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Continuous flow techniques in organic synthesis.

As part of the dramatic changes associated with the need for preparing compound libraries in pharmaceutical and agrochemical research laboratories, the search for new technologies that allow automation of synthetic processes has become one of the main topics. Despite this strong trend for automation high-throughput chemistry is still carried out in batches, whereas flow-through processes are rather restricted to production processes. This is far from understandable because the main advantages of that approach are facile automation, reproducibility, safety, and process reliability, because constant reaction parameters can be assured. Indeed, methods and technologies are missing that allow rapid transfer from the research level to process development without time-consuming adaptation and optimization of methods from the laboratory scale to production plant scale. Continuous-flow processes are considered as a universal lever to overcome these restrictions and, only recently, joint efforts between synthetic and polymer chemists and chemical engineers have resulted in the first continuous-flow devices and microreactors; these allow rapid preparation of compounds with minimum workup. Many of these approaches use immobilized reagents and catalysts, which are embedded in a structured flow-through reactor. It is generally accepted, that for achieving best reaction and kinetic parameters for convective-flow processes monolithic materials are ideally suited as solid phases or polymer supports. In addition, immobilization techniques have to be developed that allow facile regeneration of the active species in the reactor.

Journal Article↗

Clinical use of WHO haemoglobin colour scale: validation and critique.

AIM: The World Health Organisation (WHO) haemoglobin colour scale has been developed as a simple, inexpensive clinical device for diagnosing anaemia when laboratory based haemoglobinometry is not available. In an initial validation study at several health centres, scale readings were compared with measurements of haemoglobin by the laboratory. This showed the scale to have 90% sensitivity and 70% specificity in identifying whether anaemia was present or not. In addition, when present, the degree of anaemia was correctly classified in clinical terms as moderate, pronounced, or severe, with an overall sensitivity of 60% and specificity of 88%. Errors were mainly marginal--that is, between two adjacent categories--but there were also some major discrepancies, such as a blood with a haemoglobin of 6-7 g/dl being read as normal or vice versa. Because this would compromise the scale's reliability in practice, this study was undertaken to identify the cause of the discrepancies and to reassess the performance of the scale. METHODS: Venous blood samples were collected into potassium EDTA from patients attending selected clinics at three South African hospitals with good laboratory facilities. A prototype of the device was used unsupervised by nursing staff, doctors, and phlebotomists, who were told to follow the printed instructions. The blood specimens were then immediately sent to the laboratory where haemoglobin was measured by standardised automated blood cell counters. Any discrepancies > 1 g/dl were recorded and the tests were repeated by the same operators under supervision of the investigators. RESULTS: Almost all the errors that occurred resulted from the incorrect use of the device, namely: inadequate or excessive blood, reading the results too soon or too late (beyond the limit of two minutes), poor lighting, or holding the scale at the wrong angle. The accuracy improved dramatically when the tests were repeated under supervision and these faults were avoided: 95% of readings were within 1 g/dl of the reference measurements, and 97% within 1.5 g/dl. Anaemia screening showed 96% sensitivity and 86% specificity. Clinical judgement of pallor was frequently wrong, whereas the scale gave the correct diagnosis in more than 97% of cases. CONCLUSION: The study confirmed the usefulness and reliability of the scale and its advantage over clinical signs for the diagnosis of anaemia, thus providing a clinically reliable near patient method in the absence of a laboratory. The instructions are easy to follow but must be strictly adhered to.

Anemia↗

Use of a medical center's computerized health care database for notifiable disease surveillance.

The sensitivity of a medical center's inpatient and outpatient database to detect notifiable diseases was examined. Only 53 percent of inpatient and 7 percent of outpatient laboratory-confirmed cases of shigellosis, salmonellosis, giardiasis, and hepatitis were identified by an automated search for matching diagnosis codes. Reasons for lack of sensitivity include nonavailability of laboratory results at the time of diagnosis assignment, use of a standardized encounter form with limited preselected diagnosis codes, and pre-emptying of the infectious disease diagnosis by other diagnoses.

Communicable Diseases↗

Informating, not automating, the medical record.

