Search Results (183)

Access to home- and community-based services (HCBSs) varies substantially between states. Yet, it is unknown how state-level policies and administrative factors impact consumer-reported unmet service needs, an important indicator of HCBS access and quality. Using the National Core Indicators—Aging and Disability Adult Consumer Survey (2016–2019; n = 13,654 community-dwelling older adults, 13 states), we examined associations between unmet HCBS needs with four state-level factors: HCBS spending relative to institutional care spending, HCBS spending per client, percentage of Medicaid beneficiaries in managed care, and Medicaid expansion; and funding program. In the adjusted logistic regression model, the odds of overall unmet HCBS needs were lower with higher percentage Medicaid beneficiaries in managed care (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.89–0.96) and Medicaid expansion (aOR, 0.80; 95% CI, 0.73–0.87) but greater with higher HCBS spending relative to institutional care spending (aOR, 1.19; 95% CI, 1.11–1.28). Compared to Medicaid waiver, odds of unmet HCBS needs were significantly lower among consumers in Managed Long-Term Services and Supports (aOR, 0.67; 95% CI, 0.61–0.74) and Program of All-Inclusive Care for the Elderly (PACE; aOR, 0.39; 95% CI, 0.31–0.49). State policies and administrative factors are important place-based determinants of HCBS consumers’ unmet HCBS needs/access; and warrant consideration in HCBS quality assurance and improvement. Full article

Infectious diseases remain a global threat, with low- and middle-income countries disproportionately affected due to socio-economic and demographic vulnerabilities. Robust laboratory systems are critical for early detection, outbreak containment, and guiding effective interventions. This study aimed to map and evaluate Jordan’s laboratory diagnostic network for communicable diseases, identify gaps, and recommend strategies to strengthen capacity, harmonization, and alignment with international standards. A multi-method approach was employed in 2023 through collaboration between the Jordan Center for Disease Control and the Health Care Accreditation Council. Data were collected via (i) a desktop review of 226 national and international documents; (ii) 20 key informant interviews with stakeholders from the public, private, military, veterinary, and academic sectors; and (iii) 23 field visits across 27 laboratories in four Jordanian governorates. Data were analyzed thematically and synthesized using the LABNET framework, which outlined ten core laboratory capacities. Findings were validated through a multi-sectoral national workshop with 90 participants. The mapping revealed the absence of a unified national laboratory strategic plan, with governance dispersed across multiple authorities and limited inter-sectoral coordination. Standard operating protocols (SOPs) existed for high-priority diseases such as T.B, HIV, influenza, and COVID-19 but were lacking or outdated for other notifiable diseases, particularly zoonoses. Quality management was inconsistent, with limited participation in external quality assurance programs and minimal accreditation uptake. Biosafety and biosecurity frameworks were fragmented and insufficiently enforced, while workforce shortages, high turnover, and limited specialized training constrained laboratory performance. Despite these challenges, Jordan demonstrated strengths including skilled laboratory staff, established reference centers, and international collaborations, which provide a platform for improvement. Jordan’s laboratory network has foundational strengths but faces systemic challenges in policy coherence, standardization, quality assurance, and workforce capacity. Addressing these gaps requires the development of a national laboratory strategic plan, strengthened legal and regulatory frameworks, enhanced quality management and accreditation, and integrated One Health coordination across human, animal, and environmental health sectors. These measures will improve diagnostic reliability, preparedness, and alignment with the global health security agenda. Full article

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse leaders. Pilot studies and randomized controlled trials showed positive results, and thus, the program was operationalized. Methods: This quality improvement/quality assurance (QI/QA) project involved scaling the program and gathering data to evaluate implementation and impact on well-being indicators. The intervention involves structured weekly (8–9 weeks) 90-min group sessions integrating mindfulness, cognitive-behavioral techniques, and acceptance and commitment therapy. Eight licensed mental health providers were trained and delivered the program. Implementation outcomes included adoption/stakeholder engagement, fidelity, provider satisfaction, participant engagement, and sustainability. Participant outcomes were measured through validated scales and participant feedback forms. The implementation process was examined at the participant, provider, and organizational levels to identify barriers and enabling factors. Results: The program was implemented in seven acute care hospitals. From January 2023 to December 2024, 160 participants completed the program. Effective implementation strategies included intensive training and supervision of qualified providers, multi-departmental collaborations, and rigorous fidelity monitoring. Quality improvement processes addressed challenges such as early attrition and administrative burden. Evaluation data from pre- and post-intervention surveys demonstrated statistically significant improvements in psychological outcomes, with high satisfaction reported by both participants and providers. Conclusion: The findings support the effective implementation of the program as part of a broader organizational strategy to address nurse burnout and workforce mental health. Lessons, implications, and future directions for healthcare leaders are discussed. Full article

