Classifying Microscopic Images of Reactive Lymphocytosis Using Two-Step Tandem AI Models

The practical applications of automatic recognition and categorization technology for next-generation systems are desired in the clinical laboratory. We approached the identification of reactive lymphocytosis using artificial intelligence (AI) technology and studied its clinical usefulness for blood smear screening. This study created one- and two-step AI models for the identification of reactive lymphocytosis. The ResNet-101 model was applied for deep learning. The original image set for supervised AI training consisted of 5765 typical nucleated blood cell images. The subjects for clinical assessment were 25 healthy cases, 25 erythroblast cases, and 25 reactive lymphocytosis cases. The total accuracy (mean ± standard deviation) of the one- and two-step models were 0.971 ± 0.047 and 0.977 ± 0.024 in healthy, 0.938 ± 0.040 and 0.978 ± 0.018 in erythroblast, and 0.856 ± 0.056 and 0.863 ± 0.069 in reactive lymphocytosis cases, respectively. The two-step AI model showed a sensitivity of 0.960 and a specificity of 1.000 between healthy and reactive lymphocytosis cases. As our two-step tandem AI model showed high performance for identifying reactive lymphocytosis in blood smear screening, we plan to apply this method to the development of AI models to differentiate reactive and neoplastic lymphocytosis.

AN ANALYSIS OF THE ONGOING CLINICAL LABORATORY SCIENCE WORKFORCE SHORTAGES IN THE U.S

Laboratory medicine and the services provided throughout the healthcare system remain critical components in the ability to deliver quality patient care. Over the years and as of recently, due to COVID-19, delivery of proper care has been challenged with continual staffing constraints within the clinical laboratory. While this is not a new issue, its exacerbation poses an ongoing threat to clinical laboratories nationwide and has many healthcare administrators and executives searching for viable solutions. This paper focuses on exploring the depth and breadth of the issue to get to the root of the cause(s) of the critical shortage. Once these keys issues are identified, then realistic and effective solutions can be proposed and implemented throughout the laboratory field.

Reducing the Risk of Perioperative Transmission of Candida auris: The Official Voice of Perioperative Nursing

CAUSES OF C AURIS TRANSMISSION In 2009, laboratory personnel isolated C auris from discharge originating in the external ear canal of a hospitalized patient in Japan and named it accordingly.5 Although C auris is closely related to other Candida species, it behaves much differently;rather than originating in the host's flora, it is most often acquired through contact with contaminated surfaces or fomites shed from colonized or infected individuals.6 Patients infected or colonized with C auris shed the pathogen from their skin, which can contaminate the environment-including shared medical equipment.7 Because the pathogen can remain viable on surfaces for prolonged periods (eg, four weeks8), it can be transmitted to patients and lead to systemic infection.9 Traditional biochemical tests for yeast identification may misidentify C auris as another yeast,9,10 and ineffective environmental cleaning can allow it to persist on surfaces, thereby increasing the risk of an outbreak.9 The first reported health care-associated C auris outbreak occurred between April 2015 and July 2016 in a cardiothoracic center in London.11 In June 2016, the CDC issued a clinical alert to health care facilities, noting that one isolate of C auris was detected in 2013 and that the pathogen had been in identified in nine countries on four continents since 2009.12 The number of clinical C auris cases has increased each year since 2016;from 2020 to 2021, that number almost doubled (755 to 1,470).13 In December 2022, there were 1,994 clinical cases and 5,071 screening cases (ie, indicating colonization) of C auris in the United States, with the highest incidence in California, Florida, Illinois, Nevada, New York, and Texas.13 In contrast, from 2013 to 2016, there had only been 63 clinical cases and 14 screening cases reported, occurring only in Illinois, Maryland, New Jersey, and New York. The patient risk factors for acquiring C auris are comparable to those associated with other types of Candida infections, such as Candida albicans, and include * recent surgery,4 * hospitalization in an endemic country outside the United States,4 * extended stays in an intensive care unit,17 * recent care in a postacute setting (eg, long-term care facility),4 * recent therapy with broad-spectrum antimicrobials,4 * the presence of invasive medical devices (eg, central venous catheter, feeding tube, endotracheal tube),4 and * chronic conditions or immunosuppression.18 The risk of healthy individuals (eg, health care workers [HCWs]) contracting C auris is very low. STRATEGIES TO CONSIDER Preventing transmission of epidemiologically important pathogens, such as C auris, in the perioperative practice setting requires strict compliance with infection prevention and control (IPC) measures, including * adhering to hand hygiene requirements, * using transmission-based (ie, contact) precautions, * communicating effectively, and * cleaning and disinfecting the health care environment with approved products.23 In addition, appropriate screening to identify patients colonized or infected with C auris and laboratory surveillance to identify the pathogen also are needed. When caring for patients with possible or confirmed C auris colonization or infection, HCWs should use contact precautions in addition to standard precautions.23 When implementing contact precautions in perioperative areas, personnel should consult with a facility infection preventionist on required personal protective equipment (PPE), patient transport protocol, patient placement in the facility, and enhanced environmental cleaning practices.25 Effective communication may help to ensure that HCWs implement IPC measures correctly and consistently.

