Exposure control measures proposed by different organizations: the curious case of nanomaterial-involved activities

Objectives. The unique properties of nanomaterials have turned them into an emerging threat for humans and the environment. This study therefore aimed to review exposure control measures proposed for nanomaterial-involved activities. Methods. This study is based on the published guidelines of different organizations on safe handling of nanomaterials. The search for documents was provided using the keywords 'Exposure controls', 'Good practices', 'Working safely', 'Safe practices', 'Handling safely', 'Safety guide' and 'Safety and health', combined with 'Nanomaterials', 'Nanotechnology' and 'Nanoparticles' on different databases and websites. Results. Thirty-one guidelines from 27 organizations were included. Most of the guidelines recommended engineering controls, administrative controls and personal protective equipment (PPE). Changing the physical form of nanomaterials or the process, using prevention through design (PtD) and using green chemistry principals were other suggestions to reduce exposure to nanomaterials. Conclusions. Considering the difficulty of implementation and case specificity of the solutions of the first two priorities of the hierarchy of controls (elimination and substitution), the emphasis of the guidelines on the next three priorities for controlling exposure to nanomaterials is understood. The type and method of using PPE and engineering controls should be resolved by referring to cutting-edge articles.

ACVR and ECVDI consensus statement for teleradiology

Increased demand for the interpretation of diagnostic images by board-certified radiologists and profound advancements in technology have led to extremely rapid growth in the field of veterinary teleradiology over the past decade. The aim of this consensus statement is to provide a guideline for best practices for quality and safety in veterinary teleradiology. The statement addresses appropriate image acquisition and transmission, the creation of teleradiology submissions, quality control in teleradiology, and appropriate documentation of imaging reports, as deficiencies in any of these areas may directly affect the standard of patient care. The consensus statement may be used as a guide for radiologists, primary care veterinarians, technicians, and students for the use of teleradiology in practice.

Characterization of a segmented printed circuit board (PCB) as a standard for absorbed dose to water from alpha-emitting radionuclides

BACKGROUND

Our previous work introduced and evaluated a standard for surface absorbed dose rate per unit radioactivity to water from unsealed alpha-emitting radionuclides used in targeted radionuclide therapy (TRT). An overall uncertainty over 4.0% at k = 1 was reported for the absorbed dose to air measurements, which was partially attributed to the rotational alignment uncertainty in the geometrical setup.

PURPOSE

A printed circuit board (PCB) with a segmented guard was constructed to align the extrapolation chamber (EC) and the source plates using a differential capacitance technique. The PCB EC aimed to enhance the repeatability of the ionization current measurements. The PCB EC was evaluated using a thin film 210Po source. The measured absorbed dose to air cavity was compared with the Monte Carlo (MC) calculations. Using the extrapolation method, the surface absorbed dose rate to water was calculated.

METHODS

The PCB EC was constructed with a 4.50 mm diameter collector surrounded by four sectors and a guard electrode. The sectors were isolated for rotational alignment and later connected to the guard for ionization current measurements. A bridge circuit measured differential capacitance between opposing sectors, and a hexapod motion stage rotated the source substrate to minimize the differential capacitance. The EC was evaluated using a 210Po source with a 3.20 mm diameter and 1.253 μ $\mu $ Ci radioactivity. MC simulations were performed to calculate thek p o i n t ${k}_{point}$ ,k b a c k s c a t t e r ${k}_{backscatter}$ , andk d i v ${k}_{div}$ correction factors. Ionization current measurements were performed for air gaps in the 0.3-0.525 mm range and surface absorbed dose rate to water was calculated.

RESULTS

Rotational offsets of up to 3.0° were found and the current repeatability was found to increase with the absorbed dose to air uncertainty calculated to be ∼2.0%. Using the capacitance method, the effective EC diameter was measured to be 4.53 mm. The recombination, polarity, and electrometer corrections were reported to be within 1.00% across all measurement trials. The MC-calculated correction factors were calculated to be much larger than the recombination and polarity correction factors. The averagek p o i n t ${k}_{point}$ ,k b a c k s c a t t e r ${k}_{backscatter}$ , andk d i v ${k}_{div}$ corrections were calculated to be 1.063, 0.9402, and 2.136, respectively. The MC-calculated absorbed dose to air was found to overestimate the absorbed dose by over 4.00% when compared with the measured absorbed dose to air. The surface absorbed dose rate to water was calculated to be2.304 × 10 - 6 $2.304 \times {10}^{ - 6}$ Gy/s/Bq with an overall uncertainty of 4.07%.

CONCLUSIONS

The constructed PCB EC was deemed suitable as an absorbed dose standard. A repeatable rotational alignment was achieved using the differential capacitance technique. The metal electrodes on the PCB made a difference of < 1.00% on the backscatter correction when compared to the EC comprised of polystyrene-equivalent collector. A 20% difference in the surface absorbed dose rate to water was found between the two ECs, which is attributed to the cavity diameter differences leading to different magnitudes of dose fall-off along the lateral direction.

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Background

Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization's Global Strategy on Digital Health 2020-2025.

Objective

To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development?

Methods

Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research.

Results

Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers).

Conclusions

When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes.

Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review

BACKGROUND

Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety.

OBJECTIVE

This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management.

METHODS

A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management.

RESULTS

The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps.

CONCLUSIONS

Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2018-025714.

The 2024 revision of the Norwegian standard for the safe practice of anaesthesia

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

Establishment of the First National Standard for Neutralizing Antibodies against SARS-CoV-2 XBB Variants

Neutralizing antibodies (NtAbs) against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are indicators of vaccine efficacy that enable immunity surveillance. However, the rapid mutation of SARS-CoV-2 variants prevents the timely establishment of standards required for effective XBB vaccine evaluation. Therefore, we prepared four candidate standards (No. 11, No. 44, No. 22, and No. 33) using plasma, purified immunoglobulin, and a broad-spectrum neutralizing monoclonal antibody. Collaborative calibration was conducted across nine Chinese laboratories using neutralization methods against 11 strains containing the XBB and BA.2.86 sublineages. This study demonstrated the reduced neutralization potency of the first International Standard antibodies to SARS-CoV-2 variants of concern against XBB variants. No. 44 displayed broad-spectrum neutralizing activity against XBB sublineages, effectively reduced interlaboratory variability for nearly all XBB variants, and effectively minimized the geometric mean titer (GMT) difference between the live and pseudotyped virus. No. 22 showed a broader spectrum and higher neutralizing activity against all strains but failed to reduce interlaboratory variability. Thus, No. 44 was approved as a National Standard for NtAbs against XBB variants, providing a unified NtAb measurement standard for XBB variants for the first time. Moreover, No. 22 was approved as a national reference reagent for NtAbs against SARS-CoV-2, offering a broad-spectrum activity reference for current and potentially emerging variants.

Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study

BACKGROUND

Few studies have used standardized nursing records with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) to identify predictors of clinical deterioration.

OBJECTIVE

This study aims to standardize the nursing documentation records of patients with COVID-19 using SNOMED CT and identify predictive factors of clinical deterioration in patients with COVID-19 via standardized nursing records.

METHODS

In this study, 57,558 nursing statements from 226 patients with COVID-19 were analyzed. Among these, 45,852 statements were from 207 patients in the stable (control) group and 11,706 from 19 patients in the exacerbated (case) group who were transferred to the intensive care unit within 7 days. The data were collected between December 2019 and June 2022. These nursing statements were standardized using the SNOMED CT International Edition released on November 30, 2022. The 260 unique nursing statements that accounted for the top 90% of 57,558 statements were selected as the mapping source and mapped into SNOMED CT concepts based on their meaning by 2 experts with more than 5 years of SNOMED CT mapping experience. To identify the main features of nursing statements associated with the exacerbation of patient condition, random forest algorithms were used, and optimal hyperparameters were selected for nursing problems or outcomes and nursing procedure-related statements. Additionally, logistic regression analysis was conducted to identify features that determine clinical deterioration in patients with COVID-19.

