Newborn screening for congenital hypothyroidism remains challenging decades after broad implementation worldwide. Testing protocols are not uniform in terms of targets (TSH and/or T4) and protocols (parallel vs. sequential testing; one or two specimen collection times), and specificity (with or without collection of a second specimen) is overall poor. The purpose of this retrospective study is to investigate the potential impact of multivariate pattern recognition software (CLIR) to improve the post-analytical interpretation of screening results. Seven programs contributed reference data (N = 1,970,536) and two sets of true (TP, N = 1369 combined) and false (FP, N = 15,201) positive cases for validation and verification purposes, respectively. Data were adjusted for age at collection, birth weight, and location using polynomial regression models of the fifth degree to create three-dimensional regression surfaces. Customized Single Condition Tools and Dual Scatter Plots were created using CLIR to optimize the differential diagnosis between TP and FP cases in the validation set. Verification testing correctly identified 446/454 (98%) of the TP cases, and could have prevented 1931/5447 (35%) of the FP cases, with variable impact among locations (range 4% to 50%). CLIR tools either as made here or preferably standardized to the recommended uniform screening panel could improve performance of newborn screening for congenital hypothyroidism.

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This semi-automated method has few manual transfer steps, thus minimizing common manual errors and saving time. Therefore, this method would be very helpful to responding laboratories in a large-scale exposure event related to HD.

The goal of this study was to evaluate the plausibility and accuracy of commercially available on-site immunoassay urinalysis kits for the screening of compounds of interest within food matrices. In conjunction with this study, a sensitive, robust, and reproducible analytical method, utilizing solid-phase extraction liquid chromatography/quadrupole ion trap/time-of-flight mass spectrometry for confirmation analysis, was developed. The food matrices analyzed were tomato juice, apple juice, milk, beer, white wine, ground beef, powdered milk, and all-purpose flour. Compounds fortified into the food matrices included heroin, phencyclidine, cocaine, benzoylecgonine, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, imipramine, doxepin, nitrazepam, diazepam, oxazepam, temazepam, alprazolam, flunitrazepam, clonazepam, and lorazepam. Standard curves were prepared for each matrix from 10 to 500 ng/ml for each analyzed compound. All liquid chromatography/tandem mass spectrometry samples were fortified with 20 microl of deuterated internal standard at 90 ng/ml. Quality control standards were prepared at 20 and 400 ng/ml, and > 90% were within 2 SD of the mean for each analyte. The test kits were found to produce up to 85% of the expected results based on concentration levels of adulterants (i-Screen in milk). This study shows that lateral-flow immunoassay test kits are plausible as a rapid, accurate, and reliable screening method in the event of adulteration of the food supply.

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