Identifying options for oncology therapy regimen codification to improve standardization-combined results of an expert panel and a review

WHAT IS KNOWN AND OBJECTIVE

Chemotherapy drugs are often administered in combinations with predefined interdependent doses and cycle intervals. As yet, there is no global standardization system to describe these complex regimens in a universally comprehensive manner. The aim of this review is to identify which efforts for standardization have been undertaken and which recommendations for databases and nomenclature of chemotherapy regimens are available.

METHODS

A literature review was performed to identify all peer-reviewed full-text articles about oncology therapy regimen codification. In addition, the results of this search were evaluated and consensus recommendations from a European expert panel were subsequently added.

RESULTS

This review gives an overview of attempts to standardize chemotherapy nomenclature described in the literature, as well as of previously published identified gaps in regimen codification. In addition, we summarized the suggestions for improvement of chemotherapy codification found in the available literature, combining them with the expertise from a European expert panel of oncology pharmacists.

WHAT IS NEW AND CONCLUSIONS

We believe that one of the most important error-prevention measures is standardization. However, there is a paucity of data how it may be achieved. Currently available data suggest that standardization has a positive impact on usability for data networks, prescription software, safety and the measurement of the quality of cancer care delivery. Standardization is also a strong pre-requisite for all discussions including oncology pharmacists and oncologists when evaluating chemotherapy regimen in countries in Europe but also all over the world. The recommendations compiled in this review can help to support overdue standardization efforts in this important therapeutic area.

[Current standards for seeds and seedlings of Chinese materia medica and analysis]

Standards for seeds and seedlings of Chinese materia medica are very important to the production, quality control and management of seeds and seedlings of Chinese materia medica. In this paper, the current standards including international standards, national standards, industry standards, local standards and group standards before 2020, involving relevant standards for seeds and seedlings of Chinese materia medica, were comprehensively and systematically summarized. Relevant standards for seeds and seedlings of Chinese materia medica were analyzed based on the standard issue year, the source and types of Chinese materia medica, and whether they are included in the Pharmacopoeia of the People's Republic of China 2015. It is suggested that the standards for seed and seedling of Chinese materia medica shall be systematic, professional and feasible, so as to ensure the sould and sustainable development of the seed and seedling industry of Chinese materia medica.

Definitions of Palliative Care Terms: A Consensus-Oriented Decision-Making Process

Background: Lack of consistency in palliative care language can serve as barriers when designing, delivering, and accessing high-quality palliative care services. Objective: To develop a consensus-driven and evidence-based palliative care glossary for the Health Standards Organization Palliative Care Services National Standard of Canada (CAN/HSO 13001:2020). Design: Content analysis of the Palliative Care Services standard was used to refine a list of terms. Environmental scan and rapid review were used for identification of concepts and definitions. Two meetings of consultation based on the modified Delphi approach took place among a working committee consisting of 12 health care providers, administrators, academics, and patient/family representatives. Results: Palliative approach to care, quality of life, pain and symptom management, caregivers, palliative care, life-limiting illness, and serious illness were defined by modification/adoption of existing definitions. Conclusion: A glossary of key palliative care terms was developed and included in the HSO Palliative Care Services standard, which will facilitate communication using consistent language across care settings.

Validation of the Omron HEM-1040 Blood Pressure Monitor According to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization 81060-2:2013 Protocol

Objective

The accuracy of the Omron HEM-1040 automated oscillometric upper-arm blood pressure (BP) monitoring device, designed for home self-measurements in adult populations, was tested according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060–2:2013 protocol.

Methods

The requirements of this protocol were precisely followed with the recruitment of 85 individuals in whom sequential systolic BP (SBP) and diastolic BP (DBP) were measured in the same (left) arm and who fulfilled the inclusion criteria involving the ranges of arm circumference, SBP, and DBP.