RESULTS

All nursing statements were semantically mapped to SNOMED CT concepts for "clinical finding," "situation with explicit context," and "procedure" hierarchies. The interrater reliability of the mapping results was 87.7%. The most important features calculated by random forest were "oxygen saturation below reference range," "dyspnea," "tachypnea," and "cough" in "clinical finding," and "oxygen therapy," "pulse oximetry monitoring," "temperature taking," "notification of physician," and "education about isolation for infection control" in "procedure." Among these, "dyspnea" and "inadequate food diet" in "clinical finding" increased clinical deterioration risk (dyspnea: odds ratio [OR] 5.99, 95% CI 2.25-20.29; inadequate food diet: OR 10.0, 95% CI 2.71-40.84), and "oxygen therapy" and "notification of physician" in "procedure" also increased the risk of clinical deterioration in patients with COVID-19 (oxygen therapy: OR 1.89, 95% CI 1.25-3.05; notification of physician: OR 1.72, 95% CI 1.02-2.97).

CONCLUSIONS

The study used SNOMED CT to express and standardize nursing statements. Further, it revealed the importance of standardized nursing records as predictive variables for clinical deterioration in patients.

Analysing responsible innovation along a value chain-A single-cell protein case study

The British Standards Institution's Publicly Available Specification 440 (PAS 440) provides a Responsible Innovation Framework (RIF) that companies can use to continuously monitor the societal, environmental and health benefits and risks of their innovations, as well as relevant changes to the supply chain and regulations. PAS 440 is intended to help companies achieve the benefits of innovation in a timely manner and avoid any potential harm or unintended misuse of a new product, process or service. Here, the authors have applied the PAS 440 RIF to a novel single-cell protein (SCP) animal feed ingredient taking into consideration the perspectives of the value chain partners (VCPs), companies and laboratories involved in an Innovate UK research project. The authors' findings show how VCPs can use PAS440 to demonstrate that they are innovating responsibly. Using this approach to responsible innovation along the value chain-from manufacturing scale-up, through regulatory approval, to incorporation in animal feed and from there to food on supermarket shelves-can support the development of innovations that contribute to the economic and environmental sustainability of the animal feed sector. The authors conclude that the PAS 440 Guide can facilitate the progress of a new product throughout a value chain and contribute to coordinating responsible behaviour among companies involved in the value chain.

An Assessment of the Fire Safety Standards in Iranian Homes and Equipment As They Relate to Fire Accidents

Fire accidents and burns are one of the leading causes of death and disability worldwide. This study was conducted with the aim of studying the etiology of fire accidents as well as investigating the fire safety standards of both homes and equipment in Iran. Samples included patients with flame burns who consented to answer the questions. Questions covered five areas: patient demographics, epidemiological characteristics of burns, the fire safety status of the home, the fire safety status of the equipment, and the mechanism of the accident. In this study, the mean extent of the burns was 18.07 ± 14.29% of body surface area and was significantly related to the age grouping of the patients. The highest total body surface area (TBSA) was observed in patients between 19 to 39 years. The most common cause of flame injuries was gas explosions (36.81%). The interviews revealed that most of the houses were not equipped with smoke detectors or fire extinguishers. The extent of burns was significantly higher in patients living in unequipped homes (P = 0.047). Cooking equipment was often involved in the accidents (38.1%). Considering the low home fire safety and the role of equipment misuse and damaged equipment use in the occurrence of accidents, it seems that installing fire alarms and firefighting equipment, proper training on how to work with and maintain the equipment, using cooking and heating equipment correctly along with discontinuing use if damaged would all be effective and are highly suggestive to reduce fire injuries.

Promoting the process of determining brain death through standardized training

Objective

This study aims to explore the training mode for brain death determination to ensure the quality of subsequent brain death determination.

Methods

A four-skill and four-step (FFT) training model was adopted, which included a clinical neurological examination, an electroencephalogram (EEG) examination, a short-latency somatosensory evoked potential (SLSEP) examination, and a transcranial Doppler (TCD) examination. Each skill is divided into four steps: multimedia theory teaching, bedside demonstration, one-on-one real or dummy simulation training, and assessment. The authors analyzed the training results of 1,577 professional and technical personnel who participated in the FFT training model from 2013 to 2020 (25 sessions), including error rate analysis of the written examination, knowledge gap analysis, and influencing factors analysis.

Results

The total error rates for all four written examination topics were < 5%, at 4.13% for SLSEP, 4.11% for EEG, 3.71% for TCD, and 3.65% for clinical evaluation. The knowledge gap analysis of the four-skill test papers suggested that the trainees had different knowledge gaps. Based on the univariate analysis and the multiple linear regression analysis, among the six factors, specialty categories, professional and technical titles, and hospital level were the independent influencing factors of answer errors (p < 0.01).

Conclusion

The FFT model is suitable for brain death (BD) determination training in China; however, the authors should pay attention to the professional characteristics of participants, strengthen the knowledge gap training, and strive to narrow the difference in training quality.

Assessment of the clinical and analytical performance of three Seegene Allplex SARS-CoV-2 assays within the VALCOR framework

The coronavirus disease 2019 (COVID-19) pandemic demonstrated the need for accurate diagnostic testing for the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the pandemic has ended, accurate assays are still needed to monitor viral spread at national levels and beyond through population and wastewater surveillance. To enhance early detection, SARS-CoV-2 assays should have high diagnostic accuracy and should be validated to assure accurate results. Three distinct SARS-CoV-2 assays were evaluated with clinical samples using the VALCOR (VALidation of SARS-CORona Virus-2 assays) framework, with the TaqPath COVID-19 assay (ThermoFisher Scientific, USA) as a comparator. We evaluated clinical sensitivity, specificity, limit of detection (LOD), and overall concordance between comparator and three index Allplex SARS-CoV-2 assays (Seegene, South Korea): Allplex-SC2, Allplex-SC2Fast (Fast PCR), and Allplex-SC2FabR (SARS-CoV-2/FluA/FluB/respiratory syncytial virus). Analytical performance and LOD of index assays were assessed using a dilution series of three synthetic SARS-CoV-2 sequence reference materials (RMs). Ninety SARS-CoV-2 positives and 90 SARS-CoV-2 negatives were tested. All Allplex assays had 100.0% sensitivity (95%CI = 95.9%-100.0%). Allplex-SC2 and Allplex-SC2Fast assays had 97.8% specificity (95%CI = 92.3%-99.7%) and 98.9% overall concordance [κ = 0.978 (95%CI = 0.947-1.000)]. Allplex-SC2FabR assay showed 100.0% specificity (95%CI = 95.9%-100.0%) and 100.0% overall concordance [κ = 1.000 (95%CI = 1.000-1.000)]. LOD assessment of index assays revealed detection down to 2.61 × 102 copies/mL in clinical samples, while the analytical LOD was 9.00 × 102 copies/mL. In conclusion, the evaluation of the three Seegene Allplex SARS-CoV-2 assays showed high sensitivity and specificity and an overall good assay concordance with the comparator. The assays showed low analytical LOD using RM and even a slightly lower LOD in clinical samples. Non-overlapping target gene sequences between SARS-CoV-2 assays and RMs emphasize the need for aligning targeted sequences of diagnostic assays and RMs.IMPORTANCEThe coronavirus disease 2019 pandemic has a significant impact on global public health, economies, and societies. As shown through the first phases of the pandemic, accurate and timely diagnosis is crucial for disease control, prevention, and monitoring. Though the pandemic phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has concluded, diagnostic assays remain in demand to monitor SARS-CoV-2 at the individual patient level, regionally, and nationally, as well as to remain an infectious disease preparedness instrument to monitor any new SARS-CoV-2 dissemination across borders using population and wastewater surveillance. The anticipation by WHO and central health care policy entities such as the Center for Disease Control, EMA, and multiple national health authorities is that SARS-CoV-2 will reside as an endemic respiratory disease for years to come. The key strategic consideration is hence shifting from combating a pandemic situation with a high number of patients to instead allowing precise diagnostics of suspected patients with the intention of correct management in a low-prevalence setting.

