Effects of nurse visit copayment on primary care use: Do low-income households pay the price?

Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%-10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.

Breaking free How preregistration hurts scholars and science.

Pre-registration has become an increasingly popular proposal to address concerns regarding questionable research practices. Yet preregistration does not necessarily solve these problems. It also causes additional problems, including raising costs for more junior and less resourced scholars. In addition, pre-registration restricts creativity and diminishes the broader scientific enterprise. In this way, pre-registration neither solves the problems it is intended to address, nor does it come without costs. Pre-registration is neither necessary nor sufficient for producing novel or ethical work. In short, pre-registration represents a form of virtue signaling that is more performative than actual.

Quantitative protein mass-spectrometry requires a standardized pre-analytical phase.

OBJECTIVES: Quantitative protein mass-spectrometry (QPMS) in blood depends on tryptic digestion of proteins and subsequent measurement of representing peptides. Whether serum and plasma can be used interchangeably and whether in-vitro anticoagulants affect the recovery is unknown. In our laboratory serum samples are the preferred matrix for QPMS measurement of multiple apolipoproteins. In this study, we investigated the effect of different matrices on apolipoprotein quantification by mass spectrometry. METHODS: Blood samples were collected from 44 healthy donors in Beckton Dickinson blood tubes simultaneously for serum (with/without gel) and plasma (heparin, citrate or EDTA). Nine apolipoproteins were quantified according to standard operating procedure using value-assigned native serum calibrators for quantitation. Tryptic digestion kinetics were investigated in the different matrices by following formation of peptides for each apolipoprotein in time, up to 22 h. RESULTS: In citrate plasma recovery of apolipoproteins showed an overall reduction with a bias of -14.6%. For heparin plasma only -0.3% bias was found compared to serum, whereas for EDTA-plasma reduction was more pronounced (-5.3% bias) and variable with >14% reduction for peptides of apoA-I, A-II and C-III. Digestion kinetics revealed that especially slow forming peptides showed reduced formation in EDTA-plasma. CONCLUSIONS: Plasma anticoagulants affect QPMS test results. Heparin plasma showed comparable results to serum. Reduced concentrations in citrate plasma can be explained by dilution, whereas reduced recovery in EDTA-plasma is dependent on altered proteolytic digestion efficiency. The results highlight the importance of a standardized pre-analytical phase for accurate QPMS applications in clinical chemistry.

Performance of ImproGene cfDNA blood collection tubes for mutation analysis in cancer patients.

With the widely application of liquid biopsy and the development of detection technology, the standardization of pre-analysis procedures is necessary. For controlling pre-analysis variation of circulating tumor DNA (ctDNA) in blood samples, the blood collection tubes for ctDNA preservation particularly contribute a lot. The objective of this study was to investigate whether ImproGene® Cell Free DNA Tube (ImproGene tube) can be used in sample collection, preservation and NGS based mutation detection for ctDNA. We investigated hemolysis and cell free DNA (cfDNA) concentration of blood samples stored in ImproGene tubes and detected ß-actin, LINE1 and exogenous gene level by qPCR. We compared cfDNA and RNA quantity between samples in ImproGene tube and Streck Cell-Free DNA BCT® (Streck tube). And 10 gene mutations and three fusion mutations analysis were compared by sequencing. When stored at room temperature within 7 days in ImproGene tubes, blood samples had no visible hemolysis and the cfDNA concentration, levels of ß-actin, LINE1 and exogenous gene remained stable which means no genomic DNA release and cfDNA was protected. There was no significant difference in cfDNA and RNA quantity between ImproGene tubes and Streck tubes. Furthermore, based on this limited data set, ImproGene tubes showed increased detection rates of low-level mutations. Therefore, ImproGene Cell Free DNA Tubes may have promising applications in sample collection, preservation and NGS based mutation detection for ctDNA by its good preservation performance.

Variability in the Pre-Analytical Stages Influences Microbiome Laboratory Analyses.

