E-learning in transfusion medicine: An exploratory qualitative assessment.

BACKGROUND AND OBJECTIVES: E-learning programmes are increasingly offered in transfusion medicine (TM) education. The aim of this study was to explore facilitators and barriers to TM e-learning programmes, including assessment of learning outcomes and measures of effectiveness. MATERIALS AND METHODS: Participants selected from a prior survey and representing a diverse number of international e-learning programmes were invited to participate. A mixed methodology was employed, combining a survey and individual semi-structured one-on-one interviews. Interview data were analysed inductively to explore programme development, evaluation, and facilitators and barriers to implementation. RESULTS: Fourteen participants representing 13 institutions participated in the survey and 10 were interviewed. The e-learning programmes have been in use for a variable duration between 5 and 16 years. Funding sources varied, including government and institutional support. Learner assessment methods varied and encompassed multiple-choice-questions (n = 12), direct observation (n = 4) and competency assessment (n = 4). Most regional and national blood collection agencies rely on user feedback and short-term learning assessments to evaluate their programmes. Only one respondent indicated an attempt to correlate e-learning with clinical practices. Factors that facilitated programme implementation included support from management and external audits to ensure compliance with regulatory educational and training requirements. Barriers to programme implementation included the allocation of staff time for in-house development, enforcing compliance, keeping educational content up-to-date and gaining access to outcome data for educational providers. CONCLUSION: There is evidence of considerable diversity in the evaluation of e-learning programmes. Further work is needed to understand the ultimate impact of TM e-learning on transfusion practices and patient outcomes.

Single-cell analysis of early progenitor cells that build coronary arteries.

Arteries and veins are specified by antagonistic transcriptional programs. However, during development and regeneration, new arteries can arise from pre-existing veins through a poorly understood process of cell fate conversion. Here, using single-cell RNA sequencing and mouse genetics, we show that vein cells of the developing heart undergo an early cell fate switch to create a pre-artery population that subsequently builds coronary arteries. Vein cells underwent a gradual and simultaneous switch from venous to arterial fate before a subset of cells crossed a transcriptional threshold into the pre-artery state. Before the onset of coronary blood flow, pre-artery cells appeared in the immature vessel plexus, expressed mature artery markers, and decreased cell cycling. The vein-specifying transcription factor COUP-TF2 (also known as NR2F2) prevented plexus cells from overcoming the pre-artery threshold by inducing cell cycle genes. Thus, vein-derived coronary arteries are built by pre-artery cells that can differentiate independently of blood flow upon the release of inhibition mediated by COUP-TF2 and cell cycle factors.

A national survey of current immunohematologic testing practices for the diagnosis of autoimmune hemolytic anemia in India.

Autoimmune hemolytic anemia (AIHA) is a common term for several disorders that differ from one another in terms of etiology, pathogenesis, clinical features, and treatment. Management of patients with AIHA has become increasingly evidence-based in recent years. While this development has resulted in therapeutic improvements, it also carries increased requirements for optimal diagnosis using more advanced laboratory tests. Unfortunately, limited data are available from developing countries regarding the testing and transfusion management of patients with AIHA. The main objective of this survey was to explore the current immunohematologic testing practices for the diagnosis of AIHA in India. This online survey consisted of 30 questions, covering the place of work, the number of AIHA cases encountered in the 3 preceding years, testing method(s), transfusion management, and so forth. Individuals representing 89 laboratories completed the survey; only 78 of which responded that AIHA testing was performed in their facility's laboratory. The majority of respondents agreed that the most commonly affected age-group comprised individuals of older than 20 years, with a female preponderance. Regarding transfusion management, respondents indicated that transfusion with "best-match" red blood cell units remains the most common practice. Column-agglutination technology is used by 92 percent of respondents as the primary testing method. Although a monospecific direct antiglobulin test is available at 73 percent of the sites, most of them have limited access to other resources that could diagnose cold or mixed AIHA. Merely 49 percent of responding laboratories have the resources to perform adsorption studies for the detection of alloantibodies. Furthermore, three-cell antibody screening reagents are unavailable at 32 percent of laboratories. In 72 percent of centers, clinical hematologists would prefer to consult a transfusion medicine specialist before administering treatment to AIHA patients. There is unanimous agreement regarding the need for a national registry. The survey data indicate wide variability in testing practices for patients with AIHA in India. Future studies are needed to focus on the feasibility and cost-effectiveness of different testing strategies for developing countries.