Development of Clinical Decision Support System for Patient Blood Management in Hospital Information System

A data pipeline was developed to send and receive patient blood management (PBM) data from all medical institutions in Korea. By incorporating the collected data with national big data, the system will be able to generate key performance index for each medical institution. The central PBM system also provides feedback to each individual medical institution.

The Necessity of Interoperability to Uncover the Full Potential of Digital Health Devices

Personalized health care can be optimized by including patient-reported outcomes. Standardized and disease-specific questionnaires have been developed and are routinely used. These patient-reported outcome questionnaires can be simple paper forms given to the patient to fill out with a pen or embedded in digital devices. Regardless of the format used, they provide a snapshot of the patient's feelings and indicate when therapies need to be adjusted. The advantage of digitizing these questionnaires is that they can be automatically analyzed, and patients can be monitored independently of doctor visits. Although the questions of most clinical patient-reported outcome questionnaires follow defined standards and are evaluated by clinical trials, these standards do not exist for data processing. Interoperable data formats and structures would benefit multilingual and cross-study data exchange. Linking questionnaires to standardized terminologies such as the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Logical Observation Identifiers, Names, and Codes (LOINC) would improve this interoperability. However, linking clinically validated patient-reported outcome questionnaires to clinical terms available in SNOMED CT or LOINC is not as straightforward as it sounds. Here, we report our approach to link patient-reported outcomes from health applications to SNOMED CT or LOINC codes. We highlight current difficulties in this process and outline ways to minimize them.

The Laboratory Automation Protocol (LAP) Format and Repository: A Platform for Enhancing Workflow Efficiency in Synthetic Biology

Laboratory automation deals with eliminating manual tasks in high-throughput protocols. It therefore plays a crucial role in allowing fast and reliable synthetic biology. However, implementing open-source automation solutions often demands experimental scientists to possess scripting skills, and even when they do, there is no standardized toolkit available for their use. To address this, we present the Laboratory Automation Protocol (LAP) Format and Repository. LAPs adhere to a standardized script-based format, enhancing end-user implementation and simplifying further development. With a modular design, LAPs can be seamlessly combined to create customized, target-specific workflows. Furthermore, all LAPs undergo experimental validation, ensuring their reliability. Detailed information is provided within each repository entry, allowing users to validate the LAPs in their own laboratory settings. We advocate for the adoption of the LAP Format and Repository as a community resource, which will continue to expand, improving the reliability and reproducibility of the automation processes.

What are the challenges for implementing an "organic label" to camel milk?

Increasing demand for camel's milk worldwide occurred in the context of the development of the organic sector in agriculture. The implementation of an organic label for camel milk has never been established. However, the creation of such a label faces to important challenges that are investigated in the present paper. Indeed, although camel milk conveys the image of a "natural product" issued from remote places, the risk of being produced in contaminated areas (mining activities, oil extraction) cannot be neglected for grazing animals. Moreover, the management of veterinary drugs for prevention or curative treatment can lead to the presence of residues in milk, especially in camel species with different pharmacokinetics, although similar instructions than for cow milk are used. Moreover, the lack of international standards regarding both composition and hygienic rules, the risks of adulteration, and the necessity to use specific indicators or analytical procedures adapted to the behavior of camel milk, have to be taken in account in the establishment of the specifications for the camel milk producers through the world.

Attitudes Towards Standardization of Mesenchymal Stromal Cells-A Qualitative Exploration of Expert Views

Pharmacopoeial standards ensure quality control of established medicines. It is widely believed that translation of cell therapy medicines will be facilitated by defining and adopting relevant standards. Mesenchymal stromal cells (MSCs) are used extensively for multiple indications in regenerative medicine. They are highly heterogeneous in terms of their biological characteristics and their mechanisms of action, making standardization a challenging undertaking. Furthermore, the use of MSCs in therapy appears to attract diverse views, ranging from concern and caution to enthusiastic positivity. We conducted semi-structured interviews with 20 expert stakeholders from academia, industry, regulatory agencies, non-governmental organizations and clinicians to explore their views, experiences, recommendations, and concerns regarding standardization of MSCs. Qualitative thematic analysis of transcribed records led to development of a consensus framework, which identified 5 key themes to facilitate exploration of the interviews' content. On the basis of our findings, we conclude that (1) there is undoubtedly an appetite for standardization, particularly in development of assays that enable comparison or benchmarking across manufacturers, processes, and cell sources; (2) stakeholder groups are not homogeneous in their concerns and attitudes; (3) careful consideration must be given to the points along the development timeline at which different standardization approaches could be beneficial; and (4) the roles of standards could be promoted further for specific aspects of advanced therapy medicinal product (ATMP) development and regulation such as qualification of decentralized manufacturing sites. A unified cross-stakeholder approach will help to advance MSC therapeutics and other cell therapy medicines.

PCR standard curve quantification in an extensive wastewater surveillance program: results from the Dutch SARS-CoV-2 wastewater surveillance

Since the start of the COVID-19 pandemic in 2020, wastewater surveillance programs were established, or upscaled, in many countries around the world and have proven to be a cost-effective way of monitoring infectious disease pathogens. Many of these programs use RT-qPCR, and quantify the viral concentrations in samples based on standard curves, by including preparations of a reference material with known nucleic acid or virus concentrations in the RT-qPCR analyses. In high-throughput monitoring programs it is possible to combine data from multiple previous runs, circumventing the need for duplication and resulting in decreased costs and prolonged periods during which the reference material is obtained from the same batch. However, over time, systematic shifts in standard curves are likely to occur. This would affect the reliability and usefulness of wastewater surveillance as a whole. We aim to find an optimal combination of standard curve data to compensate for run-to-run measurement variance while ensuring enough flexibility to capture systematic longitudinal shifts. Based on more than 4000 observations obtained with the CDC N1 and N2 assays, taken as a part of the National Sewage Surveillance program at the Dutch National Institute for Public Health and the Environment, we show that seasonal and long-term shifts in RT-qPCR efficiency and sensitivity occur. We find that in our setting, using five days of standard-curve data to quantify, results in the least error prone curve or best approximation. This results in differences up to 100% in quantified viral loads when averaged out over a nationwide program of >300 treatment plants. Results show that combining standard curves from a limited set of runs can be a valid approach to quantification without obscuring the trends in the viral load of interest.

Do differences in diagnostic criteria for late fetal growth restriction matter?

BACKGROUND

Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable.

OBJECTIVE

This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters.

STUDY DESIGN

From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated.

RESULTS

Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight <10th percentile between 1.4 and 2.1. Birthweight <10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used.

CONCLUSION

Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.

The Danish newborn standard and the International Fetal and Newborn Growth Consortium for the 21st Century newborn standard: a nationwide register-based cohort study

BACKGROUND

It is a matter of debate whether 1 universal standard, such as the International Fetal and Newborn Growth Consortium for the 21st Century standard, can be applied to all populations.

OBJECTIVE

The primary objective was to establish a Danish newborn standard based on the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard to compare the percentiles of these 2 standards. A secondary objective was to compare the prevalence and risk of fetal and neonatal deaths related to small for gestational age defined by the 2 standards when used in the Danish reference population.

