A novel approach to increasing inventory with the current panel: Increasing donation frequency by asking for a different blood product

BACKGROUND Ongoing shortages of blood products may be addressed through additional donations. However, donation frequency rates are typically lower than medically possible. This preliminary study aims to determine voluntary nonremunerated whole blood (WB) and plasmapheresis donors' willingness, and subsequent facilitators and barriers, to make additional donations of a different type. STUDY DESIGN AND METHODS Forty individual telephone interviews were conducted posing two additional donation pattern scenarios: first, making a single and, second, making multiple plasmapheresis donations between WB donations. Stratified purposive sampling was conducted for four samples varying in donation experience: no-plasma, new-to-both-WB-and-plasma, new-to-plasma, and plasma donors. Interviews were analyzed yielding excellent (κ values > 0.81) inter-rater reliability. RESULTS Facilitators were more endorsed than barriers for a single but not multiple plasmapheresis donation. More new-to-both donors (n = 5) were willing to make multiple plasma donations between WB donations than others (n = 1 each) and identified fewer barriers (n = 3) than those more experienced in donation (n = 8 no plasma, n = 10 new to both, n = 11 plasma). Donors in the plasma sample were concerned about the subsequent reduced time between plasma donations by adding WB donations (n = 3). The no-plasma and new-to-plasma donors were concerned about the time commitment required (n = 3). CONCLUSION Current donors are willing to add different product donations but donation history influences their willingness to change. Early introduction of multiple donation types, variation in inventory levels, and addressing barriers will provide blood collection agencies with a novel and cost-effective inventory management strategy.

Using an extended theory of planned behavior to predict a change in the type of blood product donated

Background Demand for essential plasma-derived products is increasing. Purpose This prospective study aims to identify predictors of voluntary non-remunerated whole blood (WB) donors becoming plasmapheresis donors. Methods Surveys were sent to WB donors who had recently (recent n = 1,957) and not recently donated (distant n = 1,012). Theory of Planned Behavior (TPB) constructs (attitude, subjective norm, self-efficacy) were extended with moral norm, anticipatory regret, and donor identity. Intentions and objective plasmapheresis donation for 527 recent and 166 distant participants were assessed. Results Multi-group analysis revealed that the model was a good fit. Moral norm and self-efficacy were positively associated while role identity (suppressed by moral norm) was negatively associated with plasmapheresis intentions. Conclusions The extended TPB was useful in identifying factors that facilitate conversion from WB to plasmapheresis donation. A superordinate donor identity may be synonymous with WB donation and, for donors with a strong moral norm for plasmapheresis, may inhibit conversion.

Cambios hematológicos tras un programa de promoción de actividad física en sujetos inactivos. Ensayo aleatorizado controlado

Objetivo Comparar los cambios antropométricos y bioquímicos en personas inactivas, que realizan un programa de actividad física frente a los que no lo realizan desde los Centros de Atención Primaria. Métodos Cien personas inactivas de ambos sexos, mayores de 55 años fueron aleatorizadas a un grupo experimental (n = 50) y a un grupo control (n = 50). Se realizó un programa de promoción de actividad física siguiendo los criterios del Colegio Americano de Medicina del Deporte, de 60 min cada sesión, 2 sesiones por semana, durante 3 meses. Las medidas antropométricas incluyeron el índice de masa corporal y el porcentaje graso, y como variables bioquímicas el perfil lipídico, hematíes y la creatina kinasa. Resultados Completaron el estudio 75 personas. Esta investigación no presentó cambios significativos a nivel antropométrico, ni en las variables bioquímicas del perfil lipídico. Sí se observaron efectos clínicamente relevantes en la concentración de los hematíes de las mujeres que realizaron dicho programa. Conclusiones El efecto clínico global fue pequeño en las personas que realizaron el programa, pero relevante para la salud de la población. Esta intervención produce efectos a corto plazo en la bioquímica de las personas inactivas. Abstract in English Objective Compare anthropometry and biochemical changes in inactive people who participate in a physical activity program versus those who do not from the Primary Health Care Centers. Methods One hundred inactive subjects of both genders, 55 years and older, from Torremolinos, Spain were randomized into an experimental group (n = 50) and a control group (n = 50). A program promoting physical activity was carried out following the American Medical Society for Sport's Medicine criteria. The program included sessions a week for 3 months. Antropometric measurements included body mass index and fat percentage, and such as biochemical measures: the lipid profile, erythrocytes, and creatine kinase. Results Seventy-five persons completed the study. This research did not show significant changes to anthropometric or biochemical outcomes of the lipid profile. However, there were clinically relevant effects regarding red blood cells concentration in the women who participated in this program. Conclusions Overall clinical effect was small in those participating in the program, but relevant for the health of the population. This program has short-term effects on biochemistry results of inactive subjects.

