"You never want a serious crisis to go to waste."

Weill Cornell Medical Center (New York) (read more)

Weill Cornell Medicine recognizes the gravity of the pandemic caused by SARS-CoV-2, which causes COVID19 disease. This infection reaches every aspect of our lives, and it has no borders. Our response at WCM, in the disease epicenter of New York City, will help define how our society changes for the better when the pandemic is over. Towards this WCMC Biorepository has started collecting COVID biospecimens and using OpenSpecimen to manage the data.

Cambridge University (London) (read more)

Many labs in the Haematology department in CU are doing COVID-related research. Krishagni has been providing priority support to ensure that the configuration of these studies and data collection is smooth and is done in a timely manner.

University of Cape Town (read more)

University of Cape Town adopted OpenSpecimen as their biobanking LIMS to manage COVID specimens. This project is funded by the Foundation of Innovative New Diagnostics (FIND) a Geneva-based NGO accelerating the development, evaluation, delivery of high-quality, affordable diagnostics tests for poverty-related diseases. 

We are also in advanced talks with a couple of academic centers to help them accelerate their research by using OpenSpecimen.

Written by: Srikanth Adiga, CEO, Krishagni

For more details, email contact@krishagni.com

We’ll be there at the ISBER Regional Meeting this November. Come and meet us at Booth No. 8 to know more about OpenSpecimen.

Your monthly pick of biobanking buzz from the OpenSpecimen team. We are excited to announce our upcoming Annual Community Meetings in USA and Australia. Register ASAP to book your seats.

Fresh of the Press

• AIDS and Cancer Specimen Resource (ACSR) renewed with the George Washington University through $22 million grant
• The University of Wisconsin-Madison Center will lead the coordinating center for national clinical trials aimed at cancer prevention.
• Clinical research for PET imaging for prostate cancer begins at Osaka University Hospital
• Getting together in the biobank scene: BRoTHER brings biobank know-how to scientists, students, and the public
• Rare Disease Clinical Trials: FDA Awards $15M in Grants
• City of Hope is enrolling patients in the first of its kind Clinical Trial for Brain Tumor patients
• 23andMe and UK biobank database reveals: It’s possible to inherit more DNA from one parent than the other
• University at Buffalo launches “biobank” in downtown research center

Biobank Job Alerts

• Clinical Research Associate I – Biobank – Cedars-Sinai, Los Angeles, USA 
• Senior Director, Biobank  – Alexion Pharmaceuticals, Inc., USA
• Clinical Research Coordinator Associate – School of Medicine, Stanford, USA
• Clinical Research Medical Director – Cardiology – Amgen, California, USA
• Senior Manager, Biorepository – Exact Sciences, Madison, USA
• Biobank Technician – University of California, Los Angeles, USA
• Biobank Coordinator – Emerge, Melbourne, Australia 

Upcoming Events

OpenSpecimen News

New Clients

• National Eye Institute (NIH, USA)
• King’s College London for the Precise Network project (Africa)

OpenSpecimen’s mobile app development initiated

We are excited to announce the initiation of the “OpenSpecimen‘Mobile App’ development. The first version of the app will support patient registration, consents, questionnaires, and specimen collection. To enable offsite data collection in remote sites with no internet, the mobile app will also support the “offline data collection” mode. In future versions, users can look up details of specimens or boxes by scanning the labels. The first version of the mobile app will be released in Dec 2019 and will be enhanced in future releases based on customer feedback.

OSCON’19

We just concluded our “Community Meet” in Cairns Australia. A big thanks to all our adopters for participating and making the meeting successful.

Krishagni is the developer of OpenSpecimen – an open-source software for managing biospecimen data used in 65+ research centers across 16+ countries. While this article promotes “open source”, it does not necessarily promote OpenSpecimen. Customers are encouraged to evaluate all options based on their requirements before deciding which software suits them the best.

Introduction to Open Source

The “open” in OpenSpecimen stands for “Open Source”. While Open Source Software (OSS) is a very popular concept in the IT world, not many non-IT savvy people understand its importance. This article aims to explain why understanding the concept of open source is important when deciding on a software for your biobank.

What is “open source” and how is it different than “closed source”?