Instabilities near Ultrastrong Coupling in a Microwave Optomechanical Cavity.

With artificially engineered systems, it is now possible to realize the coherent interaction rate, which can become comparable to the mode frequencies, a regime known as ultrastrong coupling (USC). We experimentally realize a cavity-electromechanical device using a superconducting waveguide cavity and a mechanical resonator. In the presence of a strong pump, the mechanical-polaritons splitting can nearly reach 81% of the mechanical frequency, overwhelming all the dissipation rates. Approaching the USC limit, the steady-state response becomes unstable. We systematically measure the boundary of the unstable response while varying the pump parameters. The unstable dynamics display rich phases, such as self-induced oscillations, period-doubling bifurcation, and period-tripling oscillations, ultimately leading to the chaotic behavior. The experimental results and their theoretical modeling suggest the importance of residual nonlinear interaction terms in the weak-dissipative regime.

Light-Induced Hypoxia in Carbon Quantum Dots and Ultrahigh Photocatalytic Efficiency.

Carbon quantum dots (CQDs) represent a class of carbon materials exhibiting photoresponse and many potential applications. Here, we present a unique property that dissolved CQDs capture large amounts of molecular oxygen from the air, the quantity of which can be controlled by light irradiation. The O2 content can be varied between a remarkable 1 wt % of the CQDs in the dark to nearly half of it under illumination, in a reversible manner. Moreover, O2 depletion enhances away from the air-solution interface as the nearby CQDs quickly regain them from the air, creating a pronounced concentration gradient in the solution. We elucidate the role of the CQD functional groups and show that excitons generated under light are responsible for their tunable adsorbed-oxygen content. Because of O2 enrichment, the photocatalytic efficiency of the CQDs toward oxidation of benzylamines in the air is the same as under oxygen flow and far higher than the existing photocatalysts. The findings should encourage the development of a new class of oxygen-enricher materials and air as a sustainable oxidant in chemical transformations.

Red blood cell alloimmunization among recipients of blood transfusion in India: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: There is a varied prevalence of red cell alloimmunization being reported from different parts of India. This study aimed to estimate the overall prevalence of alloimmunization in India by performing a systematic review of the literature and to establish the most suitable antigen-matching strategy to reduce the red blood cell (RBC) alloimmunization rate among transfusion recipients. MATERIALS AND METHODS: A systematic search of all the original articles published in English on RBC alloimmunization among transfusion recipients from India in MEDLINE, SCOPUS, CINAHL and Google Scholar bibliographic databases was conducted. After screening the articles as per inclusion/exclusion criteria, data extraction was done independently by two sets of investigators. Meta-analysis was performed by the binary random-effects model using the restricted maximum likelihood method. RESULTS: A total of 44 studies on RBC alloimmunization, with a cumulative sample size of 309,986 patients, were grouped into hospital-based and multiply-transfused patients, which yielded a prevalence of 0.5 (95% confidence interval; 0.3-0.8) and 4.8 (95% confidence interval; 3.9-5.7) per 100 patients, respectively. As many as 1992 alloantibodies were identified among the 1846 alloimmunized patients. The most common antibody identified was anti-E (127; 31.99%), followed by anti-c (75; 18.89%) in multiply-transfused patients. CONCLUSION: The rate of alloimmunization was 0.5 per 100 patients tested for antibodies and 4.8 per 100 patients receiving transfusion. Considering E- and c-antigen-matched red cells along with ABO and RhD matching may significantly reduce the overall occurrence of alloimmunization among Indian population who are transfusion-dependent.

E-learning/online education in transfusion medicine: A cross-sectional international survey.