Exploring the challenges for medical tourism in the United Arab Emirates during the Covid-19 pandemic era: a stakeholder perspective

PurposeThis paper explores medical tourism development challenges in the United Arab Emirates (UAE) pre- and during Covid-19. Medical tourism is becoming a dynamic, rapid growth area and an engine of economic development.Design/methodology/approachIn-depth interviews were conducted with medical tourism professionals. Fourteen medical tourism stakeholders were interviewed from 1 January to 31 January 2020. Qualitative thematic analysis was applied on medical tourism challenges before and during the pandemic.FindingsThe major themes indicated concerns for medical tourism in the UAE and they included higher medical services costs and a shortage of highly qualified medical expertise. The emerging themes related to the challenges of coping with Covid-19 and strategies to attract medical tourists.Originality/valueThis study contributes towards (1) the theory of medical tourism, (2) the related limited prior published work on this topic relating to the UAE and (3) the importance of medical tourism in today's tourism industry. Additionally, there are theoretical and practical implications for medical tourism stakeholders in terms of attracting inbound medical tourists to the UAE from other countries during the Covid-19 crisis and in the post-pandemic situation.

Missouri's Public Health at a Glance

According to the 2021 Behavioral Risk Factor Surveillance Survey, with an obesity prevalence rate of 37-2% in adults, Missouri continues to outpace the national average of 33-9%. The model described at https://wwwhealthiermo. org/-the Foundational Public Health Services (FPHS)-aims to assure six core public health programmatic areas are available through every public health agency: chronic disease prevention, communicable disease control, environmental public health,;injury prevention, maternal, child and family health, and linkages to medical, behavioral, and community resources. With funding from the Centers for Disease Control and Prevention (CDC), DHSS will lead an effort over the next four to five years to conduct a cost analysis for full implementation of the FPHS model statewide, as well as an accountability measure planning effort with a diverse group of stakeholders inclusive of county and state policymakers. DHSS Chief Medical Officer Heidi Miller, MD, MSMA member and an internal medicine physician with extensive experience with uninsured, Medicaid and underinsured populations, joined DHSS as the department's first Chief Medical Officer in January 2023- Dr. Miller will provide medical guidance and expertise to DHSS programs, serve as the liaison with medical associations and providers, be instrumental in program and protocol development, and continue to build and implement the vision of an integrated public health and healthcare system.

