Impact of PACS on dictation turnaround time and productivity.

PubMed

Lepanto, Luigi; Paré, Guy; Aubry, David; Robillard, Pierre; Lesage, Jacques

2006-03-01

This study was conducted to measure the impact of PACS on dictation turnaround time and productivity. The radiology information system (RIS) database was interrogated to calculate the time interval between image production and dictation for every exam performed during three 90-day periods (the 3 months preceding PACS implementation, the 3 months immediately following PACS deployment, and a 3-month period 1 year after PACS implementation). Data were obtained for three exam types: chest radiographs, abdominal CT, and spine MRI. The mean dictation turnaround times obtained during the different pre- and post-PACS periods were compared using analysis of variance (ANOVA). Productivity was also determined for each period and for each exam type, and was expressed as the number of studies interpreted per full-time equivalent (FTE) radiologist. In the immediate post-PACS period, dictation turnaround time decreased 20% (p < 0.001) for radiography, but increased 13% (ns) for CT and 28% (p < 0.001) for MRI. One year after PACS was implemented, dictation turnaround time decreased 45% (p < 0.001) for radiography and 36% (p < 0.001) for MRI. For CT, 1 year post-PACS, turnaround times returned to pre-PACS levels. Productivity in the immediate post-PACS period increased 3% and 38% for radiography and CT, respectively, whereas a 6% decrease was observed for MRI. One year after implementation, productivity increased 27%, 98%, and 19% in radiography, CT, and MRI, respectively. PACS benefits, namely, shortened dictation turnaround time and increased productivity, are evident 1 year after PACS implementation. In the immediate post-PACS period, results vary with the different imaging modalities.

Turnaround Time Modeling for Conceptual Rocket Engines

NASA Technical Reports Server (NTRS)

Nix, Michael; Staton, Eric J.

2004-01-01

Recent years have brought about a paradigm shift within NASA and the Space Launch Community regarding the performance of conceptual design. Reliability, maintainability, supportability, and operability are no longer effects of design; they have moved to the forefront and are affecting design. A primary focus of this shift has been a planned decrease in vehicle turnaround time. Potentials for instituting this decrease include attacking the issues of removing, refurbishing, and replacing the engines after each flight. less, it is important to understand the operational affects of an engine on turnaround time, ground support personnel and equipment. One tool for visualizing this relationship involves the creation of a Discrete Event Simulation (DES). A DES model can be used to run a series of trade studies to determine if the engine is meeting its requirements, and, if not, what can be altered to bring it into compliance. Using DES, it is possible to look at the ways in which labor requirements, parallel maintenance versus serial maintenance, and maintenance scheduling affect the overall turnaround time. A detailed DES model of the Space Shuttle Main Engines (SSME) has been developed. Trades may be performed using the SSME Processing Model to see where maintenance bottlenecks occur, what the benefits (if any) are of increasing the numbers of personnel, or the number and location of facilities, in addition to trades previously mentioned, all with the goal of optimizing the operational turnaround time and minimizing operational cost. The SSME Processing Model was developed in such a way that it can easily be used as a foundation for developing DES models of other operational or developmental reusable engines. Performing a DES on a developmental engine during the conceptual phase makes it easier to affect the design and make changes to bring about a decrease in turnaround time and costs.

Emergency Department Overcrowding and Ambulance Turnaround Time

PubMed Central

Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul

2015-01-01

Objective The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. Methods This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Results Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). Conclusions In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance. PMID:26115183