Results

The mean device-observer difference in the 255 separate pairs of BP data was −2.7 ± 7.14 mmHg for SBP and −3.3 ± 5.70 mmHg for DBP. The data were in accordance with criterion 1 of the ANSI/AAMI/ISO 81060–2:2013 standard requirements (≤ 5 ± ≤ 8 mmHg). In addition, the mean device-observer difference in the 85 participants was −2.7 ± 5.89 mmHg for SBP and −3.3 ± 4.99 mmHg for DBP, fulfilling criterion 2 with a standard deviation of ≤ 6.39 mmHg for SBP and ≤ 6.09 mmHg for DBP.

Conclusion

The OMRON HEM-1040 BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation standard.

HYpro16: A Two-Proteome Mixture to Assess Interference in Isobaric Tag-Based Sample Multiplexing Experiments

Isobaric tagging is a powerful strategy for global proteome profiling. A caveat of isobaric-tag-based quantification is "interference", which may be caused by coeluting peptides that are coisolated, cofragmented, and coanalyzed, thereby confounding quantitative accuracy. Here, we present a two-proteome standard that challenges the mass spectrometer to measure a range of protein abundance ratios in a background of potential interference. The HYpro16 standard consists of tandem mass tag (TMT) pro16-labeled human peptides at a 1:1 ratio across all channels into which is spiked TMTpro16-labeled yeast peptides in triplicate at 20:1, 10:1, 4:1, and 2:1 ratios. We showcase the HYpro16 standard by (1) altering the MS2 isolation window width and (2) examining different data acquisition methods (hrMS2, SPS-MS3, RTS-MS3). Our data illustrate that wider isolation widths moderately increase the TMT signal, the benefits of which are offset by decreased ratio accuracy. We also show that using real-time database searching (RTS)-MS3 resulted in the most accurate ratios. Additionally, the number of quantified yeast proteins using RTS-MS3 approaches that of hrMS2 when using a yeast-specific database for real-time searching. In short, this quality control standard allows for the assessment of multiple quantitative measurements within a single run, which can be compared across instruments to benchmark and track performance.

Transient heating in fixed length optical cavities for use as temperature and pressure standards

Optical refractometry techniques enable realization of both pressure and temperature directly from properties of the gas. The NIST refractometer, a fixed length optical cavity (FLOC) has previously been evaluated for operation as pressure standard, and now in this paper, is evaluated for the feasibility of operation as a primary temperature standard as well. The challenge is that during operation, one cavity is filled with gas. Gas dynamics predicts that this will result in heating which in turn will affect the cavity temperature uniformity, impeding the ability to measure the gas temperature with sufficient accuracy to make the standard useful as a primary standard for temperature or pressure. Temperature uniformity across the refractometer must be less than 0.5 mK for measurements of the refractivity to be sufficiently accurate for the FLOC. This paper compares computer modeling to laboratory measurements, enabling us to validate the model to predict thermal behavior and to accurately determine the measurement uncertainty of the technique. The results presented in this paper show that temperature of the glass elements of the refractometer and 'thermal-shell' copper chamber are equivalent to within 0.5 mK after an equilibration time of 3000 s (when going from 1 kPa to 100 kPa). This finding enables measurements of the copper chamber to determine the gas temperature to within an uncertainty (k = 1) of 0.5 mK. Additionally, the NIST refractometer is evaluated for feasibility of operation as temperature standard.

Evaluating hospital information system according to ISO 9241 part 12

Objectives

Compliance with standards in designing information systems leads to better utilization and ease of use for users. In this study, the compliance of a widely used hospital information system (HIS) with ISO 9241 part 12 was assessed.

Methods

This applied research is a descriptive, cross-sectional study in which the HIS of 8 hospitals affiliated with Kerman University of Medical Sciences was evaluated based on ISO 9241 part 12. Data were collected by using ISO 9241/12 checklist. The data was analyzed in SPSS 16 using descriptive statistics.

Results

The analysis of data showed that the total compliance of the software with the ISO 9241/12 was 72%. The compliance of the software based on different groups of recommendations was 79% with Organization of information, 91% with Graphic objects, and 58% with Coding techniques. Compliance with different subgroups of ISO recommendations ranged from 28% related to “color coding” in coding techniques to 97% related to “General recommendation for graphical objects” in Graphic objects.

