Digital Commons Network^™

Planetary Protection Knowledge Gap Closure Enabling Crewed Missions To Mars, James A. Spry, Bette Siegel, Corien Bakermans, David W. Beaty, Mary Sue Bell, James N. Benardini, Rosalba Bonaccorsi, Sarah L. Castro-Wallace, David A. Coil, Athena Coustenis, Peter T. Doran, Lori Fenton, David P. Fidler, Brian Glass, Stephen J. Hoffman, Fathi Karouia, Joel S. Levine, Mark L. Lupisella, Javier Martin-Torres, Rakesh Mogul, Karen Olsson-Francis, Sandra Ortega-Ugalde, Manish R. Patel, David A. Pearce, Margaret S. Race, Aaron B. Regberg, Petra Rettberg, John D. Rummel, Kevin Y. Sato, Andrew C. Schuerger, Elliot Sefton-Nash, Matthew Sharkey, Nitin K. Singh

Faculty Publications

As focus for exploration of Mars transitions from current robotic explorers to development of crewed missions, it remains important to protect the integrity of scientific investigations at Mars, as well as protect the Earth's biosphere from any potential harmful effects from returned martian material. This is the discipline of planetary protection, and the Committee on Space Research (COSPAR) maintains the consensus international policy and guidelines on how this is implemented. Based on National Aeronautics and Space Administration (NASA) and European Space Agency (ESA) studies that began in 2001, COSPAR adopted principles and guidelines for human missions to Mars in 2008. …

Threading A Decolonial Feminist Response To Covid-19: One Community Psychologist's Reflection On The Assemblages Of Violence, Jesica S. Fernandez

Ethnic Studies

To challenge and interrogate the assemblages of violence produced by racial capitalism, and exacerbated by the COVID-19 pandemic, community psychologists must engage in a transdisciplinary critical ethically reflexive practice. In this reflexive essay, or first-person account, I offer a decolonial feminist response to COVID-19 that draws strength from the writings of three women of Color decolonial and postcolonial feminist thinkers: Gloria E. Anzaldúa, Sylvia Wynter, and Arundhati Roy. Through their writings I share my reflections on the sociopolitical moment associated with COVID-19. Of importance, I argue in support of engaging a decolonial feminist standpoint to understand the inequitable and dehumanizing …

Utilization Of The System Engineering Design Process To Design And Test A Low-Cost Infectious Aerosol Control Mechanism For Patient Aeromedical Evacuation, Sara Shaghaghi

Theses and Dissertations

The aeromedical evacuation of military patients is a critical component of care for Armed Forces members. The Air Force’s ability to transport patients relies on the technology and systems available. A vital transport responsibility is keeping the patient and medical personnel safe during transport. The historical and legacy systems provide reliable transport mechanisms for the Armed Forces’ patients infected with high-level biological agents, but drawbacks must be considered. This dissertation will discuss the development, conceptual design, and initial evaluation of a new low-cost, litter-mounted patient transport system, Biological-Mitigation in Patient Transport (B-MIPT), using the “V” model of the system engineering …

A Habitat Stronghold On The Precipice: A Call-To-Action For Supporting Lemur Conservation In Northeast Madagascar, Timothy M. Eppley, Cortni Borgerson, Erik R. Patel, James P. Herrera, Andrew E. Kirkby, Christopher D. Golden, Mcantonin Andriamahaihavana, Lanto Andrianandrasana, Antonio Bóveda, Dean Gibson, Louis Joxe Jaofeno, Fenohery Rakotondrasoa, Tiana A. Ramahaleo, Delaïd C. Rasamisoa, Felix Ratelolahy, Josia Razafindramanana, Charlotte Spira, Charles Welch, Natalie Vasey

Department of Anthropology Faculty Scholarship and Creative Works

The northeast of Madagascar is as diverse as it is threatened. The area bordering the Analanjirofo and SAVA regions contains six protected areas and at least 22 lemur species. Many applied research and conservation programs have been established in the region with the aim of ensuring both wildlife and people thrive in the long term. While most of the remaining humid evergreen forest of northeast Madagascar is formally protected, the local human population depends heavily on the land, and unsustainable natural resource use threatens this biodiversity hotspot. Drawing from our collective experiences managing conservation activities and research programs in northeast …

