Transfusion-related errors and associated adverse reactions and blood product wastage as reported to the National Healthcare Safety Network Hemovigilance Module, 2014-2022.

BACKGROUND: Transfusion-related errors are largely preventable but may lead to blood product wastage and adverse reactions, resulting in patient harm. In the United States, the incidence of transfusion-related errors is poorly understood nationally. We used data from the National Healthcare Safety Network (NHSN) Hemovigilance Module to describe and quantify transfusion-related errors, as well as associated transfusion-related adverse reactions and blood product wastage. METHODS: During 2014-2022, data from the NHSN Hemovigilance Module were used to analyze errors, including near misses (errors with no transfusion), incidents (errors with transfusion), and associated serious adverse reactions (severe, life-threatening, or death). RESULTS: During 2014-2022, 80 acute care facilities (75 adult; 5 pediatric) reported 63,900 errors. Most errors occurred during patient blood sample collection (21,761, 34.1%) and blood sample handling (16,277, 25.5%). Less than one-fifth of reported errors (9822, 15.4%) had a completed incident form. Of those, 8780 (89.3%) were near misses and 1042 (10.7%) incidents. More than a third of near misses (3363, 38.3%) were associated with a discarded blood product, resulting in 4862 discarded components. Overall, 87 adverse reactions were associated with errors; six (7%) were serious. CONCLUSIONS: Over half of the transfusion-related errors reported to the Hemovigilance Module occurred during blood sample collection or sample handling. Some serious adverse reactions identified were associated with errors, suggesting that additional safety interventions may be beneficial. Increased participation in the Hemovigilance Module could enhance generalizability and further inform policy development regarding error prevention.

Impact of the COVID-19 pandemic on blood donation and transfusions in the United States in 2020.

INTRODUCTION: Reports have suggested the COVID-19 pandemic resulted in blood donation shortages and adverse impacts on the blood supply. Using data from the National Blood Collection and Utilization Survey (NBCUS), we quantified the pandemic's impact on red blood cell (RBC) and apheresis platelet collections and transfusions in the United States during year 2020. METHODS: The 2021 NBCUS survey instrument was modified to include certain blood collection and utilization variables for 2020. The survey was distributed to all US blood collection centers, all US hospitals performing ≥1000 surgeries annually, and a 40% random sample of hospitals performing 100-999 surgeries annually. Weighting and imputation were used to generate national estimates for whole blood and apheresis platelet donation; RBC and platelet transfusion; and convalescent plasma distribution. RESULTS: Whole blood collections were stable from 2019 (9,790,000 units; 95% CI: 9,320,000-10,261,000) to 2020 (9,738,000 units; 95% CI: 9,365,000-10,110,000). RBC transfusions decreased by 6.0%, from 10,852,000 units (95% CI: 10,444,000-11,259,000) in 2019 to 10,202,000 units (95% CI: 9,811,000-10,593,000) in 2020. Declines were steepest during March-April 2020, with transfusions subsequently rebounding. Apheresis platelet collections increased from 2,359,000 units (95% CI: 2,240,000-2,477,000) in 2019 to 2,408,000 units (95% CI: 2,288,000-2,528,000) in 2020. Apheresis platelet transfusions increased from 1,996,000 units (95% CI: 1,846,000-2,147,000) in 2019 to 2,057,000 units (95% CI: 1,902,000-2,211,000) in 2020. CONCLUSION: The COVID-19 pandemic resulted in reduced blood donations and transfusions in some months during 2020 but only a minimal annualized decline compared with 2019.

Continued stabilization of blood collections and transfusions in the United States: Findings from the 2021 National Blood Collection and Utilization Survey.

