSI in this analysis. These findings question the utility of preoperative lab values in identifying \"at-risk\" populations for SSI after PSF for NMS.
IV Therapeutic.

Phthalate acid esters (PAEs) are of serious concern as a human health risk due to their ubiquitous presence in indoor air. In the present study, fifteen PAEs in the indoor air samples from physical, chemical, and biological laboratories in Guangzhou, southern China were analysed using gas chromatography mass spectrometry. Extremely high levels of PAEs of up to 6.39 × 104 ng/m3 were detected in some laboratories. Diisobutyl phthalate (DiBP), di(methoxyethyl) phthalate (DMEP), and di-n-butyl phthalate (DBP) were the dominant PAEs with median levels of 0.48 × 103, 0.44 × 103, and 0.39 × 103 ng/m3, respectively, followed by di-(2-propylheptyl) phthalate (DPHP) and di(2-ethylhexyl) phthlate (DEHP) (median levels: 0.16 × 103 and 0.13 × 103 ng/m3, respectively). DMEP and DPHP were found for the first time in indoor air. Principal component analysis indicated that profiles of PAEs varied greatly among laboratory types, suggesting notable variations in sources. The results of independent samples t-tests showed that levels of PAEs were significantly influenced by various environmental conditions. Both the non-carcinogenic and carcinogenic health risks from human exposure to PAEs based on the daily exposure dose in laboratory air were acceptable. Further research should be conducted to investigate the long-term health effects of exposure to PAEs in laboratories.

From the perspective of the organizers of medical electrical EMC laboratory, this paper elaborates the guiding principles, design ideas and experience of building medical EMC Laboratory. According to the needs of the laboratory, the basic requirements of anechoic chamber, the auxiliary room of anechoic chamber and other supporting rooms in the EMC laboratory are introduced. The key technologies of anechoic chamber, such as frequency range, shielding requirement and static zone, are mainly elaborated, so as to build a laboratory matching with test requirement.

BACKGROUND: Limited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change.
METHODS: Ten hospitals in 6 geographically diverse clinical centers in the United States.
METHODS: Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively.
RESULTS: The median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%-38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%-23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m(2) for RYGB and 44 kg/m(2) for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band circumference had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex.
CONCLUSIONS: Few baseline variables were associated with 3-year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual\'s chance of a successful weight loss outcome after bariatric surgery.
BACKGROUND: NCT00465829, ClinicalTrials.gov.