LEARNING THROUGH A PANDEMIC: INNOVATIONS IN LABORATORY MEDICINE

Pooling Through the Waves JARED BULLARD MD, FRCPC Jared Bullard is an Associate Professor in the Departments of Pediatrics & Child Health and Medical Microbiology & Infectious Diseases at the Max Rady College of Medicine, Rady Faculty of Health Sciences and Associate Medical Director, Cadham Provincial Laboratory Investigator, Children's Hospital Research Institute of Manitoba, in Winnipeg. [...]NH has recently developed a pathway for internationally educated MLTs (IEMLTs), who may start as laboratory clerks or MLAs and be able to secure MLT positions once they gain CSMLS certification. Rethinking Safety DAVID GOLDFARB MD, FRCPC David Goldfarb, MD, FRCPC, is a Clinical Associate Professor in the Department of Pathology and Laboratory Medicine at the University of British Columbia, Associate Head of the Department of Pathology and Laboratory Medicine at BC Children's Hospital and BC Womens Hospital and Health Centre, and Medical Microbiologist and Pediatric Infectious Disease Physician at BC Children's Hospital in Vancouver.

The Advent of Box PCR Testing

Nicknamed "SARS Stock," the event celebrated the end of the severe acute respiratory syndrome 1 (SARS-CoV-1) outbreak2 But Grant Johnson, MLT, team leader of microbiology at The Hospital for Sick Children at the time, was not at the concert. [...]Health Canada approved several in early 2020.3 CJMLS spoke to Johnson and laboratory professionals at another Canadian hospital to learn how incorporating Cepheid's GeneXpert,a popular rapid PCR box testing platform, has affected the work of laboratory professionals and patient care and how they managed issues that arose with it during the COVID-19 pandemic. Available in various sizes ranging from two to 16 modules, the GeneXpert platform can process tests for different indications simultaneously, making "on-demand molecular testing available to everyone with unprecedented speed and ease of use," according to the company's marketing materials.3 Preparation time is about five to seven minutes, and results are available within about 50 minutes.4 For example, the Cepheid GeneXpert Xpert Xpress SARS-CoV-2 assay targets two genome regions on the virus, the envelope and the nucleocapsid. Test results for individual patients confirmed whether they needed to isolate to prevent infecting others or if it was safe for them to visit loved ones, such as those in long-term care facilities with a higher risk of severe disease and mortality from SARS-CoV-2 infection.

Wastewater Surveillance-"Messy" Science With Public Health Potential

Marginalized, rural, and resource-poor communities and their associated public health institutions stand to benefit from timely wastewater disease data that can inform local decision-making and the community members. The utility of wastewater analysis goes beyond infectious disease surveillance: scientists are testing wastewater for many biomarkers of public health importance, such as pharmaceutical metabolites11 and markers of exposure to air pollution.12 Wastewater surveillance isa particularly attractive public health tool for communities with limited access to clinical testing or health care. [...]there is an opportunity for community-engaged research to design wastewater analysis approaches that meet the needs of these communities. The Centers for Disease Control and Prevention has provided laboratory capacity grants to many states to enhance their wastewater surveillance programs.

Tuberculosis: Common Questions and Answers

Approximately 10 million people worldwide were infected with tuberculosis (TB) in 2019, resulting in 1.4 million deaths. In the United States that same year, there were nearly 9,000 reported cases of TB disease and up to 13 million people were living with latent TB infection (LTBI), which is an asymptomatic, noncommunicable infection caused by Mycobacterium tuberculosis. Without treatment, LTBI will progress to active TB disease in approximately 5% to 10% of affected people. Individuals with symptoms of TB disease warrant testing. The U.S. Preventive Services Task Force recommends testing individuals at increased risk of LTBI with an interferon-gamma release assay or tuberculin skin testing. Because the incidence of LTBI in health care professionals is similar to that of the general population, periodic retesting is not recommended. After a positive test result, chest radiography should be performed and, in patients with suspected pulmonary TB disease, sputum collected for diagnosis. Both suspected and confirmed cases of LTBI and TB disease must be reported to local or state health departments. Preferred treatment regimens for LTBI include isoniazid in combination with rifapentine or rifampin, or rifampin alone for a duration of three and four months, respectively. Treatment of drug-susceptible TB disease includes an eight-week intensive phase with four drugs (isoniazid, rifampin, pyrazinamide, and ethambutol), followed by a continuation phase lasting 18 weeks or more, with two drugs based on susceptibility testing results. Consultation with a TB expert is necessary if there is suspicion or confirmation of drug-resistant TB. (Am Fam Physician. 2022;106(3):308–315. Copyright © 2022 American Academy of Family Physicians.)