Conclusion

According to this study, the design of a widely used HIS has fairly good compliance with the standard but still suffers from some problems. Considering the role of accurate, valid and timely information in management of the hospitals, and the difficulty of system optimization after implementation, it is necessary that software developers follow existing standards when designing health information systems.

Design of Industrial Standards for the Calibration of Optical Microscopes

One of the most important fields of study in material science is surface characterization. This topic is currently a field of growing interest as many functional properties depend on the surface texture. In this paper the authors, after a short a review of different methods for surface topography characterization and the determination of the traceability problems that arise in this type of measurements, propose four different designs of material standards that can be used to calibrate the most common optical measuring instruments used for these tasks, such as measuring microscopes, metallurgical microscopes, confocal microscopes, focus variation microscopes, etc. The authors consider that the use of this type of standards (or others similar to them) could provide a step forward in assuring metrological traceability for different metrological characteristics that enables a more precise measurement of surface features with optical measuring instruments. In addition, authors expect that this work could lay the groundwork for the development of custom standards with specialized features tuned to gain a better metrological control when measuring specific geometrical surface properties.

Comparison between three protocols of corneal collagen crosslinking in adults with progressive keratoconus: Standard versus accelerated CXL for keratoconus

OBJECTIVE

The study aimed to compare eye outcomes between the standard and accelerated corneal cross-linking (CXL) protocols over a 1-year follow-up, and assess whether the accelerated protocols are non-inferior to the standard.

METHODS

A retrospective cohort study including patients older than 18 years diagnosed with progressive keratoconus who underwent a CXL procedure. The primary outcome was defined as an increase of more than 1.5 diopter (D) in Kmax. The analysis included intra- and inter-group comparisons assessing differences in eye characteristics before and 12 months after the procedure. Furthermore, we assessed whether the accelerated procedures were non-inferior to the standard regarding Kmax change after 12 months.

RESULTS

Eighty-four patients included in the study of which 23, 37 and 23 underwent the standard CXL (group I), 10-min. (group II) and the 3-min. (group III) accelerated procedures, respectively. Intra-group comparison before and after 12 months of mean Ksteep and anterior corneal astigmatism showed significant improvement only for group I (-0.3D decrease for both). Inter-group comparison showed better results after 12 months for group I (-0.9 ± 1.2) compared to group III (0.1 ± 0.8) in Ksteep, Kmean (-0.5+1. vs 0.1+0.7, respectively) and anterior astigmatism (-0.5 + 0.9 vs 0.3+1.1, respectively). We could not declare that the accelerated CXLs are non-inferior to the standard (p-value = 0.11 and 0.15).

CONCLUSION

The standard CXL showed better results for keratometry and astigmatism in comparison with the accelerated. Therefore, the wide use of the accelerated CXL should be considered and reviewed for longer follow-up time and larger sample size in focus on the visual acuity parameters.

[Variety and standard arrangement of Yao medicine in Euphorbiaceae]

The names, basic sources, medicinal parts, efficacy and standards of the medicinal materials in Euphorbiaceae were systematically collated and analyzed by the textual research for Yao medicine monographs in this paper. The results showed that there were great differences in the names, basic sources, medicinal parts and efficacy of some medicinal materials recorded in different literatures. There were 19 genera and 60 species(including varieties) of Euphorbiaceae of Yao medicine, involving 50 kinds of medicinal materials. Among them, there were 42 kinds of single basic sources medicine, 8 kinds of multi basic sources medicine, 28 kinds of root medicine, 26 kinds of whole plant medicine, 25 kinds of unique Yao medicine, accounting for 50%, 11 kinds of cross with Chinese medicinal materials, accounting for 22%. There were 21 kinds of Yao medicine standards at all levels, but only 1 kind of Laoban medicine and 2 kinds of Yao medicine standards. The Yao medicine in Euphorbiaceae could be named by means of transliteration of Yao language/Yao language transliteration/Chinese medicine name, Laoban medicine, plant morphology, medicinal properties, color and smell of medicine, while the medicinal parts and efficacy of the same medicinal name were different from those of traditional Chinese medicine. Therefore, the name and basic sources of the medicinal materials in Euphorbiaceae were not standardized, and the quality standard is not perfect. The above results provided a reference for the construction and improvement of quality standard system, the promotion of the production of medicinal materials and clinical medication standards, and the further development and utilization of Euphorbiaceae.

