Application of micro capillary blood sampling in an anti-doping setting.

Blood collection is an important facet of anti-doping testing, forming the basis of the Athlete Biological Passport (ABP). Traditional blood collection via venipuncture can be uncomfortable for athletes, especially those who are tested frequently or close to competition. Athletes may also have negative perceptions of venipuncture due to past experiences or the risks of adverse health events such as bruising, hematomas, syncope, and general discomfort that has the potential to affect performance. Advances in capillary whole blood collection technology now affords the ability to collect micro-volumetric capillary whole blood from the upper arm (or other suitable vascular location such as the abdomen) that is "needle-free" and virtually painless using devices such as the Tasso+. The present study extends previous work, by collecting microliter capillary whole blood samples via the Tasso+ EDTA device in an official anti-doping setting prior to competition, as well as requiring temperature-monitored cold chain shipping by air to the laboratory before analysis. Fifty-eight matched capillary and venous blood samples were collected under official doping control conditions by certified Doping Control Officers. No impact of sample shipment by air under cool conditions was observed on sample integrity. Provided that no visible clots were identified prior to analysis, capillary and venous blood samples showed excellent laboratory agreement for all CBC parameters, with the exception of platelets. Micro capillary blood collection provides a valid alternative to venous blood collection for ABP purposes, with the advantage of providing a more athlete-friendly experience, particularly close to competition.

Use of a catch-up programme to improve routine immunization in 13 provinces of Papua New Guinea, 2020-2022.

Objective: Routine immunization coverage in Papua New Guinea has decreased in the past 5 years. This persistently low routine immunization coverage has resulted in low population immunity and frequent outbreaks of vaccine-preventable disease across the country. We describe the use of a catch-up programme to improve routine immunization during the coronavirus disease pandemic in Papua New Guinea during 2020-2022. Methods: In June 2020, 13 provinces of Papua New Guinea were selected to undergo a vaccination catch-up programme, with technical support from the World Health Organization (WHO) and the United Nations Children's Fund. Twelve provinces received financial and logistic support through the Accelerated Immunization and Health Systems Strengthening programme, and one received support from WHO. All stakeholders were involved in planning and implementing the catch-up programme. Results: Between July 2020 and June 2022, about 340 health facilities conducted catch-up activities. The highest number of children aged under 1 year were vaccinated in 2022 (n = 33 652 for third dose of pentavalent vaccine). The national coverage of routine immunization (including the catch-up vaccinations) increased between 2019 and 2020 - by 5% for the third dose of pentavalent vaccine, 11% for the measles-rubella vaccine and 16% for the inactivated poliovirus vaccine. The coverage declined slightly in 2021 before increasing again in 2022. Discussion: The catch-up programme was an instrumental tool to improve routine immunization coverage between 2020 and 2022 and during the pandemic in Papua New Guinea. With appropriate technical and logistic support, including financial and human resources, catch-up programmes can strengthen routine immunization coverage across the country.

Detection of erythropoiesis stimulating agent Luspatercept after administration to healthy volunteers for antidoping purposes.

Luspatercept (Reblozyl®) is a newly approved anti-anemic drug prohibited by the World Anti-Doping Agency. It promotes erythropoiesis by limiting apoptosis of immature erythroblasts and the risk of misuse by athletes for doping is high. Proposed detection methods have been published recently but only evaluated in vitro. The objective of this study was to perform the first administration of luspatercept in healthy volunteers for antidoping purpose and to evaluate the detectability in serum, dried capillary blood spots (DBS, collected using TASSO M20 device), and urine. Indirect detection was also evaluated by analyzing hematological parameters for the Athlete Biological Passport. Four volunteers (two males, two females) received one subtherapeutic dose of luspatercept (0.25 mg/kg) followed 3 weeks after by a second dose. Samples were collected from before administration until 7 weeks after the second dose. After immunopurification, electrophoretic separation SDS-/SAR-/IEF- polyacrylamide gel electrophoresis (PAGE), and immunodetection, luspatercept was detected at high levels in serum until the end of the collection, sign of a very slow elimination and similarly detected unchanged at lower levels in urine from 2 days after the first administration until 7 weeks postadministration. DBS showed also the same long window of detection. Luspatercept effects were however of limited amplitude on hematological markers, and only two subjects presented atypical points outside the physiological limits during the study. The direct detection method was very efficient, and change of electrophoretic method and detection antibody can be used for confirmation of suspicious samples.

