Standardizing Instructions for Ice and Cold Pack Use Can Mitigate Summer Temperatures on Two Commercially Available Outdoor Courier Lockboxes

Introduction/Objective

Clinical and Laboratory Standards Institute document GP44 recommends samples avoid temperatures >22°C during sample transport and storage. Outdoor courier lockboxes used in external sample transport can experience extreme temperatures (>40°C) in the summer. Ice (frozen at -20°C) and cold (refrigerated at 4-8°C) packs can be used to reduce internal lockbox temperatures during hot summer days. Unfortunately, there are no universally accepted instructions to maintain internal lockbox temperatures during these conditions. Therefore, our goal was to elucidate the impact of placing ice and cold packs at two specific time points to mitigate external summer temperatures in two commercially available outdoor courier lockboxes used at our institution.

Methods/Case Report

Two pairs of uniquely manufactured courier lockboxes (steel vs. urethane polymer) were placed outside in direct sunlight in Nashville, Tennessee during the second week of June 2021. Ambient outdoor and lockbox temperatures were monitored using data loggers during a four-day cycle. Each type of lockbox design had a control with no ice or cold packs. These controls were then compared to each experimental, paired lockbox with four ice packs placed at 8am and replaced with four cold packs at 4pm.

Results (if a Case Study enter NA)

The mean ambient outdoor temperature over these four days was 27.7°C (range: 22.2-39.8°C). Temperatures within the steel and urethane polymer lockboxes without ice or cold packs was 28.3°C (range: 22.4-40.8°C) and 31.6°C (range: 23.8-41.0°C), respectively. The addition of four ice packs at 8am and replaced with four cold packs at 4pm reduced temperatures in the steel box to 24.3°C (range: 17.4-27.9°C) whereas in the urethane polymer box temperatures were reduced to 13.4°C (range: 6.6-18.1°C).

Conclusion

Temperatures inside outdoor lockboxes can increase in summer commonly above the outdoor ambient temperature. Standardizing instructions for ice and cold packs can reduce internal outdoor courier lockbox temperatures during summer months, especially in urethane polymer lockboxes.

The practical utility of genetic screening in school settings

Can genetic screening be used to personalize education for students? Genome-wide association studies (GWAS) screen an individual's DNA for specific variations in their genome, and how said variations relate to specific traits. The variations can then be assigned a corresponding weight and summed to produce polygenic scores (PGS) for given traits. Though first developed for disease risk, PGS is now used to predict educational achievement. Using a novel simulation method, this paper examines if PGS could advance screening in schools, a goal of personalized education. Results show limited potential benefits for using PGS to personalize education for individual students. However, further analysis shows PGS can be effectively used alongside progress monitoring measures to screen for learning disability risk. Altogether, PGS is not useful in personalizing education for every child but has potential utility when used simultaneously with additional screening tools to help determine which children may struggle academically.

Cost-effectiveness of pediatric heart transplantation across a positive crossmatch for high waitlist urgency candidates

Allosensitized children listed with a requirement for a negative prospective crossmatch have high mortality. Previously, we found that listing with the intent to accept the first suitable organ offer, regardless of the possibility of a positive crossmatch (TAKE strategy), results in a survival advantage from the time of listing compared to awaiting transplantation across a negative crossmatch (WAIT). The cost-effectiveness of these strategies is unknown. We used Markov modeling to compare cost-effectiveness between these waitlist strategies for allosensitized children listed urgently for heart transplantation. We used registry data to estimate costs and waitlist/posttransplant outcomes. We assumed patients remained in hospital after listing, no positive crossmatches for WAIT, and a base-case probability of a positive crossmatch of 47% for TAKE. Accepting the first suitable organ offer cost less ($405 904 vs. $534 035) and gained more quality-adjusted life years (3.71 vs. 2.79). In sensitivity analyses, including substitution of waitlist data from children with unacceptable antigens specified during listing, TAKE remained cost-saving or cost-effective. Our findings suggest acceptance of the first suitable organ offer for urgently listed allosensitized pediatric heart transplant candidates is cost-effective and transplantation should not be denied because of allosensitization status alone.

Review article: self-report measures to evaluate constipation

BACKGROUND

Constipation is a subjective phenomenon, and as such must be evaluated using patient self-report. Valid and reliable measures of constipation are essential to standardize the diagnosis, assess the severity and evaluate the effectiveness of treatments.

AIM

To compare and contrast published self-report measures of constipation in terms of development, content, general characteristics, psychometric properties and clinical utility.

METHODS

MEDLINE (1966-2007), CINAHL (1980-2007), Cochrane (1993-2007) and Web of Science (1995-2007) were searched to identify self-report measures of constipation. Measures of constipation were selected if they: (i) were self-report measures that measured only constipation; (ii) had undergone psychometric testing; (iii) were used in adults and (iv) were written in English.

RESULTS

Seven self-report measures of constipation were identified. The content areas evaluated by these measures varied. Only two measures had adequate validity and reliability, sensitivity to change, or were tested in more than one sample.

CONCLUSIONS

Findings from this review suggest that the Chinese Constipation Questionnaire and the Patient Assessment of Constipation-Symptom Questionnaire demonstrate adequate psychometric properties for a constipation measure. Additional research is warranted to refine or develop a more comprehensive self-report measure to evaluate constipation in adults.