Psychiatric patients turnaround times in the emergency department

PubMed Central

2005-01-01

Background To analyze the turnaround times of psychiatric patients within the Emergency Department (ED) from registration to discharge or hospitalization in a University Hospital in 2002. Methods Data from a one-year period of psychiatric admissions to the emergency service at a University Hospital were monitored and analyzed focused on turnaround times within the ED. Information on patients variables such as age, sex, diagnosis, consultations and diagnostic procedures were extracted from the patients' charts. Results From 34.058 patients seen in the ED in 2002, 2632 patients were examined by psychiatrists on duty. Mean turnaround time in the ED was 123 (SD 97) minutes (median 95). Patients to be hospitalized on a psychiatric ward stayed shorter within the ED, patients who later were admitted to another faculty, were treated longer in the ED. Patients with cognitive or substance related disorders stayed longer in the ED than patients with other psychiatric diagnoses. The number of diagnostic procedures and consultations increased the treatment time significantly. Conclusion As the number of patients within the examined ED increases every year, the relevant variables responsible for longer or complicated treatments were assessed in order to appropriately change routine procedures without loss of medical standards. Using this basic data, comparisons with the following years and other hospitals will help to define where the benchmark of turnaround times for psychiatric emergency services might be. PMID:16351721

Comparison of turnaround time and total cost of HIV testing before and after implementation of the 2014 CDC/APHL Laboratory Testing Algorithm for diagnosis of HIV infection.

PubMed

Chen, Derrick J; Yao, Joseph D

2017-06-01

Updated recommendations for HIV diagnostic laboratory testing published by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories incorporate 4th generation HIV immunoassays, which are capable of identifying HIV infection prior to seroconversion. The purpose of this study was to compare turnaround time and cost between 3rd and 4th generation HIV immunoassay-based testing algorithms for initially reactive results. The clinical microbiology laboratory database at Mayo Clinic, Rochester, MN was queried for 3rd generation (from November 2012 to May 2014) and 4th generation (from May 2014 to November 2015) HIV immunoassay results. All results from downstream supplemental testing were recorded. Turnaround time (defined as the time of initial sample receipt in the laboratory to the time the final supplemental test in the algorithm was resulted) and cost (based on 2016 Medicare reimbursement rates) were assessed. A total of 76,454 and 78,998 initial tests were performed during the study period using the 3rd generation and 4th generation HIV immunoassays, respectively. There were 516 (0.7%) and 581 (0.7%) total initially reactive results, respectively. Of these, 304 (58.9%) and 457 (78.7%) were positive by supplemental testing. There were 10 (0.01%) cases of acute HIV infection identified with the 4th generation algorithm. The most frequent tests performed to confirm an HIV-positive case using the 3rd generation algorithm, which were reactive initial immunoassay and positive HIV-1 Western blot, took a median time of 1.1 days to complete at a cost of $45.00. In contrast, the most frequent tests performed to confirm an HIV-positive case using the 4th generation algorithm, which included a reactive initial immunoassay and positive HIV-1/-2 antibody differentiation immunoassay for HIV-1, took a median time of 0.4 days and cost $63.25. Overall median turnaround time was 2.2 and 1.5 days, and overall median cost was $63.90 and $72.50 for

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times.

PubMed

Lamm, Matthew H; Eckel, Stephen; Daniels, Rowell; Amerine, Lindsey B

2015-07-01

The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Timeliness “at a glance”: assessing the turnaround time through the six sigma metrics.

PubMed

Ialongo, Cristiano; Bernardini, Sergio

2016-01-01

Almost thirty years of systematic analysis have proven the turnaround time to be a fundamental dimension for the clinical laboratory. Several indicators are to date available to assess and report quality with respect to timeliness, but they sometimes lack the communicative immediacy and accuracy. The six sigma is a paradigm developed within the industrial domain for assessing quality and addressing goal and issues. The sigma level computed through the Z-score method is a simple and straightforward tool which delivers quality by a universal dimensionless scale and allows to handle non-normal data. Herein we report our preliminary experience in using the sigma level to assess the change in urgent (STAT) test turnaround time due to the implementation of total automation. We found that the Z-score method is a valuable and easy to use method for assessing and communicating the quality level of laboratory timeliness, providing a good correspondence with the actual change in efficiency which was retrospectively observed.

Decreasing medication turnaround time with digital scanning technology in a canadian health region.