BACKGROUND: National Blood Collection and Utilization Surveys (NBCUS) have reported decreases in U.S. blood collections and transfusions since 2008. The declines began to stabilize in 2015-2017, with a subsequent increase in transfusions in 2019. Data from the 2021 NBCUS were analyzed to understand the current dynamics of blood collection and use in the United States. METHODS: In March 2022, all community-based (53) and hospital-based (83) blood collection centers, a randomly selected 40% of transfusing hospitals performing 100-999 annual inpatient surgeries, and all transfusing hospitals performing ≥1000 annual inpatient surgeries were sent a 2021 NBCUS survey to ascertain blood collection and transfusion data. Responses were compiled, and national estimates were calculated for the number of units of blood and blood components collected, distributed, transfused, and outdated in 2021. Weighting and imputation were applied to account for non-responses and missing data, respectively. RESULTS: Survey response rates were 92.5% (49/53) for community-based blood centers, 74.7% (62/83) for hospital-based blood centers, and 76.3% (2102/2754) for transfusing hospitals. Overall, 11,784,000 (95% confidence interval [CI], 11,392,000-12,177,000) whole blood and apheresis red blood cell (RBC) units were collected in 2021, a 1.7% increase from 2019; 10,764,000 (95% CI, 10,357,000-11,171,000) whole blood-derived and apheresis RBC units were transfused, a 0.8% decrease. Total platelet units distributed increased by 0.8%; platelet units transfused decreased by 3.0%; plasma units distributed increased by 16.2%; and plasma units transfused increased by 1.4%. DISCUSSION: The 2021 NBCUS findings demonstrate a stabilization in U.S. blood collections and transfusions, suggesting a plateau has been reached for both.

Supplemental findings of the 2021 National Blood Collection and Utilization Survey.

BACKGROUND: The Department of Health and Human Services' National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and use. Supplemental data from the 2021 NBCUS not presented elsewhere are presented here. METHODS: Data on survey participation, donor characteristics, blood component cost, transfusion-associated adverse reactions, and implementation of blood safety measures, including pathogen-reduction of platelets, during 2021, were analyzed. Comparisons are made to 2019 survey data where available (2013-2019 for survey participation). RESULTS: During 2021, there were 11,507,000 successful blood donations in the United States, a 4.8% increase from 2019. Persons aged 45-64 years accounted for 42% of all successful blood donations. Donations by persons aged 65 years and older increased by 40.7%, while donations among minorities and donors aged <25 years decreased. From 2019 to 2021, the median price hospitals paid per unit of leukoreduced red blood cells, leukoreduced and pathogen-reduced apheresis platelets, and fresh frozen plasma increased. The largest increase in price per unit of blood component in 2021 was for leukoreduced apheresis platelets, which increased by ~$51. Between 2019 and 2021, the proportion of transfusing facilities reporting use of pathogen-reduced platelets increased, from 13% to 60%. Transfusion-related adverse reactions declined slightly between 2019 and 2021, although the rate of transfusion-transmitted bacterial infections remained unchanged. CONCLUSION: During 2021, blood donations increased nationally, although donations from those aged <25 years and minorities declined. The prices hospitals paid for most blood products increased, as did the use of pathogen-reduced platelets.

Kinship of long-term associates in the highly social sperm whale.

The evolution of stable social groups can be promoted by both indirect and direct fitness benefits. Sperm whales (Physeter macrocephalus) are highly social, with a hierarchical social structure based around core groups of adult females and subadults, a rare level of complexity among mammals. We combined long-term satellite tracking (ranging from 11 to 607 days) of 51 individual sperm whales with genetic kinship analysis to assess the pattern of kin associations within and among coherent social units. Unlike findings for other species with similar social structure, we find no consistent correlation between kinship and association apart from close associations between two pairs of first-order relatives. A third pair of first-order relatives did not associate, and overall, the mean relatedness was the same within as among social groups. However, social behaviour can also be promoted by ecological factors such as resource dispersion. We assessed putative foraging behaviour during travel from the satellite-tracking data, which suggested that prey resources were dispersed and unpredictable, a condition that could promote living in groups.

Data Velocity in HIV-Related Implementation Research: Estimating Time From Funding to Publication.