[The integrated approach to implementation of expertise of medical interventions]

The article analyzes and systematizes legislative rules of the medical care quality expertise. The paramount place of clinical recommendations in development of legal acts regulating expertise and assessment of medical care quality, quality control and safety of medical activity is determined.

openEHR Archetype Use and Reuse Within Multilingual Clinical Data Sets: Case Study

BACKGROUND

Despite electronic health records being in existence for over 50 years, our ability to exchange health data remains frustratingly limited. Commonly used clinical content standards, and the information models that underpin them, are primarily related to health data exchange, and so are usually document- or message-focused. In contrast, over the past 12 years, the Clinical Models program at openEHR International has gradually established a governed, coordinated, and coherent ecosystem of clinical information models, known as openEHR archetypes. Each archetype is designed as a maximal data set for a universal use-case, intended for reuse across various health data sets, known as openEHR templates. To date, only anecdotal evidence has been available to indicate if the hypothesis of archetype reuse across templates is feasible and scalable. As a response to the COVID-19 pandemic, between February and July 2020, 7 openEHR templates were independently created to represent COVID-19-related data sets for symptom screening, confirmed infection reporting, clinical decision support, and research. Each of the templates prioritized reuse of existing use-case agnostic archetypes found in openEHR International's online Clinical Knowledge Manager tool as much as possible. This study is the first opportunity to investigate archetype reuse within a range of diverse, multilingual openEHR templates.

OBJECTIVE

This study aims to investigate the use and reuse of openEHR archetypes across the 7 openEHR templates as an initial investigation about the reuse of information models across data sets used for a variety of clinical purposes.

METHODS

Analysis of both the number of occurrences of archetypes and patterns of occurrence within 7 discrete templates was carried out at the archetype or clinical concept level.

RESULTS

Across all 7 templates collectively, 203 instances of 58 unique archetypes were used. The most frequently used archetype occurred 24 times across 4 of the 7 templates. Total data points per template ranged from 40 to 179. Archetype instances per template ranged from 10 to 62. Unique archetype occurrences ranged from 10 to 28. Existing archetype reuse of use-case agnostic archetypes ranged from 40% to 90%. Total reuse of use-case agnostic archetypes ranged from 40% to 100%.

CONCLUSIONS

Investigation of the amount of archetype reuse across the 7 openEHR templates in this initial study has demonstrated significant reuse of archetypes, even across unanticipated, novel modeling challenges and multilingual deployments. While the trigger for the development of each of these templates was the COVID-19 pandemic, the templates represented a variety of types of data sets: symptom screening, infection report, clinical decision support for diagnosis and treatment, and secondary use or research. The findings support the openEHR hypothesis that it is possible to create a shared, public library of standards-based, vendor-neutral clinical information models that can be reused across a diverse range of health data sets.

The development of a consensus-based spiritual care education standard for undergraduate nursing and midwifery students: An educational mixed methods study

AIMS

The aim of this study was to develop a consensus-based Spiritual Care Education Standard for undergraduate N/M students to use in undergraduate programmes.

DESIGN

Mixed methods were used consisting of qualitative and quantitative methods based on the principles of Delphi research.

METHODS

The sample consisted of a total of 58 (N = 58) participants from 21 European countries. Data collection was conducted from June 2017 - February 2019 and took place in facilitated iterative action learning cycles and online surveys. Data were analysed by descriptive statistics and qualitative analysis. Consensus was stated by >90% agreement.

RESULTS

The process resulted in an EPICC Spiritual Care Education Standard consisting of the following four spiritual care competences: Intrapersonal spirituality, Interpersonal spirituality, Spiritual care: assessment and planning, Spiritual care: intervention and evaluation. For every competence, learning outcomes were described in knowledge, skills and attitudes.