Single-cell modeling of routine clinical blood tests reveals transient dynamics of human response to blood loss.

Low blood count is a fundamental disease state and is often an early sign of illnesses including infection, cancer, and malnutrition, but our understanding of the homeostatic response to blood loss is limited, in part by coarse interpretation of blood measurements. Many common clinical blood tests actually include thousands of single-cell measurements. We present an approach for modeling the unsteady-state population dynamics of the human response to controlled blood loss using these clinical measurements of single-red blood cell (RBC) volume and hemoglobin. We find that the response entails (1) increased production of new RBCs earlier than is currently detectable clinically and (2) a previously unrecognized decreased RBC turnover. Both component responses offset the loss of blood. The model provides a personalized dimensionless ratio that quantifies the balance between increased production and delayed clearance for each individual and may enable earlier detection of both blood loss and the response it elicits.

Detection and in vitro metabolism of the confiscated peptides BPC 157 and MGF R23H.

A new peptide, body protecting compound (BPC), BPC 157, and a variant of mechano-growth factor (MGF), MGF R23H, were identified in confiscated vials. BPC 157 has the amino acid sequence, GEPPPGKPADDAGLV, and is currently under investigation for the promotion of healing and recovery in a variety of tissues. In vitro metabolism experiments in plasma demonstrate that MGF R23H has good stability and should be detectable in urine, while BPC 157 forms a stable metabolite that should be detectable in urine. A weak cation exchange solid phase extraction method was validated for detection of BPC 157 in urine. The method has a limit of detection of 0.1 ng/mL, precision of less than 20%, and good linearity, r2 0.998. BPC 157 was stable in urine for at least 4 days. The specificity of the method is improved by measurement of a potential BPC metabolite along with the parent peptide. Copyright © 2016 John Wiley & Sons, Ltd.

Investigation of the metabolites of the HIF stabilizer FG-4592 (roxadustat) in five different in vitro models and in a human doping control sample using high resolution mass spectrometry.

FG-4592 is a hypoxia-inducible factor (HIF) stabilizer, which can increase the number of red blood cells in the body. It has not been approved by regulatory authorities, but is available for purchase on the Internet. Due to its ability to improve the oxygen transportation mechanism in the body, FG-4592 is of interest for doping control laboratories, but prior to this study, little information about its metabolism was available. In this study, the metabolism of FG-4592 was investigated in a human doping control sample and in five in vitro models: human hepatocytes and liver microsomes, equine liver microsomes and S9 fraction and the fungus Cunninghamella elegans. By using liquid chromatography coupled to a Q-TOF mass spectrometer operated in MSE and MSMS modes, twelve different metabolites were observed for FG-4592. One monohydroxylated metabolite was detected in both the human and equine liver microsome incubations. For the fungus Cunninghamella elegans eleven different metabolites were observed of which the identical monohydroxylated metabolite had the highest response. This rich metabolic profile and the higher levels of metabolites produced by Cunninghamella elegans demonstrates its usefulness as a metabolite producing medium. In the doping control urine sample, one metabolite, which was the result of a direct glucuronidation, was observed. No metabolites were detected in neither the human hepatocyte nor in the equine liver S9 fraction incubates.

Lysophosphatidic Acid Stimulates Urokinase Receptor (uPAR/CD87) in Ovarian Epithelial Cancer Cells.

BACKGROUND/AIM: Lysophosphatidic acid (LPA) is a bioactive lipid positively linked with ovarian cancer progression. The multi-functional urokinase receptor (uPAR), a cell-surface glycoprotein, binds and facilitates activation of uPA and laterally regulates integrin and tyrosine kinase receptor activities in promotion of cell migration and invasion. We hypothesized that LPA stimulates uPAR expression and activity in ovarian epithelial cancer cells. MATERIALS AND METHODS: Ovarian epithelial cancer cell lines OVCA 429 and OVCA 433 were stimulated with LPA and examined for uPAR mRNA expression and protein localization. uPA binding to OVCA plasma membranes was measured through enzymatic analysis of affinity-isolated cell-surface proteins. RESULTS: LPA drove cell-surface uPAR aggregation and mRNA expression concomitant with increased cell-surface binding of uPA. Both control and LPA-stimulated uPAR expression and uPA cell-surface association involved phosphatidylinositol 3-kinase, but not p38 or p42 mitogen-activated protein kinase, signaling. CONCLUSION: These data provide mechanistic insight into ovarian epithelial cancer cell progression by demonstrating that LPA drives uPAR expression and uPA binding.