The global construction industry faces growing pressure to minimize environmental impact while maintaining durable, high-performance building materials. Fly ash-based geopolymer concrete (GPC) provides a sustainable, low-carbon, durable, and high-performance alternative to ordinary Portland cement (OPC). However, challenges remain in accurately predicting its structural behavior, particularly flexural strength, under varying compositional and curing conditions. This study integrates a Blockchain-assisted Gene Expression Programming Framework (B-GEPF) to enhance reliability and traceability in durability assessments of fly ash-based GPC. Focusing on the silica modulus of alkaline activators, the framework aims to improve predictive accuracy for flexural strength and optimize durability performance. Flexural strength was evaluated under controlled alkaline activator conditions (8M sodium hydroxide with sodium silicate) and varying fine aggregate ratios (1:1.5, 1:2, 1:3). The predictive model captures complex nonlinear relationships among silica modulus, fly ash content, and flexural behavior. Results indicate that higher activator concentrations increase flexural strength, while fly ash improves workability, reduces heat of hydration, and sustains long-term strength through secondary reactions. The B-GEPF framework demonstrates potential to accelerate GPC formulation optimization, ensuring reproducibility, reliability, and industrial scalability. By combining AI-driven predictions with blockchain-based validation, this approach supports sustainable construction, quality assurance, regulatory compliance, and transparent stakeholder collaboration. The study highlights dual benefits of environmental sustainability and digital trust, positioning fly ash-based GPC as a durable, low-carbon, and verifiable solution for resilient infrastructure. This convergence of AI predictive modeling and blockchain-secured data governance offers a robust, scalable tool for designing, validating, and deploying eco-friendly construction materials. Full article

To address healthcare workforce shortages, Poland has experienced a significant expansion in medical education, characterized by a tripling of accredited institutions and a fourfold increase in student admissions over the past two decades. However, in 2024, the suspension of admission quotas for six newly established universities was due to concerns over accreditation of medical degree programs (MD). Given the ongoing discussions in the European Union (EU) member states about the importance of maintaining educational quality and upholding quality standards, this study seeks to thoughtfully examine trends in admissions and the institutional growth of medical education from 2004 to 2024. It draws upon the policies established by the Ministry of Health and the Polish Accreditation Committee (PKA) throughout this timeframe, while also providing an overview of the PKA’s responses to quality assurance. Study findings indicate a misalignment between institutional growth (11 to 39, 254.6% increase) and compliance with education quality, particularly in newly established programs. This study also advocates a more robust, competency-driven framework and continuous quality improvement mechanisms, as enhanced by the international standards to overcome the limitations of Poland’s current accreditation and quality assurance system in medical education. Specifically, to strengthen the institutional capacity of the accreditation body, it would be necessary to introduce the outcome-based evaluation that tracks graduate’s clinical competence, and institutional performance transparency through public reporting. This study emphasizes the critical need to align accreditation processes with national health workforce planning. This alignment is vital for establishing pathways for programs that may be underperforming in their capacity to produce a healthcare workforce that is adequately equipped for both purpose and practice across all regions. Full article