PubMed

Neville, Heather; Nodwell, Lisa; Alsharif, Sahar

2014-11-01

Reducing medication turnaround time can improve efficiency, patient safety, and quality of care in the hospital setting. Digital scanning technology (DST) can be used to electronically transmit scanned prescriber orders to a pharmacy computer queue for verification and processing, which may help to improve medication turnaround time. To evaluate medication turnaround time before and after implementation of DST for all medications and for antibiotics only. Medication turnaround times were evaluated retrospectively for periods before (June 6-10, 2011) and after (September 26-30, 2011) implementation of DST at 2 hospital sites in 1 health region. Medication turnaround time was defined as the time from composition of a medication order by the prescriber to its verification by the pharmacy (phase 1) and the time from prescriber composition to administration to the patient by a nurse (total). Median turnaround times were analyzed with SPSS software using the Mann-Whitney U test. In total, 304 and 244 medication orders were audited before and after DST implementation, respectively. Median phase 1 turnaround time for all medications declined significantly, from 2 h 23 min before DST implementation to 1 h 33 min after DST implementation (p < 0.001). Antibiotics were also processed significantly faster (1 h 51 min versus 1 h 9 min, p = 0.015). However, total turnaround time for all medications did not differ significantly (5 h 15 min versus 5 h 0 min, p = 0.42). Implementation of DST was associated with a 50-min decrease in medication turnaround time for the period from when an order was prescribed to the time it was processed by the pharmacy. Regular evaluation of medication turnaround times is recommended to compare with benchmarks, to ensure that hospital standards are being met, and to measure the effects of policy changes and implementation of new technology on medication-use processes.

Analysis of STAT laboratory turnaround times before and after conversion of the hospital information system.

PubMed

Lowe, Gary R; Griffin, Yolanda; Hart, Michael D

2014-08-01

Modern electronic health record systems (EHRS) reportedly offer advantages including improved quality, error prevention, cost reduction, and increased efficiency. This project reviewed the impact on specimen turnaround times (TAT) and percent compliance for specimens processed in a STAT laboratory after implementation of an upgraded EHRS. Before EHRS implementation, laboratory personnel received instruction and training for specimen processing. One laboratory member per shift received additional training. TAT and percent compliance data sampling occurred 4 times monthly for 13 months post-conversion and were compared with the mean of data collected for 3 months pre-conversion. Percent compliance was gauged using a benchmark of reporting 95% of all specimens within 7 min from receipt. Control charts were constructed for TAT and percent compliance with control limits set at 2 SD and applied continuously through the data collection period. TAT recovered to pre-conversion levels by the 6th month post-conversion. Percent compliance consistently returned to pre-conversion levels by the 10th month post-conversion. Statistical analyses revealed the TAT were significantly longer for 3 months post-conversion (P < .001) compared with pre-conversion levels. Statistical significance was not observed for subsequent groups. Percent compliance results were significantly lower for 6 months post-conversion (P < .001). Statistical significance was not observed for subsequent groups. Extensive efforts were made to train and prepare personnel for challenges expected after the EHRS upgrade. Specific causes identified with the upgraded EHRS included multiple issues involving personnel and the EHRS. These data suggest that system and user issues contributed to delays in returning to pre-conversion TAT and percent compliance levels following the upgrade in the EHRS.

Multiple pre- and post-analytical lean approaches to the improvement of the laboratory turnaround time in a large core laboratory.

PubMed

Lou, Amy H; Elnenaei, Manal O; Sadek, Irene; Thompson, Shauna; Crocker, Bryan D; Nassar, Bassam A