STUDY DESIGN

This was a register-based nationwide cohort study. The Danish reference population included 375,318 singletons born at 33 to 42 weeks of gestation in Denmark between January 1, 2008, and December 31, 2015. The Danish standard cohort included 37,811 newborns who fulfilled the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard. Birthweight percentiles were estimated using smoothed quantiles for each gestational week. The outcomes included birthweight percentiles, small for gestational age (defined as a birthweight of 3rd percentile), and adverse outcomes (defined as either fetal or neonatal death).

RESULTS

At all gestational ages, the Danish standard median birthweights at term were higher than the International Fetal and Newborn Growth Consortium for the 21st Century standard median birthweights: 295g for females and 320 g for males. Therefore, the estimates of the prevalence rate of small for gestational age within the entire population were different: 3.9% (n=14,698) using the Danish standard vs 0.7% (n=2640) using the International Fetal and Newborn Growth Consortium for the 21st Century standard. Accordingly, the relative risk of fetal and neonatal deaths among small-for-gestational-age fetuses differed by SGA status defined by the different standards (4.4 [Danish standard] vs 9.6 [International Fetal and Newborn Growth Consortium for the 21st Century standard]).

CONCLUSION

Our finding did not support the hypothesis that 1 universal standard birthweight curve can be applied to all populations.

A Study on Standard for Safety Requirements for Care Robots

Recently, care robots are being developed that incorporate robotics into assistive products that focus on daily care for the physically disabled or elderly with reduced physical function. However, although care robots can reduce the physical burden of human intervention, they can also be dangerous depending on their situational awareness. This study describes a standardization that defines safety requirements for care robots and includes verification methods to test their safety requirements. As an example of the application of this standard, a standard for the safety and performance method of a feeding robot is shown. This standardization study is expected to contribute to the spread of care robots in the future.

Comparative analysis of rule elements for transportation of cell therapy products among regulations and standards

Aim: This study aimed to identify the elements involved in the transportation of cell therapy products by conducting a comparative analysis of four related international standards for temperature-controlled delivery and good distribution practice (GDP). Methods: An analytical framework was constructed to cover the entire transportation process. The descriptions of each element in the Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme (PIC/S) GDP, International Organization for Standardization (ISO) 21973, Foundation for the Accreditation of Cellular Therapy Common Standards for Cellular Therapies and ISO 23412 were compared. Results: The study identified some elements that were present in the PIC/S GDP and other standards but were absent in ISO 21973, and vice versa. These elements are crucial in view of the increasing opportunities to transport allogeneic cells in the future. Conclusion: The study identified the necessary elements that should be included in the development of transport regulations for cell therapy products.

Scoring the Culture of Care as a key performance indicator in a global pharmaceutical company

Culture of Care has been an integral part of Sanofi's policy on animal protection for more than 15 years. Culture of Care goes beyond compliance with regulations and standards, since it relates to the attitudes of staff and to caring for research animals, as well as to the company's commitment to an active animal protection policy. However, the concept of Culture of Care remains subjective. Via two anonymous and voluntary surveys conducted in 2018 and 2021, it was possible to understand the level of staff engagement and the perception of company efficiency. Based on key questions, it was possible to assess individual engagement (animal welfare knowledge, pride, engagement, recognition) and company commitments (oversight body efficiency, level of transparency, Sanofi policy on animal protection). The institutional scores were 7.7/10 and 7.9/10 obtained in 2018 and in 2021, respectively. The individual score obtained for 2018 was 6.7/10 compared to 6.9/10 obtained in 2021. The combination of these two criteria helps to determine a Culture of Care score and thus make it a performance indicator. The scores are CoC2018 (7.7; 6.7) and CoC2021 (7.9; 6.9). Being able to quantify this level of engagement and the perception that employees have of the company encourages the organisation of an improvement programme and helps measure the benefits.

Structure of Health Information With Different Information Models: Evaluation Study With Competency Questions

BACKGROUND

There is a flora of health care information models but no consensus on which to use. This leads to poor information sharing and duplicate modelling work. The amount and type of differences between models has, to our knowledge, not been evaluated.

OBJECTIVE

This work aims to explore how information structured with various information models differ in practice. Our hypothesis is that differences between information models are overestimated. This work will also assess the usability of competency questions as a method for evaluation of information models within health care.

METHODS

In this study, 4 information standards, 2 standards for secondary use, and 2 electronic health record systems were included as material. Competency questions were developed for a random selection of recommendations from a clinical guideline. The information needed to answer the competency questions was modelled according to each included information model, and the results were analyzed. Differences in structure and terminology were quantified for each combination of standards.

RESULTS

In this study, 36 competency questions were developed and answered. In general, similarities between the included information models were larger than the differences. The demarcation between information model and terminology was overall similar; on average, 45% of the included structures were identical between models. Choices of terminology differed within and between models; on average, 11% was usable in interaction with each other. The information models included in this study were able to represent most information required for answering the competency questions.

CONCLUSIONS

Different but same same; in practice, different information models structure much information in a similar fashion. To increase interoperability within and between systems, it is more important to move toward structuring information with any information model rather than finding or developing a perfect information model. Competency questions are a feasible way of evaluating how information models perform in practice.

Review of the Hydrogen Permeation Test of the Polymer Liner Material of Type IV On-Board Hydrogen Storage Cylinders

Type IV hydrogen storage cylinders comprise a polymer liner and offer advantages such as lightweight construction, high hydrogen storage density, and good fatigue performance. However, they are also characterized by higher hydrogen permeability. Consequently, it is crucial for the polymer liner material to exhibit excellent resistance to hydrogen permeation. International organizations have established relevant standards mandating hydrogen permeation tests for the liner material of type IV on-board hydrogen storage cylinders. This paper provides a comprehensive review of existing research on hydrogen permeability and the hydrogen permeation test methods for the polymer liner material of type IV on-board hydrogen storage cylinders. By delving into the hydrogen permeation mechanism, a better understanding can be gained, offering valuable references for subsequent researchers in this field. This paper starts by thoroughly discussing the hydrogen permeation mechanism of the liner material. It then proceeds to compare and analyze the hydrogen permeation test methods specified by various standards. These comparisons encompass sample preparation, sample pretreatment, test device, test temperature and pressure, and qualification indicators. Then, this study offers recommendations aimed at enhancing the hydrogen permeation test method for the liner material. Additionally, the influence of test temperature, test pressure, and polymer material properties on the hydrogen permeability of the liner material is discussed. Finally, the influences of the test temperature, test pressure, and polymer material properties on the hydrogen permeability of the liner material are discussed. Future research direction on the hydrogen permeability and hydrogen permeation test method of the liner material of the type IV hydrogen storage cylinder has been prospected.

[Analysis and Reflection on Drafting Units of Medical Device Industry Standards in China]

Standard drafting is an important part in the process of standard formulation and revision. By analyzing the status of the medical device industry standards drafting, thoughts and suggestions were proposed to further promote all relevant parties to actively participate in the standard drafting, effectively improve the quality of the standards, strengthen the technical support and promote the high-quality development of the industry. The statistical data of the participation of social organizations in the drafting and as the first unit drafting medical devices standards from 2017 to 2021 was researched, and the problems in the drafting of standards at this stage were analyzed. Based on the research and analyses, some thoughts and suggestions were proposed to strengthen the management of standard drafting units and promote the participation of all relevant parties in standard drafting. It is necessary to expand and enhance social participation in standard drafting further by innovating incentives, refining and strengthening normative requirements, and creating a positive social atmosphere.