Background: p16 immunohistochemistry (IHC) serves as a surrogate marker for high-risk human papillomavirus (hrHPV) and is widely used in gynecologic pathology. However, few studies have directly compared the staining performance and reproducibility of different p16 antibody clones in this context. Methods: We retrospectively evaluated 176 gynecologic tumor specimens including 42 whole slide sections and 134 tissue microarray cores from the cervix, endometrium, vulva, and ovary using three fully automated p16 IHC assays: E6H4 (Ventana/Roche), JC8 (Agilent/Dako), and 6H12 (Leica). Two pathologists independently reviewed each case, and concordance and interobserver agreement were analyzed. Sensitivity, specificity, and Cohen’s κ statistics were calculated, with E6H4 serving as the reference. Results: All three antibody clones demonstrated excellent staining performance with preserved tissue morphology and minimal background artifacts. Concordance for p16 positivity/negativity was 100% across all clone pairings (95% CI: 97.9–100%). Interobserver reproducibility was also perfect, with a κ coefficient of 1.00 (95% CI: 0.94–1.00). Minor non-block staining patterns did not impair interpretability. Conclusions: Our findings indicate that E6H4, JC8, and 6H12 clones yield comparable staining results when used in conjunction with standardized automated protocols. These results support the practical interchangeability of these clones in clinical and research settings, particularly when cost, availability, or risk management require substitution. Laboratories should continue to perform internal validation and utilize external quality assurance programs when implementing p16 IHC. Full article

Background/Objectives: Cervical cancer (CC), caused mainly by high-risk human papillomavirus (hrHPV), remains a global health challenge despite being preventable. The disease’s incidence and mortality rates significantly vary across regions, highlighting the need for effective screening programs. The World Health Organization prioritizes CC screening to monitor and eliminate the disease. The Screening for Cervical Cancer and Early Treatment (SCCET) project aligns with this goal by adhering to the 2012 National Program for Cervical Cancer Screening and implementing the European Guidelines of Quality Assurance. Methods: The SCCET initiative facilitates access to equitable and high-quality preventive medical services for Romanian women, incorporating the Babeș–Papanicolaou smear (Pap test) and/or hrHPV DNA screening. Focused on the Muntenia Region of South Romania, the project leverages a methodical approach to gather substantial medical data on hrHPV infection rates and cervical lesions, thereby improving health management for women in the screening program. Results: Through public information and educational campaigns about HPV and its link to CC, the SCCET project has significantly enhanced participation in the screening program. In the study conducted between September 2022 and March 2023, 14,385 women aged 30 to 64 years voluntarily participated; of these, 11,996 (83.4%) underwent primary hrHPV DNA screening and were tested using the PowerGene 9600 Plus Real-Time polymerase chain reaction (PCR) system and the commercial Atila BioSystems AmpFire^® HPV Screening 16/18/HR test, version 4.1. This substantial participation indicates a positive shift in public attitudes towards CC prevention and highlights the success of the project’s outreach efforts. The study revealed an overall prevalence of hrHPV infection of 12.24%; of these, the most common genotype was other hrHPV types (9.84%), followed by HPV 16 (2.3%) and HPV 18 (0.71%). Conclusions: The SCCET project’s recent data on primary hrHPV DNA screening showcases its pivotal role in advancing the management and prevention of CC in Romania. By providing accessible, high-quality screening services and fostering public education on HPV, the initiative has made significant strides toward reducing the burden of CC. This effort aligns with global public health goals, and providing updated information on the prevalence of hrHPV types will allow the development of personalized national screening and vaccination programs to eradicate CC. Full article

Higher education institutions have undergone essential transformations in recent decades, driven by legislative reforms and changes in social and economic demands. This study examines the factors that influence the continuous improvement of educational quality in Ecuador’s private higher education institutions (HEIs). A quantitative, cross-sectional, descriptive–correlational study was conducted to analyze the adaptation of HEIs to new realities, student mobility, technological development, sustainability practices, and innovation. The results indicate that technological development and environmental sustainability are key elements. There is a strong correlation between technological development and adaptation to the world of work. This suggests that integrating sustainable practices and university–industry cooperation is critical in improving the quality of higher education in Ecuador. In addition, student mobility and graduate follow-up programs are positively related to labor market adaptation and internationalization. These findings suggest the need for a holistic approach to quality assurance and provide practical guidelines for Ecuadorian HEIs to improve their performance in a rapidly changing context. Full article