2017-10-01

Core laboratory (CL), as a new business model, facilitates consolidation and integration of laboratory services to enhance efficiency and reduce costs. This study evaluates the impact of total laboratory automation system (TLA), electric track vehicle (ETV) system and auto-verification (AV) of results on overall turnaround time (TAT) (phlebotomy to reporting TAT: PR-TAT) within a CL setting. Mean, median and percentage of outlier (OP) for PR-TAT were compared for pre- and post-CL eras using five representative tests based on different request priorities. Comparison studies were also carried out on the intra-laboratory TAT (in-lab to reporting TAT: IR-TAT) and the delivery TAT (phlebotomy to in-lab TAT: PI-TAT) to reflect the efficiency of the TLA (both before and after introducing result AV) and ETV systems respectively. Median PR-TATs for the urgent samples were reduced on average by 16% across all representative analytes. Median PR-TATs for the routine samples were curtailed by 51%, 50%, 49%, 34% and 22% for urea, potassium, thyroid stimulating hormone (TSH), complete blood count (CBC) and prothrombin time (PT) respectively. The shorter PR-TAT was attributed to a significant reduction of IR-TAT through the TLA. However, the median PI-TAT was delayed when the ETV was used. Application of various AV rules shortened the median IR-TATs for potassium and urea. However, the OP of PR-TAT for the STAT requests exceeding 60min were all higher than those from the pre-CL era. TLA and auto-verification rules help to efficiently manage substantial volumes of urgent and routine samples. However, the ETV application as it stands shows a negative impact on the PR-TAT. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Decreasing Medication Turnaround Time with Digital Scanning Technology in a Canadian Health Region

PubMed Central

Neville, Heather; Nodwell, Lisa; Alsharif, Sahar

2014-01-01

Background: Reducing medication turnaround time can improve efficiency, patient safety, and quality of care in the hospital setting. Digital scanning technology (DST) can be used to electronically transmit scanned prescriber orders to a pharmacy computer queue for verification and processing, which may help to improve medication turnaround time. Objectives: To evaluate medication turnaround time before and after implementation of DST for all medications and for antibiotics only. Methods: Medication turnaround times were evaluated retrospectively for periods before (June 6–10, 2011) and after (September 26–30, 2011) implementation of DST at 2 hospital sites in 1 health region. Medication turnaround time was defined as the time from composition of a medication order by the prescriber to its verification by the pharmacy (phase 1) and the time from prescriber composition to administration to the patient by a nurse (total). Median turnaround times were analyzed with SPSS software using the Mann–Whitney U test. Results: In total, 304 and 244 medication orders were audited before and after DST implementation, respectively. Median phase 1 turnaround time for all medications declined significantly, from 2 h 23 min before DST implementation to 1 h 33 min after DST implementation (p < 0.001). Antibiotics were also processed significantly faster (1 h 51 min versus 1 h 9 min, p = 0.015). However, total turnaround time for all medications did not differ significantly (5 h 15 min versus 5 h 0 min, p = 0.42). Conclusions: Implementation of DST was associated with a 50-min decrease in medication turnaround time for the period from when an order was prescribed to the time it was processed by the pharmacy. Regular evaluation of medication turnaround times is recommended to compare with benchmarks, to ensure that hospital standards are being met, and to measure the effects of policy changes and implementation of new technology on medication-use processes. PMID:25548397

Improving Reports Turnaround Time: An Essential Healthcare Quality Dimension.

PubMed

Khan, Mustafa; Khalid, Parwaiz; Al-Said, Youssef; Cupler, Edward; Almorsy, Lamia; Khalifa, Mohamed

2016-01-01

Turnaround time is one of the most important healthcare performance indicators. King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia worked on reducing the reports turnaround time of the neurophysiology lab from more than two weeks to only five working days for 90% of cases. The main quality improvement methodology used was the FOCUS PDCA. Using root cause analysis, Pareto analysis and qualitative survey methods, the main factors contributing to the delay of turnaround time and the suggested improvement strategies were identified and implemented, through restructuring transcriptionists daily tasks, rescheduling physicians time and alerting for new reports, engaging consultants, consistent coordination and prioritizing critical reports. After implementation; 92% of reports are verified within 5 days compared to only 6% before implementation. 7% of reports were verified in 5 days to 2 weeks and only 1% of reports needed more than 2 weeks compared to 76% before implementation.

Predictable turn-around time for post tape-out flow

NASA Astrophysics Data System (ADS)

Endo, Toshikazu; Park, Minyoung; Ghosh, Pradiptya

2012-03-01

A typical post-out flow data path at the IC Fabrication has following major components of software based processing - Boolean operations before the application of resolution enhancement techniques (RET) and optical proximity correctin (OPC), the RET and OPC step [etch retargeting, sub-resolution assist feature insertion (SRAF) and OPC], post-OPCRET Boolean operations and sometimes in the same flow simulation based verification. There are two objectives that an IC Fabrication tapeout flow manager wants to achieve with the flow - predictable completion time and fastest turn-around time (TAT). At times they may be competing. There have been studies in the literature modeling the turnaround time from historical data for runs with the same recipe and later using that to derive the resource allocation for subsequent runs. [3]. This approach is more feasible in predominantly simulation dominated tools but for edge operation dominated flow it may not be possible especially if some processing acceleration methods like pattern matching or hierarchical processing is involved. In this paper, we suggest an alternative method of providing target turnaround time and managing the priority of jobs while not doing any upfront resource modeling and resource planning. The methodology then systematically either meets the turnaround time need and potentially lets the user know if it will not as soon as possible. This builds on top of the Calibre Cluster Management (CalCM) resource management work previously published [1][2]. The paper describes the initial demonstration of the concept.

Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study.

PubMed

Boelstler, Arlene M; Rowland, Ralph; Theoret, Jennifer; Takla, Robert B; Szpunar, Susan; Patel, Shraddha P; Lowry, Andrew M; Pena, Margarita E

2015-03-01

To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Discrepancies Between Planned and Actual Operating Room Turnaround Times at a Large Rural Hospital in Germany

PubMed Central

Morgenegg, Regula; Heinze, Franziska; Wieferich, Katharina; Schiffer, Ralf; Stueber, Frank; Luedi, Markus M.; Doll, Dietrich

2017-01-01

Objectives While several factors have been shown to influence operating room (OR) turnaround times, few comparisons of planned and actual OR turnaround times have been performed. This study aimed to compare planned and actual OR turnaround times at a large rural hospital in Northern Germany. Methods This retrospective study examined the OR turnaround data of 875 elective surgery cases scheduled at the Marienhospital, Vechta, Germany, between July and October 2014. The frequency distributions of planned and actual OR turnaround times were compared and correlations between turnaround times and various factors were established, including the time of day of the procedure, patient age and the planned duration of the surgery. Results There was a significant difference between mean planned and actual OR turnaround times (0.32 versus 0.64 hours; P <0.001). In addition, significant correlations were noted between actual OR turnaround times and the time of day of the surgery, patient age, actual duration of the procedure and staffing changes affecting the surgeon or the medical specialty of the surgery (P <0.001 each). The quotient of actual/planned OR turnaround times ranged from 1.733–3.000. Conclusion Significant discrepancies between planned and actual OR turnaround times were noted during the study period. Such findings may be potentially used in future studies to establish a tool to improve OR planning, measure OR management performance and enable benchmarking. PMID:29372083

Evaluation of the impact of a total automation system in a large core laboratory on turnaround time.

PubMed

Lou, Amy H; Elnenaei, Manal O; Sadek, Irene; Thompson, Shauna; Crocker, Bryan D; Nassar, Bassam

2016-11-01

Growing financial and workload pressures on laboratories coupled with user demands for faster turnaround time (TAT) has steered the implementation of total laboratory automation (TLA). The current study evaluates the impact of a complex TLA on core laboratory efficiency through the analysis of the In-lab to Report TAT (IR-TAT) for five representative tests based on the different requested priorities. Mean, median and outlier percentages (OP) for IR-TAT were determined following TLA implementation and where possible, compared to the pre-TLA era. The shortest mean IR-TAT via the priority lanes of the TLA was 22min for Complete Blood Count (CBC), followed by 34min, 39min and 40min for Prothrombin time (PT), urea and potassium testing respectively. The mean IR-TAT for STAT CBC loaded directly on to the analyzers was 5min shorter than that processed via the TLA. The mean IR-TATs for both STAT potassium and urea via offline centrifugation were comparable to that processed by the TLA. The longest mean IR-TAT via regular lanes of the TLA was 62min for Thyroid-Stimulating Hormone (TSH) while the shortest was 17min for CBC. All parameters for IR-TAT for CBC and PT tests decreased significantly post- TLA across all requested priorities in particular the outlier percentage (OP) at 30 and 60min. TLA helps to efficiently manage substantial volumes of samples across all requested priorities. Manual processing for small STAT volumes, at both the initial centrifugation stage and front loading directly on to analyzers, is however likely to yield the shortest IR-TAT. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Turnaround Time for Early Infant HIV Diagnosis in Rural Zambia: A Chart Review