Interoperable, Domain-Specific Extensions for the German Corona Consensus (GECCO) COVID-19 Research Data Set Using an Interdisciplinary, Consensus-Based Workflow: Data Set Development Study

Background: The COVID-19 pandemic has spurred large-scale, interinstitutional research efforts. To enable these efforts, researchers must agree on data set definitions that not only cover all elements relevant to the respective medical specialty but also are syntactically and semantically interoperable. Therefore, the German Corona Consensus (GECCO) data set was developed as a harmonized, interoperable collection of the most relevant data elements for COVID-19-related patient research. As the GECCO data set is a compact core data set comprising data across all medical fields, the focused research within particular medical domains demands the definition of extension modules that include data elements that are the most relevant to the research performed in those individual medical specialties. Objective: We aimed to (1) specify a workflow for the development of interoperable data set definitions that involves close collaboration between medical experts and information scientists and (2) apply the workflow to develop data set definitions that include data elements that are the most relevant to COVID-19-related patient research regarding immunization, pediatrics, and cardiology. Methods: We developed a workflow to create data set definitions that were (1) content-wise as relevant as possible to a specific field of study and (2) universally usable across computer systems, institutions, and countries (ie, interoperable). We then gathered medical experts from 3 specialties-infectious diseases (with a focus on immunization), pediatrics, and cardiology-to select data elements that were the most relevant to COVID-19-related patient research in the respective specialty. We mapped the data elements to international standardized vocabularies and created data exchange specifications, using Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR). All steps were performed in close interdisciplinary collaboration with medical domain experts and medical information specialists. Profiles and vocabulary mappings were syntactically and semantically validated in a 2-stage process. Results: We created GECCO extension modules for the immunization, pediatrics, and cardiology domains according to pandemic-related requests. The data elements included in each module were selected, according to the developed consensus-based workflow, by medical experts from these specialties to ensure that the contents aligned with their research needs. We defined data set specifications for 48 immunization, 150 pediatrics, and 52 cardiology data elements that complement the GECCO core data set. We created and published implementation guides, example implementations, and data set annotations for each extension module. Conclusions: The GECCO extension modules, which contain data elements that are the most relevant to COVID-19-related patient research on infectious diseases (with a focus on immunization), pediatrics, and cardiology, were defined in an interdisciplinary, iterative, consensus-based workflow that may serve as a blueprint for developing further data set definitions. The GECCO extension modules provide standardized and harmonized definitions of specialty-related data sets that can help enable interinstitutional and cross-country COVID-19 research in these specialties.

[Developing process and term analysis of WFAS standard: General Requirements for the Risk Control in the Safe Use of Acupuncture]

In order to promote the application of WFAS standard, General Requirements for the Risk Control in the Safe Use of Acupuncture and the safe practice of acupuncture technology worldwide, the paper introduces the developing process and main contents of this standard, explains the developing purpose, scope, ideas, methods and basis, and analyzes the definition of the relevant terms. Through strictly complied with the development procedure of standard, the terms related to acupuncture risk in this standard are defined. The connotations of 5 special terms are clarified, i.e. "acupuncture risks" "adverse events of acupuncture" "adverse reactions of acupuncture" "acupuncture accidents" and "acupuncture negligence". The range, rank, control flow and source of risk, as well as the control measures are determined. The standard extracts the underlying common problems and basic requirement of the safe practice of acupuncture so as to lay a framework for the development of the relevant technical standards of acupuncture.

Military Standard Testing of Commercially Available Supraglottic Airway Devices for Use in a Military Combat Setting

INTRODUCTION

Airway obstruction is the second leading cause of death on the battlefield. The harsh conditions of the military combat setting require that devices be able to withstand extreme circumstances. Military standards (MIL-STD) testing is necessary before devices are fielded. We sought to determine the ability of supraglottic airway (SGA) devices to withstand MIL-STD testing.

METHODS

We tested 10 SGA models according to nine MIL-STD-810H test methods. We selected these tests by polling five military and civilian emergency-medicine subject matter experts (SMEs), who weighed the relevance of each test. We performed tests on three devices for each model, with operational and visual examinations, to assign a score (1 to 10) for each device after each test. We calculated the final score of each SGA model by averaging the score of each device and multiplying that by the weight for each test, for a possible final score of 2.6 to 26.3.

RESULTS

The scores for the SGA models were LMA Classic Airway, 25.9; AuraGain Disposable Laryngeal Mask, 25.5; i-gel Supraglottic Airway, 25.2; Solus Laryngeal Mask Airway, 24.4; LMA Fastrach Airway, 24.4; AuraStraight Disposable Laryngeal Mask, 24.1; King LTS-D Disposable Laryngeal Tube, 22.1; LMA Supreme Airway, 21.0; air-Q Disposable Intubating Laryngeal Airway, 20.1; and Baska Mask Supraglottic Airway, 18.1. The limited (one to three) samples available for testing provide adequate preliminary information but restrict the range of failures that could be discovered.

CONCLUSIONS

Lower scoring SGA models may not be optimal for military field use. Models scoring sufficiently close to the top performers (LMA Classic, AuraGain, i-gel, Solus, LMA Fastrach, AuraStraight) may be viable for use in the military setting. The findings of our testing should help guide device procurement appropriate for different battlefield conditions.

[Common diseases and drug use characteristics of Chinese herbal medicines and suggestions]

Based on the data of 56 kinds of diseases and drug use in 100 kinds of cultivated Chinese herbal medicines, this paper used frequency analysis method to count the types of diseases and their drug use characteristics, and systematically analyzed the status of drug registration and monitoring standards for disease prevention and control of Chinese herbal medicines. The results showed that 14 diseases such as root rot, powdery mildew, and drooping disease were common in the production of Chinese herbal medicines. Among the 99 pesticides reported, 67.68% were chemically synthesized, 23.23% were biological pesticides, and 9.09% were mineral pesticides. Among the reported pesticides, 92.93% of them were low toxic, with relative safety. However, 70% of the production drugs were not registered in Chinese herbal medicines, and the phenomenon of overdose was serious. The current pesticide residue monitoring standards does not match well with production drugs in China. Although the matching degree between Maximum Residue Limit of Pesticide in Food Safety National Standard(GB 2763-2021) and production drugs is more than 50%, there are few varieties of Chinese herbal medicines covered. The matching degree between Chinese Pharmacopoeia(2020 edition), Green Industry Standard of Medicinal Plants and Preparations(WM/T2-2004), and production drugs is only 1.28%. It is suggested to speed up the research and registration of Chinese herbal medicine production and further improve the pesticide residue limit standard combined with the actual production, so as to promote the high-quality development of Chinese herbal medicine industry.

Standardization Proposal for the Transmission of Waiting List Data in Italy

Each Italian region is required to manage and disclose data relating to waiting times for healthcare services which are provided by both public and private hospitals and local health units accredited to the Sistema Sanitario Nazionale (SSN - in English, National Healthcare System). The current law governing data relating to waiting times and their sharing is the Piano Nazionale di Governo delle Liste di Attesa (PNGLA - in English National Government Plan for Waiting Lists). However, this plan does not propose a standard to monitor such data, but only provides a few guidelines that the Italian regions are required to follow. The lack of a specific technical standard for managing sharing of waiting list data and the lack of precise and binding information in the PNGLA make the management and transmission of such data problematic, reducing the interoperability necessary to have an effective and efficient monitoring of the phenomenon. The proposal for a new standard for the transmission of waiting list data derives from these shortcomings. This proposed standard promotes greater interoperability, is easy to create with an implementation guide, and has sufficient degrees of freedom to assist the document author.

Investigation and Improvement of Test Methods for Capacitance and DCESR of EDLC Cells

The quick and accurate characterization of commercial electrochemical double-layer capacitor (EDLC) cells, especially their capacitance and direct-current equivalent series internal resistance (DCESR), is of great significance for the design, maintenance, and monitoring of EDLCs used in areas of energy, sensors, electric power, construction machinery, rail transit, automobile transportation, and military. In this study, the capacitance and DCESR of three commercial EDLC cells with similar performance were determined and compared by following the three commonly-used standards of IEC 62391, Maxwell, and QC/T741-2014, which are significantly different in test procedures and calculation methods. The analysis of the test procedures and results demonstrated that the IEC 62391 standard has the disadvantages of a large testing current, long testing time, and a complex and inaccurate DCESR calculation, whereas the Maxwell standard has the disadvantages of a large testing current, a small capacitance, and large DCESR testing results, and furthermore the QC/T 741 standard has the disadvantages of a high resolution requirement for the equipment and small DCESR results. Therefore, an improved method was proposed to determine the capacitance and DCESR of EDLC cells by short-time constant voltage charging and discharging interruption methods, respectively, with the advantages of high accuracy, low equipment requirements, short testing time, and the easy calculation of DCESR over the original three standards.