Introduction: There are numerous confounding variables in the pre-analytical steps in the analysis of gut microbial composition that affect data consistency and reproducibility. This study compared two DNA extraction methods from the same faecal samples to analyse differences in microbial composition. Methods: DNA was extracted from 20 faecal samples using either (A) chemical/enzymatic heat lysis (lysis buffer, proteinase K, 95 °C + 70 °C) or (B) mechanical and chemical/enzymatic heat lysis (bead-beating, lysis buffer, proteinase K, 65 °C). Gut microbiota was mapped through the 16S rRNA gene (V3−V9) using a set of pre-selected DNA probes targeting >300 bacteria on different taxonomic levels. Apart from the pre-analytical DNA extraction technique, all other parameters including microbial analysis remained the same. Bacterial abundance and deviations in the microbiome were compared between the two methods. Results: Significant variation in bacterial abundance was seen between the different DNA extraction techniques, with a higher yield of species noted in the combined mechanical and heat lysis technique (B). The five predominant bacteria seen in both (A) and (B) were Bacteroidota spp. and Prevotella spp. (p = NS), followed by Bacillota (p = 0.005), Lachhnospiraceae (p = 0.0001), Veillonella spp. (p < 0.0001) and Clostridioides (p < 0.0001). Conclusion: As microbial testing becomes more easily and commercially accessible, a unified international consensus for optimal sampling and DNA isolation procedures must be implemented for robustness and reproducibility of the results.

Performance of ImproGene Cell-Free DNA Tubes for Stabilization and Analysis of cfDNA in Blood Samples.

BACKGROUND: With the development of liquid biopsy technology, the demand for noninvasive prenatal testing (NIPT) is increasing rapidly. The aim of the study is to evaluate the effects of different blood collection tubes on plasma cfDNA and NIPT quality control. METHODS: We investigated hemolysis, cfDNA concentration, and fragment distribution within blood samples stored in EDTA, ImproGene, and Streck tubes. The effects of ImproGene and Streck tubes on NIPT quality control were evaluated. RESULTS: The ImproGene tubes prevented the time-dependent increase of cfDNA concentration and preserved the cfDNA fragment size distribution. For NIPT quality control, there is no significant difference in cfDNA, library concentration, and fetal fraction between ImproGene and Streck tubes samples. GC content of the samples in ImproGene tubes was closer to the human genome. CONCLUSION: The ImproGene cfDNA tube has excellent performance and is an effective choice for storing blood samples for NIPT testing or other cfDNA analysis.

Psychophysiology, cognition, and political differences: Guest editors' introduction to the special issue.

We introduce the Politics and the Life Sciences special issue on Psychophysiology, Cognition, and Political Differences. This issue represents the second special issue funded by the Association for Politics and the Life Sciences that adheres to the Open Science Framework for registered reports (RR). Here pre-analysis plans (PAPs) are peer-reviewed and given in-principle acceptance (IPA) prior to data being collected and/or analyzed, and are published contingent upon the preregistration of the study being followed as proposed. Bound by a common theme of the importance of incorporating psychophysiological perspectives into the study of politics, broadly defined, the articles in this special issue feature a unique set of research questions and methodologies. In the following, we summarize the findings, discuss the innovations produced by this research, and highlight the importance of open science for the future of political science research.

How to Handle CT-Guided Abscess Drainages in Microbiological Analyses? Sterile Vials vs. Blood Culture Bottles for Transport and Processing.

The aim of this investigation was to compare microbiological analyses of 100 computed tomography-guided drainages from infectious foci (thoracic, abdominal, musculoskeletal), transported and analyzed by two widely established techniques, that are (i) sterile vials or (ii) inoculated blood culture bottles. The mean number of detected microorganisms from blood culture (aerobic/anaerobic) or conventional method (sterile vial, solid and broth media) per specimen were comparable with 1.29 and 1.41, respectively (p = 1.0). The conventional method showed a trend towards shorter time-to-result (median 28.62 h) in comparison to blood culture incubation (median 43.55 h) (p = 0.0722). Of note, detection of anaerobes (13% vs. 36%) and the number of detected microorganisms in polymicrobial infections (2.76 vs. 3.26) differed significantly with an advantage towards conventional techniques (p = 0.0015; p = 0.035), especially in abdominal aspirations. Despite substantially overlapping results from both techniques, the conventional approach includes some benefits which justify its role as standard approach.

The COVID-19 pandemic and the 2020 US presidential election.

