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Automated acquisition of aptamer sequences.

While the in vitro selection of nucleic acid binding species (aptamers) requires numerous liquid-handling steps, these steps are relatively straightforward and the overall process is therefore amenable to automation. Here we demonstrate that automated selection techniques are capable of generating aptamers against a number of diverse protein targets. Automated selection techniques can be integrated with automated analytical methods, including sequencing, determination of binding constants, and structural analysis. The methods that have so far been developed can be further multiplexed, and it should soon be possible to attempt the selection of aptamers against organismal proteomes or metabolomes.

Automation↗

Central islands of corneal steepening after automated lamellar keratoplasty for myopia.

BACKGROUND: Central steep islands are a phenomena of videokeratography that demonstrate local central steepening within a larger diameter area of the cornea treated by refractive surgery that removed stromal tissue to reduce myopia. This report details four cases in which central steep islands occurred following automated lamellar keratoplasty (keratomileusis in situ). METHODS: A total of 43 automated lamellar keratoplasty procedures were performed on 32 patients between January 1993 and September 1993. Central islands were identified using video-keratography. RESULTS: Out of 43 cases of automated lamellar keratoplasty, central steep islands developed in six eyes of four patients. These steep areas developed within a few weeks after surgery; increases in the elevation of these islands correlated with recurring myopia. Slit-lamp microscopy revealed no epithelial surface abnormalities or difficulties with the interface of the resection. A central steep island did not prevent excellent uncorrected visual acuity. After subsequent refractive keratotomy for residual myopia, central steep islands either regressed or disappeared. CONCLUSION: Central islands of corneal steepening may occur after automated lamellar keratoplasty for myopia. The etiology is unknown.

Automation↗

[Unattended automated titration to determine therapeutic continuous positive airway pressure in patients with obstructive sleep apnea].

Recently, devices which use a new technology that automatically titrates positive airway pressure have become available. Such devices continually adjust the pressure to maintain airway patency. In this paper, unattended automated titration to determine the therapeutic continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea was evaluated to ascertain of it was a feasible titration to determine the therapeutic CPAP. Thirty patients participated in this study with obstructive sleep apnea syndrome defined by an apnea hypopnea index > 20/h. Automated titration during full polysomnography was performed in the hospital using auto CPAP devices (Autoset T, RESMED Co, Australia). During titration, there was no direct supervision by a technician. The titration method was as follows. Data obtained during the use of auto CPAP devices and polysomnography were used to provide a fixed single pressure for subsequent treatment. After determining the therapeutic continuous positive airway pressure, the efficacy of the patient's CPAP device was reconfirmed during full polysomnography. The results were, 1) Proper fixed single therapeutic pressure could be determined with this unattended automated titration, consequently apnea and sleep structure could be improved (Total sleep time, Sleep efficiency, %Stage 3 + 4, Apnea index, Apnea hypopnea index, Arousal index, Lowest SpO2, and Duration of SpO2 less than 90% were improved statistically (p < 0.05)). 2) The 95th percentile airway pressure of the auto CPAP device should be applied for the therapeutic pressure. 3) Automated titration during full polysomnography should be performed using auto CPAP devices. 4) After determining the therapeutic CPAP, the efficacy of the patient's CPAP device should be reconfirmed during full polysomnography. 5) This method of titration was useful at the institution without attendant technician intervention.

Automation↗

Automated image-matching technique for comparative diagnosis of the liver on CT examination.

When interpreting enhanced computer tomography (CT) images of the upper abdomen, radiologists visually select a set of images of the same anatomical positions from two or more CT image series (i.e., non-enhanced and contrast-enhanced CT images at arterial and delayed phase) to depict and to characterize any abnormalities. The same process is also necessary to create subtraction images by computer. We have developed an automated image selection system using a template-matching technique that allows the recognition of image sets at the same anatomical position from two CT image series. Using the template-matching technique, we compared several anatomical structures in each CT image at the same anatomical position. As the position of the liver may shift according to respiratory movement, not only the shape of the liver but also the gallbladder and other prominent structures included in the CT images were compared to allow appropriate selection of a set of CT images. This novel technique was applied in 11 upper abdominal CT examinations. In CT images with a slice thickness of 7.0 or 7.5 mm, the percentage of image sets selected correctly by the automated procedure was 86.6+/-15.3% per case. In CT images with a slice thickness of 1.25 mm, the percentages of correct selection of image sets by the automated procedure were 79.4+/-12.4% (non-enhanced and arterial-phase CT images) and 86.4+/-10.1% (arterial- and delayed-phase CT images). This automated method is useful for assisting in interpreting CT images and in creating digital subtraction images.