CONCLUSION

This Standard guides N/M spiritual care education, student assessment and research. It can be the starting point for discussing spiritual care competences in other healthcare professions. Follow-up research should focus on implementation of the standard and on assessment of students' spiritual competence.

IMPACT

The Standard guides curriculum and programme development. The Standard guides students in performing their learning process. The Standard provides a frame of reference for policy making and follow-up research.

Good Practice Data Linkage (GPD): A Translation of the German Version

The data linkage of different data sources for research purposes is being increasingly used in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to provide methodological guidelines and recommendations for research projects that have been consented to across different German research societies. Another aim is to endow readers with a checklist for the critical appraisal of research proposals and articles. This Good Practice Data Linkage (GPD) was already published in German in 2019, but the aspects mentioned can easily be transferred to an international context, especially for other European Union (EU) member states. Therefore, it is now also published in English. Since 2016, an expert panel of members of different German scientific societies have worked together and developed seven guidelines with a total of 27 practical recommendations. These recommendations include (1) the research objectives, research questions, data sources, and resources; (2) the data infrastructure and data flow; (3) data protection; (4) ethics; (5) the key variables and linkage methods; (6) data validation/quality assurance; and (7) the long-term use of data for questions still to be determined. The authors provide a rationale for each recommendation. Future revisions will include new developments in science and updates of data privacy regulations.

Emerging Standards and the Hybrid Model for Organizing Scientific Events During and After the COVID-19 Pandemic

Since the beginning of 2020, the coronavirus disease (COVID-19) pandemic has dramatically influenced almost every aspect of human life. Activities requiring human gatherings have either been postponed, canceled, or held completely virtually. To supplement lack of in-person contact, people have increasingly turned to virtual settings online, advantages of which include increased inclusivity and accessibility and a reduced carbon footprint. However, emerging online technologies cannot fully replace in-person scientific events. In-person meetings are not susceptible to poor Internet connectivity problems, and they provide novel opportunities for socialization, creating new collaborations and sharing ideas. To continue such activities, a hybrid model for scientific events could be a solution offering both in-person and virtual components. While participants can freely choose the mode of their participation, virtual meetings would most benefit those who cannot attend in-person due to the limitations. In-person portions of meetings should be organized with full consideration of prevention and safety strategies, including risk assessment and mitigation, venue and environmental sanitation, participant protection and disease prevention, and promoting the hybrid model. This new way of interaction between scholars can be considered as a part of a resilience system, which was neglected previously and should become a part of routine practice in the scientific community.

Requirements for human embryonic stem cells

‘Requirements for Human Embryonic Stem Cells’ is the first set of guidelines on human embryonic stem cells in China, jointly drafted and agreed upon by experts from the Chinese Society for Stem Cell Research. This standard specifies the technical requirements, test methods, test regulations, instructions for use, labelling requirements, packaging requirements, storage requirements and transportation requirements for human embryonic stem cells, which is applicable to the quality control for human embryonic stem cells. It was originally released by the China Society for Cell Biology on 26 February 2019 and was further revised on 30 April 2020. We hope that publication of these guidelines will promote institutional establishment, acceptance and execution of proper protocols, and accelerate the international standardization of human embryonic stem cells for applications.

Current understanding and future directions for an occupational infectious disease standard

The coronavirus disease 2019 pandemic has demonstrated a need for an infectious disease standard that will promote a safe and healthy work environment and assure business continuity. The current pandemic has revealed gaps in workplace preparedness and employee protections to microbial exposures. Federal and state government agencies have responded by providing interim guidelines and stop-gap measures that continue to evolve and vary in approach and required controls. This interim and inconsistent approach has resulted in confusion on the part of businesses as they work toward reopening during the pandemic and uncertainty as to the efficacy of required or suggested controls. Moving forward, the US Occupational Safety and Health Administration, with guidance from the US National Institute for Occupational Safety and Health, should establish consistent and effective strategies through a nationwide standard to address the potential microbial exposures in the workplace. Such a standard will require effective worker protections from infectious diseases and assure business continuity.