Open source is a type of software license where the source code behind the software is free and publicly available. Conversely, “closed source” software (also known as “proprietary” software) is where the developers won’t disclose the source code to the public. Popular examples of open source products are Android, Linux, Chrome, Firefox, MySQL, WordPress, OpenClinica, i2b2, and OpenEMR. Examples of closed source products are Microsoft Windows, Oracle, OnCore, REDCap, and Epic.

A natural first question is: how do open source product companies make money based on a business model that gives away their source code? The answer is that open-source businesses charge for “professional services” like training, setup, integration, data migration, etc. Most open source products have two editions: Community and Enterprise. While the Community Edition is a fully functional product that meets all the basic needs, the Enterprise Edition will have desired premium features as well as professional support.

Why open-source matters?

Software is not good just because it is open source. Open source is one of the many aspects of a good product. Other important factors include ease of use, scalability, flexibility, popularity, support, etc. Top software companies like Microsoft, Google, and Apple heavily invest in, use, develop and promote open source products.

Not “locked” to one developer

One of the most important concepts behind open-source software is that consumers of the product are not bound by a single development entity. In open-source software, consumers are not at the “mercy” of the application developers since the source code is public.

Consider these scenarios:

• The developer goes out of business or decides to stop working on the product.
• Your funding dries up and you don’t have the money to pay annual license fees every year.
• The developer decides to take the product in a direction that you and/or others in the community don’t think is a good fit

There are many options with software that is developed in a manner consistent with open-source principles. For example, another company can take the product forward or the adopter community can get together and form a consortium. With proprietary software, however, you do not have that choice as consumers are “locked-in” to the developer of the product.

Security and code quality

How would one know that the product is well-built and secure? In open-source, the source code is public and therefore audit-able. In fact, since the code is publicly available it forces the developers to take extra precautions to ensure good quality code. If desired, one could hire a security expert to review the source code to confirm that the product is indeed well developed and secure.

Community contribution and collaboration

Typically, open-source projects have a vibrant community and promote collaboration. They have open forums, webinars, monthly calls and annual meetings. OpenSpecimen has a rich history of customers contributing to the development of new features. For example, a feature first funded by the University of Leicester is further enhanced by Stanford University and later further improved by SAHMRI. This ripple effect contributes to a feature-rich and stable end product. The entire community, whether a paying customer or not, benefits from this activity.

Open Source History of OpenSpecimen

The history of OpenSpecimen is a classic example of why open source matters. OpenSpecimen started in 2004 as “caTissue” with funding from the National Cancer Institute (NCI). However, in 2009, NCI stopped the funding for the development of caTissue. By then, there were many centers that had already adopted caTissue in the USA, Australia, UK, and Singapore but were now stuck with a product that had no future development path. At Krishagni, founded by three caTissue developers, it made a perfect business sense to adopt caTissue and continue development and support. This was possible only because NCI had released caTissue under an open-source software license. Over the next few years, Krishagni rebranded caTissue as OpenSpecimen and rewrote the source code to modernize its architecture. Importantly, Krishagni retained the open source nature of OpenSpecimen – even though it was not mandatory to do so.

Summary

In the academic and non-profit world, collaboration and development of a community are important. Openness and transparency with customers should be the preferred environment for any company. OpenSpecimen is used in many centers today without any compensation to Krishagni. This includes not only centers from low-income countries like India, Egypt, and Nigeria but also leading centers like Oxford University and the University of Basel. Krishagni fully supports the entire OpenSpecimen ecosystem and views successful implementations at institutions of any size as a win for the entire biobanking community.

Customer Statements

Washington University – St.Louis, USA

“We fundamentally believe in using the best informatics tool to meet local requirements and have a long history of using proprietary, open-source and custom software to fill those needs. While each application, support mechanism, and vendor is unique with regard to licensing and total cost for using their application, we do believe that open-source tools, vendors and the community supporting the tools generate strong symbiotic relationships. Since OpenSpecimen is open-source, we feel that there is flexibility for us to engage resources, either internal or external, to meet our needs.”
Dave Mulvihill, Director of Informatics, Siteman Cancer Center

Center for Bioethics and Research (CBR) – Nigeria

“Open-source nature of OpenSpecimen has helped us tremendously in achieving the goal of a
software-driven biobank for our various research projects because we are in a low resource
environment and cannot afford many paid services and software.
Open-source software levels the playing field between research centers and institutions in
Africa and those in high resource environments to a certain degree. This enables African
research institutions to stretch their resources and participate in the latest health research
projects while embracing new technology in a way that is forward-thinking and compatible with
legacy solutions.”