OBJECTIVES: This survey aims to assess the scope of transfusion e-learning courses in blood establishments and transfusion services internationally. BACKGROUND: E-learning/online education is increasingly used in the education of medical professionals. There is limited published data on the use of e-learning for transfusion medicine. MATERIAL AND METHODS: An International survey was designed and distributed to all members of the International Society of Blood Transfusion to assess utilisation of e-learning in their institutions. Descriptive statistics were used to summarise the results. RESULTS: A total of 177 respondents participated, 68 of which had e-learning modules in their institutions. Approximately two-thirds of the courses were developed in-house (66%), and 63% are available to learners from outside the host institutions. In one-third of institutions, these courses were established during the COVID-19 pandemic, while 15% had used e-learning courses for more than 10 years. The courses target different audiences and topics ranging from blood donation to hemovigilance. The most common audiences were physicians (71%), laboratory scientists/technologists (69%) and transfusion practitioners (63%). Formal assessment of learning outcomes is used in 70% of the programs. CONCLUSIONS: The survey demonstrates the widespread use of e-learning courses in transfusion education, with a substantial proportion being developed during the COVID-19 pandemic.

Genome sequencing and annotation of multi-virulent Aeromonas veronii XhG1.2 isolated from diseased Xiphophorus hellerii.

The present study was intended to elucidate the genomic basis of antibiotic resistance and hyper-virulence of the fish pathogen Aeromonas veronii XhG1.2 characterized in our previous work. The identity of XhG1.2 was confirmed through 16S rDNA sequence analysis and whole genome sequence analysis. The top-hit species distribution analysis of XhG1.2 sequence data revealed major hits against the Aeromonas veronii. The identification of virulence genes using the VFDB showed the genome of XhG1.2 to have the genes coding for the virulence factors viz. aerolysin, RtxA, T2SS, T3SS and T6SS. The presence of antibiotic resistance predicted through the CARD database analysis showed it to have the CephA3, OXA-12, adeF and pulvomycin resistance genes. By the phylogenetic and comparative genomic analysis, A. veronii species were found to have genes for toxin production. This also confirmed the pathogenicity and drug resistance of A. veronii XhG1.2 and also its potential to cause disease in diverse ornamental fishes.

Clinical Implication of Immunohaematological Tests in ABO haemolytic disease of newborn: Revisiting an old disease.

OBJECTIVE: We aimed to assess the frequency distribution of of ABO haemolytic disease of newborn (ABO-HDN) and to know the predictive value of immunohaematological tests in identifying at risk neonates. BACKGROUND: ABO incompatibility, although a common cause of haemolytic disease of newborn, has several unaddressed issues related to it. MATERIAL AND METHODS: A prospective study over 20 months was carried out in a tertiary care centre in South India. Blood grouping, Direct Antiglobulin test (DAT) and elution studies were performed on neonatal samples, whereas blood grouping, antibody screening and antibody titration were performed on maternal samples. In suspected cases, ABO-HDN was diagnosed after excluding other possible causes for haemolysis. The laboratory results were correlated with the clinical details to assess the predictive value of the tests. RESULTS: Of the total 2856 pregnancies, 34% had ABO incompatibility. On testing with columnagglutination test (CAT), the overall DAT positivity and that among ABO-incompatible cases were 3.8% and 11.2%, respectively,) whereas by conventinal tube technique (CTT) it was 0.6% and 2.4% respectively. CAT was found to have higher sensitivity, and the predictive value was higher for CTT. Maternal IgG titre showed a positive linear relationship with the DAT strength and the rise in indirect bilirubin levels. The positive predictive value of combination of tests such as DAT, elution and titation was 94.12%, which was much higher than that of the individual tests. CONCLUSION: DAT positivity is a predictor of early rise in serum bilirubin level, and a combination of tests has a better predictive value than individual tests towards development of clinically significant hyperbilirubinemia in ABO-HDN.

Cocktail Protocol for Preparation of Platelet-Rich Fibrin Glue for Autologous Use.

BACKGROUND: Biomaterials containing platelets have been used to promote healing of ulcers and burns, as well as in implantology and maxillofacial and plastic surgery to achieve wound healing and tissue repair. Commercial devices to prepare autologous biomaterials involve diverse preparation methods that can have high production costs and low yields. Hence, we designed a protocol for preparation of large amounts of autologous platelet-rich fibrin (PRF) glue using conventional processing techniques for blood components. METHODS: Autologous whole blood collected 72 h before surgery was processed to prepare platelet concentrates and cryoprecipitate. In a closed system, calcium was added to the cryoprecipitate to release autologous thrombin and generate a firm fibrin clot. The fibrin clot, platelets and calcium were then placed in a conical flask in which a PRF glue formed. The protocol was validated through determination of pre- and post-platelet counts and fibrinogen amounts in the product. RESULTS: Platelets were recovered with 68% efficiency during the preparation. Essentially no platelets or fibrinogen were found in the supernatant of the PRF glue, suggesting that nearly all had been incorporated in a PRF glue having a relatively large (8 cm × 10 cm) size. CONCLUSION: The protocol described here is a cost-effective, simple and closed system that can be used to produce large-size PRF glue to promote repair of major surgical defects.

