Ladenson, Jack H.

Abstract The Africa Working Group, under the auspices of the Global Laboratory Quality Initiative of the Association for Diagnostics & Laboratory Medicine (ADLM), conducted several educational workshops in Africa to promote laboratory quality in the region. The challenges faced in maintaining quality in clinical laboratories in low-resource countries may differ from region to region and country to country. To better understand current gaps and inform our engagement with partners in Africa, a needs assessment survey was distributed to 1427 ADLM members in Africa and further disseminated through local partners, resulting in 121 responses from participants across 8 countries in the region. Additionally, interviews were conducted with laboratory professionals from the countries surveyed. The surveys primarily focused on quality management, continuing education, budgeting, infrastructure and funding, supplies, and staffing issues. The data collected from the surveys and interviews strongly indicate that respondents face major challenges in all areas assessed, including lack of funding, lack of equipment, lack of quality control (QC) and external quality assessment (EQA) materials, gaps in quality management, lack of appropriate budgeting, staffing issues, and lack of accessible training/continuing education. Consistent with the primary focus of ADLM;s Global Quality Initiative, improved access to continuing education was identified as the primary need by the participants (58%). The assessment highlights that while a strong role for educational workshops in mitigating some of the challenges continues to exist, there is also an opportunity to broaden the scope of the working groups beyond education.

AbstractIntroductionFour less well‐studied but promising “emerging” cerebrospinal fluid (CSF) biomarkers are elevated in late‐onset Alzheimer disease (AD): neurogranin, synaptosomal‐associated protein‐25 (SNAP‐25), visinin‐like protein 1 (VILIP‐1), and chitinase‐3‐like protein 1 (YKL‐40).MethodsCSF neurogranin, SNAP‐25, VILIP‐1, and YKL‐40 were measured in families carrying autosomal‐dominant AD mutations.ResultsThe four emerging CSF biomarkers were significantly elevated in the mutation carriers (n = 235) versus noncarriers (n = 145). CSF SNAP‐25, VILIP‐1, and YKL‐40 were altered very early in the AD time course, approximately 15–19 years before estimated symptom onset. All CSF biomarkers predicted important AD‐related outcomes including performance on a cognitive composite, brain amyloid burden as measured by amyloid positron emission tomography, and the estimated years from symptom onset.DiscussionEarly abnormalities in CSF tTau, pTau, SNAP‐25, VILIP‐1, and YKL‐40 suggest that synaptic damage, neuronal injury, and neuroinflammation begin shortly after the commencement of brain amyloid accumulation.