Red Deer College

Abstract Background Neonatal total bilirubin (NBIL) results are used to guide the medical need for phototherapy or exchange transfusion in babies. When sample analysis occurs across multiple vendors and instrument platforms, clinical result interpretation challenges can occur. This study evaluated the performance of NBIL methods across multiple general chemistry analyzers - Roche Cobas, Siemens Atellica, and Ortho Vitros - using pooled neonatal plasma samples. NBIL was measured as total bilirubin on Roche Cobas and Siemens Atellica, whereas on Ortho Vitros, it was measured as the sum of conjugated and unconjugated bilirubin fractions (Bc and Bu) using dry slide chemistry. Methods Residual neonatal plasma samples were collected at selected hospital laboratories in Alberta, Canada, and pooled. This was a process requiring meticulous effort due to the small volume typically available from each neonate. Pooled samples were divided into five sets and analyzed in duplicates at separate clinical laboratories using the NBIL method on the respective platform (two laboratories using Roche Cobas (8000 vs Pro), two laboratories using Ortho Vitros XT3400 BuBc slides (two slide generations) and one laboratory using Siemens Atellica. Results from each platform were compared to assess method performance and bias. Graphical and statistical analysis were completed, including Passing Bablok regression analysis. Total allowable difference used for the data analysis was ±20% or 6.84 umol/L. Results Method comparisons reveal up to 29% bias for neonatal bilirubin measurements between Roche Cobas and Siemens Atellica platforms, with an average bias of +27%. Ortho Vitros XT3400 showed an average bias of +11% compared to Roche Cobas. Among the three platforms studied, Siemens Atellica demonstrated the highest bias, while Roche Cobas consistently ran lower compared to the other platforms, with Vitros XT3400 positioned in between. Passing Bablok regression revealed the following relationships:Ortho Vitros (X) vs. Atellica (Y): y=1.12x-0.34Roche Cobas (X) vs. Atellica (Y): y=1.27x-0.26Ortho Vitros (X) vs. Roche Cobas (Y): y=0.86x+2.98 The average bias between two generation of slides installed on two Vitros analyzers was 0.3%, while the average difference between Cobas Pro and Cobas 8000 was 2.9%. Conclusions: Among the three vendor platform families studied, Siemens Atellica demonstrated the highest bias, while Roche Cobas was consistently lower compared to the other two platforms. These discrepancies underscore the critical need for mitigation strategies and assay performance assessment by the vendor to significantly reduce inter-platform bias, to better support patient care, minimize unnecessary or excessive patient management, and ensure consistent and reliable neonatal care. Given the significant variability observed between different vendor platforms for NBIL it is crucial for manufacturers to minimize within-platform inconsistencies. While inter-platform differences can pose challenges for clinical interpretation, reducing variability within a single manufacturer*s systems can help improve result reliability and standardization.

ABSTRACTThis study investigates the effects of leadership and adaptive capacities on local government performance, with management innovation as a moderating factor. Using structural equation modeling, data from 360 employees across Ghana's municipal assemblies were analyzed. The results reveal that leadership capacity significantly enhances performance, though its interaction with management innovation was not significant. Adaptive capacity, when moderated by management innovation, positively impacts performance, demonstrating innovation's critical role in transforming adaptability into tangible outcomes. These findings advance capacity development literature by emphasizing the dependency of adaptive capacity on innovation and reinforcing leadership capacity as a key organizational resource, consistent with resource‐based view (RBV) and knowledge‐based view (KBV) theories. Practical implications include prioritizing leadership development and integrating innovation into public sector strategies to improve performance. The study provides theoretical insights, actionable recommendations, and a basis for future research on capacity development in local government systems, particularly in resource‐constrained public sector contexts.

BackgroundImproving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population.MethodsWe undertook a scoping review using the framework by Arksey and O’Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers.ResultsThe search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings.ConclusionFindings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada.