Pre-analytical stability of coagulation parameters in plasma stored at room temperature

Introduction: Haemostasis testing is influenced by many pre-analytical variables, such as storage time and temperature, which can affect the stability of coagulation factors and influence the results of coagulation assays. We investigated the stability of haemostasis tests after storage of aliquoted plasma at RT, including the variability of measurement principle and reagent used for determination. Methods: Blood samples from 20 healthy volunteers were obtained, processed to PPP and aliquoted. Aliquots were stored at RT for 0 hour, 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24 hours and 48 hours. PT, aPTT, fibrinogen, D-Dimers and coagulation factors (FII, FV, FVII, FX, FVIII, FIX, FXI, FXII) were determined by STA-R Max (R) and ACL-TOP (R). VWF:Ag and vWF:RCo were determined by AcuStar (R). Clinically relevant changes, compared to the initial measurement, were denoted as a percentage change of > 10% according to the 99% CI. Results: For both analysers, a clinically relevant change of > 10% was observed for FV after 2 hours, FVIII after 4 hours and for aPTT, FII, FVII, FX and FXII after 48 hours of storage at RT. Statistically significant, but no clinically relevant differences were observed after 48-hours storage for PT, fibrinogen and FIX. D-Dimers, FXI, vWF: Ag and vWF: RCo were found stable up to 48 hours at RT. Conclusion: Overall, compared to the limits given by the current CLSI guidelines, for most coagulation parameters investigated in this study a longer storage period could be accepted. Time intervals for FVIII and FV dosage were shorter than recommended by the CLSI guidelines. For PT determination, our findings were consistent

Enlargement and the Historical Origins of the European Community's Democratic Identity, 1961–1978

This article examines how and when democracy entered the discursive politics of the European Community to become one of the fundamental tenets of European political identity – and in the process influenced how decision-makers approached the question of enlargement. Building on multiple archival sources, the article traces how all three Community institutions (Commission, Council and European Parliament) legitimised the expansion and continuation of the process of European integration through the discursive construction of democracy. It focuses on the debates elicited by the attempts of southern European countries to accede to the EEC in the 1960s and 1970s

Multicenter in vitro thromboelastography and thromboelastometry standardization

OBJECTIVE: To establish and compare the repeatability and reproducibility of activated thromboelastography (TEG) and thromboelastometry (ROTEM) assays. DESIGN: Multicenter in vitro test standardization. SETTING: Veterinary academic centers. ANIMALS: Test samples were obtained from normal, healthy dogs. Sixty identical 5 mL aliquots of canine platelet-rich plasma collected by apheresis, frozen in 6% dimethyl sulfoxide, were tested initially. Sixty identical 6 mL aliquots of canine fresh frozen plasma with admixed cryoprecipitate were subsequently evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Frozen study samples, quality controls, reagents, and consumables were distributed to participating centers (7 TEG and 3 ROTEM). TEG centers analyzed study samples with kaolin and tissue factor activated assays; ROTEM centers ran proprietary ellagic acid activated and tissue factor activated assays. All machines underwent quality control prior to sample analysis. Within- and between-center coefficients of variation (CVs) were calculated and compared using Mann-Whitney tests and calculation of intraclass correlation coefficients. Within and between centers, individual parameters for both TEG and ROTEM assays were comparable. Both within-center and between-center CVs varied markedly (0.7-120.5% and 1.4-116.5%, respectively) with assay type, instrument, and parameter. CVs for equivalent parameters were not significantly different between the 2 platforms. Intraclass correlation coefficients suggested moderate agreement between centers. In general, individual parameter CVs for platelet-rich plasma samples were lower in TEG centers, while CVs for canine fresh frozen plasma with admixed cryoprecipitate samples were lower in ROTEM centers. CONCLUSIONS: More variation within and between centers was identified than anticipated, but some parameters such as alpha angle were repeatable and reproducible. Sample types for future multicenter standardization efforts will require further optimization and may need to be adapted separately to each platform. Individual centers using viscoelastic tests for evaluation and management of clinical patients should take steps to minimize preanalytical and analytical sources of variation

"Migrants, States, and EU Citizenship's Unfulfilled Promise"

A constant aim of EU citizenship, and indeed the entire project of European integration, has always been to lower barriers and create a common space. If the complete elimination of national borders remains elusive, their importance has been diminished in striking ways by the development of EU citizenship and the ban against nationality based discrimination. Yet the barriers to free movement have been lowered in differential ways. Most citizens of EU member states now enjoy residence, employment and other rights throughout Europe. The extension of some rights to some categories of citizens of some new member states is admittedly sometimes subject to transition periods, but these expire. By contrast, third country nationals -- individuals who do not hold citizenship of one of the member states, even though they may have resided for many years, or even been born in Europe -- remain largely excluded from the benefits of EU citizenship. Various initiatives over the years have opened up limited rights for third country nationals. But the difficulty of enacting these rights, and current moves to more restrictive immigration and naturalization policies, highlight the continuing exclusivity of EU citizenship: immigrants migrate to national polities, and they become European only by virtue of incorporation into national states. This means that EU citizenship's transformative potential remains unrealized.Glendon College (York University