Skin color influences transcutaneous bilirubin measurements:a systematic in vitro evaluation

Objective: Concerns have been raised about the effect of skin color on the accuracy of transcutaneous bilirubin (TcB) measurements, a widely used method for hyperbilirubinemia diagnosis in newborns. Literature is inconclusive, with both reported under- and overestimations of the TcB with increasing skin pigmentation. Therefore, the influence of skin color on TcB measurements was systematically evaluated in a controlled, in vitro setting. Methods: A bilirubin meter (JM-105) was evaluated on layered phantoms that mimic neonatal skin with varying dermal bilirubin concentrations (0–250 µmol/L) and varying epidermal melanosome volume fractions (0–40%; light-dark skin color). Results: TcB measurements were influenced by skin pigmentation. Larger mimicked melanosome volume fractions and higher bilirubin levels led to larger underestimations of the measured TcB, compared to an unpigmented epidermis. In the in vitro setting of this study, these underestimations amounted to 26–132 µmol/L at a TcB level of 250 µmol/L. Conclusion: This in vitro study provides insight into the effect of skin color on TcB measurements: the TcB is underestimated as skin pigmentation increases and this effect becomes more pronounced at higher bilirubin levels. Our results highlight the need for improved TcB meter design and cautious interpretation of TcB readings on newborns with dark skin. Impact: Key message: Skin color influences transcutaneous bilirubin measurements: the darker the skin, the larger the underestimation. What this study adds to existing literature: Existing literature is inconclusive regarding the influence of skin color on transcutaneous bilirubin measurements. This study systematically evaluates and clarifies the influence of skin color on transcutaneous bilirubin measurements in a controlled, in vitro setting. Impact: This study aids to better interpret the measured TcB level in patients with varying skin colors, and is particularly important when using TcB meters on patients with dark skin colors.</p

A Middle-Aged Man With Jaundice and a Gastric Tumor Acute Myeloid Leukemia With a Gastric Myeloid Sarcoma

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Developing Cultural Self-Awareness: The First Step in Values Clarification for Early Interventionists

This article presents a discussion of the need for early interventionists to develop awareness of certain cultural assumptions underlying their practice. A wide range of literature on cultural differences is used to identify five areas of potential dissonance between professionals and families from culturally diverse backgrounds: interpretations of the meaning of disability; concepts of family structure and identity; goals of education; parent-child interaction, and communication style. It is argued that awareness of one's own cultural beliefs in these areas is an essential first step in developing effective collaboration with culturally different families

LOFT: the Large Observatory For X-ray Timing

The LOFT mission concept is one of four candidates selected by ESA for the M3 launch opportunity as Medium Size missions of the Cosmic Vision programme. The launch window is currently planned for between 2022 and 2024. LOFT is designed to exploit the diagnostics of rapid X-ray flux and spectral variability that directly probe the motion of matter down to distances very close to black holes and neutron stars, as well as the physical state of ultradense matter. These primary science goals will be addressed by a payload composed of a Large Area Detector (LAD) and a Wide Field Monitor (WFM). The LAD is a collimated (<1 degree field of view) experiment operating in the energy range 2-50 keV, with a 10 m[superscript 2] peak effective area and an energy resolution of 260 eV at 6 keV. The WFM will operate in the same energy range as the LAD, enabling simultaneous monitoring of a few-steradian wide field of view, with an angular resolution of <5 arcmin. The LAD and WFM experiments will allow us to investigate variability from submillisecond QPO’s to yearlong transient outbursts. In this paper we report the current status of the project