Establishing the Reportable Interval for Routine Clinical Laboratory Tests: A Data-Driven Strategy Leveraging Retrospective Electronic Medical Record Data.

BACKGROUND: This paper presents a data-driven strategy for establishing the reportable interval in clinical laboratory testing. The reportable interval defines the range of laboratory result values beyond which reporting should be withheld. The lack of clear guidelines and methodology for determining the reportable interval has led to potential errors in reporting and patient risk. METHODS: To address this gap, the study developed an integrated strategy that combines statistical analysis, expert review, and hypothetical outlier calculations. A large data set from an accredited clinical laboratory was utilized, analyzing over 124 million laboratory test records from 916 distinct tests. The Dixon test was applied to identify outliers and establish the highest and lowest non-outlier result values for each test, which were validated by clinical pathology experts. The methodology also included matching the reportable intervals with relevant Logical Observation Identifiers Names and Codes (LOINC) and Unified Code for Units of Measure (UCUM)-valid units for broader applicability. RESULTS: Upon establishing the reportable interval for 135 routine laboratory tests (493 LOINC codes), we applied these to a primary care laboratory data set of 23 million records, demonstrating their efficacy with over 1% of result records identified as implausible. CONCLUSIONS: We developed and tested a data-driven strategy for establishing reportable intervals utilizing large electronic medical record (EMR) data sets. Implementing the established interval in clinical laboratory settings can improve autoverification systems, enhance data reliability, and reduce errors in patient care. Ongoing refinement and reporting of cases exceeding the reportable limits will contribute to continuous improvement in laboratory result management and patient safety.

Persistent Shortness of Breath in Post-COVID-19 Patients: Inducible Laryngeal Obstruction Can Be a Cause.

BACKGROUND: Inducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown. PURPOSE: This study aimed to identify ILO as a possible cause of shortness of breath (SOB) in post-COVID-19 patients. METHODS: A retrospective study was conducted on 59 post-COVID-19 adults complaining of SOB. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test (PFT), CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure). RESULTS: ILO was detected in 8 out of 59 cases (13.5%). Two cases out of eight had glottic closure grade 1, while five cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and PFT results (the degree of upper airway restriction). PFTs in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened. CONCLUSION: ILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.

Co/Ni/Cu-NH2BDC MOF@natural Egyptian zeolite ore nanocomposite for calcium ion removal in water softening applications.

Water softening is a treatment process required to remove calcium (Ca(II)) and magnesium (Mg(II)) cations from water streams. Nanocomposites can provide solutions for such multiple challenges and have high performance and low application costs. In this work, a multimetallic cobalt, nickel, and copper 2-aminoterephthalic acid metal-organic framework ((Co/Ni/Cu-NH2BDC) MOF) was synthesized by a simple solvothermal technique. This MOF was supported on an Egyptian natural zeolite ore and was used for the adsorption of Ca(II) ions for water-softening applications. The adsorbent was characterized using Fourier transform infrared (FTIR) spectroscopy, field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), N2 adsorption-desorption isotherms, and zeta potential measurements. The adsorption isotherm data for the prepared adsorbent toward Ca(II) were best fit using the Redlich-Peterson model and showed a maximum adsorption capacity of 88.1 mg/g. The adsorption kinetics revealed an equilibrium time of 10 min, which was best fit using the Avrami model. The intermolecular interactions of Ca(II) ions with zeolite and MOF were investigated by Monte Carlo simulations, molecular dynamics simulations, and FTIR and XRD analyses. The adsorption sites in the zeolite structure were oxygen atoms, while those in the MOF structure were amine nitrogen atoms. The Ca(II) ions are coordinated with the solvent molecules in both structures. Finally, the in vitro cytotoxicity of this nanocomposite was assessed, revealing viability levels of 74.57 ± 2.1% and 21 ± 2.79% for Vero and African green monkey kidney and human liver (HepG2) cells, respectively. Cytotoxicity assays help assess the environmental impact of these materials, ensuring that they do not harm aquatic organisms or disrupt ecosystems. Thus, this study demonstrated the valorization of MOF/zeolite as a valuable and industry-ready adsorbent that can appropriate Ca(II) contaminants from aqueous streams.

Efficient dye removal from industrial wastewater using sustainable activated carbon and its polyamide nanocomposite derived from agricultural and industrial wastes in column systems.