Background and Objectives: Patent ductus arteriosus (PDA) is one of the most common cardiovascular conditions affecting preterm infants, with incidence rates reaching 60% in neonates born before 28 weeks gestation. Traditional clinical assessment alone often proves inadequate for accurate diagnosis, potentially leading to both overtreatment and undertreatment. Targeted neonatal echocardiography (TnECHO) has emerged as a powerful bedside tool that enables neonatologists to perform focused cardiac evaluations, providing real-time assessment of ductal significance and systemic hemodynamics. This systematic review aimed to comprehensively evaluate the clinical utility of TnECHO in the management of PDA in preterm infants, with specific focus on its diagnostic accuracy, impact on treatment decisions, and influence on clinical outcomes. Materials and Methods: Following PRISMA guidelines, we conducted a systematic search of PubMed, Web of Science, and Scopus from inception (earliest available date of each database) through February 2025. The search strategy combined terms for “Targeted Neonatal Echocardiography” and “Patent Ductus Arteriosus.” We included observational studies and randomized controlled trials (RCTs) evaluating TnECHO in PDA management, while excluding reviews and case reports. Data extraction focused on study design, population characteristics, TnECHO protocols, and clinical outcomes. Results: From 173 initial records, 11 studies met inclusion criteria. Eight studies were rated as high-quality (NOS score ≥ 7). TnECHO implementation was associated with a 49% reduction in PDA ligation rates and decreased need for multiple treatment courses. Studies demonstrated improved diagnostic precision in assessing shunt significance and myocardial function, leading to more tailored therapeutic approaches. The establishment of dedicated TnECHO services enhanced interdisciplinary collaboration between neonatologists and cardiologists. However, limitations included operator dependence, variable institutional protocols, and occasional missed minor cardiac anomalies. Conclusions: TnECHO represents a transformative approach to PDA management in preterm infants, enabling physiology-guided decision-making that reduces unnecessary interventions while maintaining patient safety. Current evidence supports its role in improving diagnostic accuracy and optimizing treatment timing. Future research should prioritize multicenter RCTs to establish standardized protocols and evaluate long-term neurodevelopmental outcomes. The integration of TnECHO into routine neonatal practice requires investment in training programs and quality assurance measures to maximize its clinical potential. Full article

With the swift progression of the High-Standard Farmland Construction Program in China and worldwide, many dryland wheat fields can be irrigated once during the wheat growth stage (one-off irrigation). However, the combined strategies of one-off irrigation, tillage, and N management for augmenting wheat grain yield and quality are still undeveloped in drought regions. Two-site split–split field experiments were conducted to study the impacts of irrigation, tillage, and N management and their combined effects on grain yield; the contents of protein and protein components; processing quality; and the characteristics of N accumulation and translocation in wheat from a typical dryland wheat production area in China from 2020 to 2022. The irrigation practices (I0, zero irrigation and I1, one-off irrigation), tillage methods (RT, rotary tillage; PT, plowing; and SS, subsoiling) and N management (N0, N120, N180, and N240) were applied to the main plots, subplots and sub-subplots, respectively. The experimental sites, experimental years, irrigation practices, tillage methods, and N management methods and their interaction significantly affected the yield, quality, and plant N characteristics of wheat in most cases. Compared to zero irrigation, one-off irrigation significantly increased the plant N accumulation, enhancing grain yield by 33.7% while decreasing the contents of total protein, albumin, globulin, gliadin, and glutenin by 4.4%, 6.4%, 8.0%, 12.2%, and 10.0%, respectively. It also decreased the wet gluten content, stability time, sedimentation value, extensibility by 4.1%, 10.7%, 9.7%, and 5.5%, respectively, averaged across sites and years. Subsoiling simultaneously enhanced the aforementioned indicators compared to rotary tillage and plowing in most sites and years. With the increase in N rates, wheat yield firstly increased and then decreased under zero irrigation combined with rotary tillage, while it gradually increased when one-off irrigation was combined with subsoiling; however, the contents of total protein and protein components and the quality tended to increase firstly and then stabilize regardless of irrigation practices and tillage methods. The correlations of yield and quality indicators with plant N characteristics were negative when using distinct irrigation practices and tillage methods, while they were positive under varying N management. The decrease in wheat quality induced by one-off irrigation could be alleviated by optimizing N management. I1STN180 exhibited higher yield, plant N accumulation and translocation, and better quality in most cases; thus, all metrics of wheat quality were significantly increased, with a yield enhancement of 50.3% compared to I0RTN180. Therefore, one-off irrigation with subsoiling and an N rate of 180 kg ha⁻¹ is an optimal strategy for high yield, high protein, and high quality in dryland wheat production systems where one-off irrigation is assured. Full article