Quantitative analysis of ER alpha and GAD colocalization in the hippocampus of the adult female rat

Despite the many effects of estrogen in the hippocampus, there has been little evidence that hippocampal principal cells express nuclear estrogen receptors. In the hippocampus, the alpha form of the nuclear estrogen receptor (ER alpha) has been localized to sparsely distributed cells with the morphological characteristics of inhibitory interneurons. Because inhibitory neurons may be involved in the effects of estrogen on hippocampal principal cells, quantitative description of ER alpha expression in gamma-aminobutyric acid (GABA)ergic (inhibitory) and non-GABAergic cells of the hippocampus is a key step in understanding the mechanism(s) of estrogen action on hippocampal circuitry. We used single and double-label immunohistochemistry for ER alpha and glutamic acid decarboxylase (GAD; a marker of GABAergic neurons) to determine the numbers and distributions of hippocampal GABAergic and non-GABAergic neurons that express ER alpha in the adult female rat. We found many more ER alpha-expressing cells in the hippocampus than any previous study and observed distinct dorsal vs. ventral differences in hippocampal ER alpha expression. In the dorsal hippocampus, most ER alpha-positive cells were also GAD positive; however, ER alpha was expressed in only a subset of GAD-positive cells. Double-labeled cells were concentrated at the border between str. radiatum and str. lacunosum-moleculare. In the ventral hippocampus, we found a very high number of ER alpha-positive cells, the majority of which were not immunoreactive for GAD and are likely to be pyramidal cells. These findings suggest that ER alpha can mediate the effects of estrogen primarily in GABAergic neurons in the dorsal hippocampus and in both GABAergic and non-GABAergic neurons in the ventral hippocampus.

Solvent-dependent stereoselectivity in a Still-Wittig rearrangement: an experimental and ab initio study

[see reaction]. The Still-Wittig rearrangement gave opposite selectivities for (Z:E)-alkenes in THF (3:1) vs toluene (1:3) in the synthesis of serine-proline dipeptide amide isosteres. Four transition states leading to (Z)-and (E)-alkenes with THF and without (representing toluene) were identified by ab initio calculations at the 3-21G* level. The calculated (Z:E)-ratios with THF (4.7:1) and without THF (1:3.2) suggested that the transition state geometries and energies were well-represented by the calculations.

Estrogen increases synaptic connectivity between single presynaptic inputs and multiple postsynaptic CA1 pyramidal cells: a serial electron-microscopic study

Dendritic spines are sites of the vast majority of excitatory synaptic input to hippocampal CA1 pyramidal cells. Estrogen has been shown to increase the density of dendritic spines on CA1 pyramidal cell dendrites in adult female rats. In parallel with increased spine density, estrogen has been shown also to increase the number of spine synapses formed with multiple synapse boutons (MSBs). These findings suggest that estrogen-induced dendritic spines form synaptic contacts with preexisting presynaptic boutons, transforming some previously single synapse boutons (SSBs) into MSBs. The goal of the current study was to determine whether estrogen-induced MSBs form multiple synapses with the same or different postsynaptic cells. To quantify same-cell vs. different-cell MSBs, we filled individual CA1 pyramidal cells with biocytin and serially reconstructed dendrites and dendritic spines of the labeled cells, as well as presynaptic boutons in synaptic contact with labeled and unlabeled (i.e., different-cell) spines. We found that the overwhelming majority of MSBs in estrogen-treated animals form synapses with more than one postsynaptic cell. Thus, in addition to increasing the density of excitatory synaptic input to individual CA1 pyramidal cells, estrogen also increases the divergence of input from individual presynaptic boutons to multiple postsynaptic CA1 pyramidal cells. These findings suggest the formation of new synaptic connections between previously unconnected hippocampal neurons.

Patterns of surgical treatment of breast cancer in Victoria

We analysed data on admissions to Victorian public hospitals for surgical treatment of breast cancer over the period July 1985 to December 1988. Of the 2993 women admitted, 28.7% received breast-preserving surgery. The probability of a woman being treated conservatively was dependent on age, with women aged less than 50 or more than 70 years more likely to receive breast-preserving surgery than women aged 50-69. There was an age-specific change, of marginal statistical significance, in the proportion of women receiving breast-preserving surgery over the period. The public hospitals admissions database is a potentially useful means of monitoring patterns of surgical treatment.

Fine needle aspiration cytology in breast disease management--a 4 year experience

At the Queen Victoria Medical Centre between 1981 and 1984, 2920 fine needle aspirates of the breast were examined with an overall diagnostic accuracy of 97% and a sensitivity of 80%. This high diagnostic accuracy combined with the ease and complication-free nature of the procedure has meant that fine needle aspiration (FNA) has become an important part of the investigation and management of breast disease within the breast service of the Queen Victoria Medical Centre.

Recognition memory in Alzheimer's disease

Recognition memory for several types of stimulus material was examined in patients clinically diagnosed as having early Alzheimer's disease and in normal elderly controls. Although performance deficits were demonstrated for verbal and abstract stimuli (geometric shapes and histology slides), memory for faces was relatively intact in the patient group. Patients made more false positive responses than controls, but this could not be accounted for by a general disinhibition of responding. It is suggested that a contextual processing deficit may explain the pattern of false positive responding and this is discussed in relation to previous findings of drug studies in Alzheimer's disease.

Dormia basket removal of a residual common duct stone: report of a case

A case is presented of successful removal of a residual common bile duct calculus by the use of a Dormia basket introduced through a T tube.

Menopausal age and symptomatology in a general practice

Most women in Western society seem to reach the menopause in their early fifties; the median age in this Aberdeen series being 50.1 years. As far as symptoms were concerned, only the vasomotor disorders, flushing and night sweats, were definitely correlated with the menopause.