BACKGROUND: Given available effective biomedical and behavioral prevention and treatment interventions, HIV-related implementation research (IR) is expanding. The rapid generation and dissemination of IR to inform guidelines and practice has the potential to optimize the impact of the Ending the Epidemic Initiative and the HIV pandemic response more broadly. METHODS: We leveraged a prior mapping review of NIH-funded awards in HIV and IR from January 2013 to March 2018 and identified all publications linked to those grants in NIH RePORTER through January 1, 2021 (n = 1509). Deduplication and screening of nonoriginal research reduced the count to 1032 articles, of which 952 were eligible and included in this review. Publication volume and timing were summarized; Kaplan-Meier plots estimated time to publication. RESULTS: Among the 215 NIH-funded IR-related awards, 127 of 215 (59%) published original research directly related to the grant, averaging 2.0 articles (SD: 3.3) per award, largely in the early IR phases. Many articles (521 of 952, 55%) attributed to grants did not report grant-related data. Time from article submission to publication averaged 205 days (SD: 107). The median time-to-first publication from funding start was 4 years. Data dissemination velocity varied by award type, trending toward faster publication in recent years. Delays in data velocity included (1) time from funding to enrollment, (2) enrollment length, and (3) time from data collection completion to publication. CONCLUSION: Research publication was high overall, and time-to-publication is accelerating; however, over 40% of grants have yet to publish findings from grant-related data. Addressing bottlenecks in the production and dissemination of HIV-related IR would reinforce its programmatic and policy relevance in the HIV response.

SARS-CoV-2 Variants in Paraguay: Detection and Surveillance with an Economical and Scalable Molecular Protocol.

SARS-CoV-2 variant detection relies on resource-intensive whole-genome sequencing methods. We sought to develop a scalable protocol for variant detection and surveillance in Paraguay, pairing rRT-PCR for spike mutations with Nanopore sequencing. A total of 201 acute-phase nasopharyngeal samples were included. Samples were positive for the SARS-CoV-2 N2 target and tested with the Spike SNP assay to detect mutations associated with the following variants: alpha (501Y), beta/gamma (417variant/484K/501Y), delta (452R/478K), and lambda (452Q/490S). Spike SNP calls were confirmed using amplicon (Sanger) sequencing and whole-genome (Nanopore) sequencing on a subset of samples with confirmed variant lineages. Samples had a mean N2 Ct of 20.8 (SD 5.6); 198/201 samples (98.5%) tested positive in the Spike SNP assay. The most common genotype was 417variant/484K/501Y, detected in 102/198 samples (51.5%), which was consistent with the P.1 lineage (gamma variant) in Paraguay. No mutations (K417 only) were found in 64/198 (32.3%), and K417/484K was identified in 22/198 (11.1%), consistent with P.2 (zeta). Seven samples (3.5%) tested positive for 452R without 478K, and one sample with genotype K417/501Y was confirmed as B.1.1.7 (alpha). The results were confirmed using Sanger sequencing in 181/181 samples, and variant calls were consistent with Nanopore sequencing in 29/29 samples. The Spike SNP assay could improve population-level surveillance for mutations associated with SARS-CoV-2 variants and inform the judicious use of sequencing resources.

Temporal and demographic variation in partial migration of the North Atlantic right whale.

Animal movement plays a fundamental role in the ecology of migratory species, and understanding migration patterns is required for effective management. To evaluate intrinsic and environmental factors associated with probabilities of endangered North Atlantic right whales Eubalaena glacialis migrating to a wintering ground off the southeastern United States (SEUS), we applied a multistate temporary emigration capture-recapture model to 22 years of photo-identification data. Migration probabilities for juveniles were generally higher yet more variable than those for adults, and non-calving adult females were the least likely group to migrate. The highest migration probabilities for juveniles and adult males coincided with years of relatively high calving rates, following years of higher prey availability in a fall feeding ground. Right whale migration to the SEUS can be classified as condition-dependent partial migration, which includes skipped breeding partial migration for reproductive females, and is likely influenced by tradeoffs among ecological factors such as reproductive costs and foraging opportunities that vary across individuals and time. The high variability in migration reported in this study provides insight into the ecological drivers of migration but presents challenges to right whale monitoring and conservation strategies.