The author suggests that reference should be made in the future to the need to informate and not to automate the medical record. The reason for this recommended semantic change is first to avoid the mistaken notion that the computerization of medical records will reduce the number of personnel processing medical information. Instead, personnel will shift their attention from rote clerical activities to analytic activities made possible by the creation of new data bases by computers. These new data bases, a byproduct of informating the medical record, describe work processes and lend themselves to analytic activities which will enhance quality and efficiency in hospitals. The recent availability of report generators on commercial Laboratory Information Systems (LISs) mark their transition from automating to informating systems. One example of an ad hoc report used to enhance quality and efficiency in the clinical laboratories is the throughput report.

Clinical Laboratory Information Systems↗

Evaluation of the Cobasbact automated antimicrobial susceptibility testing system.

The Cobasbact is an automated system for use in the microbiological laboratory which is capable of performing antimicrobial susceptibility tests within five hours. The performance of the Cobasbact system was evaluated using 2000 non-fastidious, facultative and aerobic clinical bacterial isolates. The standard Kirby-Bauer disk diffusion test served as reference method. For gram-positive isolates, the rate of overall full and essential agreement between Cobasbact and reference antibiograms was 90% and 95.5% respectively, for Enterobacteriaceae 91% and 95.5% and for Pseudomonas spp. 90% and 96%. Reproducibility studies yielded an essential agreement rate of 98%. On the basis of this preliminary evaluation it would seem that the Cobasbact system can rapidly produce reasonably accurate and reproducible results of antimicrobial susceptibility tests for gram-positive cocci, Enterobacteriaceae and Pseudomonas spp.

Automation↗

One year's experience with two different image analysis systems for automated reading of the contrast fluorescence test.

We have tested two different personal-computer-based color image analysis systems for automated reading of the microlymphocytotoxicity test (LCT) for HLA-A,B,C typing and screening. Over 17,000 single LCT reactions were prepared using the simultaneous double fluorescent variant of the LCT (contrast fluorescence test, CFT). All tests were read visually by experienced laboratory staff members. For digital image analysis, an automated scanning system was used. The reactions were first recorded on a videotape recorder using a color (CCD) videocamera und subsequently analyzed with the two different image analysis systems by specifically developed programs. Good correlation (r = 0.89) of the score values assigned by digital image analysis with the visual tray reading was obtained. Since also the other main performance characteristics of the prototype system were acceptable for routine application, we may conclude that digital image analysis is a feasible and very interesting new technique for automated evaluation of the LCT.

Algorithms↗

A new assay for rapid measurement of MIF levels by 3H-labelled cells in liquid scintillation counting vials: statistical implications for the measurement of migration inhibition.

A new quantitative assay for migration inhibitory factor (MIF) employs 3H-labelled cultured mouse or human lymphoid cells migrating from capillary tubes. Capillaries filled with labelled cells are placed in liquid scintillation counting vials, along with the MIF-containing sample and are removed at the end of a five-hour incubation period. The residual, labelled cells which have migrated out of the tubes are solubilized and counted in a liquid scintillation counter. While cultured lymphoblast cells are routinely used in the assay, the method was checked against mouse and guinea pig peritoneal exudate cells in both the labelled cell technique and the conventional chamber assay. The assay is technically simple to perform and a useful tool for laboratory research purposes because of the short span of time needed to obtain the results. These advantages indicate a potential for automation and use of this assay in a clinical immunology laboratory. Statistical analysis of data from both assays demonstrated that the relative variation among replicates is lower in the labelled cell assay. The new assay also measured a significant difference between controls and MIF-containing samples when the migration index (MI) was greater than 80%. Criteria for significant inhibition of migration are discussed in regard to the use of analysis of variance (ANOVA) and other statistical procedures, and the inadequacy of a single measure, such as the MI, is discussed.

Animals↗

Automated differential leucocyte counting by the Geometric Data Hematrak system: eighteen months experience in a private pathology laboratory.

The Geometric Data Hematrak is a computerized electronic pattern recognition system designed to scan Wright's stained blood films. The instrument consists of a microscopy and data processing computer which classifies leucocytes by a digital image processing system into various cell types. Additional features include facilities for automatic appraisal of red cell morphology and estimation of platelet numbers. We report our experience with the routine use of a Hematrak Model 360 over an 18 mth period, during which time approximately 60 000 blood films have been processed by this system.

Computers↗

A comparison of chemical dipsticks read visually or by photometry in the routine screening of urine specimens in the clinical microbiology laboratory.