An Introduction Of Adaptive Training Aid Concepts And Its Application To Accelerated Training For Air Battle Managers, John C. Gillispie

Theses and Dissertations

Over the years, the integration of artificial intelligence (AI) to enable autonomous systems has undergone transformative shifts in the Department of Defense (DoD), revolutionizing capabilities and strategic approaches. To further optimize these advancements, varying levels of autonomy have been introduced across critical military applications, spanning intelligence, surveillance, reconnaissance (ISR), air battle management, and offensive/defensive air operations. As the technological landscape expands, so do the opportunities for autonomy to augment operations through human-agent teaming. Within the Air Force, one notably cognitively demanding role that stands to benefit from these strides is that of the Air Battle Manager (ABM). In support of …

Deploying Field-Capable Genome Sequencing: Human Performance Considerations Under Various Personal Protective Equipment Ensembles, Steven A. Torres

Theses and Dissertations

Field-portable genome sequencing enhances the Department of Defense's strategy for detecting biological threats, particularly in resource-limited environments. While current field-capable detection methods are effective, challenges in identifying emerging threats pose risks to personnel safety. As biotechnological advancements like portable nanopore genome sequencing can advance biological detection capabilities, the viability of conducting laboratory tasks under Mission-Oriented Protective Posture (MOPP) ensembles lacks sufficient data. This research assesses the effectiveness of tools like pipettes, centrifuges, vortexes, and nanopore sequencing within a MOPP ensemble. Novice participants were utilized to explore the extension of this capability, and they completed tasks in three conditions: Fatigues, Laboratory …

March 2024: Region 10 Emerging Special Pathogen Treatment Center (Resptc) At Providence Sacred Heart Medical Center & Children’S Hospital, Providence - Special Pathogens Program

Special Pathogens Newsletters

REGION 10 SPECIAL PATHOGENS NEWSLETTER

Casinos, Covid, And Coverage: Jurisprudential And Insurance Implications Of A Litigation Pandemic, Jeffrey W. Stempel

UNLV Gaming Law Journal

The onset of the COVID-19 pandemic in early 2020 impacted all walks of American life. Litigation and insurance coverage disputes were no exception. In addition to the impact on dispute resolution procedure (e.g., postponed trials, masked trials, the rise of remote depositions, hearings, and oral argument), there were more than two thousand insurance coverage lawsuits spurred by pandemic-related restrictions on business operations and the resulting lost revenue.

Entertainment and retail venues not deemed “essential” were particularly impacted due to both official government orders closing or restricting operations as well as reduced customer demand stemming from fear of infection. Although some …

Voices From Grenada: An Impact Evaluation Of A Community-Academic Partnership., Sade Richardson

Doctor of Social Work Capstone Projects

The purpose of this study was to evaluate the impact of the community-academic partnership between the University of Michigan School of Public Health Office of Public Health Practice and the Grenadian community. Five key informant interviews were conducted to analyze the partnership from the perspectives of the community partners in Grenada to understand the strengths, challenges, and existing opportunities, specifically within the context of a global collaboration.

The findings highlighted the benefits of community-based collaboration, considerations for partnership design, and opportunities for education, practice, policy, research, and leadership. The organizations spoke highly of the partnership, underscoring their desire for expanded …

Staphylococcus Aureus Oleate Hydratase Produces Ligands That Activate Host Ppara, Christopher D. Radka, Matthew W. Frank, Tyler S. Simmons, Cydney N. Johnson, Jason W. Rosch, Charles O. Rock

Markey Cancer Center Faculty Publications

Commensal gut bacteria use oleate hydratase to release a spectrum of hydroxylated fatty acids using host-derived unsaturated fatty acids. These compounds are thought to attenuate the immune response, but the underlying signaling mechanism(s) remain to be established. The pathogen Staphylococcus aureus also expresses an oleate hydratase and 10- hydroxyoctadecanoic acid (h18:0) is the most abundant oleate hydratase metabolite found at Staphylococcal skin infection sites. Here, we show h18:0 stimulates the transcription of a set of lipid metabolism genes associated with the activation of peroxisome proliferator activated receptor (PPAR) in the RAW 264.7 macrophage cell line and mouse primary bone marrow-derived …