Reflections On COVID-19: Making Eilen Richards Proud: FCS Responds to COVID-19

Affirming yourself for each accomplished step and acknowledging that some days wifl be more productive than others can give your mental health a boost. * Maintain a regular schedule including a standard bed time, a consistent time for meals, and a commitment to retaining personal grooming standards, work or study schedules, as well as exercise. * Cultivate creative skills rather than ingesting a steady diet of information from the news and social media. * Utilize research skills to locate reliable sources such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for information about the virus. * Model a healthy lifestyle by: о Sharpening the nutritional concepts and food preparation skills that Ellen Richard's "laboratory" promoted. о Creating economical meals using shelf-stable ingredients. о Becoming imaginative in relation to physical activities. Modeling a healthy lifestyle vall more than likely improve your outlook on life and perhaps provide opportunities to share the Family and Consumer Sciences Body of Knowledge with others. * Clean, purge, and organize. Combine sightseeing and problem solving with a challenging, picturesque jigsaw puzzle if travel was a source of relaxation. * Develop a strategy for coping with the "new normal."

Unusual Clinical Experience in BRAF Exon 15 p.K601E-Mutated Lung Cancer: A Case Report and Brief Review of the Literature

Molecular profiling has revolutionized the treatment of metastatic NSCLC. Uncommon mutations have been reported primarily in EGFR and BRAF genes and are frequently associated with atypical clinical presentations. Here, we present a rare case of a patient affected by BRAF exon 15 p.K601E-mutated lung cancer with synchronous peritoneal carcinomatosis. First line treatment with chemo-immunotherapy combinations provided a PFS of 8–9 months, whereas a second line treatment with BRAF and MEK inhibitors elicited a dissociated response. The latter clinical outcome suggests that these inhibitors have only partial activity against this rare mutation.

Autopsy Histopathologic Cardiac Findings in 2 Adolescents Following the Second COVID-19 Vaccine Dose/In Reply

The authors correctly stated that the Centers for Disease Control and Prevention (CDC) performed testing for SARS-CoV-2 and found no evidence of SARS-CoV-2 infection in autopsy tissues from the decedents. Molecular analysis included polymerase chain reaction (PCR) assays on nucleic acid extracted from FFPE heart tissue, including SARS-CoV-2 and enterovirus reverse transcriptase PCR (RT-PCR) assays2,3 and conventional PCR for parvovirus B19. Clostridium septicum produces multiple toxins that cause necrosis of striated muscle cells9,11 and inhibit influx of neutrophils to infected tissues;indeed, paucity of neutrophilic infiltrates in tissues infected with C septicum is considered a hallmark of this disease.9,12 Clostridium septicum is not considered normal flora of the human intestinal tract,13,14 but rather an opportunistic invader of immunologically compromised hosts, particularly persons with colonic adenocarcinoma, leukemia, diabetes, bowel ischemia, or cyclic, congenital, or acquired neutropenia.7,8 Spontaneous infections have been described for a few pediatric patients with no recognized risk factor and for whom microscopic breaches in the mucosa of the large intestine were considered the likely portal of entry.8,15 No representative samples of the small or large intestine were provided to the IDPB for evaluation;however, histologic evidence of bacterial invasion of the external surfaces of the adrenals, kidneys, liver, and spleen support an intraabdominal source of infection. The findings and conclusions in this letter are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. doi: 10.5858/arpa.2022-0084-LE In Reply.-We thank the Centers for Disease Control and Prevention's (CDC's) Infectious Diseases Pathology Branch laboratory for performing these tests and for sharing the full extent of its workup.