Determining the rate of achievement of outpatient education standards in major departments of Shiraz medical school from interns' viewpoints, based on ministry's clinical education standards in 2018-2019

INTRODUCTION

In order to improve outpatient education, it is necessary to carry out formative standard evaluation to reveal the strengths and weaknesses to improve planning the quality of clinical education. Due to numerous challenges in clinical education, the present study was conducted to determine the extent to which outpatient education standards were achieved in the major departments of Shiraz Medical School.

METHODS

In this quantitative combined, cross-sectional and practical investigation in the academic year 2018-2019, 178 interns who had passed the outpatient education in the four major wards (internal medicine, pediatrics, gynecology, and surgery) in Shiraz Medical School were randomly selected. A 26-item researcher-made questionnaire, based on the Handbook of the Ministry of Clinical Education (Outpatient Education) for Health and Medical Education's Criteria and indicators, was used in three areas of preparation, timing and implementation; and the psychometric properties of the questionnaire were determined. For quantitative data analysis, SPSS version 22 was used. Furthermore, we performed a qualitative study through semi-structured interviews with 16 interns and analyzed the data using MAXQDA 10 software.

RESULTS

The results of the quantitative study showed that 8.4% of interns evaluated the program as poor, 66.3% moderate, and 25.3% good. The qualitative study showed that number and diversity of patients, instructor's educational model, and number of interns had a significant role.

CONCLUSION

Although the outpatient teaching in the four major departments of Shiraz Medical School was evaluated relatively acceptable, it is far from the ideal point and need to be improved.

Climate Warming and Occupational Heat and Hot Environment Standards in Thailand

Background

During the period 2001 to 2016, the maximum temperatures in Thailand rose from 38–41^oC to 42–44^oC. The current occupational heat exposure standard of Thailand issued in 2006 is based on wet bulb globe temperature (WBGT) defined for three workload levels without a work–rest regimen. This study examined whether the present standard still protects most workers.

Methods

The sample comprised 168 heat acclimatized workers (90 in construction sites, 78 in foundries). Heart rate and auditory canal temperature were recorded continuously for 2 hours. Workplace WBGT, relative humidity, and wind velocity were monitored, and the participants' workloads were estimated. Heat-related symptoms and signs were collected by a questionnaire.

Results

Only 55% of the participants worked in workplaces complying with the heat standard. Of them, 79% had auditory canal temperature ≤ 38.5^oC, compared with only 58% in noncompliant workplaces. 18% and 43% of the workers in compliant and noncompliant workplaces, respectively, had symptoms from heat stress, the trend being similar across all workload levels. An increase of one degree (C) in WBGT was associated with a 1.85-fold increase (95% confidence interval: 1.44–2.48) in odds for having symptoms.

Conclusion

Compliance with the current occupational heat standard protects 4/5 of the workers, whereas noncompliance reduces this proportion to one half. The reasons for noncompliance include the gaps and ambiguities in the law. The law should specify work/rest schedules; outdoor work should be identified as an occupational heat hazard; and the staff should include occupational personnel to manage heat stress in establishments involving heat exposure.

Recency of Practice and the Maintenance of Professional Competence for Nurses and Midwives: A Scoping Review Protocol

Australian and international nursing regulators have specific requirements for continuing competence and the professional, safe practice of nurses and midwives. Requirements can dictate duration of practice, time away from/recency of practice, revalidation policies, and time between study program completion and practice commencement. Requirements vary between contexts and are periodically updated. To identify and examine Australian and international evidence for best regulatory practices relating to recency and the maintenance of professional competence among nurses and midwives, a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be undertaken. This protocol details the scope, inclusion criteria, and methodology that will guide the scoping review, which will inform an update to the Nursing and Midwifery Board of Australia's Registration Standard: Recency of Practice.