Quality assurance programs are critical to ensuring the consistency and reliability of point-of-care surveillance test results. In 2022, we launched Laos’ inaugural quality control (QC) and external quality assessment (EQA) program for national HIV recent infection surveillance. Our study aims to implement the first QC and EQA program for national HIV recent infection surveillance in Laos, utilizing non-infectious dried tube specimens (DTS) for quality control testing. This initiative seeks to monitor and assure the quality of HIV infection surveillance. We employed the Asante HIV-1 Rapid Test for Recent Infection (HIV-1 RTRI) point-of-care kit, using plasma specimens from the Thai Red Cross Society to create dried tube specimens (DTS). The DTS panels, including HIV-1 negative, HIV-1 recent, and HIV-1 long-term samples, met ISO 13528:2022 standards to ensure homogeneity and stability. These panels were transported from the Thai National Institute of Health (Thai NIH) to the Laos National Center for Laboratory and Epidemiology (NCLE) and subsequently shipped to 12 remote laboratories at ambient temperature. The laboratory results were electronically transmitted to Thai NIH 15 days after receiving the panel for performance analysis. The concordance results with the sample types were scored, and laboratories that achieved 100% concordance across all sample panels were considered to have satisfactorily met the established standards. Almost all laboratories demonstrated satisfactory results with 100% concordance across all sample panels during all three rounds of QC: 11 out of 12 (92%) in June, 10 out of 12 (83%) in July, and 11 out of 12 (91%) in August. The two rounds of EQA performed in June and August 2022 were satisfied by 8 out of 11 (72%) and 5 out of 10 (50%) laboratories, respectively. QC and EQA monitoring identified errors such as testing protocol mistakes and insufficient DTS panel dissolution, leading to improvements in HIV recency testing quality. Laboratories that reported errors were corrected and implemented further preventive actions. The QC and EQA program for HIV-1 RTRI identified errors in HIV recent infection testing. Implementing a specialized QC and EQA program for DTS marks a significant advancement in improving the accuracy and consistency of HIV recent infection surveillance. Continuous assessment is vital for addressing recurring issues. Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

New methods for real-time materials phase identification based upon focal construct tomography (FCT) have been examined. Such quantitative assessment has significant potential in sectors where in-line analysis is required, including screening within aviation security. As a recent component of work programs developing FCT, its capability for accurate, quantitative analysis has been assessed for the first time. Diffraction signatures from mixed-phase materials were acquired from an energy-dispersive FCT system running under normal operational conditions. A calibration curve was constructed from the spectra and subsequently employed to assess the composition of ‘blind’ samples. The results demonstrated that this approach was able to precisely predict the polymorphic phase composition of samples to ±5 wt%. Conclusions: The potential impact of these findings is significant and will enable applications of FCT beyond those requiring a phase identification to those necessitating quantification, such as counterfeit medicines, pharmaceutical quality assurance, aging of explosives, and cement production. Full article

