The knowledge content for our outpatient clinical decision support system was developed at Partners HealthCare and evaluated by a physician and pharmacist expert panel with recommendations from First DataBank, Hansten’s, and the U.S. Food and Drug Administration, among other sources. 20 Specifically, contributions from preexisting knowledge bases and evidence-based literature helped focus the list and guide clinical importance. The knowledge base only in- cluded alerts pertinent to ambulatory care. Through multi- ple discussions, the expert panel placed each alert into one of three clinical severity tiers, where non-interruptive had the least likely and the least severe consequences based on clinical studies, case findings, and panel experience. The interruptive alerts required providers either to completely abort the order or to give a reason for overriding the warning. With non-interruptive alerts, the recommenda- tions included baseline monitoring, use of a drug with caution, or increased monitoring to capture any unwanted effects. Moreover, providers did not have to supply re- sponse to the warning in order to proceed with the intended medication order. In this particular evaluation, an example of a non-interruptive medication laboratorymonitoring alert would be to monitor potassium when prescribing ACE inhibitors—the full list of medication-laboratorymonitoring rules are listed in Appendix 1 (available as a JAMIA online supplement at www.jamia.org ). All decisions required con- sensus, and clinical specialists were consulted if the scope extended beyond the panel’s expertise.
Since the Institute of Medicine highlighted the impact of medical errors on patient morbidity and mortality in To Err is Human, 1 signiﬁcant effort has focused on reducing medical errors and improving patient safety in the USA. Medical errors result in 44 000e98 000 deaths per year, a large proportion of which are due to adverse drug events (ADEs). 1 Laboratorymonitoring errors are a major cause of potential ADEs, occurring in 60.8% of preventable ADEs in ambulatory older adults 2 and in 45.4% of preventable ADEs requiring hospital admission. 3 Baseline monitoring rates are low, with up to 58% of initial drug dispensings occurring without appropriate laboratorymonitoring for ambulatory older adults. 4 Because patients sometimes miss more than one test for a given drug and often take many drugs, the rate of all potential laboratory- monitoring errors was estimated to be extremely high (w80%) among patients taking chronic medications in 2001. 5 Because poor adherence to
We developed a set of ‘test groups’ for primary care clini- cians to use when ordering tests to monitor patients with a number of chronic diseases, particularly for QOF annual reviews. They were designed to ensure that only tests that were necessary and sufficient to provide an answer to the clinical question were included. We found it helpful to reframe problems as clinical questions as they would be seen from the perspective of the patient. For instance, the purpose of annual blood monitoring in patients with hypertension might be to ask, "Are my kidneys OK? Is there any evidence I am suffering side effects from my medication?" From this, we can see that the tests that would be necessary and sufficient to answer these ques- tions would include only a renal profile (sodium, potas- sium, creatinine and estimated glomerular filtration rate). This ‘outside-in’ approach provides a useful touch- stone for interdisciplinary discussion about what consti- tutes necessary and sufficient testing that often resolves conflict.
thromboelastometry (ROTEM) assessments (n=3/24). The impact of monitoring on treatment decisions was, however, rarely reported. In conclusion, many methods of perioperative monitoring of haemophilia patients with inhibitors have been identified in this review, yet there is a lack of reporting in larger scale cohort studies. More detailed reporting on the impact of monitoring outcomes on treatment decisions is also needed to share best practice, particularly as new therapeutic agents emerge.
Remote monitoring and control technology such as MQTT and the message broker can be used to implement ”lights-out” operations of labs, factories, oil wells, etc, with no need for anyone to be physically present at the location being monitored or controlled. This being particularly problematic when dangerous equipment is being remotely controlled. The use of local mechanical and electrical in- terlocks can help to aid this, but adding remote monitoring the operator is placed in a more knowledgeable position. Security devices such as PIR sensors and door/pressure switches can be used to raise an alert if anyone unexpect- edly enters a room or building. Identification technology such as RFID tagging can also be used to verify the identity of personnel who do enter or leave a controlled area, again using MQTT to alert the appropriate parties.
Laboratorymonitoring. The aPTT is the preferred test for monitoring the anticoagulant activity of hirudin in most clinical settings but not in aortocoronary venous bypass. An aPTT ratio of 1.5 to 3.0 (for Actin FS or Neothromtin) or of 1.5 to 2.5 (for other reagents) should be achieved (17). At least daily moni- toring of the aPTT is mandatory in order to assess the need for dose adjustment (1, 13). If normal, the patient’s own baseline level before anticoagulation may serve as the aPTT reference. If not, the median of the hospital’s normal range should be used. A therapeutically induced prolongation of the aPTT can be achieved in around 70% of patients, but the interindividual variability is high (17). In a study with healthy volunteers, the aPTT was doubled by 0.4 g of recombinant hirudin (r-hiru- din) per ml of plasma, and in a case report on a patient awaiting surgery for aortic valve replacement, a prolonged aPTT of between 60 and 80 s was associated with a plasma r-hirudin concentration of 1 to 1.5 g/ml (8, 48). Potzsch et al. found a correlation coefficient of 0.61 between prolongation of the aPTT and the plasma r-hirudin concentration in r-hirudin- treated patients (44). An aPTT exceeding 70 s is increasingly insensitive to increasing concentrations of r-hirudin and there- fore is not suitable for procedures and clinical settings with the need for high concentrations of hirudin (e.g., cardiopulmonary bypass surgery [CPB]) (18).
