Point-of-Care Testing Biosafety Decisions: An Investigation Summary Illustrating Current Decision-Making Process in Ontario, Canada.

BACKGROUND: Point-of-care testing (POCT) is increasingly being used in healthcare, including hospitals, and POCT-style tests are also used within some laboratories. The principles of biosafety, including risk assessment and containment of biohazardous agents, can be utilized as a foundation to establish policies and procedures guiding safe performance of POCT. However, specific biosafety guidelines for POCT are generally lacking, particularly for those performed outside laboratories by healthcare workers. This study aims to explore POCT biosafety program decision-making infrastructure and oversight in Ontario. CONTENT: The Institute of Quality Management in Healthcare distributed a survey to 249 laboratories in Ontario. There were 11 questions on POCT biosafety practices. SUMMARY: The survey had a high response rate of 88.7%. How POCT biosafety decisions were made was variable among respondents. For POCT-style tests conducted within laboratories, the biosafety officer (BSO) and/or the microbiologist were involved in biosafety decisions in 95% of microbiology labs or 55% of other labs. Only 27% of the respondents reported that biosafety decisions were made by BSOs and/or microbiologists when POCT was conducted outside the laboratory. When POCT is performed outside the laboratory, biosafety decisions were made largely by Infection Prevention and Control (IPAC) and POCT laboratory staff. Similarly, training and auditing of staff who perform POCT were mainly done by IPAC and POCT laboratory staff. The survey showed that a wide variety of POCT was being conducted for COVID-19 patients during the pandemic.

Effect of near real-time feedback tool in the electronic medical record on protocol compliance during laparoscopic cholecystectomy: a single-center retrospective analysis.

Implementation of evidence-based medicine has proved difficult across medical fields. Leveraging the electronic medical record may improve clinician compliance to published best practices. Our hypothesis was that the use of a near real-time feedback tool would improve compliance to the protocol steps. In order to test this hypothesis, we performed a retrospective chart review to compare compliance to a proprietary enhanced recovery protocol for patients undergoing laparoscopic cholecystectomy with and without a near real-time feedback tool embedded in the electronic medical record. Deviations to the care pathway were quantified and classified as allowable or as errors of commission, omission, or dose. During the study period, 2625 laparoscopic cholecystectomies were performed. A total of 16,972 protocol steps were evaluated. Complete protocol compliance improved from 10.3 to 61.5% (p < 0.001) with the use of the feedback tool. Individual protocol component compliance increased from 4994/8418 (59.3%) to 7669/8554 (89.7%) (p < 0.001). The near real-time feedback tool reduced the number of cases with every number of deviations (except zero) at p < 0.001. The near real-time feedback tool significantly improved protocol compliance for patients undergoing laparoscopic cholecystectomy.

Evidence of intraspecific prey switching: stage-structured predation of polar bears on ringed seals.

Prey switching is a phenomenon in which a predator disproportionately consumes the most abundant prey type, and switches to preferentially consume another prey type if the first becomes relatively rare. This concept may be expanded outside of its usual usage describing switching between prey species (interspecific), to describe switching between prey stages within a given species (intraspecific). Polar bears (Ursus maritimus) are thought to seek out naive ringed seal (Pusa hispida) pups in the spring, but how that may change in years with low seal productivity is unknown. We addressed two main questions: If polar bears typically select for ringed seals' pups, how does this change in years with reduced ringed-seal productivity? How does polar bear predation during years with low ringed-seal productivity impact the ringed seal population? We created a matrix population model for ringed seals to get an estimate of each stage's availability to polar bears in the spring. These estimates of availability were combined with existing studies on the ages of seals consumed by polar bears in years of both high and low ringed seal productivity. Our results suggest that polar bears typically strongly select for ringed seal pups, but switch to disproportionately select older ringed seals in years with low pup availability. The effects of this on ringed seal population growth appear negligible. Non-intuitive results on the effect of prey switching on the prey population emphasize the importance of considering environmental sequences rather than individual years.

Activation by c-Myc of transcription by RNA polymerases I, II and III.

The proto-oncogene product c-Myc can induce cell growth and proliferation. It regulates a large number of RNA polymerase II-transcribed genes, many of which encode ribosomal proteins, translation factors and other components of the biosynthetic apparatus. We have found that c-Myc can also activate transcription by RNA polymerases I and III, thereby stimulating production of rRNA and tRNA. As such, c-Myc may possess the unprecedented capacity to induce expression of all ribosomal components. This may explain its potent ability to drive cell growth, which depends on the accumulation of ribosomes. The activation of RNA polymerase II transcription by c-Myc is often inefficient, but its induction of rRNA and tRNA genes can be very strong in comparison. We will describe what is known about the mechanisms used by c-Myc to activate transcription by RNA polymerases I and II.