Aged↗

Automation support of patient-focused care.

The use of automation in hospital pharmacies is essential to support the concept of patient-focused care. Patient-focused care principles are defined, and the positive effect automation can have on supporting these principles is discussed. Automated technologies supporting drug distribution, sterile product production, prescription filling, and point of care information systems are summarized. Drug distribution technologies include distribution to and from the patient care area, distribution of medication to the patient, inventory control, controlled substance systems, and documentation of medication administration. Finally, a comprehensive automated technology system at a university teaching hospital is described.

Automation↗

In vivo rodent erythrocyte micronucleus assay. II. Some aspects of protocol design including repeated treatments, integration with toxicity testing, and automated scoring.

An expert working group on the in vivo micronucleus assay, formed as part of the International Workshop on Genotoxicity Test Procedures (IWGTP), discussed protocols for the conduct of established and proposed micronucleus assays at a meeting held March 25-26, 1999 in Washington, DC, in conjunction with the annual meeting of the Environmental Mutagen Society. The working group reached consensus on a number issues, including: (1) protocols using repeated dosing in mice and rats; (2) integration of the (rodent erythrocyte) micronucleus assay into general toxicology studies; (3) the possible omission of concurrently-treated positive control animals from the assay; (4) automation of micronucleus scoring by flow cytometry or image analysis; (5) criteria for regulatory acceptance; (6) detection of aneuploidy induction in the micronucleus assay; and (7) micronucleus assays in tissues (germ cells, other organs, neonatal tissue) other than bone marrow. This report summarizes the discussions and recommendations of this working group. In the classic rodent erythrocyte assay, treatment schedules using repeated dosing of mice or rats, and integration of assays using such schedules into short-term toxicology studies, were considered acceptable as long as certain study criteria were met. When the micronucleus assay is integrated into ongoing toxicology studies, relatively short-term repeated-dose studies should be used preferentially because there is not yet sufficient data to demonstrate that conservative dose selection in longer term studies (longer than 1 month) does not reduce the sensitivity of the assay. Additional validation data are needed to resolve this point. In studies with mice, either bone marrow or blood was considered acceptable as the tissue for assessing micronucleus induction, provided that the absence of spleen function has been verified in the animal strains used. In studies with rats, the principal endpoint should be the frequency of micronucleated immature erythrocytes in bone marrow, although scoring of peripheral blood samples gives important supplementary data about the time course of micronucleus induction. When dose concentration and stability are verified appropriately, concurrent treatment with a positive control agent is not necessary. Control of staining and scoring procedures can be obtained by including appropriate reference samples that have been obtained from a separate experiment. For studies in rats or mice, treatment/sampling regimens should include treatment at intervals of no more than 24 hr (unless the test article has a half-life of more than 24 hr) with sampling of bone marrow or blood, respectively, within 24 or 40 hr after the last treatment. The use of a DNA specific stain is recommended for the identification of micronuclei, especially for studies in the rat. In the case of a negative assay result with a non-toxic test article, it is desirable that systemic exposure to the test article is demonstrated. The group concluded that successful application of automated scoring by both flow cytometry and image analysis had been achieved, and defined criteria that should be met if automated scoring is employed. It was not felt appropriate to attempt to define specific recommended protocols for automated scoring at the present time. Other issues reviewed and discussed by the working group included micronucleus assays that have been developed in a number of tissues other than bone marrow. The group felt that these assays were useful research tools that could also be used to elucidate mechanisms in certain regulatory situations, but that these assays had not yet been standardized and validated for routine regulatory application.

Animals↗

[Recent trends in the standardization of laboratory automation].

Laboratory automation systems have been introduced to many clinical laboratories since early 1990s. Meanwhile, it was found that the difference in the specimen tube dimensions, specimen identification formats, specimen carrier transportation equipment architecture, electromechanical interfaces between the analyzers and the automation systems was preventing the systems from being introduced to a wider extent. To standardize the different interfaces and reduce the cost necessary for the laboratory automation, NCCLS and JCCLS started establishing standards for the laboratory automation in 1996 and 1997 respectively. NCCLS has published five proposed standards which that are expected to be approved by the end of 2000.