What is the effect of the COVID-19 pandemic on the 2020 US presidential election? Guided by a pre-analysis plan, we estimate the effect of COVID-19 cases and deaths on the change in county-level voting for Donald Trump between 2016 and 2020. To account for potential confounders, we include a large number of COVID-19-related controls as well as demographic and socioeconomic variables. Moreover, we instrument the numbers of cases and deaths with the share of workers employed in meat-processing factories to sharpen our identification strategy. We find that COVID-19 cases negatively affected Trump's vote share. The estimated effect appears strongest in urban counties, in states without stay-at-home orders, in swing states, and in states that Trump won in 2016. A simple counterfactual analysis suggests that Trump would likely have won re-election if COVID-19 cases had been 5 percent lower. We also find some evidence that COVID-19 incidence had a positive effect on voters' mobilization, helping Biden win the presidency.

Improving Science by Overcoming Laboratory Pitfalls With Hormone Measurements.

Despite all the effort taken, there is often surprisingly little attention paid to the hormone analyses involved in research studies. Thinking carefully about the quality of the hormone measurements in these studies is, however, of major importance, as this attention to methods may prevent false conclusions and inappropriate follow-up studies. We discuss issues regarding hormone measurements that one should consider, ideally prior to starting, or otherwise, as they arise during a scientific study: quality of the technique, expertise, matrices, timing and storage conditions, freeze-thaw cycles, lot-to-lot and day-to-day variation, analyses per batch or sample-wise, singlicate or duplicate measurements, combining methods, and standardization. This article and the examples mentioned herein aim to clarify the need to pay attention to the hormone analyses, and to help in making decisions. In addition, these examples help editors and reviewers of scientific journals to pay attention to the methods section in the submitted manuscripts and ask the right critical questions when needed.

Disgust and political attitudes Guest Editors' Introduction to the Special Issue.

We introduce the Politics and the Life Sciences Special Issue on Disgust and Political Attitudes discussing the importance of understanding state and trait disgust, the innovative and transparent process by which registered reports and preregistered studies were chosen and funded, and the manuscripts that make up this special issue. This essay concludes by discussing future research directions in disgust and political attitudes, as well as the benefits of a transparent review process that avoids the "file drawer problem" of unpublished null findings.

Factors that drive the increasing use of FFPE tissue in basic and translational cancer research.

The decision to use 10% neutral buffered formalin fixed, paraffin embedded (FFPE) archival pathology material may be dictated by the cancer research question or analytical technique, or may be governed by national ethical, legal and social implications (ELSI), biobank, and sample availability and access policy. Biobanked samples of common tumors are likely to be available, but not all samples will be annotated with treatment and outcomes data and this may limit their application. Tumors that are rare or very small exist mostly in FFPE pathology archives. Pathology departments worldwide contain millions of FFPE archival samples, but there are challenges to availability. Pathology departments lack resources for retrieving materials for research or for having pathologists select precise areas in paraffin blocks, a critical quality control step. When samples must be sourced from several pathology departments, different fixation and tissue processing approaches create variability in quality. Researchers must decide what sample quality and quality tolerance fit their specific purpose and whether sample enrichment is required. Recent publications report variable success with techniques modified to examine all common species of molecular targets in FFPE samples. Rigorous quality management may be particularly important in sample preparation for next generation sequencing and for optimizing the quality of extracted proteins for proteomics studies. Unpredictable failures, including unpublished ones, likely are related to pre-analytical factors, unstable molecular targets, biological and clinical sampling factors associated with specific tissue types or suboptimal quality management of pathology archives. Reproducible results depend on adherence to pre-analytical phase standards for molecular in vitro diagnostic analyses for DNA, RNA and in particular, extracted proteins. With continuing adaptations of techniques for application to FFPE, the potential to acquire much larger numbers of FFPE samples and the greater convenience of using FFPE in assays for precision medicine, the choice of material in the future will become increasingly biased toward FFPE samples from pathology archives. Recognition that FFPE samples may harbor greater variation in quality than frozen samples for several reasons, including variations in fixation and tissue processing, requires that FFPE results be validated provided a cohort of frozen tissue samples is available.