Advantage of zinc oxide nanoparticles over silver nanoparticles for the management of Aeromonas veronii infection in Xiphophorus hellerii.

Bacterial pathogens cause significant challenge to the ornamental fish industry. Eventhough antibiotic administration has been recommended to manage fish diseases, there is alarming concern with emergence of antibiotic resistance. This indicates the need for the development of alternative methods with multi-targeted action to manage fish diseases. In the study, silver (AgNPs) and zinc oxide (ZnONPs) nanoparticles have been evaluated for its activity against Aeromonas veronii. Both the AgNPs and ZnONPs were found to have bactericidal activity against A. veronii. In vivo experiments with A. veronii was found to cause severe mortality in Xiphophorus hellerii with a LD50 of 1.4 × 108 CFU/mL. However, treatment with AgNPs and ZnONPs each at a concentration of 1 mg/L was found to enhance the survival rate of X. hellerii to 83.3% and 100% respectively. Further histopathological analysis showed alterations in gill, intestine and liver of X. hellerii due to A. veronii in the infection control. In the case of AgNPs treated group, symptoms of moderate tissue damage could be observed. However, the ZnONPs treated X. hellerii showed normal histological features with minimum tissue damage. The bath dip method further confirmed the protective ability of the zinc oxide nanoparticles (1 mg/L) on X. hellerii.

Characterization and environmental implications of selenate co-precipitation with barite.

This study investigated the sequestration of dissolved selenate (SeO42-) via co-precipitation in barite for a range of SeO42- concentrations (0-~8650 mg/L), as well as its release at near neutral pH conditions (pH = ~5.5-6.5). Solid precipitates were characterized via X-ray diffraction and subsequent Rietveld refinements, Raman spectroscopy, Brunauer-Emmett-Teller surface area analyses, scanning electron microscopy, electron probe microanalyses (EPMA), inductively coupled plasma optical emission spectroscopy (ICP-OES), and X-ray absorption spectroscopy (XAS). ICP-OES results suggested barite efficiently removed >99% of SeO42- from the test solutions during all co-precipitation experiments. EPMA results showed the SeO42- was sequestered from the aqueous phase via co-precipitation with barite. XAS analyses indicated the SeO42- tetrahedron is incorporated into the barite structure by substituting for sulfate (SO42-) and bonding to Ba2+ atoms through bidentate mononuclear and bidentate binuclear complexes. Dissolution data showed the release of SeO42- sequestered in barite to the aqueous phase is unlikely due to the low solubility and stability of the barite phase. As such, co-precipitation of SeO42- with barite could be effective for removing SeO42- from waters affected by mining and metallurgical operations.

Viability of power distribution in India - Challenges and Way Forward.

Energy is a key component for economic growth as well as for human development. India is the third-ranking electricity generator in the world but ranks 106th in terms of per capita consumption. Specifically, the distribution of power is the most important link in the value chain of the power sector since it is the cash register for the entire sector. In India, electricity is a concurrent subject shared between the Central and State Governments. While the generation of power has been deregulated since 2003, the supply of power to the consumers is generally carried out by Government-owned power Distribution Companies (DISCOMs). In this paper, the authors analyze the financial distress of DISCOMs in India, and explain how the supply-demand mismatch due to over-ambitious demand projections, the fixed and energy charges of thermal power plants, and the excess procurement of "must-run" renewable sources together contribute to the high cost of power procurement that drives the financial stress faced by DISCOMs. The authors support their assertion with a study of nine DISCOMs supplying electricity to 155 million people in three States and propose policy recommendations for a turnaround of such DISCOMs which can be rolled out with suitable modifications across India.

Tracing Molybdenum Attenuation in Mining Environments Using Molybdenum Stable Isotopes.