Systems biology markup language (SBML) level 3 package: multistate, multicomponent and multicompartment species, version 1, release 2

Rule-based modeling is an approach that permits constructing reaction networks based on the specification of rules for molecular interactions and transformations. These rules can encompass details such as the interacting sub-molecular domains and the states and binding status of the involved components. Conceptually, fine-grained spatial information such as locations can also be provided. Through “wildcards” representing component states, entire families of molecule complexes sharing certain properties can be specified as patterns. This can significantly simplify the definition of models involving species with multiple components, multiple states, and multiple compartments. The systems biology markup language (SBML) Level 3 Multi Package Version 1 extends the SBML Level 3 Version 1 core with the “type” concept in the Species and Compartment classes. Therefore, reaction rules may contain species that can be patterns and exist in multiple locations. Multiple software tools such as Simmune and BioNetGen support this standard that thus also becomes a medium for exchanging rule-based models. This document provides the specification for Release 2 of Version 1 of the SBML Level 3 Multi package. No design changes have been made to the description of models between Release 1 and Release 2; changes are restricted to the correction of errata and the addition of clarifications.

Consensus recommendations on calf- and herd-level passive immunity in dairy calves in the United States

Passive immunity in calves is evaluated or quantified by measuring serum or plasma IgG or serum total protein within the first 7 d of age. While these measurements inform about circulating concentrations of this important protein, they are also a proxy for evaluating all of the additional benefits of colostral ingestion. The current individual calf standard for categorizing dairy calves with successful passive transfer or failure of passive transfer of immunity are based on serum IgG concentrations of ≥10 and <10 g/L, respectively. This cutoff was based on higher mortality rates in calves with serum IgG <10 g/L. Mortality rates have decreased since 1991, but the percentage of calves with morbidity events has not changed over the same time period. Almost 90% of calves sampled in the USDA National Animal Health Monitoring System's Dairy 2014 study had successful passive immunity based on the dichotomous standard. Based on these observations, a group of calf experts were assembled to evaluate current data and determine if changes to the passive immunity standards were necessary to reduce morbidity and possibly mortality. In addition to the USDA National Animal Health Monitoring System's Dairy 2014 study, other peer-reviewed publications and personal experience were used to identify and evaluate potential standards. Four options were evaluated based on the observed statistical differences between categories. The proposed standard includes 4 serum IgG categories: excellent, good, fair, and poor with serum IgG levels of ≥25.0, 18.0-24.9, 10.0-17.9, and <10 g/L, respectively. At the herd level, we propose an achievable standard of >40, 30, 20, and <10% of calves in the excellent, good, fair, and poor categories, respectively. Because serum IgG concentrations are not practical for on-farm implementation, we provide corresponding serum total protein and %Brix values for use on farm. With one-third of heifer calves in 2014 already meeting the goal of ≥25 g/L serum IgG at 24 h of life, this achievable standard will require more refinement of colostrum management programs on many dairy farms. Implementation of the proposed standard should further reduce the risk of both mortality and morbidity in preweaned dairy calves, improving overall calf health and welfare.

The YSI 2300 Analyzer Replacement Meeting Report

This is a summary report of the most important aspects discussed during the YSI 2300 Analyzer Replacement Meeting. The aim is to provide the interested reader with an overview of the complex topic and propose solutions for the current issue. This solution should not only be adequate for the United States or Europe markets but also for all other countries. The meeting addendum presents three outcomes of the meeting.

Development of a test method for adult ice hockey helmet evaluation

Ice hockey helmet standards have primarily been developed to reduce risk of traumatic brain injury (TBI). While severe TBI has become a rare event in ice hockey, concussion, a type of mild TBI, remains a common head injury. Concussions, in ice hockey result from a number of head impact events including, collisions, stick impacts, puck impacts, falls into the boards, impacts to the glass, and falls to the ice. Helmet testing methods need to represent the impact events creating concussions in ice hockey. The purpose of this research was to develop a helmet test protocol and performance metric for concussive impacts in ice hockey. A protocol using concussion impact parameters from published literature was created that used monorail and linear impactors to impact a helmeted Hybrid III headform. The linear and rotational acceleration time curves were then used to calculate brain tissue strain using the University College Brain Trauma Model. The proposed test protocols created kinematic responses that were representative of levels associated with concussion in ice hockey. Rotational velocity and rotational acceleration were both identified as useful performance metrics representing levels of risk for concussion.

Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Introduction:

Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening.

Material and Methods:

We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.

Results:

The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.

Conclusion:

Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.