Hymenoptera venom skin testing: Adopting an accelerated test protocol

BACKGROUND

The standard method of Hymenoptera venom intradermal skin test is performed at a starting concentration of 0.001 to 0.01 μg/ml and increased by 10-fold concentrations until positive or a maximum concentration of 1 μg/ml. Accelerated methods that start at higher concentrations have been reported as safe, however many institutions have not adopted this approach.

OBJECTIVE

We aim to compare the outcome and safety of standard and accelerated venom skin test protocols.

METHODS

This was a retrospective chart review of patients with suspected venom allergy who underwent skin testing at four allergy clinics within a single healthcare system from 2012-2022. Demographic data, test protocol (standard vs. accelerated), test results, and adverse reactions were reviewed.

RESULTS

Two out of 134 patients (1.5%) who underwent standard venom skin test experienced an adverse reaction while none of the 77 patients who underwent accelerated venom skin test experienced an adverse reaction. One patient, with a history of chronic urticaria, experienced urticaria. The other experienced anaphylaxis requiring epinephrine although had tested negative to all venom concentrations. Within the standard testing protocol, >75% of positive results occurred at concentrations of 0.1 or 1 μg/ml. Within the accelerated testing protocol, > 60% of positive results occurred at 1 μg/ml.

CONCLUSION

The study underscores the overall safety of venom intradermal skin test. Majority of positive results occurred at 0.1 or 1 μg/ml. Adopting an accelerated approach would reduce time and cost associated with testing.

Tissue-Like 3D Standard and Protocols for Microscope Quality Management

This article outlines a global study conducted by the Association of Biomedical Resource Facilities (ABRF) Light Microscopy Research Group (LMRG). The results present a novel 3D tissue-like biologically relevant standard sample that is affordable and straightforward to prepare. Detailed sample preparation, instrument-specific image acquisition protocols and image analysis methods are presented and made available to the community. The standard consists of sub-resolution and large well characterized relative intensity fluorescence microspheres embedded in a 120 µm thick 3D gel with a refractive index of 1.365. The standard allows the evaluation of several properties as a function of depth. These include the following: 1) microscope resolution with automated analysis of the point-spread function (PSF), 2) automated signal-to-noise ratio analysis, 3) calibration and correction of fluorescence intensity loss, and 4) quantitative relative intensity. Results demonstrate expected refractive index mismatch dependent losses in intensity and resolution with depth, but the relative intensities of different objects at similar depths are maintained. This is a robust standard showing reproducible results across laboratories, microscope manufacturers and objective lens types (e.g., magnification, immersion medium). Thus, these tools will be valuable for the global community to benchmark fluorescence microscopes and will contribute to improved scientific rigor and reproducibility.

What Makes a Quality Health App-Developing a Global Research-Based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: Delphi Study

BACKGROUND

The lack of an international standard for assessing and communicating health app quality and the lack of consensus about what makes a high-quality health app negatively affect the uptake of such apps. At the request of the European Commission, the international Standard Development Organizations (SDOs), European Committee for Standardization, International Organization for Standardization, and International Electrotechnical Commission have joined forces to develop a technical specification (TS) for assessing the quality and reliability of health and wellness apps.

OBJECTIVE

This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality.

METHODS

A 2-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42, 51%) or both (n=41, 49%) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the maximum 100 requirement questions for the uptake of apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries that participated in the SDO technical committees were invited to comment on 4 working drafts and subsequently vote on the TS.

RESULTS

The final quality assessment framework includes 81 questions, 67 (83%) of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as "Healthy and safe," "Easy to use," "Secure data," and "Robust build." The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2-4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software - Part 2: Health and wellness apps - Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs, including 6 of the 10 most populous countries worldwide.

CONCLUSIONS

A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers enhance and efficiently demonstrate the quality of health apps, consumers, and health care professionals to make informed decisions on health apps. It will also help insurers to make reimbursement decisions on health apps.

Comparison between a fitness tracker (EquimetreTM) and standard base-apex electrocardiography in dromedary camels

Background

Personalized healthcare technology has grown explosively through the use of portable and smart monitoring devices for diagnosis. The objective of this study was to determine the practicality and usability of the EquimetreTM fitness tracker on camels in comparison to the standard base-apex system in normal and clinical cases.

Methods

Five apparently healthy adult camels, five clinical adult cases and two clinical calves were enrolled in this study. The camels were equipped with two monitoring systems: EquimetreTM and a standard base-apex electrocardiogarphy. Each tracing was evaluated for the normal ECG variable's measure, including heart rate beats per min, P-R, QRS, R-R, Q-T, S-T intervals, and P-R and S-T segments in seconds. The amplitudes for P, Q, R, S, and T-peaks were evaluated in millivolts.

Results

EquimetreTM showed stability on ECG tracing with less movement artifacts compared with the standard base-apex system. Different polarities were observed for the P-waves and T-waves between the standard base-apex system and EquimetreTM. Both devices showed perfect agreement for heart rate (ICC = 1.00, P ≥ 0.0001, 95% = 1.00-1.00) in healthy and clinical adults. A good correlation was observed for the R-R interval between the devices in healthy and clinical adults. A moderate correlation was observed between the devices for Q-peak in clinical adults, with no correlation in clinical calves.

Conclusions

This study demonstrated acceptable ECG measurements between the standard base-apex and EquimetreTM device. This suggests that EquimetreTM could be a useful device in camels for initial electrocardiographic examinations in remote areas such as deserts.

Health and Safety Regulations for COVID-19: A Policy Analysis

The COVID-19 pandemic spurred some regulators in the USA to require occupational health and safety programs to prevent COVID-19 transmission in workplaces. The objective of this study was to describe such state and federal regulations enacted between January 2020 and January 2022. Regulations, including emergency temporary standards (ETS) and permanent standards, were identified through a search of Nexis Uni and Bloomberg Law and review of US OSHA websites and the Federal Register. Full texts were reviewed for regulatory scope, hazard and exposure definitions, determination of exposure or risk levels, and control strategies. Four state (California, Michigan, Virginia, and Oregon) and two federal regulations were identified. All regulations described respiratory aerosols as the primary source of SARS-CoV-2 and recognized person-to-person transmission by droplet, airborne, and contact routes. Only the US OSHA ETS for healthcare explicitly stated that inhalation of respiratory particles was the most likely method of COVID-19 transmission. The Virginia, Michigan, and Oregon regulations described different categories of risk defined by exposure frequency and duration or specific workplace activities. California described exposure as places and times when employees come into contact or congregate with other people. The US OSHA ETS for healthcare described exposure as involving close contact with suspected or confirmed COVID-19 patients. While all of the state regulations required strategies from across the hierarchy, only the Virginia regulations specifically incorporated the hierarchy of controls. Only the California and Virginia regulations explicitly linked control strategies to the transmission route, while Virginia demarcated control strategies by risk level. Oregon linked risk level to occupancy levels and physical distancing requirements and referred to the use of a layered approach for transmission control. The US OSHA ETS for healthcare defined droplet and airborne precautions but made no mention of the hierarchy of controls or risk levels. Respirators were discussed in most of the regulations. The first Michigan regulation explicitly required respirators appropriate to exposure risk. The California regulations noted that respirators protect the wearer while face coverings protect people around the wearer. These regulations offer insights for a permanent US OSHA infectious disease regulation, such as the need to consider a range of transmission modes including near- and far-range aerosol inhalation, endemic and novel pathogens, workplaces beyond healthcare settings, factors that contribute to exposure and risk, the hierarchy of controls, the role of vaccination, and the importance of written exposure assessment and infection prevention plans.

Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer: a multicenter randomized controlled trial

BACKGROUND

The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial, and more high-level clinical evidence is needed. This study aimed to evaluate the outcome of extended pancreatoduodenectomy (EPD) with retroperitoneal nerve resection in pancreatic head cancer.

METHODS

This multicenter randomized trial was performed at 6 Chinese high-volume hospitals that enrolled patients between October 3, 2012, and September 21, 2017. Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments (preoperative chemotherapy or chemoradiation) within three months were randomly assigned to undergo standard pancreatoduodenectomy (SPD) or EPD, with the latter followed by dissection of additional lymph nodes (LNs), nerves and soft tissues 270° on the right side surrounding the superior mesenteric artery and celiac axis. The primary endpoint was overall survival (OS) by intention-to-treat (ITT). The secondary endpoints were disease-free survival (DFS), mortality, morbidity, and postoperative pain intensity.

RESULTS

The R1 rate was slightly lower with EPD (8.46%) than with SPD (12.56%). The morbidity and mortality rates were similar between the two groups. The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort (23.0 vs. 20.2 months, P = 0.100), while the median DFS was superior in the EPD group (16.1 vs. 13.2 months, P = 0.031). Patients with preoperative CA19-9 < 200.0 U/mL had significantly improved OS and DFS with EPD (EPD vs. SPD, 30.8 vs. 20.9 months, P = 0.009; 23.4 vs. 13.5 months, P < 0.001). The EPD group exhibited significantly lower locoregional (16.48% vs. 35.20%, P < 0.001) and mesenteric LN recurrence rates (3.98% vs. 10.06%, P = 0.022). The EPD group exhibited less back pain 6 months postoperation than the SPD group.

CONCLUSIONS

EPD for pancreatic head cancer did not significantly improve OS, but patients with EPD treatment had significantly improved DFS. In the subgroup analysis, improvements in both OS and DFS in the EPD arm were observed in patients with preoperative CA19-9 < 200.0 U/mL. EPD could be used as an effective surgical procedure for patients with pancreatic head cancer, especially those with preoperative CA19-9 < 200.0 U/mL.

Mismatch Negativity Responses to Different Auditory Attributes in Normally Developing Infants and Children

Introduction Mismatch negativity (MMN) is a change-specific component of the event-related potentials that is elicited by an irregularity in repetitive auditory stimulation. As it is developmentally stable and can be measured in the absence of the participant's attention, it can be a valuable method for assessing auditory discrimination in infants and young children. The classic MMN paradigm involves tone frequency as the mismatching attribute. Multi-feature MMN paradigms which involve different auditory attributes can assess discrimination abilities in a wider group of disorders. The study aimed to report standardised MMN values obtained with MMN paradigms including several auditory attributes to extend the clinical applicability of the test in infants and young children. Methods MMN responses were recorded in 42 normal infants and young children (2 months to 5 years) with multi-feature MMN paradigms. MMN variables in different trials were compared by one-way ANOVA. Pearson's correlation coefficient and independent sample t-test were performed for finding an association with the age and gender of the participants respectively. P<0.05 was considered as statistically significant. Results MMN amplitude exhibited statistically significant differences in different MMN paradigms (p<0.05). An increase in the degree of standard and deviant differences and double deviant responses also resulted in larger MMN. MMN latency variation in the trials was not statistically significant. The age and gender of the participants did not influence the MMN variables with statistical significance. Conclusion MMN paradigms with different auditory attributes report significant amplitude variations. Multi-feature MMN paradigms can optimize the clinical applicability of the test and can determine the profile of different auditory discrimination abilities.

[Analysis and Evaluation of Magnetic Resonance Compatibility Magnetic Torque Test Method for Implants]

With the increase in the number of patients carrying implants, the demand for magnetic resonance imaging diagnosis is getting higher and higher, and a variety of magnetic resonance compatibility magnetic torque test methods for medical implants have been proposed internationally. The standard conversion is far behind the international in terms of timeliness, testing technology, and testing equipment. This study analyzes the existing medical implant magnetic resonance compatibility standards, compares the magnetic resonance compatibility magnetic torque test methods and devices of the implants, analyzes the advantages and disadvantages of the detection methods and devices, so as to optimize China's medical implants magnetic resonance compatibility magnetic torque test method and device.

Serology Standard for Anti-SARS-CoV-2 Antibody Detection

The SARS-CoV-2 pandemic resulted in a demand for highly specific and sensitive serological testing to evaluate seroprevalence and antiviral immune responses to infection and vaccines. Hence, there was an urgent need for a serology standard to harmonize results across different natural history and vaccine studies. The Frederick National Laboratory for Cancer Research (FNLCR) generated a U.S. serology standard for SARS-CoV-2 serology assays and subsequently calibrated it to the WHO international standard (National Institute for Biological Standards and Control [NIBSC] code 20/136) (WHO IS). The development included a collaborative study to evaluate the suitability of the U.S. serology standard as a calibrator for SARS-CoV-2 serology assays. The eight laboratories participating in the study tested a total of 17 assays, which included commercial and in-house-derived binding antibody assays, as well as neutralization assays. Notably, the use of the U.S. serology standard to normalize results led to a reduction in the inter-assay coefficient of variation (CV) for IgM levels (pre-normalization range, 370.6% to 1,026.7%, and post-normalization range, 52.8% to 242.3%) and a reduction in the inter-assay CV for IgG levels (pre-normalization range, 3,416.3% to 6,160.8%, and post-normalization range, 41.6% to 134.6%). The following results were assigned to the U.S. serology standard following calibration against the WHO IS: 246 binding antibody units (BAU)/mL for Spike IgM, 764 BAU/mL for Spike IgG, 1,037 BAU/mL for Nucleocapsid IgM, 681 BAU/mL for Nucleocapsid IgG assays, and 813 neutralizing international units (IU)/mL for neutralization assays. The U.S. serology standard has been made publicly available as a resource to the scientific community around the globe to help harmonize results between laboratories.

ACVR and ECVDI Consensus Statement for the Standardization of the Abdominal Ultrasound Examination

This consensus statement is designed to provide a standard of care document and describes the ACVR and ECVDI definition for performing a standard abdominal ultrasound examination in dogs and cats. The ACVR and ECVDI define a standard abdominal ultrasonographic examination as a complete exam of the abdominal organs which is appropriately documented. The consensus statement intends to provide guidance to veterinary sonographers and veterinarians for the performance and documentation of high-quality diagnostic ultrasound examination. The document may also serve as a teaching aid for veterinary students, veterinarians, and residents in diagnostic imaging who seek proficiency in diagnostic ultrasound. Finally, it may serve an additional role in educating the public as to what a high-quality abdominal ultrasound examination should entail.

