Comparison of Polybrene DAT and Conventional DAT in Cases of Suspected DAT Negative Autoimmune Hemolytic Anemia (AIHA)

Introduction/Objective A negative Direct Antiglobulin Test (DAT) is seen in approximately 1-5% of patients presenting with signs and symptoms of immune hemolysis. A well-performed ‘standard’ DAT detects ~100-500 molecules of bound IgG per red cell. A more sensitive polybrene DAT may be helpful in order to confirm a diagnosis of AIHA in patients whose samples have tested negative via standard DAT. However, there has been little reported on utility of the polybrene DAT in evaluating such cases with modern DAT reagents. We hypothesized that the polybrene DAT would not contribute substantially to the analysis of Coombs-negative hemolytic anemia (C-NHA), based primarily on our anecdotal observation. As such, we undertook a study to assess results of polybrene DAT in cases evaluated for possible (C-NHA). Methods/Case Report Two study sites were used for data analysis (Yale-New Haven Hospital, Site A, and VA Connecticut, Site B) over a five year period (2016-2021). During this time, standard DATs were performed at both study sites by the tube method using polyspecific antiglobulin and, if positive, reflex to anti-IgG and -C3. For cases of suspected C-NHA (which are reported to Blood Bank via a consult mechanism), conventioned DAT- samples are referred to our regional immunohematology laboratory (American Red Cross, Farmington, CT) for manual hexadimethrine bromide (Polybrene) DAT. Polybrene DAT is reported as negative with two sources of polyspecific AHG. Subsets of patients also underwent acid elution studies (Gamma ELU-KITII) as part of a C-NHA algorithm developed during the study period. Results of standard DAT, acId elution, and polybrene DAT were extracted from Blood Bank electronic records at both study sites. Results (if a Case Study enter NA) Evaluation for C-NHA was performed in 32 patients/cases over the study period. Amongst these individuals, 96.8% (31/32) underwent polybrene DAT assessment and none (0%; 0/31) demonstrated a positive polybrene DAT result. Notably, acid elution studies were performed in 90.6% (29/32) of traditional DAT negative cases. Of these, 10.3% (3/29) had reactive eluates. Conclusion Performance of the polybrene DAT appeared to be of no value in the assessment of suspected C-NHA. Given that nearly 10% of individuals with a negative conventional DAT had a positive acid elution, this testing step appears to be of greater value in potentially identifying an autoantibody in suspected cases of C-NHA.

The Spoofing Detection of Dynamic Underwater Positioning Systems (DUPS) Based on Vehicles Retrofitted with Acoustic Speakers

The need of precision for underwater positioning and navigation should be considered as strict as those present at the sea surface. GNSS provides 4D positioning (XYZT). Each satellite contains two rubidium and two cesium atomic clocks. They are monitored by an atomic clock on the ground, and the entire system is constantly calibrated to a universal time standard, Coordinated Universal Time (UTC). GNSS receivers determine the time T to within 100 billionths of a second without the cost of owning, operating and maintaining an atomic clock. Of particular importance is the measurement of XYZT underwater. We assume that some surface vehicles are additionally equipped with an Acoustic Speaker, which transmits the XY coordinates of the vessel with an indication of accuracy and the time T of the vessel. Submarine vehicles determine their position by help of acoustic signals from several surface acoustic sources using the Time of Arrival (ToA) algorithm. Detection of Spoofing for the Dynamic Underwater Positioning Systems (DUPS) based on vehicles retrofitted with acoustic speakers is very actual problem. Underwater spoofing works as follows: N acoustic speaker on N ships transmit the coordinates . GNSS signals are susceptible to interference due to their very low power (−130 dBm) and can be easily jammed by other sources, which may be accidental or intentional. The spoofer, like an underwater vehicle, receives these signals from N vessels, distorts them and transmits with increased acoustic power. All receivers into the spoofed area will calculate the same coordinates, so the indication of the coincidence of coordinates from a pair of diversity receivers is an indication of spoofing detection.

Towards a more objective time standard in competitive rowing

Rowing needs a standardized Gold Medal Standard (GMS) to clearly compare performance across boat classes in competition. Here, we report a method to factor out environmental effects, developing a fairer GMS for individual rowing events. We used results from World Rowing Championships and Olympics Games (2005–2016) to calculate the difference between the fastest winning time of the day and other event winning times on the same day. From this, we calculated a prognostic GMS time for each event via repeated k-fold cross-validation linear regression. Then, we compared these values with the 10-year average winning time and the World Best Time (WBT). We repeated this process to develop prognostic podium standard (PS) times. The prognostic GMS times (RMSE = 9.47; R 2 = 0.875) were universally slower than the WBT (current GMS) by 6.2 s on average but faster than the 10-year average by 12.3 s. The prognostic PS times (RMSE = 10.5; R 2 = 897) were also slower than the WBT but faster than the 10-year average, by 12.2 and 6.3 s respectively. Our time-difference prediction model based on historical data generates non-outlier prognostic times. With the utilization of relative time difference, this approach promises a selection standard independent of environmental conditions, easily applicable across different sports.

