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Performance evaluation of automated assays for beta-CrossLaps, N-MID-Osteocalcin and intact parathyroid hormone (BIOROSE Multicenter Study).

INTRODUCTION: Biochemical markers of bone metabolism have been mainly determined manually until now and the precision and accuracy of these methods have not always been satisfactory. This has been shown in several external quality assessment schemes (EQAS). OBJECTIVE AND STUDY DESIGN: A study named BIOROSE was undertaken to evaluate new automated assays for serum markers of bone metabolism. The main focus was to evaluate the assay performance in a multicenter setting with 20 laboratories participating in Germany. The evaluation consists of a familiarization phase to determine precision and accuracy and an EQAS to evaluate the comparability between laboratories. MATERIALS: The parameters beta-CrossLaps (CTX), N-MID-Osteocalcin (OC) and intact parathyroid hormone (PTH) were measured with reagents including calibrators and control sera obtained from Roche Diagnostics, Mannheim, Germany, with electrochemiluminescence immunoassays (ECLIA) on the automated analyzer Elecsys 2010. RESULTS: We calculated for the control samples, PCB 1-3, the mean and median values from the measured values of all participating laboratories and used these as target values. From these target values, a recovery range for the participating laboratories was calculated for beta-CrossLaps, OC and intact PTH of better than 80-126% for PCB 2 and PCB 3, and for PCB 1 (low concentration range) for beta-CrossLaps 79-129%, OC 90-120% and intact PTH 78-126%. The between-day imprecision was 2.4-7.2% for beta-CrossLaps, 1.1-5.9% for OC and 1.7-5.5% for intact PTH in the elevated range (sample PCB 2). In the EQAS, the inter-laboratory imprecision for beta-CrossLaps in the sample with a value of 0.8 ng/ml (above the upper limit of normal, which is 0.6 ng/ml) was 9.8% on day 1 and 9.7% on day 2. CONCLUSION: The performance evaluation of automated assays for beta-CrossLaps, N-MID-Osteocalcin and intact parathyroid hormone in the BIOROSE multicenter study showed that the participating laboratories had no problems in setting up these methods and they yielded results for precision and accuracy that are superior to results achieved in external quality assessment schemes for manually performed methods. In addition, at the clinically important decision level of the upper limit of the normal range, all three tested analytes gave precise results that improved medical decisions.

Automation↗

Cognitive anchoring on self-generated decisions reduces operator reliance on automated diagnostic aids.

Automation users often disagree with diagnostic aids that are imperfectly reliable. The extent to which users' agreements with an aid are anchored to their personal, self-generated diagnoses was explored. Participants (N = 75) performed 200 trials in which they diagnosed pump failures using an imperfectly reliable automated aid. One group (nonforced anchor, n = 50) provided diagnoses only after consulting the aid. Another group (forced anchor, n = 25) provided diagnoses both before and after receiving feedback from the aid. Within the nonforced anchor group, participants' self-reported tendency to prediagnose system failures significantly predicted their tendency to disagree with the aid, revealing a cognitive anchoring effect. Agreement rates of participants in the forced anchor group indicated that public commitment to a diagnosis did not strengthen this effect. Potential applications include the development of methods for reducing cognitive anchoring effects and improving automation utilization in high-risk domains.

Analysis of Variance↗

Heuristic automation for decluttering tactical displays.

Tactical displays can quickly become cluttered with large numbers of symbols that can compromise effective monitoring. Here, we studied how heuristic automation can aid users by intelligently "decluttering" the display. In a realistic simulated naval air defense task, 27 experienced U.S. Navy users monitored a cluttered airspace and executed defensive responses against significant threats. An algorithm continuously evaluated aircraft for their levels of threat and decluttered the less threatening ones by dimming their symbols. Users appropriately distrusted and spot-checked the automation's assessments, and decluttering had very little effect on which aircraft were judged as significantly threatening. Nonetheless, decluttering improved the timeliness of responses to threatening aircraft by 25% as compared with a baseline display with no decluttering; it was especially beneficial for threats in more peripheral locations, and 25 of 27 participants preferred decluttering. Heuristic automation, when properly designed to guide users' attention by decluttering less important objects, may prove valuable in many cluttered monitoring situations, including air traffic management, crisis team management, and tactical situation awareness in general.