Although the transition to electric vehicles (EVs) is well underway and expected to continue in global car markets, most vehicles on the world’s roads will be powered by internal combustion engine vehicles (ICEVs) and fossil fuels for the foreseeable future, possibly well past 2050. Thus, good environmental performance and effective emission control of ICE vehicles will continue to be of paramount importance if the world is to achieve the stated air and climate pollution reduction goals. In this study, we review 228 publications and identify four main issues confronting these objectives: (1) cheating by vehicle manufacturers, (2) tampering by vehicle owners, (3) malfunctioning emission control systems, and (4) inadequate in-service emission programs. With progressively more stringent vehicle emission and fuel quality standards being implemented in all major markets, engine designs and emission control systems have become increasingly complex and sophisticated, creating opportunities for cheating and tampering. This is not a new phenomenon, with the first cases reported in the 1970s and continuing to happen today. Cheating appears not to be restricted to specific manufacturers or vehicle types. Suspicious real-world emissions behavior suggests that the use of defeat devices may be widespread. Defeat devices are primarily a concern with diesel vehicles, where emission control deactivation in real-world driving can lower manufacturing costs, improve fuel economy, reduce engine noise, improve vehicle performance, and extend refill intervals for diesel exhaust fluid, if present. Despite the financial penalties, undesired global attention, damage to brand reputation, a temporary drop in sales and stock value, and forced recalls, cheating may continue. Private vehicle owners resort to tampering to (1) improve performance and fuel efficiency; (2) avoid operating costs, including repairs; (3) increase the resale value of the vehicle (i.e., odometer tampering); or (4) simply to rebel against established norms. Tampering and cheating in the commercial freight sector also mean undercutting law-abiding operators, gaining unfair economic advantage, and posing excess harm to the environment and public health. At the individual vehicle level, the impacts of cheating, tampering, or malfunctioning emission control systems can be substantial. The removal or deactivation of emission control systems increases emissions—for instance, typically 70% (NO_x and EGR), a factor of 3 or more (NO_x and SCR), and a factor of 25–100 (PM and DPF). Our analysis shows significant uncertainty and (geographic) variability regarding the occurrence of cheating and tampering by vehicle owners. The available evidence suggests that fleet-wide impacts of cheating and tampering on emissions are undeniable, substantial, and cannot be ignored. The presence of a relatively small fraction of high-emitters, due to either cheating, tampering, or malfunctioning, causes excess pollution that must be tackled by environmental authorities around the world, in particular in emerging economies, where millions of used ICE vehicles from the US and EU end up. Modernized in-service emission programs designed to efficiently identify and fix large faults are needed to ensure that the benefits of modern vehicle technologies are not lost. Effective programs should address malfunctions, engine problems, incorrect repairs, a lack of servicing and maintenance, poorly retrofitted fuel and emission control systems, the use of improper or low-quality fuels and tampering. Periodic Test and Repair (PTR) is a common in-service program. We estimate that PTR generally reduces emissions by 11% (8–14%), 11% (7–15%), and 4% (−1–10%) for carbon monoxide (CO), hydrocarbons (HC), and oxides of nitrogen (NO_x), respectively. This is based on the grand mean effect and the associated 95% confidence interval. PTR effectiveness could be significantly higher, but we find that it critically depends on various design factors, including (1) comprehensive fleet coverage, (2) a suitable test procedure, (3) compliance and enforcement, (4) proper technician training, (5) quality control and quality assurance, (6) periodic program evaluation, and (7) minimization of waivers and exemptions. Now that both particulate matter (PM, i.e., DPF) and NO_x (i.e., SCR) emission controls are common in all modern new diesel vehicles, and commonly the focus of cheating and tampering, robust measurement approaches for assessing in-use emissions performance are urgently needed to modernize PTR programs. To increase (cost) effectiveness, a modern approach could include screening methods, such as remote sensing and plume chasing. We conclude this study with recommendations and suggestions for future improvements and research, listing a range of potential solutions for the issues identified in new and in-service vehicles. Full article

Newborn bloodspot screening for one or more lysosomal storage disorders (NBS-LSD) is currently performed by many public health NBS laboratories globally. The screening tests measure activities of selected lysosomal enzymes on dried blood spot (DBS) specimens collected from newborns by the heel stick method Because these assays measure enzyme activity, the quantitative results are dependent on the particular analytical method. DBS quality control (DBS QC) materials with assay-specific certified values that span the relevant range from typical to LSD-affected newborns are an important component of quality assurance in NBS laboratories. The Newborn Screening Quality Assurance Program (NSQAP) at the U.S. Centers for Disease Control and Prevention (CDC) provides public health NBS laboratories with DBS QC sets for NBS-LSD comprising four admixtures of pooled umbilical cord blood and a base pool made from leukodepleted peripheral blood and heat-inactivated serum. To evaluate the suitability of these materials for use with digital microfluidics fluorometry (DMF) assays which can currently measure the activity of four enzymes (acid α-galactosidase (GLA); acid β-glucocerebrosidase (GBA); acid α-glucosidase (GAA); and iduronidase (IDUA)), CDC collaborated with the Newborn Screening Unit at the Missouri State Public Health Laboratory (MSPHL). Using MSPHL criteria, we found that the certified results from each of two DBS QC lots collectively spanned the range from typical (screen negative) to enzyme deficient (screen positive) newborn DBS levels for each of the four lysosomal enzymes measured. The range included borderline results that would require repeat screening of the newborn under the MSPHL protocol. We conclude that these DBS QC preparations are suitable for use as external quality control materials for DMF assays used to detect LSDs in newborns. Full article