Human resources for health: lessons from the cholera outbreak in Papua New Guinea.

ISSUE: Papua New Guinea is striving to achieve the minimum core requirements under the International Health Regulations in surveillance and outbreak response, and has experienced challenges in the availability and distribution of health professionals. CONTEXT: Since mid-2009, a large cholera outbreak spread across lowland regions of the country and has been associated with more than 15 500 notifications at a case fatality ratio of 3.2%. The outbreak placed significant pressure on clinical and public health services. ACTION: We describe some of the challenges to cholera preparedness and response in this human resource-limited setting, the strategies used to ensure effective cholera management and lessons learnt. OUTCOME: Cholera task forces were useful to establish a clear system of leadership and accountability for cholera outbreak response and ensure efficiencies in each technical area. Cholera outbreak preparedness and response was strongest when human resource and health systems functioned well before the outbreak. Communication relied on coordination of existing networks and methods for empowering local leaders and villagers to modify behaviours of the population. DISCUSSION: In line with the national health emergencies plan, the successes of human resource strategies during the cholera outbreak should be built upon through emergency exercises, especially in non-affected provinces. Population needs for all public health professionals involved in health emergency preparedness and response should be mapped, and planning should be implemented to increase the numbers in relevant areas. Human resource planning should be integrated with health emergency planning. It is essential to maintain and strengthen the human resource capacities and experiences gained during the cholera outbreak to ensure a more effective response to the next health emergency.

Dissociation energy and electronic and vibrational spectroscopy of Co(+)(H2O) and its isotopomers.

The electronic spectra of Co(+)(H(2)O), Co(+)(HOD), and Co(+)(D(2)O) have been measured from 13,500 to 18,400 cm(-1) using photodissociation spectroscopy. Transitions to four excited electronic states with vibrational and partially resolved rotational structure are observed. Each electronic transition has an extended progression in the metal-ligand stretch, v(3), and the absolute vibrational quantum numbering is assigned by comparing isotopic shifts between Co(+)(H(2)(16)O) and Co(+)(H(2)(18)O). For the low-lying excited electronic states, the first observed transition is to v(3)' = 1. This allows the Co(+)-(H(2)O) binding energy to be determined as D(0)(0 K)(Co(+)-H(2)O) = 13730 ± 90 cm(-1) (164.2 ± 1.1 kJ/mol). The photodissociation spectrum shows a well-resolved K(a) band structure due to rotation about the Co-O axis. This permits determination of the spin rotation constants ε(aa)" = -6 cm(-1) and ε(aa)' = 4 cm(-1). However, the K(a) rotational structure depends on v(3)'. These perturbations in the spectrum make the rotational constants unreliable. From the nuclear spin statistics of the rotational structure, the ground state is assigned as (3)B(1). The electronic transitions observed are from the Co(+)(H(2)O) ground state, which correlates to the cobalt ion's (3)F, 3d(8) ground state, to excited states which correlate to the (3)F, 3d(7)4s and (3)P, 3d(8) excited states of Co(+). These excited states of Co(+) interact less strongly with water than the ground state. As a result, the excited states are less tightly bound and have longer metal-ligand bonds. Calculations at the CCSD(T)/aug-cc-pVTZ level also predict that binding to Co(+) increases the H-O-H angle in water from 104.1° to 106.8°, as the metal removes electron density from the oxygen lone pairs. The O-H stretching frequencies of the ground electronic state of Co(+)(H(2)O) and Co(+)(HOD) have been measured by combining IR excitation with visible photodissociation in a double resonance experiment. In Co(+)(H(2)O) the O-H symmetric stretch is ν(1)" = 3609.7 ± 1 cm(-1). The antisymmetric stretch is ν(5)" = 3679.5 ± 2 cm(-1). These values are 47 and 76 cm(-1), respectively, lower than those in bare H(2)O. In Co(+)(HOD) the O-H stretch is observed at 3650 cm(-1), a red shift of 57 cm(-1) relative to bare HOD.