THE Pacific WAY

Angela the PPTC's newly appointed Microbiology Specialist and Programme Support Medical Laboratory Scientist commenced employment with the PPTC on the 26th April 2022. Since February 2018, Angela has been employed as a Medical Laboratory Scientist in Microbiology at Canterbury Health Laboratories. PPTC consultancy staff 2022 Philip Wakem NZCS, DipMLS, MMLSc (Otago, NZ), MNZIMLS Chief Executive Officer and Haematology Specialist Navin Karan BMLSc (Otago,NZ) PGDipPH (Massey,NZ) MNZIMLS * Microbiology/Molecular Diagnostics Specialist * Programme Manager For COVID 19 and Infectious Disease * Contract Management * Centre based Courses * Molecular Diagnostics * COVID 19 EQA Filipo Faiga BSc, DipMLS, MNZIMLS * Biochemistry Specialist * Programme Manager * For PPTC External Quality Assessment * Health And Safety * Biochemistry Contracts Russell Cole NZCS, DipMLS, MNZIMLS * Microbiology Specialist * Programme Manager for Laboratory Quality Management * Diploma in Medical Laboratory Science * Microbiology Contracts Angela Lewis BSc, GradDipSci, MNZIMLS * Medical Laboratory Scientist * Microbiology Specialist and Programme Support. * Assistance in Molecular diagnostic platforms and Contacts New PPTC consultants who have joined the PPTC EQA programme Donna Mitchell, NZCS, DipMLS, DipMktg Donna has recently taken over the role of Serology Quality Assurance Consultant for the PPTC's Serology REQA Programme. While at the Princess Margaret Hospital for Canterbury Health Laboratories and later at SCL from 1991, Donna was involved in a variety of work including routine clinical work, research, and evaluation and implementation of Ligase Chain Reaction assays for Chlamydia and M. tuberculosis, and latterly the introduction of the ProbeTec Strand Displacement Assay for both Chlamydia and M. tuberculosis. [...]of the LCR work Donna was asked by Abbott Diagnostics Ltd to introduce the technology to laboratories in both Sydney and Melbourne.

The Pae Ora Healthy Futures Bill and health reforms

The outcome of this was a new national operational entity to be called Health NZ alongside a Māori Health Authority (MHA) and the formation of a national Public Health Agency (PHA). At this time the NZIMLS Executive on behalf of the NZIMLS, was involved in providing submissions on the future structure of the PHA which will be a national agency that will provides significant public health research and diagnostic testing input into Health NZ and the MHA. AUTHOR INFORMATION Terry Taylor BSc DipMLS, MNZIMLS, President New Zealand Institute of Medical Laboratory Science, Rangiora Correspondence: president@nzimls.org.nz REFERENCES 1. https://systemreview.health.govt.nz/final-report 2. https://dpmc.govt.nz/sites/default/files/2021-04/heallthreform-white-paper-summary-apr21.pdf 3. https://legislation.govt.nz/bill/government/2021/0085/ latest/LMS575405.html 4. https://www.parliament.nz/en/pb/sc/submissions-andadvice/document/53SCPOL_EVI_116317_POL1642/newzealand-institute-of-medical-laboratory-science 5. https://issuu.com/associationofsalariedmedicalspecialists/ docs/asms-creating-solutions-fa-web_-_final

ROLE OF REAL TIME PCR (RT-PCR) IN CLINICAL DIAGNOSIS FOR COVID-19 REVIEW

The pandemic of Coronavirus Disease 2019 (COVID19) has compelled scientists to create highly reliable diagnostic tools quickly in order to successfully and properly diagnose this pathology and thereby prevent infection transmission. Even though structural and molecular properties of the severe acute respiratory syndrome coronavirus 2 (SARSCoV2) were previously unknown, private research institutes and biomedical firms quickly developed numerous diagnostic procedures beneficial for making a correct detection of COVID19. Rapid antigen or antibody testing, immunoenzymatic serological tests, and RT-PCR based molecular assays are the most frequently used and validated procedures now available. The PCR has grown in popularity in molecular diagnostics to the point where it is still considered the gold standard for finding nucleotides from a variety of sources becoming an indispensable tool in the research lab. Because of its improved speed, sensitivity, reproducibility, and lower likelihood of carry-over contamination, real-time PCR has gained greater popularity. Currently, five different chemistries are employed to detect PCR product during real-time PCR. The selffluorescing amplicons, DNA binding fluorophores, 5' endonuclease, neighbouring linear and hairpin oligoprobes, and self-fluorescing amplicons are all detailed in depth. We also go through the problems that have hampered the development of multiplex real-time PCR and the importance of real-time PCR in nucleic acid quantification.

Data Mining in Medical Laboratory Service Improves Disease Surveillance and Quality Healthcare

Day in day out, data are turned out in various medical laboratories which are adequately documented and used for surveillance in various diseases of concern in public health. Though data mining seems to be new in healthcare, medical laboratory services as very important component of healthcare need serious data mining for diagnosis of ailments and numerous public health diseases. This chapter was carried out based on review of literatures and practices available in Nigeria which contributes to healthcare quality improvement. The chapter examined origin, basic principles, advantages and disadvantages, uses, and challenges of data mining in relation to medical laboratory information management system (MLIMS) while looking at data management from hard to soft copies, possible applications, ethico-legal perspectives, implications of data mining, disease surveillance, and data mining toward quality improvement as used in medical laboratories. It is evident that most of decisions taken in healthcare and public health are based on information provided by data mining from medical laboratory services based on the diseases of interest. Data mining in medical laboratory services is a tool that aids in monitoring trends in the diagnosis of cancer, HIV, COVID-19, malaria, diabetes, and other diseases based on various parameters of assessment with all demographic variables well documented and analyzed. The interested agencies or ministries may apply data mining techniques based on medical laboratory results to find trends in disease outbreaks or deaths, per hospital, state, region, or country through which policies could be formulated and implemented toward surveillance and quality healthcare improvement. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

2021 NZIMLS top student award recipient: Natalie Heath

[...]I specialised in clinical chemistry and transfusion science. Blood Transfusion is unique since you're providing products to patients, not solely reporting results. For Blood Transfusion in Northland, that means thinking of the people at component processing in Auckland who send us our orders of red cell components, as well as the doctors and nurses at the patient bedside, when making decisions.

Water Management Best Practices During And After Low or No Occupancy

At the time of this column's writing, public buildings across the country and around the world had been closed or were seeing low to no occupancy. Many states had issued "shelter in place" directives,1 and millions of Americans were working from home. The hospitality industry was hit particularly hard, seeing steep declines in occupancy and a rash of closures. Water stagnation causes several issues. Ordinarily, disinfectant levels in public drinking water can manage harmful bacteria in the distribution system and even help slow or stop its growth in buildings. However, during times of water stagnation, disinfectants can dissipate, leaving building systems vulnerable to increased pathogen growth. Maintaining good water quality, and therefore public health, is top of mind across the globe. It is critical for building owners, operators and water treaters to ensure that building water stagnation does not contribute to increased risk from L. pneumophila and Legionnaires' disease. There are several water management best practices to follow while public buildings have low or no occupancy.

INNOVATIONS in Laboratory Medicine

Saving Blood Product in Nova Scotia Dr. Calvino Cheng, a staff hematopathologist at Queen Elizabeth II Health Sciences Centre (QEII), the centre's former Blood Transfusion Director and current Director of Pathology Informatics, and Professor in the Department of Pathology at Dalhousie University in Halifax, Nova Scotia, has developed an algorithm in conjunction with his colleague Dr. Jason Quinn, the Blood Transfusion Director at Queen Elizabeth II Health Sciences Centre. Theywere motivated to look at a strategy to minimize expired red blood cell units in the hospital's blood bank and improve the efficienc of the red cell inventory ordering process. The automated algorithm calculates the number of red blood cell units to be ordered from Canadian Blood Services based on both retrospective daily use and prospectively based on hemoglobin values on all patients in the hospital system. Bridging a Physical Gap for Patient Care in Alberta It was at a medical conference in late 2019 when Wade Hawkins, principal investigator at the Southern Alberta Institute for Technology's Centre for Innovation and Research in Unmanned Systems, had an informal chat with infectious diseases physician Dr. John Conly, a professor in the Cumming School of Medicine at the University of Calgary in Calgary, Alberta, about the concept of using drones to deliver medical supplies to remote First Nations communities.