therefore necessary to select the appropriate anaesthetic regime and to implement suitable systems for monitoring anaesthetised animals during image acquisition. In addition, repeated anaesthesia required for longitudinal studies, the exposure of ionising radiations and the use of contrast agents and/or imaging biomarkers may also have consequences on the physiology of the animal and its response to anaesthesia, which need to be considered while monitoring the animals during imaging studies. We will review the anaesthesia protocols and monitoring systems commonly used during imaging of laboratory rodents. A variety of imaging modalities are used for imaging rodents, including magnetic resonance imaging, computed tomography, positron emission tomography, single photon emission computed tomography, high frequency ultrasound and optical imaging techniques such as bioluminescence and fluorescence imaging. While all these modalities are implemented for non-invasive in vivo imaging, there are certain differences in terms of animal handling and preparation, how the monitoring systems are implemented and, importantly, how the imaging procedures themselves can affect mammalian physiology. The most important and critical adverse effects of anaesthetic agents are depression of respiration, cardiovascular system disruption and thermoregulation. When anaesthetising rodents, one must carefully consider if these adverse effects occur at the therapeutic dose required for anaesthesia, if they are likely to affect the image acquisitions and, importantly, if they compromise the well-being of the animals. We will review how these challenges can be successfully addressed through an appropriate understanding of anaesthetic protocols and the implementation of adequate physiological monitoring systems.
Microbial activity is the cause of a variety of problems in water injection systems, e.g., microbial corrosion, plugging, and biofouling. Efficient monitoring of Saudi Aramco’s vast water injection system requires the development of online and automated technologies for monitoring microbial activities in the system. A previous system review and technology screening has identified five single-analyte strategies , which were evaluated in this study with a laboratory-scale setup to determine their applicability for automated determination of microbial activity in the injection water system. Four of the five single-analyte measuring principles tested in the laboratory setup were deemed less suitable for automation and/or reliable for use in the detection of microbial ac- tivity in the company injection water system. These four principles were: luminescence assay for adenosine-5’-triphosphate (ATP), detection and electrochemical measurements of H 2 S, determi-
For inbred, co-isogenic and congenic strains, breeding methods and genetic stability programmes help to min- imize substrain divergence due to genetic drift, and also to prevent genetic contamination by accidental crosses with other strains. To reduce genetic drift, the number of gen- erations of in-house breeding should be minimized, and the lines submitted to repositories such as, JAX, EMMA, MMRRC, IMSR or RIKEN, to be archived as frozen embryos and/or sperm. This secures the line and provides a means of replacing the breeding stock every 10 gener- ations as recommended by The Jackson Laboratory Genetic Stability Program (GSP) in order to slow down cumulative genetic drift. 42 For outbred stocks, the intent is to minimize inbreeding, maintain heterozygosity and manage genetic drift that would otherwise lead to colony divergence. Ideally, outbred colonies should be maintained with 25 breeding pairs, all of which have to contribute to the next generation, in order to avoid an increase of the inbreeding coeﬃcient per generation of more than 1%. Smaller colonies drift fast toward homozygosity because breeders are closely related. 58
Nyarko, J.B.B., Osae, S., Adeku, F., Darko, E.O., Amoako, J.K., Owusu-Banahene, J., Inkoom, S., Agyeman, B.K., Manteaw, P., Amoatey, E., Aseidu, G.O., Appiah, P., Bekoe, B.D. and Charles, D.F. (2019) Level of Practical Skills in Personnel Dosimetry Monitoring and the Laboratory Experience with Different Types of TLD Readers. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 8, 141-150.
To avoid different schemes of implementation that could impede international trade in chemicals, OECD Member countries have pursued international harmonisation of test methods and good laboratory practice. In 1979 and 1980, an international group of experts established under the Special Programme on the Control of Chemicals developed the “OECD Principles of Good Laboratory Practice” (GLP), utilising common managerial and scientific practices and experience from various national and international sources. These Principles of GLP were adopted by the OECD Council in 1981, as an Annex to the Council Decision on the Mutual Acceptance of Data in the Assessment of Chemicals [C(81)30(Final)].