Sugar beet crown (SBC) waste was employed to produce sustainable activated carbon (AC) by a thermo-chemical activation procedure using a fixed ratio of H3PO4/SBC (1 : 1 w/w ratio) at 550 °C/2 h. An activated carbon/polyamide nano-composite (AC/PA) was also prepared through the polymerization of the fabricated AC (90%) with polyamide (PA, 10%) synthetic textile waste using a proper dissolving agent at a specified w/w ratio with the employed polymer (formic acid/PA = 82/18%). Both AC and its derivative AC/PA were employed in the remediation of dyes from industrial wastewater in column systems, and their efficiencies were compared at various applied experimental conditions. The adsorption of the industrial dye waste (IDW) was a pH-, flow rate-, and bed thickness-controlled process by the regarded adsorbents. Kinetic studies confirmed the suitability of the Thomas equation over the Yoon and Nelson model in predicting the dynamic adsorption process of IDW by AC and AC/PA as was assured by the close agreement among the calculated and experimental uptake capacities of both adsorbents at the same applied flow rates, suggesting the chemisorption nature of IDW adsorption. Additionally, electrostatic attraction was the leading mechanism of IDW adsorption by AC and AC/PA composite with some advantages of the former over the latter.

Radiation Attenuation Assessment of Serpentinite Rocks from a Geological Perspective.

Serpentinites are metamorphic rocks that are widely applied as aggregates in the production of radiation-shielding concrete. Different varieties of massive serpentinite mountains located in Egypt exist without real investment. Hence, this study aims to evaluate the radiation shielding efficacy of three varieties of serpentinite rocks from different geological perspectives: mineralogical, geochemical, and morphological characteristics. X-ray diffraction, transmitted-light microscopy, and thermal analysis were required to characterize their mineralogical composition, while X-ray fluorescence was necessary to investigate their geochemical features. Moreover, scanning electron microscopy was used to detect their morphological characteristics. On the other hand, the PuBe source and stilbene detector were employed for the experimental determination of fast neutrons and γ-ray attenuations, which were conducted at energy ranges of 0.8−11 and 0.4−8.3 MeV, respectively. Based on the mineralogical, geochemical, and morphological characteristics of these rocks, the radiation attenuation capacity of lizardite > antigorite > chrysotile. However, these serpentinites can be applied as a natural alternative to some radiation-shielding concrete in radiotherapy centers and other counterpart facilities.

Carbon nanotube impregnated anthracite (An/CNT) as a superior sorbent for azo dye removal.

Raw anthracite was impregnated with a minute amount of multi-walled carbon-nanotubes at a solid/solid ratio of 50 : 1 via calcination at 950 °C for 2 h to produce anthracite/carbon nanotube (An/CNT) composite with superior sorption efficiency. Both An/CNT composite and its precursor anthracite were characterized by XRD, SEM, FT-IR and BET surface area (S BET). The removal efficiency of an azo dye methyl orange (MO) by the An/CNT composite was evaluated under different experimental parameters. The MO sorption isotherm data fitted to the Langmuir model well with an R 2 of 0.999 and a MO sorption capacity (q max) of 416.7 mg g-1. The distribution coefficient K d decreases from 117.9 to 16.1 L g-1 as the initial MO concentrations increased from 40 to 140 mg L-1. The MO sorption kinetic data was well described by the pseudo-second-order equation with an R 2 of 1. The external (film) diffusion followed by intra-particle diffusion was the major driving process during the early stage of MO sorption. The electrostatic interaction between the oxygen- and nitrogen-bearing functional groups on the An/CNT surface and MO ions was the key controlling mechanism for the MO sorption process, particularly at pH < pHPZC of the composite. Meanwhile, valuable contributions from Yoshida and dipole-dipole H bonding mechanisms can explain the MO sorption by the addressed composite, especially at pH > pHPZC.

Enhancing adsorption capacity of Egyptian diatomaceous earth by thermo-chemical purification: Methylene blue uptake.

In the current study, calcination and thermo-chemical methods were applied in treatment of the processed diatomite fraction (<45 µm), which containing nearly 82.6 wt.% of the raw Egyptian diatomaceous earth. The untreated and modified diatomite fractions were characterized by optical microscopy (OM), X-ray fluorescence (XRF), X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Thermo-chemical purification produced the highest concentration of diatom frustules (>92% SiO2) without blocking impurities and created SiOSi active sites. These fractions were tested for Methylene blue (MB) adsorption at different pH solutions (2.0-10.0). The purified diatomite via thermo-chemical treatment (PD) gave the greatest adsorption capacity for MB compared to the untreated (UD) and calcinated (CUD) diatomite fractions. Effects of experimental parameters such as MB concentration (60-200 mg L-1), contact time (5-480 min), adsorbent mass (50-250 mg) and temperature (30-55 °C) on MB uptake were investigated. Linear and non-linear forms of Langmuir, Freundlich and Dubinin-Radushkevich (D-R) models indicated that Langmuir model with a maximum adsorption capacity (qmax=105.03mgg-1) fitted well the adsorption data. The chemical nature of MB uptake was revealed by the values of mean free energy E=8.655kJ/moland correlation coefficient of the pseudo-second-order model (R2=0.9997). The calculated thermodynamic parameters (ΔH0, ΔG0 and ΔS0) indicated that the removal of MB is spontaneous and endothermic.