Human Papillomavirus Prevalence And Dynamics: Insights From A 5-Year Population-Based Study In Jeddah, Kingdom Of Saudi Arabia, Khalid H. Sait, Nisreen M. Anfinan, Hesham K. Sait, Hussain A. Basalamah

Saudi Medical Journal

Objectives: To estimate the prevalence and dynamics of human papillomavirus (HPV) infection, over a 5-year period, among Saudi women. Methods: A 2-phase, population-based study combining cross-sectional and cohort designs was carried out with 5360 ever-married women aged 30–65 from Jeddah, Saudi Arabia, between 2013 and 2018. Participants were enrolled in a designated screening program and screened using the hybrid capture 2 HPV test. Women testing positive for HPV were followed up after one year to estimate the HPV clearance rate, while those testing negative had a follow-up after 5 years to assess new HPV infections. Factors associated with HPV positivity …

Waning Effectiveness Of Mrna Covid-19 Vaccines Against Inpatient And Emergency Department Encounters, Theodoros V. Giannouchos, Nicole L. Hair Ph.D., Bankole Olatosi Ph.D., Xiaoming Li Ph.D.

Faculty Publications

In the United States, most real-world estimates of COVID-19 vaccine effectiveness are based on data drawn from large health systems or sentinel populations. More data is needed to understand how the benefits of vaccination may vary across US populations with disparate risk profiles and policy contexts. We aimed to provide estimates of mRNA COVID-19 vaccine effectiveness against moderate and severe outcomes of COVID-19 based on state population-level data sources. Using statewide integrated administrative and clinical data and a test-negative case-control study design, we assessed mRNA COVID-19 vaccine effectiveness against SARS-CoV-2-related hospitalizations and emergency department visits among adults in South Carolina. …

Extramedullary Hematopoiesis In Cancer, Derek A G Barisas, Kyunghee Choi

2020-Current year OA Pubs

Hematopoiesis can occur outside of the bone marrow during inflammatory stress to increase the production of primarily myeloid cells at extramedullary sites; this process is known as extramedullary hematopoiesis (EMH). As observed in a broad range of hematologic and nonhematologic diseases, EMH is now recognized for its important contributions to solid tumor pathology and prognosis. To initiate EMH, hematopoietic stem cells (HSCs) are mobilized from the bone marrow into the circulation and to extramedullary sites such as the spleen and liver. At these sites, HSCs primarily produce a pathological subset of myeloid cells that contributes to tumor pathology. The EMH …

Attrition And Turnover Intentions Of Paramedic Program Directors In The State Of Texas, Jacob Charles Braddock

Electronic Theses and Dissertations

Prehospital care currently finds itself in a critical crisis as the number of emergency medical technicians continues to decline nationwide. This is especially alarming as such shortages have been exacerbated in the wake of the COVID-19 pandemic. Emergency medical service agencies are looking to educational institutions to ensure that an adequate number of providers are entering the field. These institutions are led by program directors, who oversee all aspects of the program. However, these individuals are also leaving the role at alarming rates nationwide. The purpose of this action research study was to take a qualitative descriptive approach to explore …

Determining A Urinary-Specific Antibiogram And Risk Factors Of Trimethoprim/Sulfamethoxazole, Ciprofloxacin And Multidrug Resistance Among Enterobacterales In Primary Care, Marissa Valentine-King, Michael A Hansen, Roger Zoorob, Matthew Schlueter, Jennifer L Matas, Samuel E Willis, Lisa C K Danek, Kenneth Muldrew, Mohammad Zare, Forrest Hudson, Robert L Atmar, Andrew Chou, Barbara W Trautner, Larissa Grigoryan

Faculty, Staff and Student Publications

Background: Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined.

Objectives: We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales.

Methods: We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020.

Results: Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with …

Tuberculosis In People Of Ukrainian Origin In The European Union And The European Economic Area, 2019 To 2022, Krista Stoycheva, Veronica Cristea, Csaba Ködmön, Senia Rosales-Klintz, Dominik Zenner, Anca Vasiliu, Marieke Van Der Werf, Christoph Lange

Faculty, Staff and Students Publications

Approximately five million Ukrainians were displaced to the EU/EEA following the Russian invasion of Ukraine. While tuberculosis (TB) notification rates per 100,000 Ukrainians in the EU/EEA remained stable, the number of notified TB cases in Ukrainians increased almost fourfold (mean 2019-2021: 201; 2022: 780). In 2022, 71% cases were notified in three countries, and almost 20% of drug-resistant TB cases were of Ukrainian origin. Targeted healthcare services for Ukrainians are vital for early diagnosis and treatment, and preventing transmission.

Rehabilitation Outcomes In Multiple Sclerosis Patients On Ocrelizumab Diagnosed With West Nile Virus Encephalitis, Taylor R Johnson, Stephanie Gandelman, Lauren R Serafin, Jeremy Y Charles, Dina Jacobs

Faculty, Staff and Student Publications

Multiple sclerosis (MS) has a global prevalence exceeding two million people and is a leading cause of non-traumatic physical disability. MS can be treated with ocrelizumab, an anti-CD20 monoclonal antibody. West Nile virus (WNV) is the most common cause of mosquito-borne viral encephalitis in North America. It can lead to neuroinvasive WNV disease (WNND) affecting the brain and peripheral nervous system, especially in immunocompromised patients, such as those being treated with ocrelizumab for MS. WNND is exceedingly rare and reported in less than 1% of cases of WNV. It has been established that inpatient rehabilitation improves functional outcomes in patients …

Oxidation Of Hydrogen Sulfide To Polysulfide And Thiosulfate By A Carbon Nanozyme: Therapeutic Implications With An Emphasis On Down Syndrome, Paul J Derry, Anton V Liopo, Karthik Mouli, Emily A Mchugh, Anh T T Vo, Ann Mckelvey, Larry J Suva, Gang Wu, Yan Gao, Kenneth R Olson, James M Tour, Thomas A Kent

Faculty, Staff and Student Publications

Hydrogen sulfide (H2S) is a noxious, potentially poisonous, but necessary gas produced from sulfur metabolism in humans. In Down Syndrome (DS), the production of H2S is elevated and associated with degraded mitochondrial function. Therefore, removing H2S from the body as a stable oxide could be an approach to reducing the deleterious effects of H2S in DS. In this report we describe the catalytic oxidation of hydrogen sulfide (H2S) to polysulfides (HS2+n−) and thiosulfate (S2O32−) by poly(ethylene glycol) hydrophilic carbon clusters (PEG-HCCs) and poly(ethylene glycol) oxidized activated charcoal (PEG-OACs), examples of oxidized carbon nanozymes (OCNs). We show that OCNs oxidize H2S …

Reply To Williams Et Al., M Hong Nguyen, Luis Ostrosky-Zeichner, Peter G Pappas, Thomas J Walsh, Joseph Bubalo, Barbara D Alexander, Marisa H Miceli, Jeanette Jiang, Yi Song, George R Thompson

Faculty, Staff and Student Publications

No abstract provided.

Treatment Outcomes With Standard Of Care In Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Real-World Data Analysis, Andrew Ip, Alex Mutebi, Tongsheng Wang, Monika Jun, Anupama Kalsekar, Fernando Rivas Navarro, Anthony Wang, Rajesh Kamalakar, Mariana Sacchi, Brian Elliott

Faculty, Staff and Student Publications

INTRODUCTION: Despite new therapies for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), treatments with chemotherapy, single-agent rituximab/obinutuzumab, single-agent lenalidomide, or combinations of these agents continue to be commonly used.

METHODS: This retrospective study utilized longitudinal data from 4226 real-world electronic health records to characterize outcomes in patients with R/R DLBCL. Eligible patients were diagnosed with DLBCL between January 2010 and March 2022 and had R/R disease treated with ≥ 1 prior systemic line of therapy (LOT), including ≥ 1 anti-CD20-containing regimen.