Adult↗

Automated classification and quantification of F-actin-containing ruffles in confocal micrographs.

Membrane ruffles are actin-rich protrusions of the plasma membrane that can be observed on the surface of many cell types. Phase contrast and fluorescent microscopy are widely used in the analysis of ruffles, which are commonly identified in cells stained with fluorescently labeled phalloidin. Currently, comparison of cellular ruffle formation under different experimental conditions is generally qualitative or semiquantitative. Ruffle structures are often defined using manual tracing and thresholding methods. Here, we report the rapid and accurate segmentation of ruffles from two-dimensional confocal projections of cells using automated method based on well-established image processing and analysis methods. Line-shaped ruffles were detected using line detectors and were then separated from the filtered images. Automated categorizing of the segmented line structures enabled accurate quantification of the ruffles. This automated approach is efficient and reliable and hence can serve as a powerful tool in studies of the mechanism of ruffle formation.

Actins↗

Flexible software architecture for user-interface and machine control in laboratory automation.

We describe a modular, layered software architecture for automated laboratory instruments. The design consists of a sophisticated user interface, a machine controller and multiple individual hardware subsystems, each interacting through a client-server architecture built entirely on top of open Internet standards. In our implementation, the user-interface components are built as Java applets that are downloaded from a server integrated into the machine controller. The user-interface client can thereby provide laboratory personnel with a familiar environment for experiment design through a standard World Wide Web browser. Data management and security are seamlessly integrated at the machine-controller layer using QNX, a real-time operating system. This layer also controls hardware subsystems through a second client-server interface. This architecture has proven flexible and relatively easy to implement and allows users to operate laboratory automation instruments remotely through an Internet connection. The software architecture was implemented and demonstrated on the Acapella, an automated fluid-sample-processing system that is under development at the University of Washington.

Automation↗

Application of an automation system and a supervisory control and data acquisition (SCADA) system for the optimal operation of a membrane adsorption hybrid system.

The application of automation and supervisory control and data acquisition (SCADA) systems to municipal water and wastewater treatment plants is rapidly increasing. However, the application of these systems is less frequent in the research and development phases of emerging treatment technologies used in these industries. This study involved the implementation of automation and a SCADA system to the submerged membrane adsorption hybrid system for use in a semi-pilot scale research project. An incremental approach was used in the development of the automation and SCADA systems, leading to the development of two new control systems. The first system developed involved closed loop control of the backwash initiation, based upon a pressure increase, leading to productivity improvements as the backwash is only activated when required, not at a fixed time. This system resulted in a 40% reduction in the number of backwashes required and also enabled optimised operations under unsteady concentrations of wastewater. The second system developed involved closed loop control of the backwash duration, whereby the backwash was terminated when the pressure reached a steady state. This system resulted in a reduction of the duration of the backwash of up to 25% and enabled optimised operations as the foulant build-up within the reactor increased.

Adsorption↗

Accelerating drug discovery by integrative implementation of laboratory automation in the work flow.

Acceleration of the drug discovery process in pre-clinical pharmaceutical research is a highly desirable goal and combinatorial chemistry united with automation technology promised to accomplish this task. Through the accumulation of experience with automated devices over time it became evident that only by harmonisation and streamlining of work-flow procedures the efficiency of the overall process can be improved. An open architecture of efficient data management and appropriate utilisation of automated laboratory protocols provides the opportunity to react in a flexible and advisable way. Only an integrative workflow concept promotes the enhancement of the overall performance. However, the foundation of any efforts towards the accelerated synthesis of new and desired compound arrays lies in the development of reliable chemistry protocols amenable to solid- and solution phase chemistry.