Molybdenum contamination is a concern in mining regions worldwide. Better understanding of processes controlling Mo mobility in mine wastes is critical for assessing potential impacts and developing water-quality management strategies associated with this element. Here, we used Mo stable isotope (δ98/95Mo) analyses to investigate geochemical controls on Mo mobility within a tailings management facility (TMF) featuring oxic and anoxic environments. These isotopic analyses were integrated with X-ray absorption spectroscopy, X-ray diffraction, Raman spectroscopy, transmission electron microscopy, and aqueous chemical data. Dissolved Mo concentrations were inversely correlated with δ98/95Mo values such that enrichment of heavy Mo isotopes in solution reflected attenuation processes. Inner-sphere complexation of Mo(VI) with ferrihydrite was the primary driver of Mo removal and was accompanied by a ca. 1‰ isotope fractionation. Limited Mo attenuation and isotope fractionation were observed in Fe(II)- and Mo-rich anoxic TMF seepage, while attenuation and isotope fractionation were greatest during discharge and oxidation of this seepage after discharge into a pond where Fe-(oxyhydr)oxide precipitation promoted Mo sorption. Overall, this study highlights the role of sorption onto Fe-(oxyhydr)oxides in attenuating Mo in oxic environments, a process which can be traced by Mo isotope analyses.

Entanglement monogamy in indistinguishable particle systems.

Recently, it has been realized that indistinguishability is a resource for quantum information processing. A new method to represent the indistinguishable particles by Franco et al. (Sci Rep 6:20603, 2016, https://doi.org/10.1038/srep20603 ) and measure the concurrence is developed by Nosrati et al. (npj Quantum Inf 6:39, 2020, https://doi.org/10.1038/s41534-020-0271-7 ). The monogamy property says that quantum entanglement cannot be shared freely between more than two particles. For three distinguishable particles, the monogamy of entanglement was first expressed as an inequality using squared concurrence where each particle has a single degree of freedom (for pure or mixed states). Using multiple degrees of freedom, similar inequality was shown to be held between two distinguishable particles. However, for two indistinguishable particles, where each particle cannot be addressed individually, the monogamy inequality was shown to be violated maximally for a specific state. Thus a question naturally arises: what happens to the monogamy of entanglement in the case of three or more indistinguishable particles? We prove that monogamy holds in this scenario and the inequality becomes equality for all pure indistinguishable states. Further, we provide three major operational meanings of our result. Finally, we present an experimental schematic using photons to observe our result.

Topological data analysis of human brain networks through order statistics.

Understanding the common topological characteristics of the human brain network across a population is central to understanding brain functions. The abstraction of human connectome as a graph has been pivotal in gaining insights on the topological properties of the brain network. The development of group-level statistical inference procedures in brain graphs while accounting for the heterogeneity and randomness still remains a difficult task. In this study, we develop a robust statistical framework based on persistent homology using the order statistics for analyzing brain networks. The use of order statistics greatly simplifies the computation of the persistent barcodes. We validate the proposed methods using comprehensive simulation studies and subsequently apply to the resting-state functional magnetic resonance images. We found a statistically significant topological difference between the male and female brain networks.

An early Indian experience with benralizumab - A compendium on severe asthma cases: a case series.

Background: Severe eosinophilic asthma (SEA), one of the phenotypes of asthma that is characterized by elevated blood eosinophil counts, is a common cause of uncontrolled asthma. Patients with SEA often experience severe persistent symptoms and have frequent exacerbations despite optimal inhaler therapy. They also have poor lung function and quality of life (QoL). Benralizumab (Fasenra), a monoclonal antibody, has been approved for managing cases of SEA. This series of six cases, the first of its kind from India, aims to add to the real-world evidence of benralizumab in India. Methods: Benralizumab 30 mg (once in four weeks for the first three doses followed by a dose every eight weeks for two years) was administered in six patients with symptoms of cough, breathlessness on exertion, and wheezing, diagnosed with SEA. The following were the endpoints assessed: (i) overlap between high immunoglobulin E (IgE) and eosinophilic asthma; (ii) reduction of exacerbations; (iii) withdrawal of oral corticosteroids; and (iv) improvement in lung function and QoL. Results: In all cases, management with benralizumab resulted in optimal clinical and functional improvement, a decline in systemic steroid use, and improved QoL. Conclusions: The cases presented here are the first of their kind in the Indian asthmatic population with all SEA patients demonstrating significant improvement in symptoms with the use of benralizumab.