Two different commercially available urine dipsticks were evaluated to determine their usefulness as a screening test for the detection of non-infected urine specimens. The reactions of both dipstick strips were read visually and, in addition, one was read by semi-automated reflectance photometry. 2928 consecutive routine urine specimens received by the microbiology laboratory during normal working hours underwent testing by the conventional method of microscopy and culture and the results were compared with those obtained by dipstick testing. There were poor correlations between microscopy for red and white blood cells and dipstick results for blood and leucocyte esterase respectively. The dipsticks had a low positive predictive value (PPV) in identifying infected urines. In contrast, dipsticks had a very high negative predictive value (NPV) of 98.6-99.5% and correctly identified a significant proportion (about 1/3) of non-infected urines as reported by the conventional method. Introduction of dipstick testing of urine specimens in our hospital has led to significant time saving as dipstick-negative urines are not processed further (except for specific clinical indications) and there has also been a significant decrease (25%) in the number of specimens submitted to the laboratory. Further efficiencies may be obtainable with increased automation.

Adolescent↗

Comparison of the automated AxSYM and ADVIA centaur immunoassays for homocysteine determination.

A new fully automated chemiluminescence assay for total homocysteine (tHcy) determination (ADVIA Centaur homocysteine, Bayer) was evaluated in comparison with a previously established fluorescence polarization assay (AxSYM homocysteine, Abbott). Linearity could be demonstrated in a concentration range up to 50 micromol/l for both methods. The detection limit was 0.92 micromol/l for the AxSYM and 0.61 micromol/l for the ADVIA Centaur analyzer. Within-run coefficients of variation (%CV) ranged from 1.7% to 1.8% for the AxSYM, and from 2.2% to 2.7% for the ADVIA Centaur analyzer, total CV ranged from 2.5% to 3.5% for the AxSYM, and from 3.6% to 4.5% for the ADVIA Centaur analyzer. Passing and Bablock regression analysis of 180 samples with the AxSYM assay as reference method revealed an intercept of -0.41 micromol/l (95% CI -1.17 to 0.20 micromol/l) and a slope of 1.11 (95% CI 1.05 to 1.18), the Bland-Altman difference plot showed a mean difference of -0.9 micromol/l between tHcy measurements with wide 95% limits of agreement (-3.6 to 1.7 micromol/l). At thresholds of 10 and 15 micromol/l there was a considerable proportion of discordant classifications of study subjects by the AxSYM and ADVIA Centaur method. When evaluating case-control status for vascular disease both assays showed similar characteristics (i.e., significant difference of tHcy in 71 CAD patients and 109 control subjects, and non-significant odds ratios for tHcy in the multivariate model). In conclusion, both methods are reliable for routine tHcy determination in clinical laboratories, as they are fast and completely automated systems with good accuracy and precision allowing sample random access, automatic dilution and stored calibration capabilities. However, results of both assays may not be used interchangeably since the ADVIA Centaur method tends to overestimate tHcy values compared to the AxSYM method.

Autoanalysis↗

Interlaboratory variability of rotational chair test results. Interlaboratory Rotational Chair Study Group.

Test-retest reliability of rotational chair testing for a single facility has previously been examined by others. The actual data analysis methods, however, have received far less attention. The variety of both hardware and software currently used theoretically may affect the results for a given subject tested at different facilities. The purposes of this study were, first, to quantify the amount of variability in the analysis of identical raw data files at multiple rotational chair testing facilities by using automated analysis; second, to evaluate the effect of operator intervention on the analysis; and third, to identify possible sources of variability. Raw data were collected from 10 normal subjects at 0.05 Hz and 0.5 Hz (50 degrees per second peak velocity). Diskettes containing raw electro-oculogram data files were then distributed to eight participating laboratories for analysis by two methods: (1) using automated analysis algorithms and (2) using the same algorithms but allowing operator intervention into the analysis. Response parameters calculated were gain and phase (re: velocity). The SD of gain values per subject for automated analysis ranged from 0.01 to 0.32 gain units and of phase values from 0.4 to 13.7 degrees. For analysis with operator intervention, the SD of gain values ranged from 0.02 to 0.10 gain units and of phase values from 0.4 to 4.4 degrees. The difference between automated analysis and analysis with operator intervention was significant for gain calculations (p < 0.02) but not for phase calculations (p > 0.05). This study demonstrates significant variability in automated analysis of rotational chair raw data for gain and phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Development of blood cell measurement].

