Blood Sample Rejection Rates in the Emergency Department

Background: The national average for laboratory rejection of blood samples ranges from 0.3% to 0.8%. The rate of rejection at a local emergency department averaged 2.8% in 2014. Purpose: Discover prevalent causes of laboratory blood sample rejection in the emergency department and determine best practice for maintaining acceptable rejection rates. Methods: Analyze data from the hospital laboratory to identify reasons for blood sample rejection and which personnel procured the rejected samples. Review literature to find common sources of error and explore evidence based practices in drawing blood for laboratory testing. Results: Data showed that hemolysis and clotting were the main reasons for blood sample rejection. Registered nurses were responsible for the largest number of rejections. Literature states best practice is to avoid using intravenous catheter starts for drawing blood samples and to use phlebotomists for lab draws rather than registered nurses. Discussion/Recommendations: Registered nurses may have higher rejection rates because of their tendency to draw blood from intravenous catheter starts. Therefore, the first recommendation is to revise policy and educate personnel to avoid this method of obtaining blood samples. The second recommendation is to use a dedicated phlebotomist or technician for blood draws instead of registered nurses. Considering the effect of laboratory rejections on efficient care delivery, healthcare costs, and patient satisfaction, reducing the blood sample rejection rate in the emergency department should be prioritized

Modeling interstellar amorphous solid water grains by tight-binding based methods: comparison between GFN-XTB and CCSD(T) results for water clusters

One believed path to Interstellar Complexes Organic Molecules (iCOMs) formation inside the Interstellar Medium (ISM) is through chemical recombination at the surface of amorphous solid water (ASW) mantle covering the silicate-based core of the interstellar grains. The study of these iCOMs formation and their binding energy to the ASW, using computational chemistry, depends strongly on the ASW models used, as different models may exhibit sites with different adsorbing features. ASW extended models are rare in the literature because large sizes require very large computational resources when quantum mechanical methods based on DFT are used. To circumvent this problem, we propose to use the newly developed GFN-xTB Semi-empirical Quantum Mechanical (SQM) methods from the Grimme's group. These methods are, at least, two orders of magnitude faster than conventional DFT, only require modest central memory, and in this paper we aim to benchmark their accuracy against rigorous and resource hungry quantum mechanical methods. We focused on 38 water structures studied by MP2 and CCSD(T) approaches comparing energetic and structures with three levels of GFN-xTB parametrization (GFN0, GFN1, GFN2) methods. The extremely good results obtained at the very cheap GFN-xTB level for both water cluster structures and energetic paved the way towards the modeling of very large AWS models of astrochemical interest.Comment: 9 pages, 4 figures, Submitted to LNCS (Springer) ICCSA202

The Role of Non-Covalent Interactions on Cluster Formation: Pentamer, Hexamers and Heptamer of Difluoromethane

The role of non-covalent interactions (NCIs) has broadened with the inclusion of new types of interactions and a plethora of weak donor/acceptor partners. This work illustrates the potential of chirped-pulse Fourier transform microwave technique, which has revolutionized the field of rotational spectroscopy. In particular, it has been exploited to reveal the role of NCIs’ in the molecular self-aggregation of difluoromethane where a pentamer, two hexamers and a heptamer were detected. The development of a new automated assignment program and a sophisticated computational screening protocol was essential for identifying the homoclusters in conditions of spectral congestion. The major role of dispersion forces leads to less directional interactions and more distorted structures than those found in polar clusters, although a detailed analysis demonstrates that the dominant interaction energy is the pairwise interaction. The tetramer cluster is identified as a structural unit in larger clusters, representing the maximum expression of bond between dimers

Infant High-Grade Gliomas Comprise Multiple Subgroups Characterized by Novel Targetable Gene Fusions and Favorable Outcomes.

Infant high-grade gliomas appear clinically distinct from their counterparts in older children, indicating that histopathologic grading may not accurately reflect the biology of these tumors. We have collected 241 cases under 4 years of age, and carried out histologic review, methylation profiling, and custom panel, genome, or exome sequencing. After excluding tumors representing other established entities or subgroups, we identified 130 cases to be part of an "intrinsic" spectrum of disease specific to the infant population. These included those with targetable MAPK alterations, and a large proportion of remaining cases harboring gene fusions targeting ALK (n = 31), NTRK1/2/3 (n = 21), ROS1 (n = 9), and MET (n = 4) as their driving alterations, with evidence of efficacy of targeted agents in the clinic. These data strongly support the concept that infant gliomas require a change in diagnostic practice and management. SIGNIFICANCE: Infant high-grade gliomas in the cerebral hemispheres comprise novel subgroups, with a prevalence of ALK, NTRK1/2/3, ROS1, or MET gene fusions. Kinase fusion-positive tumors have better outcome and respond to targeted therapy clinically. Other subgroups have poor outcome, with fusion-negative cases possibly representing an epigenetically driven pluripotent stem cell phenotype.See related commentary by Szulzewsky and Cimino, p. 904.This article is highlighted in the In This Issue feature, p. 890