Correlation between architectural variables and torque in the erector spinae muscle during maximal isometric contraction

This study analysed whether a significant relationship exists between the torque and muscle thickness and pennation angle of the erector spinae muscle during a maximal isometric lumbar extension with the lumbar spine in neutral position. This was a cross-sectional study in which 46 healthy adults performed three repetitions for 5 s of maximal isometric lumbar extension with rests of 90 s. During the lumbar extensions, bilateral ultrasound images of the erector spinae muscle (to measure pennation angle and muscle thickness) and torque were acquired. Reliability test analysis calculating the internal consistency (Cronbach's alpha) of the measure, correlation between pennation angle, muscle thickness and torque extensions were examined. Through a linear regression the contribution of each independent variable (muscle thickness and pennation angle) to the variation of the dependent variable (torque) was calculated. The results of the reliability test were: 0.976–0.979 (pennation angle), 0.980–0.980 (muscle thickness) and 0.994 (torque). The results show that pennation angle and muscle thickness were significantly related to each other with a range between 0.295 and 0.762. In addition, multiple regression analysis showed that the two variables considered in this study explained 68% of the variance in the torque. Pennation angle and muscle thickness have a moderate impact on the variance exerted on the torque during a maximal isometric lumbar extension with the lumbar spine in neutral position.

The modified card sorting test: Test-retest stability and relationships with demographic variables in a healthy older adult sample

Objectives. To investigate the test-retest stability of a standardized version of Nelson's (1976) Modified Card Sorting Test (MCST) and its relationships with demographic variables in a sample of healthy older adults. Design. A standard card order and administration were devised for the MCST and administered to participants at an initial assessment, and again at a second session conducted a minimum of six months later in order to examine its test-retest stability. Participants were also administered the WAIS-R at initial assessment in order to provide a measure of psychometric intelligence. Methods. Thirty-six (24 female, 12 male) healthy older adults aged 52 to 77 years with mean education 12.42 years (SD = 3.53) completed the MCST on two occasions approximately 7.5 months (SD = 1.61) apart. Stability coefficients and test-retest differences were calculated for the range of scores. The effect of gender on MCST performance was examined. Correlations between MCST scores and age, education and WAIS-R IQs were also determined. Results. Stability coefficients ranged from .26 for the percent perseverative errors measure to .49 for the failure to maintain set measure. Several measures were significantly correlated with age, education and WAIS-R IQs, although no effect of gender on MCST performance was found. Conclusions. None of the stability coefficients reached the level required for clinical decision making. The results indicate that participants' age, education, and intelligence need to be considered when interpreting MCST performance. Normative studies of MCST performance as well as further studies with patients with executive dysfunction are needed.

Assessment of dynamic susceptibility contrast cerebral blood flow response to amphetamine challenge: A human pharmacological magnetic resonance imaging study at 1.5 and 4 T

Pharmacological MRI (phMRI) techniques can be used to monitor the neurophysiological effects of central nervous system (CNS) active drugs. In this study, we investigated whether dynamic susceptibility contrast (DSC) perfusion imaging employing the use of superparamagnetic iron oxide nanoparticles (Resovist) could be used to measure hemodynamic response to d-amphetamine challenge in human subjects at both 1.5 and 4 T. Significant changes in cerebral blood flow (CBF) were found in focal regions associated with the nigrostriatal circuit and mesolimbic and mesocortical dopaminergic pathways. More significant CBF responses were found at higher field strength, mainly within striatal structures. The results from this study indicate that DSC perfusion imaging using Resovist can be used to assess the efficacy of CNS-active drugs and may play a role in the development of novel psychiatric therapies at the preclinical level. © 2005 Wiley-Liss, Inc.

‘True Blood’ the critical care story: An audit of blood sampling practice across three adult, paediatric and neonatal intensive care settings

Background Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. Objectives Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. Methods Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood samples obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. Results A total of 940 blood sampling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood sampling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal samples taken (p <. 0.001). Adult patients had significantly more median [IQR] samples per day in comparison to paediatrics and neonates (adults 5.0 [2.4]; paediatrics 2.3 [2.9]; neonatal 0.7 [2.7]), which significantly increased median [IQR] blood sampling costs per day (adults AUD$101.11 [54.71]; paediatrics AUD$41.55 [56.74]; neonatal AUD$8.13 [14.95]; p <. 0.001). The total volume of samples per day (median [IQR]) was also highest in adults (adults 22.3. mL [16.8]; paediatrics 5.0. mL [1.0]; neonates 0.16. mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. Conclusions There was significant variation in blood sampling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.