Automation↗

Microsatellite allele sizing: difference between automated capillary electrophoresis and manual technique.

By comparing data collected with different automated sequencers and a manual technique (fragment separation in a silver-stained polyacrylamide gel), we found strong discrepancies in allele size of microsatellite loci. To quantify the sizing bias generated by automated capillary electrophoresis, we typed 51 alleles at seven loci andfound that differences between actual (manual) and called (automated) sizing were inversely related to locus size. This result seems independent of the fluorescent dye but might be due to different migration patterns of the size standard and the microsatellite loci. Thus, it is essential to distinguish between actual (that can only be confirmed by sequencing) and called (obtained with automated sequencer) allele sizes. To enable the comparison of data collected by different laboratories on different instruments, the greatest attention should be paid to material and protocol descriptions used for allele sizing, and reference standard DNA genotypes should be shared between collaborating laboratories. Without these precautions, scoring errors in allele size might result in important misleading conclusions.

Alleles↗

Correlation between CT scan and automated perimetry in supratentorial tumors.

An attempt was made to correlate various types of visual field defects on automated perimetry with the findings of computed tomography in 44 patients of supratentorial tumors. All the patients above the age of 10 years were subjected to complete neurological examination including investigations like plain X-rays and CT scan, however, MRI and angiography were performed wherever indicated. Ocular examination particularly pertaining to neuro-ophthalmological profile was carried out with special emphasis on automated perimetry on Humphrey field analyser. The results indicated that automated perimetry was capable of reliably detecting and quantitating the visual field defects and thus established the location of the tumor in 72% patients when compared to CT scan. Hence, any patient with neuro-ophthalmic features should be subjected to automated perimetry for early diagnosis and probable location of intracranial space occupying lesion affecting visual pathways.

Adult↗

Automated transport and sorting system in a large reference laboratory: part 2. Implementation of the system and performance measures over three years.

BACKGROUND: Our laboratory implemented a major automation system in November 1998. A related report describes a 4-year process of evaluation and planning leading to system installation. This report describes the implementation and performance results over 3 years since the system was placed into use. METHODS: Project management software was used to track the project. Turnaround times of our top 500 tests before and after automation were measured. We compared the rate of hiring of employees and the billed unit per employee ratio before and after automation by use of linear regression analysis. Finally, we analyzed the financial contribution of the project through an analysis of return on investment. RESULTS: Since implementation, the volume of work transported and sorted has grown to >15,000 new tubes and >25,000 total tubes per day. Median turnaround time has decreased by an estimated 7 h, and turnaround time at the 95th percentile has decreased by 12 h. Lost specimens have decreased by 58%. A comparison of pre- and post-implementation hiring rates of employees estimated a savings of 33.6 employees, whereas a similar comparison of ratios of billed units per employee estimated a savings of 49.1 employees. Using the higher figure, we estimated that the $4.02 million cost of the project would be paid off approximately 4.9 years subsequent to placing the system into daily use. CONCLUSIONS: The overall automation project implemented in our laboratory has contributed considerably to improvement of key performance measures and has met our original project objectives.

Automation↗

Comparison of photometric cyanmethemoglobin and automated methods for hemoglobin estimation.

BACKGROUND: Hemoglobin estimation is the most frequent laboratory investigation requested. Different methods include acid haematin, photometric cyanmethemoglobin estimation and automated estimation with the help of counters. Aims and objectives of the current study were to compare photometric cyanmethemoglobin method with hemoglobin estimation by Medonic automated counter. METHODS: One hundred and ten adult cases were included through convenience sampling. Samples with hemolysis were excluded from the study. Blood was drawn in CP bottles. Sample was thoroughly mixed and hemoglobin estimation was done by Medonic counter as well by photometer 4010. Commercial controls were run with each batch. RESULTS: By manual methods, results revealed mean 0.85% increase compared to automated counter. Commercial control results showed 2.3% and 2.7% coefficient of variation by Medonic counter and photometer 4010 respectively. CONCLUSIONS: It was concluded that both methods are accurate and precise, with reference range 2.61% more in manual method. It is recommended that with small samples and with parameters like hemoglobin or hemoglobin with erythrocyte sedimentation rate, manual method is cost effective and feasible. However with multiple parameters like absolute values and with very large batches, like in tertiary laboratory, automated method is time effective and feasible, provided the laboratory can bear the cost.

