Establishing a quantitative fluorescence assay for the rapid detection of kynurenine in urine.

The kynurenine metabolite is associated with many diseases and disorders, ranging from diabetes and sepsis to more recently COVID-19. Here we report a fluorescence-based assay for the detection of kynurenine in urine using a specific chemosensor, 3-formyl-4-(ethylthio)-7-(diethylamino)-coumarin. The assay produces a linear response at clinically relevant ranges (1-20 µM), with a limit of detection of 0.7 µM. The average standard addition recoveries of kynurenine in synthetic urine samples are near to 100%, and the relative standard deviation values are less than 8%. The established fluorescence assay for quantitative analysis of kynurenine in urine is facile, sensitive and accurate and holds great potential for low-cost and high-throughput analysis of kynurenine in clinical laboratory settings.

Using National Inpatient Death Rates as a Benchmark to Identify Hospitals with Inaccurate Cause of Death Reporting - Missouri, 2009-2012.

Reporting causes of death accurately is essential to public health and hospital-based programs; however, some U.S. studies have identified substantial inaccuracies in cause of death reporting. Using CDC's national inpatient hospital death rates as a benchmark, the Missouri Department of Health and Senior Services (DHSS) analyzed inpatient death rates reported by hospitals with high inpatient death rates in St. Louis and Kansas City metro areas. Among the selected hospitals with high inpatient death rates, 45.8% of death certificates indicated an underlying cause of death that was inconsistent with CDC's Guidelines for Death Certificate completion. Selected hospitals with high inpatient death rates were more likely to overreport heart disease and renal disease, and underreport cancer as an underlying cause of death. Based on these findings, the Missouri DHSS initiated a new web-based training module for death certificate completion based on the CDC guidelines in an effort to improve accuracy in cause of death reporting.

Are Statutory Requirements Followed in the Certification of Traumatic, Unexpected, and Unattended Deaths in Missouri?

Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross-sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined agreement between cause and manner of death by year and ME/C contact as well as 2010-2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97, p < 0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p =< 0.0001). There was a significantly higher proportion of ME/C-certified deaths using the electronic system in 2010-2012 (aOR = 1.18, 95% CI 1.15, 1.21) compared to the manual system in 2007-2009. Black, non-Hispanic (aOR = 1.50, 95% CI 1.43,1.57) and Hispanic (aOR = 1.31, 95% CI 1.13, 1.51) deaths, compared to White, non-Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.