Automation↗

Titanium(IV) isopropoxide mediated solution phase reductive amination on an automated platform: application in the generation of urea and amide libraries.

Amine libraries and their derivatives are important targets for high throughput synthesis because of their versatility as medicinal agents and agrochemicals. As a part of our efforts towards automated chemical library synthesis, a titanium(IV) isopropoxide mediated solution phase reductive amination protocol was successfully translated to automation on the Trident(TM) library synthesizer of Argonaut Technologies. An array of 24 secondary amines was prepared in high yield and purity from 4 primary amines and 6 carbonyl compounds. These secondary amines were further utilized in a split synthesis to generate libraries of ureas, amides and sulfonamides in solution phase on the Trident(TM). The automated runs included 192 reactions to synthesize 96 ureas in duplicate and 96 reactions to synthesize 48 amides and 48 sulfonamides. A number of polymer-assisted solution phase protocols were employed for parallel work-up and purification of the products in each step.

Amides↗

Automated parallel, multi-step polymer-assisted solution phase (PASP) synthesis of substituted benzimidazole derivatives.

The automated polymer-assisted solution phase (PASP) synthesis of a 72 member library of 2-alkylthio-benzimidazoles 16 and benzimidazolin-2-ones 17 using commercially available robotic workstations is described. By incorporating both automated aqueous work-ups, in-line scavenging and 'catch and release' protocols the desired compounds were obtained directly in good yields and excellent purities without the need for conventional chromatographic purification. The synthesis described demonstrates how both manual and automated equipment may be utilised together to provide a versatile approach that facilitates parallel compound synthesis.

Automation↗

Automation in medicinal chemistry.

The implementation of appropriate automation can make a significant improvement in productivity at each stage of the drug discovery process, if it is incorporated into an efficient overall process. Automated chemistry has evolved rapidly from the 'combinatorial' techniques implemented in many industrial laboratories in the early 1990's which focused primarily on the hit discovery phase, and were highly dependent on solid-phase techniques and instrumentation derived from peptide synthesis. Automated tools and strategies have been developed which can impact the hit discovery, hit expansion and lead optimization phases, not only in synthesis, but also in reaction optimization, work-up, and purification of compounds. This article discusses the implementation of some of these techniques, based especially on experiences at Millennium Pharmaceuticals Research and Development Ltd.

Automation↗

Automated in situ keratomileusis for myopia.

BACKGROUND: In situ keratomileusis is a rapidly changing refractive corneal surgical procedure for the correction of myopia. We report here the results of a retrospective study of in situ keratomileusis with the refractive cut made with a microkeratome. The technique represents an intermediate stage of development that used a sutured corneal disc, an early automated microkeratome, and no reoperations for residual refractive error. METHODS: We carried out a retrospective chart review of the first 107 consecutive eyes (73 patients) that received in situ keratomileusis with an automated microkeratome (Ruiz corneal shaper) at the El Maghraby Hospital in Jeddah, Saudi Arabia between November, 1991 and February, 1993. Sixty-three eyes (59%) were followed for a mean of 1 year. Manifest refraction measured by an ophthalmologist or optometrist was the major response variable. Surgery followed the Ruiz nomogram, which specified an anterior corneal disc approximately 7.2 mm in diameter and 160 microns in thickness and a plano in situ refractive cut a mean of 4.2 mm in diameter and 93 microns in thickness. RESULTS: The mean baseline spherical equivalent of the manifest refraction was -11.97 +/- 5.30 diopters (D) (range, -3.75 to -28.00 D). At a mean of 1 year after surgery, the mean refraction was -1.86 +/- 3.13 D (range, -13.25 to +4.63 D); 13 eyes (21%) had a refraction within +/- 0.50 D and 22 (35%) within +/- 1.00 D. Undercorrection of more than -1.00 D was present in 36 eyes (57%). At baseline, 48 of 63 eyes (75%) could see 20/40 or better with spectacle correction. At 1 year, 13 of 63 eyes (21%) could see 20/40 or better uncorrected. To measure the stability of refraction in 61 eyes, the mean refraction at 1 month of +0.62 +/- 2.43 D was compared to that at 1 year after surgery (mean, -1.41 +/- 3.10 D), indicating a loss of effect in the direction of increasing myopia. Nine eyes (14%) lost two to five lines of spectacle-corrected visual acuity. Two eyes had central epithelial implantation plaques in the lamellar bed that required removal. CONCLUSION: In situ keratomileusis using an automated corneal shaper and sutured corneal discs at an intermediate stage of development produced less than desirable refractive and visual acuity results.