John Hopkins University- Baltimore, Maryland, USA

“At JHU, we view the open source nature of OpenSpecimen as a key part of the application’s appeal. It promotes a strong user community that allows development to be driven by the needs of research, not software developers. Its openness allows us to really “see” what we’re getting and allows our technical team to have a fuller understanding that helps us support our researchers.
Combined with OpenSpecimen’s plugin architecture, we have the flexibility to customize the application to our needs which will become increasingly important as we continue to roll out across our institution. While we have been very satisfied with Krishagni’s support and direction, it is also good to know that we are not beholden to that, because we ultimately have ownership of OpenSpecimen at JHU. Lastly, and perhaps most importantly, the availability of good biobanking software to everyone, regardless of that institution’s means, will make research and collaboration stronger for all of us.”

Written by: Srikanth Adiga, CEO, Krishagni

For more details, email contact@krishagni.com

Biobanks: The Past

Historically, the Department of Defense (DoD) has been maintaining biorepositories and using the materials stored to expand our understanding of diseases and for developing medical countermeasures since the Civil War. Other U.S. Government and nongovernmental organizations are also engaged in curating human and other samples for future studies, as are organizations in other countries. One of the first biorepositories was established as part of the Army Medical Museum in Washington, DC, by DoD in 1862.

In the olden days, scientists often collected and used biospecimens in isolation. They had to work out the best ways to collect, handle and store different types of biospecimens. Inconsistent collection, shipping, and processing protocols often led to poor quality specimens and suboptimal experimental results ¹. Moreover, in the past, the scope of biospecimen use was limited. Researchers often collected biospecimens for a single study and stored information in a laboratory notebook. International collaborations were also limited due to a lack of funding as well as resources.

In 1999 the United States National Bioethics Advisory Commission issued a report containing policy recommendations about handling human biological specimens. In 2005 the United States National Cancer Institute founded the Office of Biorepositories and Biospecimen Research (OBBR) so that it could have a division to establish a common database and standard operating procedures for its partner organizations with biospecimen collections. In 2006 the Council of the European Union adopted a policy on human biological specimens which was novel for discussing issues unique to biobanks.

ISBER was the brainchild of our first president Elaine Gunter, and was organized in 1999 through a series of meetings at the American Type Culture Collection headquarters in Virginia, and at McKesson Bioservices and the National Cancer Institute (NCI), both in Maryland. The founding members were from a variety of government, commercial and academic biobanking organizations. The first meeting was co-sponsored by the NCI and was held in Rockville Maryland in 2000. Today ISBER has thousands of members across 30+ countries involved in long-term preservation and storage of animal, environmental, human, microorganism culture, museum, and plant/seed collections.

Other organizations which participated in creating written guidelines about biobanking are the following: World Medical Association, Council for International Organizations of Medical Sciences, Council of Europe, Human Genome Organisation, World Health Organization, and UNESCO.

Biobanks: The Present

We are entering the golden age of biobanking. The last two decades have witnessed a massive rise in chronic diseases such as heart disease and cancer ². But new technologies now allow scientists to catalog changes in the genes, proteins, and cellular metabolism for different diseases. The increase in disease burden and technological advances have, in turn, led to an increased reliance on biorepositories to collect and manage biospecimens for research. Millions of samples are now deposited in biobanks every year ³. Furthermore, the biobanking market is expected to reach USD2.69 billion by 2022 ⁴.

Advances in epidemiology and omics science have also led to an increased interest in infrastructure development and data sharing facilitated by biobank of specimens and linked health information ⁹.

However, biobanks still grapple with a number of technical, financial, legal and ethical issues ¹. There is still no global harmonization of biospecimen handling processes. Variations in sample management can drastically affect biospecimen quality ⁵. Organizations like ISBER have published best practice guidelines to help standardize specimen handling ⁶.

Recent efforts by the International Organization for Standardization (ISO) have also contributed to the standardized biobanking practices. The ISO 20387 standard lays down the general requirements for biobanking.

Many questions remain about specimen “ownership”, informed consent and use of specimens in different studies ¹. The laws on consent for specimen use vary around the world. Concerns also remain about specimen and data privacy ⁷. Biobanking software can keep data private while at the same time allowing researchers to track biospecimens and monitor storage temperatures and specimen quality.