Automated blood cell analyzers used in hematology laboratories are required to measure many specimens rapidly and efficiency has been realized through increasing the measurement parameters and throughput volume in one instrument. In the period of 1950's through the early part of 1960's, only red blood cells and white blood cells could be counted. In 1965, Technicon Corporation developed an instrument which can measure the number of blood cells, hemoglobin, hematocrit and calculate corpuscular constants simultaneously. Thereafter, the methodologies for simultaneous platelet measurement and precise determination of blood cell distribution have been developed. Then, the development of new reagents has achieved three part differentials in the distribution of white blood cells. Thanks to this development, microscopic white blood cell differentials has been replaced by blood cell analyzers in screening tests. Though blood cell analyzers may be further improved by expanding of the number of parameters available for simultaneous measurements, meeting social needs in the new era will not be possible without the creation and realization of new concepts employing new technologies such as IT (Information Technology).

Automation↗

[Clinico-laboratory algorithms for assessing the functional activity of the thyroid gland].

Three diagnostic algorithms making use of automated chemiluminescent analyzers are proposed for evaluation of the thyroid function, depending on the clinical situation. Laboratory criteria of hypothyrosis and thyrotoxicosis therapy monitoring are discussed. Main variants of disagreement between clinical data and values of thyrotropic hormone and free T4 are presented.

Algorithms↗

Technology and laboratory instrumentation in the next decade.

We are affected by many forces as we approach the first decade of the new millennium. Rapid advances in computer technology and robotic automation, from sample identification to collection, processing, analysis, and reporting of results, are opening doors for drastic improvements that will ultimately lead to miniaturization and cost reduction. Noninvasive technology, whether in vivo or ex vivo, is waiting in the wings to make its debut. Technology that has previously had an inordinately long period of gestation, such as near-infrared sensors for noninvasive measurement of glucose and other analytes, could well become a reality. The end of the next decade may be an era of nanotechnology that will drastically change the face of today's clinical laboratory.

Automation↗

Performance evaluation of the ADVIA 2120 hematology analyzer: an international multicenter clinical trial.

Automated cell counters are widely used in modern clinical laboratories to provide reliable, fast, and cost-effective complete blood counts (CBCs), white blood cell differentials, and reticulocyte measurements. In addition, some advanced instruments provide novel parameters, such as the hemoglobin content of reticulocytes or the percentage of hypochromic cells, and are capable of analysis of a variety of body fluids. Bayer recently introduced the ADVIA 2120 system as an automation-ready cell counter for mid- to high-volume testing in the clinical laboratory. This instrument, which builds on the established technology of the ADVIA 120 system, operates with a cyanide-free method for hemoglobin measurement, has a new user interface, and can routinely analyze biological fluid samples in addition to blood. We used 749 samples from 6 worldwide trial sites to evaluate the clinical performance of this new device. Accuracy of the ADVIA 2120 system versus its predecessor model, the ADVIA 120 system, was excellent for all CBC and white cell differential parameters and reticulocyte counts (all correlation coefficients except for basophils >0.9). Correlation of the white cell differential with the standard manual method and within-run precision of the ADVIA 2120 system also was very good. Use of the novel cyanide-free method for hemoglobin measurement had no clinically significant impact on hemoglobin results, even in patients with hemoglobinopathies. We concluded that the ADVIA 2120 system has clinically equivalent performance to the ADVIA 120 system.

Automation↗

Evaluation of the Beckman Coulter AcT 5 diff AL hematology analyzer in a hospital setting.