Wintering habitat model for the North Atlantic Right Whale (Eubalaena glacialis) in the southeastern United States.

The coastal waters off the southeastern United States (SEUS) are a primary wintering ground for the endangered North Atlantic right whale (Eubalaena glacialis), used by calving females along with other adult and juvenile whales. Management actions implemented in this area for the recovery of the right whale population rely on accurate habitat characterization and the ability to predict whale distribution over time. We developed a temporally dynamic habitat model to predict wintering right whale distribution in the SEUS using a generalized additive model framework and aerial survey data from 2003/2004 through 2012/2013. We built upon previous habitat models for right whales in the SEUS and include data from new aerial surveys that extend the spatial coverage of the analysis, particularly in the northern portion of this wintering ground. We summarized whale sightings, survey effort corrected for probability of whale detection, and environmental data at a semimonthly resolution. Consistent with previous studies, sea surface temperature (SST), water depth, and survey year were significant predictors of right whale relative abundance. Additionally, distance to shore, distance to the 22°C SST isotherm, and an interaction between time of year and latitude (to account for the latitudinal migration of whales) were also selected in the analysis presented here. Predictions from the model revealed that the location of preferred habitat differs within and between years in correspondence with variation in environmental conditions. Although cow-calf pairs were rarely sighted in the company of other whales, there was minimal evidence that the preferred habitat of cow-calf pairs was different than that of whale groups without calves at the scale of this study. The results of this updated habitat model can be used to inform management decisions for a migratory species in a dynamic oceanic environment.

Estimating distribution of hidden objects with drones: from tennis balls to manatees.

Unmanned aerial vehicles (UAV), or drones, have been used widely in military applications, but more recently civilian applications have emerged (e.g., wildlife population monitoring, traffic monitoring, law enforcement, oil and gas pipeline threat detection). UAV can have several advantages over manned aircraft for wildlife surveys, including reduced ecological footprint, increased safety, and the ability to collect high-resolution geo-referenced imagery that can document the presence of species without the use of a human observer. We illustrate how geo-referenced data collected with UAV technology in combination with recently developed statistical models can improve our ability to estimate the distribution of organisms. To demonstrate the efficacy of this methodology, we conducted an experiment in which tennis balls were used as surrogates of organisms to be surveyed. We used a UAV to collect images of an experimental field with a known number of tennis balls, each of which had a certain probability of being hidden. We then applied spatially explicit occupancy models to estimate the number of balls and created precise distribution maps. We conducted three consecutive surveys over the experimental field and estimated the total number of balls to be 328 (95%CI: 312, 348). The true number was 329 balls, but simple counts based on the UAV pictures would have led to a total maximum count of 284. The distribution of the balls in the field followed a simulated environmental gradient. We also were able to accurately estimate the relationship between the gradient and the distribution of balls. Our experiment demonstrates how this technology can be used to create precise distribution maps in which discrete regions of the study area are assigned a probability of presence of an object. Finally, we discuss the applicability and relevance of this experimental study to the case study of Florida manatee distribution at power plants.

Caracterización clínica del labio leporino con fisura palatina o sin ésta en Cuba / Clinical characterization of cleft lip with or without cleft palate in Cuba

Entre los 8 004 recién nacidos malformados del Registro Cubano de Malformaciones Congénitas, en el período de abril de 1985 a diciembre de 1994, se detectaron 288 casos con labio leporino con fisura palatina o sin ella, aislado o asociado con otros(s) defecto(s). El defecto se presentó en su forma aislada en el 77,4 por ciento y en más de 2/3 partes de los casos la lesión incluyó al paladar. Hubo un predominio en el sexo masculino y para la localización anatómica izquierda en uno y otro sexos. Entre los asociados, desde el punto de vista patogénico, predominaron los síndromes cromosómicos con una tasa de 8 por ciento, y entre estos prevaleció la trisomía 13 con 21 casos

Comportamiento de los defectos congénitos aislados más frecuentes en Cuba / More frequent isolated birth defects in Cuba