Adult↗

Assessment of limb volume by manual and automated methods in patients with limb edema or lymphedema.

OBJECTIVE: Limb edema and lymphedema due to chronic venous insufficiency or mastectomy and radiotherapy negatively effects patient well-being, lifestyle, tissue blood flow, oxygenation, and wound healing. Assessment of the efficacy of volume reduction therapy requires adequate estimation of progressive limb-segment volume changes, which are usually done manually with a tape measure. This study investigated the possibility that an optoelectronic automated method--a potentially less time-consuming and less operator-dependent method--might provide adequate limb volume assessment. DESIGN: A total of 184 manual and automated measurements of limb volume were made in 62 consecutive patients with limb edema of the legs (n = 142) and arms (n = 42). SETTING: Clinical center. RESULTS: Comparisons between automated and manual methods showed that inter-method volume estimates were highly correlated (4.14 +/- 0.54% for legs; 6.97 +/- 1.18% for arms). In patients with unilateral edema, the affected limb's percentage of edema was virtually identical when estimated by each method. CONCLUSION: These findings show that the automated method of measuring limb volume is a useful alternative in suitable patients in clinical and research applications.

Anthropometry↗

Upscaling and automation of electrophysiology: toward high throughput screening in ion channel drug discovery.

Effective screening of large compound libraries in ion channel drug discovery requires the development of new electrophysiological techniques with substantially increased throughputs compared to the conventional patch clamp technique. Sophion Bioscience is aiming to meet this challenge by developing two lines of automated patch clamp products, a traditional pipette-based system called Apatchi-1, and a silicon chip-based system QPatch. The degree of automation spans from semi-automation (Apatchi-1) where a trained technician interacts with the system in a limited way, to a complete automation (QPatch 96) where the system works continuously and unattended until screening of a full compound library is completed. The performance of the systems range from medium to high throughputs.

Animals↗

Development of automated high-throughput ecotoxicity and genotoxicity test systems and fields of application.

Bioassays like growth inhibition and genotoxicity assays are frequently used for the characterization of chemicals and contaminated environmental samples. In this work two standardized bioassays are automated completely using newly developed liquid handling stations and robotics. A high-throughput algal growth inhibition assay prototype is set up and optimized in cooperation with Hoelle & Huettner AG (Tuebingen, Germany) and Polygen GmbH (Langen, Germany). A software package for both the control of the test system and for data evaluation has been developed (Biolane Supervisor, BioLane Manager HTT). The applicability of the prototype is demonstrated by testing reference compounds with the automated assay in parallel with the Erlenmeyer flask assay. It is shown that EC50-values of chemicals do not differ significantly when incubation parameters like homogeneity of light intensity, temperature and evaporation during 72 hours of incubation are optimized. The umu-genotoxicity test is automated completely using a "RoboSeq 4204 SE" pipetting station (MWG AG, Ebersberg, Germany) equipped with two shakers, microplate photometer, four pipettes, stacker for ten microplates and incubation cabin with temperature regulation. As a result of miniaturization and automation large numbers of toxicants and far more treatments and parallels can be tested and, additionally, only low sample volumes are needed.

Automation↗

Spuriously elevated automated platelet count in severe burns--a report of two cases.

Increasing use of automated analyzers in the hematology laboratory has resulted in enhanced accuracy of results. However, operators of automated analyzers and the end users utilizing the automated data need to be aware of factitious results which might be reported at times by these instruments. Case summaries of two patients with severe burns showing spuriously elevated automated platelet count are presented here.

Adolescent↗

[Automation of parenteral nutrition elaboration: adaptation to in force legislation].