Biobanks: The Future

The future of biobanking is particularly exciting. Artificial intelligence, deep learning, computational models and semantic searches could all revolutionize biobanking as we know it ⁴.

Some of the fields that will particularly be impacted by this onset of technology are ⁸:

• Biosamples and data types (Microbiome, body fluids, imaging data)
• Sampling technologies (Circulating free DNA)
• Sample stabilization ( Room temperature stabilization of biomolecules)
• Sample storage
• Sample analytics (Metabolomics, proteomics, NMR)
• Data management solutions

Artificial Intelligence will play a big role in the coming years. AI will define and measure the quality of biosamples; for example, AI systems could assess DNA integrity with DNA gel electrophoresis images and could determine the percentage of tumor and necrosis with digital histopathology images of tissue samples. AI applications will also analyze the contents of the research proposal and then will recommend biosamples suitable to specific uses. For this, AI could extract important information (e.g., the type of biosample, the type of analyte, the method of analysis, the target disease, and research purposes) from the research proposal and could analyze the references to preanalytical and analytical variations related to these elements ¹⁰.

Conclusions

Biobanks have come a long way in the past century. Methods to process, store and analyze biospecimens have become increasingly sophisticated. The industry as a whole is working to develop standardized best practices.
Given the complexity and challenges faced by biorepositories, all biorepository administrators, including those with established repositories and those who are just starting repositories, both nationally and internationally, are encouraged to collaborate in an organized and productive manner to address common concerns and formulate acceptable standards and practices, and to deal with these in a comprehensive and thoughtful manner. The first challenge is identifying those who will take the lead in this effort. The future of biobanking will be very exciting as we leverage the power of new technologies to improve our biospecimen management.

References

1. Vaught and Lockhart. The Evolution of Biobanking Best Practices. Clin Chim Acta. 2013
2. Integrated chronic disease prevention and control. World Health Organization (Online) Accessed June 17, 2019.
3. The Continuing Evolution of Biobanking: Marching Toward Standardization. Fluidigm (Online) Accessed June 17, 2019
4. Kurt Zatloukal. Innovative Technology and Its Contribution to Biobanking. Presentation at Global Biobank Week. (Online) Accessed June 17, 2019
5. NCI Best Practices for Biospecimen Resources. National Cancer Institute. 2016 (Online) Accessed June 17, 2019
6. Campbell et al. Revision of the ISBER Best Practices: Summary of Changes and the Editorial Team’s Development Process. Biopreserv. Biobank. 2018
7. Harris et al. Toward a roadmap in global biobanking for health. European Journal of Human Genetics. 2012
8. Innovative Technology and Its Contribution to Biobanking Kurt Zatloukal M.D.Institute of Pathology, University of Graz, Austria
9. Biobanking in a Constantly Developing Medical World – Artene, Ciurea, Purcaru, Tache, Tataranu, Lupu, Dricu
10. Jae-Eun Lee. Artificial Intelligence in the Future Biobanking: Current Issues in the Biobank and Future Possibilities of Artificial Intelligence. Biomed J Sci&Tech Res 7(3)- 2018.

Written by: Srikanth Adiga, CEO, Krishagni

For more details, email contact@krishagni.com

Despite these advances, many biorepositories face significant challenges, such as maximizing sample use and maintaining financial viability ². However, not every biorepository faces the same challenges. A biobank classification system may make it easier to understand the unique problems in different types of biorepositories. It may also help researchers find biospecimens ³.

A Proposed Biorepository Classification System

A group from the University of Leeds interviewed 33 biorepositories in 9 countries. The researchers then used this data to classify biobanks based on the types of biospecimens they store, the type of research they support, how they store samples and whether they are part of the private or public sector⁴. This paper suggests the following biobank classification:

Storage Networks

In storage networks, groups of researchers come together to form a shared biorepository facility. This approach lowers storage costs and improves biospecimen quality, compared with each group storing their own biospecimens. These networks typically do not share samples with external researchers. Example, Peter MacCallum tissue bank.

Bring and Share Networks

Similar to storage networks, except these facilities offer researchers a lower storage fee if they are willing to share their biospecimens with other researchers. Example, Biological Bank and Cell Factory, Italy.