The role of context and motivation variables in mobile commerce usage: A further perspective on Chong (2013)

We comment on a recent article by Chong (2013) on the roles of demographic and motivation variables in mobile commerce usage. Drawing on the recent research on the service-dominant logic, socioemotional selectivity theory, and data from a first empirical study, we argue that a broader discussion on the value relevance of mobile commerce activities for customers and the consideration of consumers' future time perspectives would provide a richer, potentially more appropriate picture of the drivers of mobile commerce usage. Furthermore, using data from a second empirical study, we highlight several validity issues of the used scales. We hope to motivate a replication and extension of Chong's study and also provide recommendations for future research on this area.

Pedestrian Crashes in Ethiopia: Identification of contributing factors through modelling of exposure and road environment variables

Pedestrian safety is a critical issue in Ethiopia. Reports show that 50 to 60% of traffic fatality victims in the country are pedestrians. The primary aim of this research was to examine the possible causes of and contributing factors to crashes with pedestrians in Ethiopia, and improve pedestrian safety by recommending possible countermeasures. The secondary aim was to develop appropriate pedestrian crash models for two-way two-lane rural roads and roundabouts in the capital city of Ethiopia. This research uses quantitative methods throughout the process of the investigation. The research has applied various statistical methods. The results of this research support the idea that geometric and operational features have significant influence on pedestrian safety and crashes. Accordingly, policies and strategies are needed to safeguard pedestrians in Ethiopia.

Health and guardianship law: Children, consent and the refusal of blood products: A recent Queensland case

This column provides a summary of the recent decision of The Hospital v T [2015] QSC 185

Serum levels of soluble receptor for advanced glycation end products and of S100 proteins are associated with inflammatory, autoantibody, and classical risk markers of joint and vascular damage in rheumatoid arthritis

Introduction: The receptor for advanced glycation end products (RAGE) is a member of the immunoglobulin superfamily of cell surface receptor molecules. High concentrations of three of its putative proinflammatory ligands, S100A8/A9 complex (calprotectin), S100A8, and S100A12, are found in rheumatoid arthritis (RA) serum and synovial fluid. In contrast, soluble RAGE (sRAGE) may prevent proinflammatory effects by acting as a decoy. This study evaluated the serum levels of S100A9, S100A8, S100A12 and sRAGE in RA patients, to determine their relationship to inflammation and joint and vascular damage. Methods: Serum sRAGE, S100A9, S100A8 and S100A12 levels from 138 patients with established RA and 44 healthy controls were measured by ELISA and compared by unpaired t test. In RA patients, associations with disease activity and severity variables were analyzed by simple and multiple linear regressions. Results: Serum S100A9, S100A8 and S100A12 levels were correlated in RA patients. S100A9 levels were associated with body mass index (BMI), and with serum levels of S100A8 and S100A12. S100A8 levels were associated with serum levels of S100A9, presence of anti-citrullinated peptide antibodies (ACPA), and rheumatoid factor (RF). S100A12 levels were associated with presence of ACPA, history of diabetes, and serum S100A9 levels. sRAGE levels were negatively associated with serum levels of C-reactive protein (CRP) and high-density lipoprotein (HDL), history of vasculitis, and the presence of the RAGE 82Ser polymorphism. Conclusions: sRAGE and S100 proteins were associated not just with RA inflammation and autoantibody production, but also with classical vascular risk factors for end-organ damage. Consistent with its role as a RAGE decoy molecule, sRAGE had the opposite effects to S100 proteins in that S100 proteins were associated with autoantibodies and vascular risk, whereas sRAGE was associated with protection against joint and vascular damage. These data suggest that RAGE activity influences co-development of joint and vascular disease in rheumatoid arthritis patients.

Whole blood transcriptional profiling in ankylosing spondylitis identifies novel candidate genes that might contribute to the inflammatory and tissue-destructive disease aspects

Introduction: A number of genetic-association studies have identified genes contributing to ankylosing spondylitis (AS) susceptibility but such approaches provide little information as to the gene activity changes occurring during the disease process. Transcriptional profiling generates a 'snapshot' of the sampled cells' activity and thus can provide insights into the molecular processes driving the disease process. We undertook a whole-genome microarray approach to identify candidate genes associated with AS and validated these gene-expression changes in a larger sample cohort. Methods: A total of 18 active AS patients, classified according to the New York criteria, and 18 gender- and age-matched controls were profiled using Illumina HT-12 whole-genome expression BeadChips which carry cDNAs for 48,000 genes and transcripts. Class comparison analysis identified a number of differentially expressed candidate genes. These candidate genes were then validated in a larger cohort using qPCR-based TaqMan low density arrays (TLDAs). Results: A total of 239 probes corresponding to 221 genes were identified as being significantly different between patients and controls with a P-value <0.0005 (80% confidence level of false discovery rate). Forty-seven genes were then selected for validation studies, using the TLDAs. Thirteen of these genes were validated in the second patient cohort with 12 downregulated 1.3- to 2-fold and only 1 upregulated (1.6-fold). Among a number of identified genes with well-documented inflammatory roles we also validated genes that might be of great interest to the understanding of AS progression such as SPOCK2 (osteonectin) and EP300, which modulate cartilage and bone metabolism. Conclusions: We have validated a gene expression signature for AS from whole blood and identified strong candidate genes that may play roles in both the inflammatory and joint destruction aspects of the disease.