INTRODUCTION: Quality and efficiency criteria of allowances associated to technological procedures are developing in a setting that values quality, and from there the Real Decree RD175/2001 has been issued by which the rules of correct elaboration and quality control of formulations and pharmacy preparations. Parenteral nutrition (PN) is a formulation and, as such, its elaboration and control have to agree with the in force regulations. With this aim, at the Bellvitge University Hospital we have developed a project for automation of elaboration of PN mixtures with the MicroMacro Pump 23 Baxa Compounder. OBJECTIVES: To assess the impact of implementing an automated system of volumetric control in PN elaboration. MATERIAL AND METHODS: The project development may be divided into two differentiated aspects. The first one consisted in the implementation and optimization of the automated system of volumetric control (ASVC). The second aspect comprehends the comparative control performed between the new system and the previous one, and which consisted of a gravimetric system with visual control. For that, real weights were gathered and were compared to predicted weights, and the time of elaboration per bag before and at two times after the implementation of the automated system was registered; the first time just after implementation of the system, and the second time within one year. RESULTS: For the comparison study between both systems used, 141 preparations in total, corresponding to individualized PN, were analyzed: 47 elaborated by means of the gravimetric system (GS), 47 with the ASVC during the implementation period (PN ASVC period 1), 47 PN elaborated with the ASVC within one year of implementation (PN ASVC period 2). The average variation between real weight and predicted weight at the three periods (pre-ASVC, NP ASVC period 1, NP ASVC period 2) was 2.41%, 1.35% and 1.25% respectively (table I). This decrease was statistically significant (p = 0.014). When analyzing the percentage of preparations out of the 3% variation range, we observed a significant reduction (p = 0.00001) by comparing the three periods (Table II). The average elaboration time with the ASVC increased approximately in 4 minutes by bag (3 min 58 sec) during the first studied period, and 3 min 10 sec during the second period, as compared with the study period with the GS. CONCLUSIONS: The new bag-filling system by means of volumetric control represents an improvement in accuracy control and a decrease in the risk for surpassing the acceptable limits. The implementation of a new technological procedure is a difficult task that implies the change of many aspects of the daily practice and that requires a "cultural" change in the PN Unit with the aim of optimizing the process. However, these issues allow for an adaptation to legal requisites in force regarding the regulations of proper elaboration and quality control of formulations as well as an improvement in the integral quality of care.

Automation↗

Procedural errors in air traffic control: effects of traffic density, expertise, and automation.

INTRODUCTION: Air traffic management requires operators to frequently shift between multiple tasks and/or goals with different levels of accomplishment. Procedural errors can occur when a controller accomplishes one of the tasks before the entire operation has been completed. The present study had two goals: first, to verify the occurrence of post-completion errors in air traffic control (ATC) tasks; and second, to assess effects on performance of medium term conflict detection (MTCD) tools. METHODS: There were 18 military controllers who performed a simulated ATC task with and without automation support (MTCD vs. manual) in high and low air traffic density conditions. During the task, which consisted of managing several simulated flights in an enroute ATC scenario, a trace suddenly disappeared "after" the operator took the aircraft in charge, "during" the management of the trace, or "before" the pilot's first contact. RESULTS: In the manual condition, only the fault type "during" was found to be significantly different from the other two. On the contrary, when in the MTCD condition, the fault type "after" generated significantly less errors than the fault type "before." Additionally, automation was found to affect performance of junior controllers, whereas seniors' performance was not affected. DISCUSSION: Procedural errors can happen in ATC, but automation can mitigate this effect. Lack of benefits for the "before" fault type may be due to the fact that operators extend their reliance to a part of the task that is unsupported by the automated system.

Accidents, Aviation↗

Automated image-based cytometry with fluorescence-stained specimens.

The combination of digitized microscopy, algorithms for object recognition and fluorescent labeling is a promising approach for reliable, quick, automated and cost-effective screening of clinical specimens. We describe two conceptually different algorithms for detecting objects in fluorescence microscopic images. One, which is partially automated, compares a mask that represents a typical object with every position in the image; the other, which is fully automated, calculates threshold intensities to segment the image into regions of objects and background. Applications of the algorithms in conjunction with a prototype image-based cytometer are demonstrated for determining the DNA ploidy distribution of cultured human endometrial cells and determining the DNA ploidy distribution and the fraction of cells expressing the E6 antigen of human papilloma virus serotypes 16 and 18 in a PAP smear. The encouraging results from this study suggest that automated image-based cytometry utilizing fluorescent stains will be a valuable asset for clinical screening.

Algorithms↗