Retrospective evaluation of a local protocol used to enhance laboratory savings through minimizing the performance of alkaline phosphatase isoenzyme analysis

Background: Alkaline phosphatase isoenzyme analysis is an expensive and time-consuming laboratory test. We evaluated the effect of a locally derived screening algorithm for alkaline phosphatase isoenzyme requests on the number of alkaline phosphatase isoenzyme analyses performed, laboratory cost and patient care. Method: A total of 110 alkaline phosphatase isoenzyme analysis requests from the year 2015 were reviewed and subsequent alkaline phosphatase concentrations were monitored over a two-year period, to determine if the decision of performing/not performing alkaline phosphatase isoenzyme analysis, based on the algorithm, had an impact on patient care and laboratory cost. All alkaline phosphatase isoenzyme analysis requests with two consecutive elevated alkaline phosphatase concentrations (>upper limit of reference interval) were screened and, subject to the gamma glutamyl transferase being within the reference interval, either Bone alkaline phosphatase or 25 hydroxyvitamin D was measured depending on the age of the patient. Results: Compliance with this algorithm led to the normalization of subsequent serum alkaline phosphatase in 97% of patients without requiring alkaline phosphatase isoenzyme analysis. The cost of performing Bone alkaline phosphatase and 25 hydroxyvitamin D in-house was £778.50, while the cost of performing alkaline phosphatase isoenzyme analysis would have been £3040. This resulted in a laboratory saving of £2261.50. Conclusions: Implementation of this algorithm led to a significant reduction in alkaline phosphatase isoenzyme analysis, without compromising patient care. Total savings could be increased if 25 hydroxyvitamin D was used as a first-line test, for all patients with an elevated alkaline phosphatase and a normal gamma glutamyl transferase regardless of age. This algorithm is cost-effective and can be implemented in laboratories with 25 hydroxyvitamin D assay

Market Segmentation, Customers, and Value Propositions Analysis for Polymer Clay Art Business Start-Up

Polymer clay art is one of the creative businesses that are recently starting to get a lot of attentions. To prepare a startup business in this field, analysis from a lot of aspects is needed. The purpose of this article was to explain the approach of the polymer clay art business startup from the market segmentation, customer, and value proposition side of the business. The method was applied by analyzing those steps in details. The analysis started from brainstorming to choose the market matching to business, the customer side, value proposition, and between both aspects. The result of the analysis shows the business focus of the polymer clay art business, where the value propositions are focusing on unique decorations, and several types of customer segments

Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? : A qualitative study

Funding The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external fundingPeer reviewedPostprin

Encephalomyocarditis virus may use different pathways to initiateinfection of primary human cardiomyocytes

Encephalomyocarditis virus (EMCV) caninfect a wide range of vertebrate species including swineand non-human primates, but few data are available forhumans. We therefore wanted to gain further insight intothe mechanisms involved in EMCV infection of humancells. For this purpose, we analyzed the permissiveness ofprimary human cardiomyocytes towards two strains ofEMCV; a pig myocardial strain (B279/95) and a rat strain(1086C). In this study, we show that both strains productivelyinfect primary human cardiomyocytes and inducecomplete cytolysis. Binding and infection inhibitionexperiments indicated that attachment and infection areindependent of sialic acid and heparan sulfate for B279/95and dependent for 1086C. Sequence comparison betweenthe two strains and three-dimensional analysis of the capsidrevealed that six of the seven variable residues are surfaceexposed,suggesting a role for these amino acids in binding.Moreover, analysis of variants isolated from the 1086Cstrain revealed the importance of lysine 231 of VP1 in theattachment of EMCV to cell-surface sialic acid residues.Together, these results show a potential for EMCV strainsto use at least two different binding possibilities to initiateinfection and provide new insights into the mechanismsinvolved in primary human cell recognition by EMCV

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

L'instruction au sosie pour la transformation du travail : la conduite du conseil de classe par des chefs d'établissement

International audience“Instruction by the use of stand-ins” is a technique used to explore experience in the workplace. Taking the form of a dialogue between an instructor and a stand-in it does not rely on any documented record or trace of the activity discussed. The technique is tested here with a group: the principal of a secondary school gives instructions to his “stand-in” (the author of this paper) in front of an audience of 15 of his public service executive counterparts.The subject of the exercise is how to conduct a “conseil de classe” which in French schools is a meeting where teachers and class representatives discuss the results and marks of each pupil. The merits and limits of the technique are discussed from three different perspectives: the knowledge produced regarding the occupational activities of a school principal (a professional dilemma is revealed), the level of accessibility to his own respective workplace practices the method offers to each of the participants and how, as a result of the exercise, each of the school principals plans to self-regulate the way he works in the future.L’instruction au sosie est une méthode permettant d’approcher l’expérience vécue dans le travail. Sous forme de dialogue entre un instructeur et un sosie, elle ne nécessite pas de recours aux traces de l’activité. Elle est ici expérimentée dans un usage collectif : un chef d’établissement d’enseignement secondaire donne des instructions à son « sosie » (l’auteur de cette communication), écouté par 15 de ses homologues cadres de la fonction publique. Elle porte sur la conduite de réunion de type « conseil de classe ». L’intérêt et les limites de la méthode sont discutés sous trois angles : celui de la production de connaissances sur le travail des cadres (un dilemme professionnel est mis en évidence), celui de l’accessibilité à des éléments de l’activité et celui des régulations de l’activité envisagées par chacun des chefs d’établissement