PubMed Central

Sutcliffe, Catherine G.; van Dijk, Janneke H.; Hamangaba, Francis; Mayani, Felix; Moss, William J.

2014-01-01

Background Early infant HIV diagnosis is challenging in sub-Saharan Africa, particularly in rural areas where laboratory capacity is limited. Specimens must be transported to central laboratories for testing, leading to delays in diagnosis and initiation of antiretroviral therapy. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis. Methods Chart reviews were conducted from 2010–2012 for children undergoing early infant HIV diagnosis at Macha Hospital in Zambia. Relevant dates, receipt of drugs by mother and child for the prevention of mother-to-child transmission (PMTCT), and test results were abstracted. Results 403 infants provided 476 samples for early infant diagnosis. The median age at the “6-week” and “6-month” assessments was 8.1 weeks and 7.0 months, respectively. The majority of mothers (80%) and infants (67%) received PMTCT. The median time between sample collection and arrival at the central laboratory in Lusaka was 17 days (IQR: 10, 28); arrival at the central laboratory to testing was 6 days (IQR: 5, 11); testing to return of results to the clinic was 29 days (IQR: 17, 36); arrival of results at the clinic to return of results to the caregiver was 45 days (IQR: 24, 79). The total median time from sample collection to return of results to the caregiver was 92 days (IQR: 84, 145). The proportion of HIV PCR positive samples was 12%. The total median turnaround time was shorter for HIV PCR positive as compared to negative or invalid samples (85 vs. 92 days; p = 0.08). Conclusions Delays in processing and communicating test results were identified, particularly in returning results from the central laboratory to the clinic and from the clinic to the caregiver. A more efficient process is needed so that caregivers can be provided test results more rapidly, potentially resulting in earlier treatment initiation and better outcomes for HIV-infected infants

A point-of-care chemistry test for reduction of turnaround and clinical decision time.

PubMed

Lee, Eui Jung; Shin, Sang Do; Song, Kyoung Jun; Kim, Seong Chun; Cho, Jin Seong; Lee, Seung Chul; Park, Ju Ok; Cha, Won Chul

2011-06-01

Our study compared clinical decision time between patients managed with a point-of-care chemistry test (POCT) and patients managed with the traditional central laboratory test (CLT). This was a randomized controlled multicenter trial in the emergency departments (EDs) of 5 academic teaching hospitals. We randomly assigned patients to POCT or CLT stratified by the Emergency Severity Index. A POCT chemistry analyzer (Piccolo; Abaxis, Inc, Union City, Calif), which is able to test liver panel, renal panel, pancreas enzymes, lipid panel, electrolytes, and blood gases, was set up in each ED. Primary and secondary end point was turnaround time and door-to-clinical-decision time. The total 2323 patients were randomly assigned to the POCT group (n = 1167) or to the CLT group (n = 1156). All of the basic characteristics were similar in the 2 groups. The turnaround time (median, interquartile range [IQR]) of the POCT group was shorter than that of the CLT group (14, 12-19 versus 55, 45-69 minutes; P < .0001). The median (IQR) door-to-clinical-decision time was also shorter in the POCT compared with the CLT group (46, 33-61 versus 86, 68-107 minutes; P < .0001). The proportion of patients who had new decisions within 60 minutes was 72.8% for the POCT group and 12.5% for the CLT group (P < .0001). A POCT chemistry analyzer in the ED shortens the test turnaround and ED clinical decision times compared with CLT. Copyright © 2011 Elsevier Inc. All rights reserved.

Upfront dilution of ferritin samples to reduce hook effect, improve turnaround time and reduce costs.

