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Background Singapore General Hospital (SGH) Pharmacy department set up a novel 24-h medication locker service in November 2019 to serve hospital staff on work shifts who were unable to collect medication within the pharmacy operating hours. However, the initial uptake rate was modest. Objectives Primary objective was to increase the daily locker service uptake by staff from five lockers to 42 lockers (100%) in 6 months, starting from June 2020. Secondary objectives include exploring the cost savings and impact of the locker service on the pharmacy’s operational efficiency, as well as compare the medication collection experience of hospital staff using the locker service and in the pharmacy. Methods FOCUS-PDSA was the adopted QI methodology. Two Plan-Do-Study-Act (PDSA) cycles were used to implement the final identified solutions. PDSA cycle one focused on improving publicity and educational efforts. PDSA cycle two then focused on expanding the service to include the entire hospital campus staff and setting up a self-registration booth at the pharmacy entrance. Results The primary objective of achieving 100% locker utilization was attained in October 2020, with daily average service uptake rate increasing from 12.6 at baseline to 49.8 by the end of PDSA cycle 2. Annual pharmacist manpower savings of 0.88 Full Time Equivalent (FTE) was also achieved. Locker service users gave a higher average satisfaction score compared to those who collected from the pharmacy. Conclusion Project SAPPORO successfully increased the daily locker service, providing hospital campus staff with increased convenience and positive medication collection experience during the COVID-19 pandemic.

Abstract Apis laboriosa is the largest honeybee that lives mainly on cliff faces, with strong migratory ability. In this study, we firstly sequenced and assembled two complete mitochondrial genomes of A. laboriosa isolated from two distant locations in China (Chongqing and Shangri‐La regions). Combined with the published mitochondrial genome of A. laboriosa from Nepal, comparative genomic analyses were conducted to gain insight into the genetic diversity of giant honeybees from different geographical distributions. The mitochondrial genomes of A. laboriosa from Chongqing and Shangri‐La regions were 15,579 and 15,683 bp in length, respectively, both larger than that from Nepal with the length of 15,510 bp. Three mitochondrial genomes all harbor 37 common genes and present the same AT bias and the frequency of codon usage. However, the fragments including COX1, SSUrRNA, LSUrRNA, and the AT‐rich region of the mitochondrial genome from Shangri‐La region demonstrate distinctive insertions and deletions compared to those from Chongqing and Nepal regions. Phylogenetic trees of mitochondrial genomes show that A. laboriosa from Chongqing is most closely related to that from Nepal, rather than to Shangri‐La. Genetic distance between Shangri‐La and Chongqing or Nepal was even larger than that between the various subspecies of Apis mellifera. Overall, these results unmark that A. laboriosa in different geographical distributions can exhibit high genetic diversity at the mitochondrial genomic level, and therein, A. laboriosa from Shangri‐La may be the subspecies. All these studies will contribute to our understanding of the geographical distribution and genetic differentiation of black giant honeybee in Asian region.

Abstract In this present study, a novel method to fabricate bimetallic Fe-Co catalyst supported on waste silica was investigated for the photo-Fenton-like (PFL) degradation of Methylene Blue (MB) dye. The uniqueness of this work is on the preparation of the catalyst via fluidized-bed crystallization (FBC) process. Under the optimum conditions of initial pH of 3.0, 3.0 mM of H2O2, and 1.0 g L-1 of FBC-derived Fe-Co/SiO2 catalyst (fFCS), the maximum response for the decoloration and mineralization efficiencies of 20 mg L-1 of MB in 60 min were 100 and 65%, respectively. Compared to the impregnated Fe-Co/SiO2 catalyst, the fFCS catalyst exhibited comparable decoloration and mineralization efficiencies, and relatively lower metal leaching for both iron and cobalt. Superoxide radical was unveiled to be the dominant reactive oxygen species in the PFL system over the fFCS catalyst. The catalysts were characterized by Fourier Transform Infrared spectroscopy, Energy Dispersive X-ray spectroscopy and Scanning Electron Microscopy. The results show the successful incorporation of iron and cobalt on the surface of the SiO2 support material.

Context.--RNA-based next-generation sequencing (NGS) assays are being used with increasing frequency for comprehensive molecular profiling of solid tumors. Objective.--To evaluate factors that might impact clinical assay performance. Design.--A 4-month retrospective review of cases analyzed by a targeted RNA-based NGS assay to detect fusions was performed. RNA extraction was performed from formalin-fixed, paraffin-embedded tissue sections and/or cytology smears of 767 cases, including 493 in-house and 274 outside referral cases. The types of samples included 422 core needle biopsy specimens (55%), 268 resection specimens (35%), and 77 cytology samples (10%). Results.--Successful NGS fusion testing was achieved in 697 specimens (90.9%) and correlated positively with RNA yield (P < .001) and negatively with specimen necrosis (P = .002), decalcification (P < .001), and paraffin block age of more than 2 years (P = .001). Of the 697 cases that were successfully sequenced, 50 (7.2%) had clinically relevant fusions. The testing success rates and fusion detection rates were similar between core needle biopsy and cytology samples. In contrast, RNA fusion testing was often less successful using resection specimens (P = .007). Testing success was independent of the tumor percentage in the specimen, given that at least 20% tumor cellularity was present. Conclusions.--The success of RNA-based NGS testing is multifactorial and is influenced by RNA quality and quantity. Identification of preanalytical factors affecting RNA quality and yield can improve NGS testing success rates. (Arch Pathol Lab Med. 2021;145:1405-1412; doi: 10.5858/arpa.2020-0415-OA), With the increasing use of targeted therapeutic agents in solid tumors, RNA-based next-generation sequencing (NGS) assays are progressively used for comprehensive molecular analysis. (1) Chromosome translocations and/or gene fusions are [...]