Human resources for health: lessons from the cholera outbreak in Papua New Guinea

Issue：Papua New Guinea is striving to achieve the minimum core requirements under the International Health Regulations in surveillance and outbreak response, and has experienced challenges in the availability and distribution of health professionals.Context：Since mid-2009, a large cholera outbreak spread across lowland regions of the country and has been associated with more than 15 500 notifications at a case fatality ratio of 3.2%. The outbreak placed significant pressure on clinical and public health services.Action：We describe some of the challenges to cholera preparedness and response in this human resource-limited setting, the strategies used to ensure effective cholera management and lessons learnt.Outcome：Cholera task forces were useful to establish a clear system of leadership and accountability for cholera outbreak response and ensure efficiencies in each technical area. Cholera outbreak preparedness and response was strongest when human resource and health systems functioned well before the outbreak. Communication relied on coordination of existing networks and methods for empowering local leaders and villagers to modify behaviours of the population.Discussion：In line with the national health emergencies plan, the successes of human resource strategies during the cholera outbreak should be built upon through emergency exercises, especially in non-affected provinces. Population needs for all public health professionals involved in health emergency preparedness and response should be mapped, and planning should be implemented to increase the numbers in relevant areas. Human resource planning should be integrated with health emergency planning. It is essential to maintain and strengthen the human resource capacities and experiences gained during the cholera outbreak to ensure a more effective response to the next health emergency.

International collaborative faculty development program on simulation-based healthcare education: a report on its successes and challenges.

PURPOSE: Countries that are less experienced with simulation-based healthcare education (SBHE) often import Western programs to initiate their efforts to deliver effective simulation training. Acknowledging cultural differences, we sought to determine whether faculty development program on SBHE in the United States could be transported successfully to train faculty members in Korea. METHODS: An international, collaborative, multi-professional program from a pre-existing Western model was adapted. The process focused on prioritization of curricular elements based on local needs, translation of course materials, and delivery of the program in small group facilitation exercises. Three types of evaluation data were collected: participants' simulation experience; participants' ratings of the course; and participant's self-assessment of the impact of the course on their knowledge, skills, and attitudes (KSA) toward simulation teaching. RESULTS: Thirty faculty teachers participated in the course. Eighty percent of the participants answered that they spent less than 25% of their time as simulation instructors. Time spent on planning, scenario development, delivering training, research, and administrative work ranged from 10% to 30%. Twenty-eight of 30 participants agreed or strongly agreed that the course was excellent and relevant to their needs. The participants' assessment of the impact of the course on their KSA toward simulation teaching improved significantly. CONCLUSION: Although there were many challenges to overcome, a systematic approach in the adaptation of a Western simulation faculty development course model was successfully implemented in Korea, and the program improves self-confidence and learning in participants.

Vibrational spectroscopy and theory of Fe(+)(CH(4))(n) (n = 1-4).

Vibrational spectra are measured for Fe(+)(CH(4))(n) (n = 1-4) in the C-H stretching region (2500-3200 cm(-1)) using photofragment spectroscopy. Spectra are obtained by monitoring CH(4) fragment loss following absorption of one photon (for n = 3, 4) or sequential absorption of multiple photons (for n = 1, 2). The spectra have a band near the position of the antisymmetric C-H stretch in isolated methane (3019 cm(-1)), along with bands extending >250 cm(-1) to the red of the symmetric C-H stretch in methane (2917 cm(-1)). The spectra are sensitive to the ligand configuration (η(2) vs η(3)) and to the Fe-C distance. Hybrid density functional theory calculations are used to identify possible structures and predict their vibrational spectra. The IR photodissociation spectrum shows that the Fe(+)(CH(4)) complex is a quartet, with an η(3) configuration. There is also a small contribution to the spectrum from the metastable sextet η(3) complex. The Fe(+)(CH(4))(2) complex is also a quartet with both CH(4) in an η(3) configuration. For the larger clusters, the configuration switches from η(3) to η(2). In Fe(+)(CH(4))(3), the methane ligands are not equivalent. Rather, there is one short and two long Fe-C bonds, and each methane is bound to the metal in an η(2) configuration. For Fe(+)(CH(4))(4), the calculations predict three low-lying structures, all with η(2) binding of methane and very similar Fe-C bond lengths. No single structure reproduces the observed spectrum. The approximately tetrahedral C(1) ((4)A) structure contributes to the spectrum; the nearly square-planar D(2d) ((4)B(2)) and the approximately tetrahedral C(2) ((4)A) structure may contribute as well.

Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study.