A comprehensive ovine model of blood transfusion

Background The growing awareness of transfusion-associated morbidity and mortality necessitates investigations into the underlying mechanisms. Small animals have been the dominant transfusion model but have associated limitations. This study aimed to develop a comprehensive large animal (ovine) model of transfusion encompassing: blood collection, processing and storage, compatibility testing right through to post-transfusion outcomes. Materials and methods Two units of blood were collected from each of 12 adult male Merino sheep and processed into 24 ovine-packed red blood cell (PRBC) units. Baseline haematological parameters of ovine blood and PRBC cells were analysed. Biochemical changes in ovine PRBCs were characterized during the 42-day storage period. Immunological compatibility of the blood was confirmed with sera from potential recipient sheep, using a saline and albumin agglutination cross-match. Following confirmation of compatibility, each recipient sheep (n = 12) was transfused with two units of ovine PRBC. Results Procedures for collecting, processing, cross-matching and transfusing ovine blood were established. Although ovine red blood cells are smaller and higher in number, their mean cell haemoglobin concentration is similar to human red blood cells. Ovine PRBC showed improved storage properties in saline–adenine–glucose–mannitol (SAG-M) compared with previous human PRBC studies. Seventy-six compatibility tests were performed and 17·1% were incompatible. Only cross-match compatible ovine PRBC were transfused and no adverse reactions were observed. Conclusion These findings demonstrate the utility of the ovine model for future blood transfusion studies and highlight the importance of compatibility testing in animal models involving homologous transfusions.

Flow evaluation and hemolysis analysis of BVAD centrifugal blood pump by computational fluids dynamics

Computational fluid dynamics (CFD) and particle image velocimetry (PIV) are commonly used techniques to evaluate the flow characteristics in the development stage of blood pumps. CFD technique allows rapid change to pump parameters to optimize the pump performance without having to construct a costly prototype model. These techniques are used in the construction of a bi-ventricular assist device (BVAD) which combines the functions of LVAD and RVAD in a compact unit. The BVAD construction consists of two separate chambers with similar impellers, volutes, inlet and output sections. To achieve the required flow characteristics of an average flow rate of 5 l/min and different pressure heads (left – 100mmHg and right – 20mmHg), the impellers were set at different rotating speeds. From the CFD results, a six-blade impeller design was adopted for the development of the BVAD. It was also observed that the fluid can flow smoothly through the pump with minimum shear stress and area of stagnation which are related to haemolysis and thrombosis. Based on the compatible Reynolds number the flow through the model was calculated for the left and the right pumps. As it was not possible to have both the left and right chambers in the experimental model, the left and right pumps were tested separately.

Effect of age, gender and mannose-binding lectin (MBL) status on the inflammatory profile in peripheral blood plasma of Australian blood donors

Transfusion of blood components has been associated with poor patient outcomes and, an overall increase in morbidity and mortality. Differences in the blood components arising from donor health, age and immune status may impact on outcomes of transfusion and transfusion-related immune modulation in recipients. The aim of this study was to investigate differences in inflammatory profile in donors and association with parameters including age, gender and deficiency status of pattern recognition molecule mannose-binding lectin (MBL). MBL level was determined by ELISA. Serum levels of interleukin (IL)-1α, IL-1β, IL-6, IL-8, IL-10, IL-12, tumour necrosis factor (TNF)-α, macrophage inflammatory protein (MIP)-1α, monocyte chemoattractant protein (MCP)-1, interferon (IFN)-α, and IFN-γ were examined by cytometric bead array (CBA). C-reactive protein (CRP) and rheumatoid factor (RF) were examined by immunoturbidimetry. This study demonstrated age was a parameter associated with the immune profile of blood donors, with significant increases in MCP-1 (p < 0.05) and RF (p < 0.05) and decreases in IL-1α evident in the older donors (61–76 years). Significant gender-associated differences in MCP-1, IL-12 and CRP plasma levels in the blood donor cohort were also reported. There was no significant difference in the level of any inflammatory markers studied according to MBL status. This study demonstrated that age and gender are associated with inflammatory profile in donors. These differences may be a factor impacting on outcomes of transfusion.