Catalogue Networks

Catalogue networks make their samples available to external researchers. They also have a freely-available biospecimen catalogue or database that can be searched by external researchers. Example, Australian Brain Bank Network.

Partnership Networks

Similar to storage networks, partnership networks involve a consortium of research groups working together to lower biospecimen storage costs. However, unlike storage networks, partnership networks may use several storage sites, instead of one central biorepository. A partnership network may link many previously independent biorepositories under one umbrella organization. Example, The Australasian Leukaemia and Lymphoma Group Price Waterhouse Cooper Tissue Bank.

Conceptual Classification Approach

In a separate paper³, Peter Watson and Rebecca Barnes propose a different way to classify biorepositories. They used the following criteria:

1. Biospecimen donor
2. Collection methods and design, for example:

• Are the specimens prospective or retrospective?
• Are the specimens managed and collected directly for the primary purpose of research or indirectly during a medical procedure
• Is it a small collection for a single study or a large multi-study, multi-use collection

3. Biospecimen type e.g. blood, tissue, fresh or fixed etc.
4. Brand and intended users. Will the specimens be used by a single group or institution or multiple users?

They proposed a schema for classifying biobanks into 3 groups (mono-, oligo-, and poly-user), primarily based upon biospecimen access policies. The study used that research to further classify biobanks concluding that Poly-user biobanks employed significantly more full-time equivalent staff, and were significantly more likely to have a website, share staff between biobanks, access governance support, utilize quality control measures, be aware of biobanking best practice documents, and offer staff training. Mono-/oligo-user biobanks were significantly more likely to seek advice from other biobanks.

Conclusion

There are no widely-accepted guidelines to classify biorepositories. In this post, we have shared two options. Please let us know in the comments below, whether you think the community should work towards a universal biorepository classification system.

References
1. De Souza and Greenspan. Biobanking Past, Present and Future: Responsibilities and Benefits. AIDS. 2013
2. Brown et al. How Biobanks Are Assessing and Measuring Their Financial Sustainability. Biopreserv. and Biobank. 2017
3. Watson and Barnes. A Proposed Schema for Classifying Human Research Biobanks. Biopreserv. And Biobank. 2011.
4. Shickle et al. Inter- and Intra-Biobank Networks: Classification of Biobanks. Pathobiology. 2010

Written by: Srikanth Adiga, CEO, Krishagni

For more details, email contact@krishagni.com

Here are the highlights of the release:

• Archive users and create users as contacts
• Dropdown manager: Bulk operations like export, edit and delete on values
• LDAP and SAML configurations via UI
• Bulk operation: Support for semicolon delimiter
• REDCap integration enhancements
• Saved reports: Upcoming visits and minor to major reconsent
• Many bug fixes and improvements

Refer to release notes for more details.

Here is a quick overview.

v6.0 released

Two very interesting features are introduced in this release: Google-like keyword search and Freezer Defragmentation report. For more details visit: https://www.openspecimen.org/openspecimen-v6-0-release/

OpenSpecimen v6.1 will be released in mid-May. Track v6.1 tickets here (needs Jira login).

New Adopters

• MSKCC – Clinical Trial Center (New York, USA)
• Allegheny Hospital Network (Philadelphia)
• University of Miami – Cancer Center (Miami, USA)
• Columbia University Medical Center (New York, USA)
• NavarraBiomed (Navarra, Spain)
• University of Basel (Basel, Switzerland)
• Telethon Kids (Perth, Australia)

Case Studies

Johns Hopkins’s adoption of OpenSpecimen over the years
JHU has been using OpenSpecimen since 2008 (since the caTissue times) and has been a very active member of the OpenSpecimen community. This case study describes this collaboration over the years.

OpenSpecimen Helps SAHMRI (Adelaide) Manage Large Sample Inventory
SAHMRI is one of the recent adopters of OpenSpecimen in Australia. This case study outlines why they selected OpenSpecimen and how they went about adopting it.

Profiled feature: SpecimenCatalog

OpenSpecimen supports creating one or more catalogs to enable biobanks to share data with its researchers. It is very easy to create without any IT support and is highly configurable. I.e. which fields to expose on the catalog, filtering rare specimens, etc. For more details: https://www.openspecimen.org/specimencatalog-article/

On the other hand, biobanks have a bigger problem – improving their specimen utilization rate. More than two-thirds of American biobanks worry about specimens under-utilization (1,2). Specimens use has both economic and ethical implications. Biobanks are only sustainable if they can recover some of their operating costs by sharing specimens. Since public money is often used to collect and store biospecimens, there is also an ethical obligation to maximize specimen use and avoid duplication efforts (3).