Adolescent↗

Automated detection of malaria pigment in white blood cells for the diagnosis of malaria in Portugal.

A novel automated method (Cell-Dyn 3500) allows malaria diagnosis by detecting malaria pigment in white blood cells during routine full blood counts. In Portugal, 174 samples from 148 patients who presented to the emergency department were analyzed. Compared with microscopy the sensitivity was 95% and the specificity was 88%. In 5 cases, false-positive Cell-Dyn 3500 results were from patients who had a recent history of treated malaria, indicating that the method may remain positive during convalescence. Six patients were diagnosed due to the changes observed with the automated method only, because clinicians had not requested malaria smears. This instrument appears to provide a promising method for the diagnosis of malaria, especially where automated full blood counts are routine in the work-up of febrile patients.

Animals↗

Automated analysis of differentiation-induced leukemic cells during all-trans retinoic Acid therapy of acute promyelocytic leukemia.

During differentiation-induction therapy of acute promyelocytic leukemia (APL) patients with all-trans retinoic acid (ATRA), a variety of APL-derived bizarre granulocytic cells appear in the peripheral blood. To evaluate the differentiation induction of leukemic cells, we have developed a new scattergram analyzing program with an automated hematology analyzer and compared the data with the flow cytometry measuring the expression of differentiation-associated cell surface antigens, CD11b and CD16. We used the fluorescence intensity and side scatter as parameters of granulocytic maturation in the analysis with the automated hematology analyzer. The analysis of 2 ATRA-treated APL patients and in vitro study using HL-60 cells demonstrated that the levels of fluorescence intensity and side scatter decreased as accompanied with granulocytic maturation, and these changes were parallel with the results of flow cytometry. Our automated scattergram analysis of cell differentiation will contribute to general, objective, and real-time evaluation of differentiation-induction therapy of APL with ATRA.

Adult↗

Experience with an automated point-of-use unit-dose drug distribution system.

Two years' experience with an automated, point-of-use unit-dose system at the University of California, San Diego Medical Center (UCSDMC) is described. Growing concerns about the efficiency and cost-effectiveness of the traditional unit-dose drug distribution system at UCSDMC, and the corresponding diversion of professional staff time from pharmaceutical care responsibilities, led us to investigate alternative systems. Criteria for a new system were developed and used in evaluating alternatives. Consideration was given to three possibilities: 1) improving the existing system, 2) automating the unit-dose cassette fill process, or 3) automating the final step in medication delivery at the nursing station. Based on the realization that our traditional unit-dose system was largely inefficient in today's hospital environment, it was concluded that the drug distribution system needed to be re-engineered in a way that simplified delivery and reduced waiting time. The Medstation Rx system marketed by the Pyxis Corporation (San Diego, CA) seemed to meet the need. During a 2-year period a Medstation Rx system was implemented in most of the hospital (in all but three specialty units) and evaluated. This system has resulted in several benefits, including a net savings in labor costs, a significant reduction in waiting time for first doses, and a reduction in dispensing errors. In the process, it was possible to minimize the disruption of pharmacists engaged in the direct provision of pharmaceutical care, thereby increasing their efficiency.

Automation↗

Injecting a little automation into needle packaging.