Establishment and application of central tube preparation system for blood samples from hospitalized patients in clinical laboratories / 临床检验杂志

Objective To establish the central tube preparation system for the blood samples from hospitalized patients in clinical laboratories and explore its application value.Methods A central tube preparation system for clinical specimen was researched and developed.The system was directly connected with the laboratory information management system (LIMS) and hospital information management system (HIMS) for monitoring and tracking management on-line with standardization,intellectualization and informatization during the whole process of collection,detection and report of clinical specimens.Results The central tube preparation system for blood samples from hospitalized patients in clinical laboratories was successfully established.The development and application of this system optimized the blood collection process,avoided incidental human mistakes in traditional blood collection process,realized the real-time monitoring of the clinical samples during the whole process and reduced the labor intensity of nurses.Therefore,the working efficiency and degree of clinical satisfaction were increased greatly.Conclusion The developed system could process the specimens intelligently,improve the management level of hospital and department and provide guarantee for standardized management of clinical laboratories.

Technical and clinical validation of the Greiner FC-Mix glycaemia tube.

BACKGROUND: Measurement of adequate glucose concentrations is complicated by in vitro breakdown of glucose due to glycolysis. Unlike the commonly used NaF-EDTA and NaF-oxalate phlebotomy tubes, citrated NaF-EDTA tubes are reported to directly and thereby completely inhibit glycolysis. Recently, Greiner introduced the Vacuette® FC-Mix NaF-EDTA-citrate tube, currently the only NaF-citrate tube without volume-disturbing liquid additions available on the European market. Here we present its potential as alternative for the laborious and therefore unfeasible conditions for glucose sampling as recommended by the World Health Organization (WHO). METHODS: The FC-Mix tube was tested against the WHO recommended method of optimal laboratory conditions, both in healthy volunteers and pregnant woman undergoing oral glucose tolerance test (oGTT) for screening of gestational diabetes mellitus (GDM). Glucose concentrations were measured after different incubation times (0-48 h) and temperatures (room temperature, 37 °C), both in uncentrifuged whole blood and centrifuged material. RESULTS: Deming regression analysis shows that glucose concentrations measured in the FC-Mix tube correlate to the WHO recommended method. Stability is maintained at room temperature for 48 h and at least 24 h at 37 °C. The use of the FC-Mix tube was also validated in screening for GDM and proved comparable to the WHO recommended method in diagnostic outcome. CONCLUSIONS: The new Greiner FC-Mix tube combines the easy handling of a routine tube with dry additive with the ability to immediately inhibit glycolysis as in the WHO method for optimal pre-analytical and analytical conditions and performs equally to those conditions when screening for GDM.

Mesoporous silica chip: enabled peptide profiling as an effective platform for controlling bio-sample quality and optimizing handling procedure.

BACKGROUND: High quality clinical samples are critical for meaningful interpretation of data obtained in both basic and translational medicine. More specifically, optimized pre-analysis handling to bio-sample is crucial for avoiding biased analysis in a clinical setting. A universally applicable method for the evaluation of sample quality and pre-analysis handling is therefore in great demand. METHODS: The fingerprint pattern of low molecular weight (LMW) peptides in sera is directly associated with sample quality and handling process. Previous studies for enrichment/isolation of LMW peptides have shown that LMW peptides can be enriched by silica meso-porous material in a sensitive and high-throughput manner. Here, a peptide profile approach utilizing mesoporous silica chip-based sample preparation combined with MALDI MS analysis was used as a new platform for evaluation of bio-sample quality. Rat sera were selected as model sample and analyzed according to their LMW peptide fingerprint spectra. RESULTS: This novel method can complete the entire sample preparation procedure in a short period of time (<40 min), requires minimum amounts of sample (<10 µL), is of high sensitivity (LOD 10 ng/mL) as well as high reproducibility (CV% < 15%). According to the acquired LMW peptide spectra, we were able to distinguish the serum samples processed under different conditions (including different storage temperature, time, and freezing/thaw cycles) with the help of bioinformatics tools (principle composition analysis and significant difference analysis), and identify the samples that had significantly changed due to the inappropriate processing. Based on the percentage of significantly changed peaks in LMW peptide mass spectrum after handling, a judgment standard was established that can be used to evaluate the status of preservation of a biological sample. In addition, our principle study established recommendations for storage time, storage temperature and freeze/thaw conditions. CONCLUSION: Our novel method for analysis of bio-samples allows for effective identification of variations in composition within samples, and provides a cost-effective tool for simple sample manipulation in a clinical setting.