BACKGROUND: Gastric bypass has repeatedly been shown to improve and even cure type 2 diabetes by substantially improving insulin resistance. The mechanism by which it achieves this is not currently known, but some have hypothesized that there may be important humoral effects brought about by the bypass of the stomach, duodenum or proximal jejunum. A better understanding of the time course of the changes in insulin resistance after surgery might assist our understanding of potential mechanisms. METHODS: Intravenous glucose tolerance tests (IVGTT) were performed in 26 severely obese patients on the morning of gastric bypass surgery and again 6 days later. In addition insulin resistance was assessed in 71 patients undergoing gastric bypass surgery by the homeostasis model assessment (HOMA) method before surgery, and again at 6 days, 3, 6, 9, and 12 months. Patients were divided into 3 groups for analysis: diabetics, impaired glucose tolerance and normal glucose tolerance. RESULTS: All 3 groups of patients were noted to have insulin resistance prior to surgery. This was greatest in the diabetic patients, as indicated by HOMA. There was marked loss of/improvement in insulin resistance within 6 days of gastric bypass by both IVGTT and HOMA methods in all groups, which was maintained over the 12-month period. The study included 31 diabetic patients, of whom only 3 required medication following hospital discharge. CONCLUSION: The changes in insulin resistance seen after gastric bypass, which are responsible for the resolution or improvement of type 2 diabetes occur within 6 days of the surgery, before any appreciable weight loss has occurred. This finding has implications for our understanding of the mechanism of insulin resistance in severely obese patients and is consistent with a humoral mechanism emanating from the GI tract.

Self-reported diabetes and health behaviors in remote indigenous communities in northern queensland, australia.

OBJECTIVE: This study examines associations between self-reported diabetes and self-reported smoking, alcohol consumption, fruit consumption, and participation in adequate exercise in remote indigenous communities, using data from the Well Persons' Health Check (WPHC). RESEARCH DESIGN AND METHODS: The WPHC was a cross-sectional survey of 2,862 indigenous individuals (1,602 Aborigines, 1,074 Torres Strait Islanders, and 186 persons of joint descent) aged > or =15 years. The study was conducted in 26 remote communities in northern Queensland, Australia, between March 1998 and October 2000. RESULTS: A total of 32% of individuals with self-reported diabetes and 25% of other individuals reported eating enough fruit, according to National Health and Medical Research Council criteria: odds ratio (OR) 1.407 (95% CI 1.108-1.786), P = 0.006. After adjustment for age, sex, and ethnicity, no significant difference could be observed: adjusted OR 1.22 (0.944-1.574), P = 0.128. A total of 58% of participants who reported diabetes and 51% of others reported adequate exercise: OR 0.761 (0.609-0.952), P = 0.018. This difference was not significant after adjustment for age, sex, and ethnicity: adjusted OR 0.896 (0.705-1.14), P = 0.370. A total of 43% of individuals who reported diabetes and 72% of others reported consuming alcohol: OR 0.295 (0.235-0.369), P < 0.001. After adjustment for age, sex, and ethnicity, this difference was still significant: adjusted OR 0.550 (0.428-0.709), P < 0.001. Diabetic drinkers consumed alcohol at harmful levels similar to those of nondiabetic drinkers (P = 0.691). A total of 40% of individuals who reported diabetes and 63% of other persons were tobacco smokers: OR 0.403 (0.322-0.505), P < 0.001. Although this crude difference was attenuated by adjustment for age, sex, and ethnicity, persons with self-reported diabetes were still significantly less likely to smoke tobacco than other participants: adjusted OR 0.666 (0.521-0.852), P = 0.001. Smoking prevalence among the diabetic indigenous participants was more than double that in nondiabetic nonindigenous Australians. CONCLUSIONS: This study suggests that indigenous individuals with diabetes living in rural and remote communities are not adopting lifestyle changes required for optimal self-management of the disease. This contributes to the large excess of mortality and morbidity experienced by this population.

Teaching pharmacy history: the antipodean experience.

This paper, co-authored by Dr. Rosemary Beresford, the Associate Dean of Undergraduate Programmes in the School of Pharmacy at the University of Otago, in New Zealand was presented by Mr Geoffrey Miller to the 75th Anniversary Congress of the International Society for the History of Pharmacy, held in Lucern Switzerland in September 2001.

Tasmania: green pastures for the Browne family of pharmacists.

This is the story of another Pharmacy dynasty, the Brownes of Tasmania, who can trace three generations of pharmacists from the one family, going back to 1882.