BackgroundSending a patient to the operating room is the first step in surgery. Delayed patient transport causes the patient to go hungry for a longer time, aggravating the patient’s physical discomfort and psychological stress. The issue of delays in transporting inpatients to the operating room has rarely been discussed in the literature. The Toyota production system is a famous and excellent scientific method of reducing waste and increasing efficiency. Our goal is to use the Toyota method to decrease the time required to transport the inpatient to the operating room and to review the concepts underlying lean thinking.MethodsWe employed an A3 8-step problem-solving process. A current value stream map featuring numerical data (concerning 46 patients) measured in the workplace was developed. The total time spent on transport was 53 min, but we expected patients to be transported within 30 min. We hoped to reduce the time wasted by half, i.e., by 23*50% = 12 min. These 12 min were saved by reducing the time spent on “waiting for an attendant at the ward” by 9 min and the time spent on “elevator transport” by 3 min. According to the value stream map featuring the time measurements, the root causes of delayed transportation can be divided into process-related, attendant-related, and elevator-related factors. We formulated 5 countermeasures. The ECRS (Eliminate, Combine, Rearrange, Simplify) technique was used to rearrange, combine, and simplify the existing process. Hospital executives established norms for attendant prioritization of work and rules for elevator use.ResultsAccording to the original indicators, all goals were attained. “Total time spent” decreased by 62.3%. The time required for attendants to report to the nursing station decreased by 56.5%. The time spent on elevator transport decreased by 44.4%. We developed a process for future use based on information-assisted patient and staff identification. Finally, we standardized successful processes.ConclusionThe seemingly trivial factors that delay patient transport are associated with seven types of waste. The A3 8-step problem-solving process is useful in this context. In proposing this improvement process, we believe that we are following the spirit of the Toyota production system.

Blood-brain barrier (BBB) disruption underlies the vasogenic edema and neuronal cell death induced by acute ischemic stroke. Reducing this disruption has therapeutic potential. Transcranial focused ultrasound stimulation has shown neuromodulatory and neuroprotective effects in various brain diseases including ischemic stroke. Ultrasound stimulation can reduce inflammation and promote angiogenesis and neural circuit remodeling. However, its effect on the BBB in the acute phase of ischemic stroke is unknown. In this study of mice subjected to middle cerebral artery occlusion for 90 minutes, low-intensity low-frequency (0.5 MHz) transcranial focused ultrasound stimulation was applied 2, 4, and 8 hours after occlusion. Ultrasound stimulation reduced edema volume, improved neurobehavioral outcomes, improved BBB integrity (enhanced tight junction protein ZO-1 expression and reduced IgG leakage), and reduced secretion of the inflammatory factors tumor necrosis factor-α and activation of matrix metalloproteinase-9 in the ischemic brain. Our results show that low-intensity ultrasound stimulation attenuated BBB disruption and edema formation, which suggests it may have therapeutic use in ischemic brain disease as a protector of BBB integrity.

The vegetative insecticidal protein Vip3Aa from Bacillus thuringiensis (Bt) has been produced by transgenic crops to counter pest resistance to the widely used crystalline (Cry) insecticidal proteins from Bt. To proactively manage pest resistance, there is an urgent need to better understand the genetic basis of resistance to Vip3Aa, which has been largely unknown. We discovered that retrotransposon-mediated alternative splicing of a midgut-specific chitin synthase gene was associated with 5,560-fold resistance to Vip3Aa in a laboratory-selected strain of the fall armyworm, a globally important crop pest. The same mutation in this gene was also detected in a field population. Knockout of this gene via CRISPR/Cas9 caused high levels of resistance to Vip3Aa in fall armyworm and 2 other lepidopteran pests. The insights provided by these results could help to advance monitoring and management of pest resistance to Vip3Aa. The insecticidal protein Vip3Aa is used in genetically engineered crops to overcome pest resistance to other insecticidal transgenes. This study shows that insertion of a transposable element into a gut-specific chitin synthase gene causes Vip3Aa resistance in field-collected individuals of the lepidopteran pest Spodoptera frugiperda (fall armyworm). [ABSTRACT FROM AUTHOR]