Identifying Factors Influencing Attention in Adolescents with a Co-Created Questionnaire: A Citizen Science Approach with Secondary Students in Barcelona, Spain

Studies on factors that can influence attention in healthy adolescents are recent and focus on recurrent topics. Students’ contribution to public health research often revolves around collecting data but rarely around creating data collection instruments. The ATENC!Ó project reunited secondary students and scientists to create a questionnaire including factors that students thought could affect their attention. We conducted a cross-sectional study to assess whether the factors included in this questionnaire had an effect on attention in adolescents. A total of 1667 students (13–16 years old) from 28 schools in Barcelona performed a validated attention test and answered the questionnaire. The response speed consistency (attentiveness), expressed as hit reaction time standard error (HRT-SE, in ms), was used as the primary outcome. Analyses were conducted using conditional linear regression with school as strata, adjusted for sociodemographic characteristics and further stratified by gender and maternal social class. Some factors showed a negative influence on attention, including taking medication and not reading regularly. We found a significant 14.3% (95% confidence interval: 3.4%, 25.3%) higher median of HRT-SE (increase inattentiveness) among students who reported not having a good relationship with classmates. Students’ input into research is relevant for advancing the knowledge production in public health.

Early intervention in psychosis team (EIT): pathways to care

AimsThe main aim of this study was to investigate whether the EIT access and waiting time standard (>60% of people experiencing first episode psychosis (FEP) are treated with a NICE-approved care package within two weeks of referral) was being met within Liverpool EIT.We also wanted to understand the pathway to treatment within EIT services, identify delays in the process of triage/assessment/MDT/medical review and implement changes to reduce delays.MethodThis study was a retrospective cross-sectional audit of all patients accepted on to the FEP pathway following MDT discussion in the Liverpool EIT Teams across May and June 2020.Case notes were analysed for delays in referral, engagement with assessment and care-coordinators, as well as prescriber review offering medication. The data were collated and analysed before implementing changes.Result40 patients presented as FEP in May and June 2020, 6 were excluded due to an extended inpatient stay.Within the remaining patient cohort (n = 34), 64.7% of patients were engaged with a care package within 14 days. Only 14.7% of patients received an offer of medication within 14 days, the mean time to be offered medication was 39 days.26% of patients first contact within MerseyCare Trust was with EIT, 74% presented elsewhere. 24% instead presented to liaison psychiatry from A&E departments, 18% to the single point of access team, 9% to criminal justice liaison team (CJLT) and 9% to North West Ambulance Service triage car.29% of referrals came from the community (GP and counselling services), 15% from CRHT (crisis resolution and home treatment team), 14% from CJLT, 12% from urgent care team, 9% from liaison psychiatry.ConclusionThe Access and Waiting time standard was met. However, this study showed that patients were not being referred to EIT at first point of contact. This study shows 26% of service users first presented to liaison psychiatry, yet only 1/3 of those were immediately referred to EIT, the remainder being later referred by other services e.g. CRHT.In addition to referral delays, lack of medical practitioner availability caused significant delays in arranging medical reviews, delaying patients access to medication.The changes implemented to address these issues included educating MerseyCare services in the early recognition of psychosis to increase early referral. Non-medical prescribers’ roles were developed to perform initial medical reviews in addition to doctors, allowing patients earlier medication access. This allowed ‘urgent slots’ to be developed, time set aside for emergencies enabling prompt review of urgent cases.

Improvement of the method for standardizing the duration of rail cars shunting

Purpose. To improve the method for calculating the time standard for shunting cars from track to track in order to take into account the local operating conditions of railway stations and railway sidings. Methodology. During the research, the methods of theory of railway operation were used. The problem of calculating the time standard for shunting operation was solved as the problem of searching the optimal division of train set into the car groups to achieve minimal time consumption for shunting operation. Findings. In the course of the study, the methods for calculating the time standards for initial and final operations, as well as movements performed when shunting cars from track to track were improved. It was proved that the minimum time spent on shunting cars from track to track was achieved when the train set was divided into the minimum possible number of parts and the cars were shunted in the longest possible groups and one remaining group. It was also established that with sufficient accuracy for engineering problems the duration of shunting train set from track to track can be represented by the piecewise linear function of the car number in it. Originality. The work originality consists in improving the method for calculating the time standard for shunting cars from track to track, that, unlike the existing one, takes into account the length limitations of the car groups being shunted from track to track, as well as the actual composition of operations performed in the process of shunting. Practical value. The use of the developed method allows setting time standards for shunting cars from track to track, taking into account the local operating conditions of railway stations and sidings of industrial enterprises. The method also makes it possible to simplify solving problems of searching the optimal order of performing more complex shunting operations, such as sorting cars into several tracks, collecting cars on one track, train formation, and others.

Access and Waiting Time Standard for Early Intervention in Psychosis: At Risk Mental State Identification and Interventions Accepted within a Routine Service

Aim: Following the introduction of an access and waiting time standard for Early Intervention in Psychosis (EIP) services, the identification and treatment of people experiencing an At-Risk Mental State (ARMS) for psychosis has become a national priority. However, there is a dearth of literature concerning what is offered to and accepted by ARMS service users within routine services. Methods: This descriptive evaluation reports upon the assessment and treatment of people with an at-risk mental state identified during the first year of a routine service operating in line with the EIP standard. The paper details referral sources, referral to treatment times, socio-demographic characteristics, ARMS subgroups and the interventions accepted by these service users. Results: A total of 138 ARMS cases were identified over the evaluation period, with 73% (n=101) aged between 18-34 years and 86% (n=118) meeting attenuated psychotic symptoms criteria. The majority (64%) of service users engaged in multiple interventions; 54% (n=75) accepted psychoeducation and coping skills enhancement work, 42% (n=58) participated in a sleep programme, 33% (n=45) undertook coping with voices and visions work and 28% (n=39) engaged in individual psychological therapy. Conclusion: The findings indicate that the majority of ARMS service users presenting to the EIP service were aged 18-34 and experienced attenuated psychotic symptoms. A range of NICE and CBT informed interventions as well as individual psychological therapies appear to be acceptable to ARMS service users and many engaged in multiple interventions offered.