Within the framework of the third OECD Consensus Workshop on Good Laboratory Practice held 5th to 8th October 1992, in Interlaken, Switzerland, a working group of experts discussed the interpretation of the GLP Principles as applied to computerised systems. The working group was chaired by Dr. Theo Helder of the Dutch GLP Compliance Monitoring Authority. The Rapporteur was Mr. Bryan Doherty (Chairman of the Computing Committee of the British Association for Research Quality Assurance). Participants in the Working Group were from both national GLP compliance monitoring authorities and from testing laboratories in the following countries: Austria, Belgium, Denmark, Finland, France, Germany, Japan, the Netherlands, Switzerland, United Kingdom, United States. That Working Group was unable to reach consensus on a detailed guidance document in the time available to it. It did, however, develop a document entitled "Concepts relating to Computerised Systems in a GLP Environment", which set out the general principles and described the issues involved for each. That document was circulated to comments to Member countries.
The recent development of miniaturised gas sensor technolo- gies has created the opportunity to develop cheap and simple techniques for the rapid and sensitive in situ O 3 measurement without requirement for high gaseous sample ﬂows in laboratory experiments. Compared with above three conventional O 3 mon- itoring devices O 3 sensors are much lower in cost (<$200), have lower power consumption (<5 W), are lighter in weight (<10 g), whilst maintaining high time-resolution (1 s) of measurement. For air quality monitoring, gas sensor techniques can poten- tially realise low cost ﬂexible networks at high spatial resolution, reducing air pollution monitoring costs and increasing coverage especially in remote areas [5,6] . Cost-efﬁcient ozone sensors based on gas-sensitive semiconducting oxide technology were previously deployed for accurate surface O 3 monitoring in a high spatial den- sity in a valley of New Zealand  . Several portable gas sensors was employed to capture the spatial variability of trafﬁc-related air pol- lution such as O 3 and NO 2  . Due to their portability and low power consumption, other atmospheric gas sensors have been utilised on several speciﬁc occasions such as during aircraft measurements and for personal exposure determinations. A custom, compact, laser- based methane sensor was developed and coupled to an unmanned aerial vehicle, which was ﬂown around a compressor station to quantify fugitive methane emissions  . A black carbon sensor combined with a smartphone was employed to continuously mea- sure black carbon levels to estimate personal exposures related to residential air pollution and commuting based on personal loca- tion and physical activity level  . Electrochemical sensors have been employed for monitoring ambient air quality on several occa- sions [9–14] . However, there are a wide range of sensor types and brands and the sensor performances are still not well understood or comprehensively tested [12,15] .
The biggest benefit of a laboratory notebook is that through practice, students are able to make meaningful claims that are based on well-documented, high-quality data. The notebook supports students’ generation and in- terpretation of data, allowing them to confidently make claims using their own data as evidence. This is par- ticularly critical when they conduct their own inquiry- based investigations, as students can examine questions generated from their own research.
Recently, activities and interest in monitoring the heat evolution of cement hydration in concrete have increased. This is because the development of early-age concrete properties (such as workability, setting time, strength gain, and thermal cracking resistance) is predominantly influenced by the kinetics of cement hydration. Various test methods are currently available for measuring heat of cement hydration; however, most existing methods require expensive equipment, complex testing procedures, and/or extensive time, thus making them unsuitable for field application. Although ASTM C 186 is used for determining the heat of hydration of cement, there is no standard test method for concrete.
But bricks showed important and fast weathering that could be prejudicial to the conservation of the site. In the tun- nels, bricks were entirely covered with suits accumulated during the use of the railway. The bricks of the south- facing walls showed cavernous weathering features possibly resulting from salt weathering, while the north-facing walls showed weathering that could be attributed to frost action (Fig. 1). Indeed, a preliminary study showed that angular flake detachments 1–6 cm thick occurred during winter. The purpose of this study was to understand this weathering and ultimately to prevent it. Thus, field monitoring started in win- ter 2003. It was connected to laboratory experiments which intended to reproduce what was noticed in the tunnels, to understand which factor prevailed, how porous network in- fluenced location of cracking and when cracking occurred.
Objectives: The objective of this study was to determine the quality of laboratory services in a clinical laboratory at the primary health care level in the city of Osijek, from the point of view of their patients.
Participants and methods: 400 patients (252 women and 148 men) were included in this research study. The study was organized on the principle of a cross-sectional study. The survey was conducted in the period from October 1, 2016 to February 28, 2017, with a response rate of 80 % (400 out of 500). A specially designed questionnaire and a standardized Servqual questionnaire were used in the study to assess the quality of laboratory services. Original written applications for databases and the statistical package Statistica for Windows 2010 were used for the statistical analysis of data.
Caloric cooling and heat pumping rely on reversible thermal effects triggered in solids by magnetic, electric or stress fields. In the recent past, there have been several successful demonstrations of using first-order phase transition materials in laboratory cooling devices based on both the giant magnetocaloric and elastocaloric effects. All such materials exhibit non-equilibrium behaviours when driven through phase transformations by corresponding fields. Common wisdom is that non-equilibrium states should be avoided; yet, as we show using a model material exhibiting a giant magnetocaloric effect, non-equilibrium phase-separated states offer a unique opportunity to achieve uncommonly large caloric effects by very small perturbations of the driving field(s).