The Coulter AcT 5-part differential (5 diff) autoloader (AL) hematology analyzer from Beckman Coulter (Fullerton, CA, USA) was evaluated at the Florida Medical Center in Fort Lauderdale, Florida, an acute care hospital facility. The AcT 5 diff AL is a new, fully automated bench-top 5-part differential hematology analyzer with automatic loading and sampling. It is designed as a front-line instrument for small- to medium-sized laboratories or as a backup in larger laboratories. We evaluated the performance of the AcT 5 diff AL for complete blood counts (CBCs). The Coulter Onyx AL was used as the reference instrument and the 5-part differential against the reference 400-cell manual differential count (2 operators x 200 cells). A total of 140 patient samples were analyzed in the study, with most of the samples obtained from our own laboratory workload. We supplemented this dataset with pediatric and oncology samples from nearby practices. All samples were analyzed within 4 hours of collection, and the AcT 5 diff AL demonstrated excellent accuracy with correlation values (r) > 0.98 for all directly measured CBC parameters (white blood cell count, red blood cell count, hemoglobin, mean corpuscular volume, and platelets). Reproducibility studies on the AcT 5 diff AL also showed excellent results, with coefficients of variation much lower than the manufacturer's specifications. Initial differential comparisons showed good correlations for neutrophils, lymphocytes, and eosinophils (r = 0.84, 0.96, and 0.88, respectively) with a lower correlation for monocytes (r = 0.43). On subsequent review and data analysis we found differential discrepancies in 39 of the 140 samples, for which all showed multiple morphological flags, R diff flags, or poor scatterplot separations indicating that the AcT 5 diff AL differential was likely to be inaccurate and that a morphological assessment and differential was necessary. Given the acutecare setting that our laboratory serves and the skewing of the dataset of our study because of the addition of abnormal pediatric and oncology cases, these abnormal sample results were not surprising. These 39 samples all had markedly abnormal differentials with either increased numbers of immature and/or abnormal cells due to such conditions as end-stage liver disease, respiratory failure, renal failure, sepsis and pneumonia, high white blood cell leukemias, and a variety of other acute illnesses. Reanalysis of the differential data, excluding these 39 grossly abnormal samples with R flags and multiple flags, showed the AcT 5 diff AL differential gave very good correlations for neutrophils, lymphocytes, monocytes, and eosinophils (r = 0.93, 0.97, 0.66, and 0.85, respectively). Our technologists were also impressed with the reliability of the AcT 5 diff AL, its ease of use and transfer from stand-by to ready mode, the user friendliness of the software, and the clarity of the printed report. We concluded that the AcT 5 diff AL gives accurate and precise CBC and 5-part differential results and is an excellent, easy-to-use instrument ideally suited for small- to moderate-sized hospital laboratories, as a back-up in a large hospital laboratory, or for use in physician office laboratories.

Automation↗

Studies on the quantification of proteoglycans by the dimethylmethylene blue dye-binding method. Specificity, quantitation in synovial lavage fluid, and automation.

The dimethylmethylene blue (DMMB) dye-binding technique is widely used for the quantification of sulfated glycosaminoglycans (sGAG) and proteoglycans. We conducted further studies on this technique in our laboratory and found that concentrations of DNA and RNA in excess of 20 micrograms/ml interfered negatively with the detection of sGAGs; interference was eliminated by using DNase and RNase. Hyaluronan at 40 micrograms per ml did not interfere with the detection of sGAG. However, because of the higher concentrations of hyaluronan in synovial lavage fluid, it was necessary to treat this fluid with Streptomyces hyaluronidase in order to quantify sGAG. The DMMB assay was automated with a laboratory work station and compared to the standard method.

Animals↗

Automated antibiotic susceptibility testing: comparative evaluation of four commercial systems and present state.

Automation of AST has come quite some way and is here to stay. In particular, fully automated, "hands off" instruments have great appeal to laboratories with a limited number of well-trained and experienced clinical microbiology personnel. None of the evaluated instruments is perfect, but then neither are the standard or reference techniques. Overnight incubation has been the yardstick since the early days of in vitro AST. Given the usually shorter therapeutic intervals of 4- to 12-hour dosage schedules, it is quite possible that shorter incubation times for in vitro tests will become more of a standard. Until that time, newer, including automatic, techniques need to be evaluated against the more traditional standard methods. Quality control is critical, and since no systematic approach aside from individual manufacturers' suggestions exists, it should be developed by the NCCLS or similar agencies. Quality control might include standards for the evaluation of such equipment and systems because the development of new technology in this area will continue. Overall, reproducibility and accuracy of the instruments and methods evaluated were quite promising and should encourage well-designed studies of clinical correlation and relevance. The AMS equipment has been in use for routine AST in the clinical laboratories of the Seattle Veterans Administration Medical Center and the University of Washington Hospital. Because of its simplicity and flexibility, the Kirby-Bauer method continues to be an alternate technique for certain important clinical isolates, for instance, blood cultures in both laboratories. Finally, it should be remembered that the most critical function of all such equipment is the reliable detection of resistance.

Automation↗