Furthermore, funding bodies and government organizations such as the U.K.’s Medical Research Council want biobanks to maximize biospecimen use to fulfill their ethical obligations to specimen donors and uphold public trust in the biobanking community (2,3).

“Awareness and use can be improved through high-quality online information about the resources.” – Medical Research Council

According to leaders in the biobanking field, biobanks can maximize biospecimen use by engaging in marketing, education, and outreach to ensure that researchers know how to access specimens (1).

Therefore, a web-based easily searchable database of research specimens with good quality dataset will help bridge the gap between biobanks and researchers.

Solution: A Web-Based Biospecimen Catalog

OpenSpecimen is an established biospecimen informatics platform used in 70+ biobanks across 20+ countries. The SpecimenCatalog module within OpenSpecimen enables biobanks to share biospecimen data with internal or external researchers.

For Biobanks

Biobank staff can easily create one or more catalogs within OpenSpecimen without any IT support. What data to expose on the catalog and which specimens to share is configurable and decided by the biobank. For example, one might want to hide rare specimens or the ones collected for a specific study.

Also, multiple catalogs can be created. For example, based on disease like Breast cancer catalog, Lung cancer catalog, or based on the study group.

For Researchers

Researchers can search the SpecimenCatalog using an easy-to-use user interface. Researchers can shortlist specimens of interest and fill in a request form to access these resources. Biobanks receive these requests and initiate the process to review the application. 

Many studies have shown that specimen quality affects research results (4). Researchers need standardized, high-quality biospecimens to perform reproducible experiments (1,4). Furthermore, biobanking best practices recommend linking all specimens to de-identified clinical data and quality management data to maximize the value of specimens to researchers (3). SpecimenCatalog makes it easy to include these datasets.

Biobanks can also create multiple catalogs based on diseases or studies e.g. Breast cancer catalog, Diabetes catalog, etc. Creating new catalogs is very simple and can be done without any IT support.

Summary

SpecimenCatalog closes the gap between biobanks and researchers, making it easier for researchers to find the specimens and data they need, and for biobanks to publicize their biospecimen collections and maximize use of their specimens.

References

1. Sawyer, SJ et al. Ensuring Biobank Value Through Effective Utilization. Biopreserv. Biobank. 2015
2. Cadigan et al. Underutilization of specimens in biobanks: An ethical as well as practical concern? Genet Med. 2014.
3. MRC ethics series. Human Tissue and Biological Samples for Use in Research: Operational and Ethical Guidelines. Medical Research Council. 2014.
4. NCI Best Practices for Biospecimen Resources. National Cancer Institute. 2016.

Written by: Srikanth Adiga, CEO, Krishagni

For more details, email contact@krishagni.com

New features

Google-like Keyword search

Quickly search for any label, title, name of objects via a single edit box. E.g. box name, sample label, barcode, shipment name, protocol title, etc.

Freezer Defragmentation Report

Freezers have to be consolidated once in a while. OpenSpecimen makes this tedious process a bit easier by generating a report on the most optimal way to “defragment” the freezer.

Other Enhancements

Apart from the above two features, there are many bug fixes and minor improvements in the release. Refer to the release notes for full details: https://openspecimen.atlassian.net/wiki/x/iABdFg

We are conducting three one-day workshops across Australia on “OpenSpecimen – A Comprehensive Biobanking Informatics Platform” (www.openspecimen.org).

Please email contact@krishagni.com if you are interested in attending any of them. The details are as follows:

1. Melbourne (Oct 17th): Registration link
2. Adelaide (Oct 23rd): Hosted by South Australian Health and Medical Research Institute (SAHMRI)
3. Sydney (Oct 24th): Hosted by University of New South Wales (UNSW)

These are also an excellent opportunity to meet current users of OpenSpecimen and learn how they use it in their biobanks.

We will also be present in the ABNA Conference in Melbourne (Oct 18/19).

Thanks,

Srikanth Adiga,

C.E.O, OpenSpecimen