RESULTS: A total of 573 patients treated with ≥ 1 prior LOT were included (31.2% and 13.4% …

Cost Analysis For Robotic And Open Gastrectomy, Yuki Hirata, Heather G Lyu, Ahad M Azimuddin, Pamela Lu, Jeeva Ajith, Jason A Schmeisser, Elizabeth P Ninan, Kyung Hyun Lee, Brian D Badgwell, Paul Mansfield, Naruhiko Ikoma

Faculty, Staff and Student Publications

Objective: To determine the magnitude of the perioperative costs associated with robotic gastrectomy (RG).

Background: A robotic surgery platform has a high implementation cost and requires maintenance costs; however, whether the overall cost of RG, including all perioperative costs, is higher than conventional open gastrectomy (OG) remains unknown.

Methods: Patients who underwent a major gastrectomy during February 2018 through December 2021 were retrospectively identified. We calculated the perioperative costs of RG and OG and compared them overall as well as in different phases, including intraoperative costs and 30-day postsurgery inpatient and outpatient costs. We investigated factors potentially associated with high …

A Case Of Epstein-Barr Virus Encephalitis And Orbital-Face Inflammation, Rui T Tang, Jose Gavito-Higuera, Claudia M Prospero Ponce

Faculty, Staff and Student Publications

Epstein-Barr virus (EBV) can cause follicular conjunctivitis, keratitis, oculoglandular syndrome, meningitis, and encephalitis. We report a 54-year-old Hispanic male who presented with right pupil-involved complete ophthalmoplegia, orbital and masticatory muscle inflammation, trigeminal enhancement, and new corneal infiltrate highly suggestive of EBV. Labwork was negative except for positive EBV polymerase chain reaction (PCR) in serum. Magnetic resonance imaging (MRI) of his brain and orbits with contrast showed enhancement of the right ganglion of the trigeminal nerve, oculomotor nerve, all extraocular muscles in the right orbit, and right masticatory and temporalis muscles and a right subacute lacunar infarct. The patient was diagnosed …

Chimeric Systems Composed Of Swapped Tra Subunits Between Distantly-Related F Plasmids Reveal Striking Plasticity Among Type Iv Secretion Machines, Kouhei Kishida, Yang Grace Li, Natsumi Ogawa-Kishida, Pratick Khara, Abu Amar M Al Mamun, Rachel E Bosserman, Peter J Christie

Faculty, Staff and Student Publications

Bacterial type IV secretion systems (T4SSs) are a versatile family of macromolecular translocators, collectively able to recruit diverse DNA and protein substrates and deliver them to a wide range of cell types. Presently, there is little understanding of how T4SSs recognize substrate repertoires and form productive contacts with specific target cells. Although T4SSs are composed of a number of conserved subunits and adopt certain conserved structural features, they also display considerable compositional and structural diversity. Here, we explored the structural bases underlying the functional versatility of T4SSs through systematic deletion and subunit swapping between two conjugation systems encoded by the …

Grievance Politics And Technocracy In A Developmental State, Ijlal Naqvi, Federico M. Rossi, Rayner Kay Jin Tan

Research Collection School of Social Sciences

This article uses a process-tracing approach to understand changes in Singapore’s health sector from the start of self-rule in 1959 to the end of the COVID-19 pandemic in 2022. Singapore is a developmental state recognized for its effective management of healthcare costs and its lack of political freedom. In both respects, the ‘Singapore model’ is of interest to other cities and nations. The standard narrative is one of technocratic proficiency in a context in which civic freedoms are heavily constrained, but this article identifies the surprisingly important role of social voices at key moments. It finds episodes in which effective …

The Effect Of Mitochondrial Transplant Therapy On Muscle Damage And Exercise Performance, Samantha Lynn Davis

Electronic Theses and Dissertations Archive

Objective: To determine if weekly mitochondrial transplants given to animals undergoing a muscle damaging protocol will improve exercise performance and immune responses. Methods: Mitochondrial injections were given to eight-week-old C57/BL6 mice (N=7/group) for 6 weeks under a muscle damaging exercise protocol. A run-to-fatigue test was completed at baseline, 4, and 6 weeks. Blood was collected immediately after the last run; tissues and organs were harvested 24 hours later for transcription measurements and histology. Results: No significant differences were found in exercise performance in any week. Histological analysis did not show any differences between groups. PGC1-α transcripts were significantly decreased in …