Repurposing Vandetanib plus Everolimus for the Treatment of ACVR1-Mutant Diffuse Intrinsic Pontine Glioma.

Somatic mutations in ACVR1 are found in a quarter of children with diffuse intrinsic pontine glioma (DIPG), but there are no ACVR1 inhibitors licensed for the disease. Using an artificial intelligence-based platform to search for approved compounds for ACVR1-mutant DIPG, the combination of vandetanib and everolimus was identified as a possible therapeutic approach. Vandetanib, an inhibitor of VEGFR/RET/EGFR, was found to target ACVR1 (K d = 150 nmol/L) and reduce DIPG cell viability in vitro but has limited ability to cross the blood-brain barrier. In addition to mTOR, everolimus inhibited ABCG2 (BCRP) and ABCB1 (P-gp) transporters and was synergistic in DIPG cells when combined with vandetanib in vitro. This combination was well tolerated in vivo and significantly extended survival and reduced tumor burden in an orthotopic ACVR1-mutant patient-derived DIPG xenograft model. Four patients with ACVR1-mutant DIPG were treated with vandetanib plus an mTOR inhibitor, informing the dosing and toxicity profile of this combination for future clinical studies. SIGNIFICANCE: Twenty-five percent of patients with the incurable brainstem tumor DIPG harbor somatic activating mutations in ACVR1, but there are no approved drugs targeting the receptor. Using artificial intelligence, we identify and validate, both experimentally and clinically, the novel combination of vandetanib and everolimus in these children based on both signaling and pharmacokinetic synergies.This article is highlighted in the In This Issue feature, p. 275

Corannulene and its complex with water: A tiny cup of water

Contains fulltext : 174624.pdf (publisher's version ) (Open Access) Contains fulltext : 174624_suppl.pdf (publisher's version ) (Open Access

Structure and thermodynamics of H3O+(H2O)8 clusters: A combined molecular dynamics and quantum mechanics approach

We have studied the structure and stability of H3O+(H2O)8 clusters using a combination of molecular dynamics sampling and high-level ab initio calculations. 20 distinct oxygen frameworks are found within 2 kcal/mol of the electronic or standard Gibbs free energy minimum. The impact of quantum zero-point vibrational corrections on the relative stability of these isomers is quite significant. The box-like isomers are favored in terms of electronic energy, but with the inclusion of zero-point vibrational corrections and entropic effects tree-like isomers are favored at higher temperatures. Under conditions from 0 to 298.15 K, the global minimum is predicted to be a tree-like structure with one dangling singly coordinated water molecule. Above 298.15 K, higher entropy tree-like isomers with two or more singly coordinated water molecules are favored. These assignments are generally consistent with experimental IR spectra of (H3O+)(H2O)8 obtained at 150 K

Exploring the Rich Potential Energy Surface of (H2O)11 and Its Physical Implications

The rich potential energy surface of the water undecamer (H2O)11 was explored with a basin hopping algorithm using a TIP4P potential and other methods followed by extensive ab initio MP2 minimizations and CCSD(T) corrections. This protocol yielded 17, 66, and 125 distinct isomers within 0.5, 1.0, and 2.0 kcal mol–1 of the complete basis set CCSD(T) global minimum, respectively. These isomers were categorized into 15 different families based on their oxygen framework and hydrogen bonding topology. Determination of the global minimum proved challenging because of the presence of many nearly isoenergetic isomers. The predicted global minimum varied among ab initio methods, density functionals, and model potentials, and it was sensitive to the choice of energy extrapolation schemes, higher-order CCSD(T) corrections, and inclusion of zero-point vibrational energy. The presence of a large number of nearly degenerate structures and the isomerization between them has manifested itself in the anomalous broadening of the heat capacity curve of the undecamer in simulations around the melting region

Le Courrier

15 juin 18481848/06/15 (N166)