Manufacturers of sterile medical devices can benefit from an automated production system. In this article, the authors describe in detail the use of a fully automated packaging operation for injection needles. In relation to the German standard DIN 13097, they advocate high-speed automation, together with observance of the Good Manufacturing Practice (GMP) code in order to attain high output, consistently high quality, and greater economy.

Automation↗

Evaluation of between-sample carryover on an automated coagulation instrument: recommendations for quality control procedures.

OBJECTIVE: To assess sample probe carryover levels in a modern automated coagulation analyzer. SETTING: Washoe Medical Center Clinical Laboratory, Reno, Nevada. DESIGN: Analysis of the relative degree of prolongation of coagulation assays using a sequential series of samples following a sample with inherent or added components with the potential for prolonging or accelerating coagulation when significant sample probe carryover is present. PARTICIPANTS: Not applicable. MAIN OUTCOME MEASURE: The extent of prolongation or acceleration of APTT or PT assays. RESULTS: The first sample positions assayed subsequent to specimans with potential accelerating or prolonging coagulation activity were affected by 3.9% to 17.8%. CONCLUSION: Results suggest that a potential exists in automated sampling coagulation analyzers. A mechanism for quality control analysis of carryover should be incorporated in automated probe coagulation analyzers. A suggested "1-2-1" control sequence is discussed as a possible quality assurance tool for measuring carryover within individual assay runs.

Anticoagulants↗

Application of a computer-directed automated microscope in mycobacteriology.

Microscopy is currently the fastest, cheapest and most easily performed technique in mycobacteriology; it can be used in any laboratory. However, the sensitivity of microscopy is unsatisfactory and it is time-consuming. To eliminate these drawbacks, we have constructed a computer-directed automated microscope. To evaluate the equipment, we examined a total of 132 smears of sputum and 74 smears of liquid media. Manual microscopy was positive for 53 and negative for 79 sputum smears, while automated microscopy was positive for 55 and negative for 77 sputum smears. Both methods furnished 50 positive and 24 negative smears of liquid media. We conclude that the automated microscope is able to detect acid-fast bacteria, the examination procedure with the instrument is more rapid (1.8-3.5 min/slide) and it is always possible to follow the standard recommendations of microscopy.

Automation↗

[Automation of cytological analysis of cervical smears].

Quality Control (QC) is essential in cytologic laboratories. To reduce or avoid false negatives due to screening or interpretation errors, all cervical smears may be analyzed twice by two different cytopathologists (CP). During rescreening or Quality Control (QC), the second CP may be assisted by an automated device. Today there are different instruments: computerized microscope Ac Cell Series 2000 Pathfinder System), semiautomated or interactive systems (PAPNET, CytoRich or AutoCyte, ACCESS), automated systems (AutoPap 300). These devices, except computerized microscopes, utilize algorithmic image analysis that values single cells using morphological features but has difficulty in analyzing clusters of overlapping cells. For this reason it is better to use thin or monolayer preparations. This approach results in the loss of background and cells useful for the diagnosis and modifies sampling and processing methods. However, the techniques to obtain thin or monolayer preparations may process a higher number of cells than conventional method; moreover, the samples obtained may be valued also by the optic microscope, making cytologic analysis easier. The only device that combines the use of algorithmic image analysis with neural networks is the PAPNET system. Neural networks was inspired by neurobiology and may identify different cellular morphology and overlapping cells. In our laboratory, the PAPNET was proposed in 1995. In the present study, the last rescreening results of 1958 negative cervical smears are reported, analyzed during primary screening from July 1997 to February 1998. During the QC assisted by the PAPNET, 6 false negatives (0.31%), due to cytologic errors in the primary screening were detected. These results confirm the usefulness and the effectiveness of QC assisted by automated devices. However, only the CP evaluates abnormal cells detected by semiautomated systems or analyzes more atypical smears identified by the instruments. The work of CP is difficult: therefore a strict collaboration between clinician and CP to formulate the correct diagnosis is essential.

Automation↗