The effects of pre-analysis sample handling on human plasma amino acid concentrations.

BACKGROUND: The accurate and reliable quantification of amino acid concentrations in human plasma is important for the investigation of a number of diseases. However, few systematic studies investigating the changes in amino acid concentrations related to blood collection and storage conditions have been completed. METHODS: Blood samples were collected with EDTA-Na2 from 3 healthy volunteers and subjected to a number of different treatments; hemolysis, temperature after blood collection, time from blood collection to cooling, the influence of platelets, long term storage conditions, and repeated freeze-thaw cycles. Changes in the concentrations of 22 amino acids were determined using an Amino Acid Analyzer. RESULTS: Of the conditions influencing sample stability between blood collection and amino acid analysis, hemolysis, temperature after blood collection, and long-term storage at -20°C affected the concentrations of 11 amino acids. Time from blood collection to cooling, platelet contamination and repeated freeze-thaw cycles altered the levels of 4 amino acids. CONCLUSIONS: We observed changes in amino acid concentrations relating to blood collection and storage conditions. If attention is paid to 4 key factors (hemolysis, temperature immediately following blood collection, time from collection to cooling, and long-term storage temperature) 19 amino acids can be reliably quantified.

The significance of after quality control in clinical laboratory work / 国际检验医学杂志

Objective To explore the significance of quality control after clinical laboratory analysis .Methods A total of 450 pieces of unqualified testing reports were collected from the Department of Clinical Laboratory from January 2012 to June 2014 and reasons causing unqualified testing reports were analyzed .Results In all 450 pieces of unqualified testing reports ,testing results of 169 pieces were inconsistent with results of clinical diagnosis ,accounted for 37 .6% ;149 pieces with missing or indirect inspection i‐tems ,accounted for 33 .1% ;62 pieces did not indicate staff or department sending specimens ,accounted for 13 .8% ;results of 36 pieces reached the critical value but without re‐inspection or did not indicate the re‐inspection ,accounted for 8 .0% ;18 pieces did not clarify specimens with lipid turbidity or jaundice and so on ,accounted for 4 .0% ;16 pieces marked with wrong sample types ,accoun‐ted for 3 .6% .Conclusion It is necessary to conduct quality control after clinical laboratory analysis before delivering report ,stand‐ardize operating procedures ,check every report seriously ,make clear responsibility and improve awareness of responsibility ,in order to provide a qualified testing report for clinical practice .

Analysis of reason and countermeasures of 11 024 unqualified blood specimens / 国际检验医学杂志

Objective To analyze reason and countermeasures of unqualified blood specimens ,improve the qualified rate of sam-ples ,to strengthen the quality control before analysis .Methods A retrospective statistical analysis were conducted to analyze the characteristics of the unqualified specimen and reasons from January 2013 to June 2014 .Results A total of 11 024 unqualified spec-imens accepted in the inspection center from January 2013 to June 2014 ,accounting for 0 .331% of reasons of unqualified specimens including hemolysis(26 .7% ) ,blood coagulation(25 .8% ) .The unqualified specimen in surgical system was higher than that in med-ical system .Conclusion Control specimen qualified rate system should be established in clinical laboratory ,the fraction defective samples should be reduced through continuous analysis and communication with clinical medical personnel to ensure the quality be-fore analyzing .

Influence of sample collection techniques on test results / Эрүүл мэндийн лаборатори

Background:Laboratory test are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment and prevention of disease. Laboratory test gives 70% of information to get a right diagnosis. By some study, physiological factors such as diet, stress, exercise and sample collection techniques are influencing 32%-75% of test accuracy and reliability. That is why we want to studyhow nurses follow standard of sample collection techniques in UB.Our study conducted in 5 different hospitals. We observed nursesway of collecting sample from 150 patientsResult:Nurses did not identify patients ID in 80% of patients and did not ask test preparation and diet of 100%. They prepare necessary items to blood draw 95%. Also nurses did not fully follow blood draw standard in such way: hand sterilization, asepticize place of puncture and using bandage. Conclusion:Nurses don’t follow standard of draw blood from vein and did not clarifies patients test preparation. Pre-analysis process is the most influencing factor in the test result. So we have to train nurses to follow their standard of sample collection procedure.