A Baker's Dozen Of Top Antimicrobial Stewardship Intervention Publications In 2022., Reagan K Barfield, Matthew L Brown, Benjamin Albrecht, Katie E Barber, Jeannette Bouchard, Amy L Carr, Elias B Chahine, David Cluck, Elizabeth W Covington, Connor R Deri, Spencer H Durham, Carmen Faulkner-Fennell, Lauren K Freeman, Timothy P Gauthier, Geneen M Gibson, Sarah B Green, Athena L V Hobbs, Bruce M Jones, Caroline C Jozefczyk, Ashley H Marx, Edo-Abasi U. Mcgee, Lacie J Mckamey, Rachel Musgrove, Emily Perez, Douglas Slain, Kayla R Stover, Michelle S Turner, Cyle White, P Brandon Bookstaver, Christopher M Bland

PCOM Scholarly Works

Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship-related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation.

A Systematic Review Of Measures Of Healthcare Workers’ Vaccine Confidence, Kofoworola Akinsola, Ayobami Bakare, Elisa Gobbo, Carina King, Claudia Hanson, Adegoke Falade, Sibylle Herzig Van Wees

Centre of Excellence in Women and Child Health

Healthcare workers (HCW) perceptions toward vaccines influence patient and community vaccine decision making. In an era of rising vaccine hesitancy, understanding HCW vaccine confidence is critical. This systematic review aims to review instruments that have been validated to measure HCW vaccine confidence. We conducted a search in five databases in June 2023. Data was descriptively synthesized. Twelve articles describing 10 different tools were included. Most tools included dimensions or items on vaccine knowledge (n = 9), safety (n = 8), vaccine usefulness (n = 8), recommendation behavior (n = 8), and self-vaccination practice (n = 7). All, except one study, …

Weed Detection Using Lightweight Deep Learning Models With Transfer Learning And Hyperparameter Optimization, Ali Shaheen

Masters Theses & Doctoral Dissertations

In agriculture, the presence of weeds adversely impacts yield. Confronting this challenge manually requires continuous and labor-intensive field monitoring processes. Artificial intelligence, notably deep learning is one the most promising for weed detection, particularly when deployed to edge devices. However, these edge devices have limited computational resources, making it challenging to deploy large Deep Learning (DL) models often resulting in a performance-size trade-off. This research proposes a three-pronged approach that leverages DL lightweight architectures (LWA) to optimize for size and minimize computational resources at the edge, transfer learning to mitigate constraints associated with limited data commonly encountered in this domain, …

Understanding Provider Perspectives: Catalysts And Challenges Of Intelligent Clinical Decision Support Systems, Andrew Behrens

Masters Theses & Doctoral Dissertations

The study aims to understand the providers' perspectives of Intelligent Clinical Decision Support Systems (ICDSS). Providers are the key users of ICDSS. ICDSS uptake is heavily reliant on providers. However, providers have a powerful sense of personal identity due to their prestige, high autonomy, and socially accepted role. Currently, providers are resisting ICDSS. ICDSS resistance is due to poor fit with workflow, lack of relevant output and usefulness, insensitivity to complex patients, autonomy challenges, and an impact on the provider-patient relationship. Recently, researchers have overlooked the providers' contextual perspectives of ICDSS. The study addressed the research gap by understanding the …

Validation Of A Whole Blood Machine Learning Strategy For Distinguishing Between Bacterial And Viral Infection In A Pediatric Hospital Setting, Ridwan B Ibrahim, Herda Ona, Anil K Chokkalla, Estella Tam, Sridevi Devaraj

Faculty, Staff and Students Publications

Similar symptoms between viral and bacterial diseases often make diagnosis difficult. This study assessed the clinical performance of the newly cleared whole-blood Bacterial versus Viral Score assay in our pediatric cohort to the previously validated serum assay and emergency department physician diagnosis. This assay shows excellent agreement (R = 0.997) with the serum assay and has great diagnostic accuracy when compared to physician diagnosis.