Chemometrics for Raman Spectroscopy Harmonization

Raman spectroscopy is used in a wide variety of fields, and in a plethora of different configurations. Raman spectra of simple analytes can often be analyzed using univariate approaches and interpreted in a straightforward manner. For more complex spetral data such as time series or line profiles (1D), Raman maps (2D), or even volumes (3D), multivariate data analysis (MVDA) becomes a requirement. Even though there are some existing standards for creation, implementation, and validation of methods and models employed in industry and academics, further research and development in the field must contribute to their improvement. This review will cover, in broad terms, existing techniques as well as new developments for MVDA for Raman spectroscopic data, and in particular the use associated with instrumentation and data calibration. Chemometric models are often generated via fusion of analytical data from different sources, which enhances model discrimination and prediction abilities as compared to models derived from a single data source. For Raman spectroscopy, raw or unprocessed data is rarely ever used. Instead, spectra are usually corrected and manipulated,¹ often by case-specific rather than universal methods. Calibration models can be used to characterize qualitatively and/or quantitatively samples measured with the same instrumentation that was used to create the model. However, regular validation is required to ensure that aging or incorrect maintenance of the instrument does not alter the model's predictions, particularly when applied in regulated fields such as pharmaceuticals. Furthermore, a model transfer may be required for different reasons, such as replacement or significant repair of the instrumentation. Modeling can also be used to consistently harmonize Raman spectroscopic data across several instrumental designs, accounting for variations in the resulting spectrum induced by different components. Data for Raman harmonization models should be processed in a protocolled manner, and the original data accessible to allow for model reconstruction or transfer when new data is added. Important processing steps will be the calibration of the spectral axes and instrument dependent effects, such as spectral resolution. In addition, data fusion and model transfer are essential for allowing new instrumentation to build on existing models to harmonize their own data. Ideally, an open access database would be created and maintained, for the purpose of allowing for continued harmonization of new Raman instruments using an outlined and accepted protocol.

Novel and Simplified Procedure to Test Immunity of Low-Power Voltage Transformers

International technical committees put considerable efforts into the writing process of standards. They always try to find a tradeoff between the rigorous scientific requirements and the practical needs of manufacturers and final users. In addition, researchers keep investigating to improve the existing standards with new procedures, achievements, and findings. The purpose of this work is to contribute to that direction. It introduces a simplified and low-cost procedure to test low-power voltage transformers (LPVTs). The procedure is designed to assess the immunity of LPVTs when subjected to external electric fields. The need for this procedure comes from the existing immunity test, which is efficient but sometimes difficult to implement. The proposed one, instead, is simpler, cheaper, does not require the application of the rated voltage, and can be replicated at all voltage levels. In the paper, the procedure is described and demonstrated with experimental tests. From the results, it is possible to appreciate the validity of the proposed solution and the different ways it could be developed, implemented, and improved.

Applying the Hearing Aid Fitting Standard to Selection for Adults

The recent hearing aid fitting standard for adults outlines the minimum practice for audiologists fitting adult patients with hearing loss. This article focuses on three items of the standard (5, 6, and 7), which focus on the selection of unilateral/bilateral hearing aids, hearing aid style, and coupling, in addition to feature selection. The standard emphasizes that decisions around these three aspects should be recommended for a patient in an individualized manner, based on their needs assessment. For these decisions, the needs assessment might include measures of speech-in-noise ability, social network size, patient preference, and a trial period. Additional elements could include assessments of manual dexterity, binaural interference, and attitude toward hearing aids. However, there are a multitude of ways to practice clinically and still meet the items outlined in the standard. As long as the selection decisions consider individualized patient factors and are capable of meeting validated prescriptive targets, a clinician would be meeting the adult hearing aid fitting minimum standard guidance. In addition, despite the large number of past studies supporting these standards, additional, high-quality research including randomized, controlled, clinical trials are still needed to further support appropriate minimum standard recommendations.

The Launch of the iCoDE Standard Project

INTRODUCTION

The first meeting of the Integration of Continuous Glucose Monitor Data into the Electronic Health Record (iCoDE) project, organized by Diabetes Technology Society, took place virtually on January 27, 2022.

METHODS

Clinicians, government officials, data aggregators, attorneys, and standards experts spoke in panels and breakout groups. Three themes were covered: 1) why digital health data integration into the electronic health record (EHR) is needed, 2) what integrated continuously monitored glucose data will look like, and 3) how this process can be achieved in a way that will satisfy clinicians, healthcare organizations, and regulatory experts.

RESULTS

The meeting themes were addressed within eight sessions: 1) What Do Inpatient Clinicians Want to See With Integration of CGM Data into the EHR?, 2) What Do Outpatient Clinicians Want to See With Integration of CGM Data into the EHR?, 3) Why Are Data Standards and Guidances Useful?, 4) What Value Can Data Integration Services Add?, 5) What Are Examples of Successful Integration?, 6) Which Privacy, Security, and Regulatory Issues Must Be Addressed to Integrate CGM Data into the EHR?, 7) Breakout Group Discussions, and 8) Presentation of Breakout Group Ideas.

CONCLUSIONS

Creation of data standards and workflow guidance are necessary components of the Integration of Continuous Glucose Monitor Data into the Electronic Health Record (iCoDE) standard project. This meeting, which launched iCoDE, will be followed by a set of working group meetings intended to create the needed standard.

ISO/IEC-Standards on Quality and Safety of Telehealth Services and Mobile Medical Apps

This paper investigates consistency of ISO/IEC-standards on quality and safety of telehealth services and mobile medical apps. Since mobile medical apps are 'software as a medical device', requirements for these apps are in software standards, in particular health software standards, as well as in medical device standards. These requirements were analyzed within an analysis model that has three domains: quality and safety management, core healthcare processes and resources. Telehealth services are healthcare processes and mobile medical apps are resources. There is good alignment of the standards that pertain to quality and safety management, the healthcare processes and medical devices. However, there is a lack of alignment, consistency and transparency of the ISO/IEC-standards on quality and safety of telehealth services and mobile medical apps. An international effort to address these issues is recommended.

[Recent Advance of Stainless Steel Used In Non-active Surgical Implantable Medical Device and Regulatory Perspective]

Stainless steel has been widely used in non-active surgical implantable medical device of cardiovascular, orthopedics, dental and ophthalmology. In this paper, we mainly focused on development of stainless steel, as well as the material-related standard evolution. We further summarized the recent advancement of stainless steel use in surgical implantable medical device. Insight and regulatory perspective has been further demonstrated.

[The medical rehabilitation: planning work load and number of positions]

The article presents the results of analysis of normative legal documents and their changes related to planning of volume of medical care in "medical rehabilitation" profile. The calculation of planned normative number of beds of this profile from 2014 to 2021 is presented according to the number of bed-days and planned beds turnover. The number of arithmetic errors in planned indices of specialized medical care in hospital conditions for medical rehabilitation is demonstrated in the letters of the Minzdrav of Russia related to formation and economic validation of territorial program of state guarantees. So, significant decrease (by 44%) in recommended volumes in 2021 contradicts data presented in the Decree of the Government the Russian Federation. The violations of nomenclatures of positions of medical workers, double standard of the number of positions for day-and-night work are defects of vast majority of Orders about Procedures of provision of medical care that may testify severe problems in actual health planning. At the same time, such changes in Orders on Procedures of organizing medical rehabilitation as division into adults and children, alterations of set of units, staging in provision of medical care and corresponding staff standards, increasing of standard number of positions should result in improvement of quality of medical rehabilitation, including its implementation at early stages and expanding possibilities of rehabilitation without hospitalization related to organization of day hospital.

The European Standard EN 17398:2020 on Patient Involvement in Health Care - a Fairclough-Inspired Critical Discourse Analysis

The concept of ‘patient involvement’ is highlighted in healthcare. However, hindrances can prevent its implementation. This article explored how ‘patient involvement’ is understood and on what ideas this understanding is based through a critical textual analysis of the European document on patient involvement in health systems using a Fairclough-inspired critical discourse analysis. The findings showed that the document arose from a social discourse based on a mix of a neoliberal ideology, with a marketisation of care focusing on a cost-effective and evidence-based logic of care, and a humanistic ideology of patient involvement. It had the form of a normative, consensus-based standard, supported by European organisations. The document incorporated a visionary, well-intentioned abstract guide to promote patient involvement across European care contexts, however without addressing hindrances nor differences across the contexts in which it ought to be implemented. It raises questions about its usability, inviting further research into empirical applications.