El Registro Cubano de Malformaciones Congénitas (RECUMAC) ha analizado 572 561 recién nacidos en 36 hospitales maternos de 13 provincias de Cuba, en un período de 13 años (marzo de 1985 a diciembre de 1997), en el cual la prevalencia de las malformaciones congénitas en su forma aislada es de 134,92 por 10 000 nacimientos. Los defectos congénitos aislados más frecuentemente observados fueron la polidactilia, la hipospadias y las cardiopatías, con una prevalencia al nacimiento de 24,2, 13,5 y 11,4 por 10 000 nacimientos respectivamente. Del análisis de la tendencia de la frecuencia en el período estudiado se concluyó que la polidactilia fue francamente decreciente, la hipospadias ligeramente creciente y las cardiopatías francamente crecientes

Tendencias del síndrome de Down en Cuba: su relación con edad materna y tasa de fecundidad / Trends of the Down's syndrome in Cuba: its relationship with maternal age and fertility rate

Durante un período de 12 años (1985-1996) el Registro Cubano de Malformaciones Congénitas ha analizado un total de 520 578 nacimientos procedentes de 36 hospitales ginecoobstétricos de las 14 provincias de Cuba, de los cuales 9 362 recién nacidos presentaron al menos un defecto congénito detectado antes del alta hospitalaria. De éstos, 397 recién nacidos presentaron síndrome de Down, para una prevalencia al nacimiento de 7,8 por 10 000 nacimientos en el período. Al incluir los casos diagnosticados e interrumpidos por el Programa Nacional de Diagnóstico Prenatal Citogenético (125) se estimó entonces una incidencia al nacimiento de 9,8 por 10 000 nacidos vivos. Se analizó la tendencia de la prevalencia al nacimiento del síndrome de Down en relación con la tasa de fecundidad y la edad materna. En las madres menores de 20 años la prevalencia al nacimiento se mantuvo estable y la tasa de fecundidad decreció. En el resto de los grupos, de 20 a 34 años y más de 35 años decrecieron tanto la prevalencia al nacimiento como la tasa de fecundidad. En general tanto la prevalencia al nacimiento como la incidencia estimada al nacimiento tienen una tendencia decreciente, en este período

Caracterización patogénica de los recién nacidos con malformaciones múltiples / Pathogenic characterization of the newborns with multiple malformations

El Registro Cubano de Malformaciones Congénitas (RECUMAC) ha analizado 520 578 recién nacidos en 36 hospitales ginecobstétricos de 13 provincias de Cuba en un período de 12 años (de marzo de 1985 a diciembre de 1996), en el cual la prevalencia de malformaciones congénitas al nacimiento es de 179,8 por 10 000 nacimientos. El 24,6 porciento de los casos presentó 2 ó más malformaciones asociadas entre sí. Se realizó la clasificación de los multimalformados y los síndromes resultaron ser los más frecuentes. Entre los cromosómicos, el síndrome de Down ocupó el primer lugar, con una prevalencia al nacimiento de 7,8 por 10 000 nacimientos. En relación con los monogénicos heredados con modelos autosómicos dominante y recesivo la acondroplasia y el albinismo presentaron el mayor número de casos para una prevalencia al nacimiento de 0,44 y 0,21 por 10 000 nacimientos, respectivamente

Genética ciencia del presente y futuro / Genetic science of the present and future

Presenta algunos de los más significativos avances hechos en el área de la genética en especial de la genética médica. Los avances de esta ciencia incluyen: el mapeo del genoma humano, el tratamiento específico para enfermedeades genéticas, el reconocimiento del rol que desempeñan los factores genéticos en las enfermedades de la madurez o del adulto y la aplicación en esta década de nuevos conocimientos y tecnologías genéticas, necesarias para el médico. Cada día aparecen síndromes y enfermedades cuya etiología tiene una base genética por lo que estos conocimientos proporcionan una mayor predicción de la historia natural y el pronóstico de la enfermedad, un apropiado plan de tratamiento para el paciente y una planificación reproductiva de la familia...