PubMed

Wu, Shu Juan; Hayden, Joshua A

2018-02-15

Sandwich immunoassays offer advantages in the clinical laboratory but can yield erroneously low results due to hook (prozone) effect, especially with analytes whose concentrations span several orders of magnitude such as ferritin. This study investigated a new approach to reduce the likelihood of hook effect in ferritin immunoassays by performing upfront, five-fold dilutions of all samples for ferritin analysis. The impact of this change on turnaround time and costs were also investigated. Ferritin concentrations were analysed in routine clinical practice with and without upfront dilutions on Siemens Centaur® XP (Siemens Healthineers, Erlang, Germany) immunoanalysers. In addition, one month of baseline data (1026 results) were collected prior to implementing upfront dilutions and one month of data (1033 results) were collected after implementation. Without upfront dilutions, hook effect was observed in samples with ferritin concentrations as low as 86,028 µg/L. With upfront dilutions, samples with ferritin concentrations as high as 126,050 µg/L yielded values greater than the measurement interval and would have been diluted until an accurate value was obtained. The implementation of upfront dilution of ferritin samples led to a decrease in turnaround time from a median of 2 hours and 3 minutes to 1 hour and 18 minutes (P = 0.002). Implementation of upfront dilutions of all ferritin samples reduced the possibility of hook effect, improved turnaround time and saved the cost of performing additional dilutions.

Impact of an in-house emergency radiologist on report turnaround time.

PubMed

Lamb, Leslie; Kashani, Paria; Ryan, John; Hebert, Guy; Sheikh, Adnan; Thornhill, Rebecca; Fasih, Najla

2015-01-01

One of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow. The purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time. Preliminary and final report turnaround times, provided by the radiology resident and staff, respectively, for patients undergoing computed tomography or ultrasonography of their abdomen/pelvis in 2008 (before the implementation of emergency radiology in-house staff service) were compared to those performed during the same time frame in 2009 and 2010 (after staffing protocols were changed). A total of 1,624 reports were reviewed. Overall, there was no statistically significant decrease in the preliminary report turnaround times between 2008 and 2009 (p = 0.1102), 2009 and 2010 (p = 0.6232), or 2008 and 2010 (p = 0.0890), although times consistently decreased from a median of 2.40 hours to 2.08 hours to 2.05 hours (2008 to 2009 to 2010). There was a statistically significant decrease in final report turnaround times between 2008 and 2009 (p < 0.0001), 2009 and 2010 (p < 0.0011), and 2008 and 2010 (p < 0.0001). Median final report times decreased from 5.00 hours to 3.08 hours to 2.75 hours in 2008, 2009, and 2010, respectively. There was also a significant decrease in the time interval between preliminary and final reports between 2008 and 2009 (p < 0.0001) and 2008 and 2010 (p < 0.0001) but no significant change between 2009 and 2010 (p = 0.4144). Our results indicate that the presence of a dedicated ED radiologist significantly reduces final report turnaround time and thus may positively impact the time to ED patient disposition

Optimal turnaround time for direct identification of microorganisms by mass spectrometry in blood culture.

PubMed

Randazzo, Adrien; Simon, Marc; Goffinet, Pierre; Classen, Jean-François; Hougardy, Nicolas; Pierre, Pascal; Kinzinger, Philippe; Mauel, Etienne; Goffinet, Jean-Sébastien

2016-11-01

During the past few years, several studies describing direct identification of bacteria from blood culture using mass spectrometry have been published. These methods cannot, however, be easily integrated into a common laboratory workflow because of the high hands-on time they require. In this paper, we propose a new method of identification with a short hands-on time and a turnaround time shorter than 15min. Positive blood bottles were homogenised and 600μL of blood were transferred to an Eppendorf tube where 600μL of lysis buffer were added. After homogenisation, a centrifugation step of 4min at 10,500g was performed and the supernatant was discarded. The pellet was then washed and loaded in quadruplicate into wells of a Vitek® MS-DS plate. Each well was covered with a saturated matrix solution and a MALDI-TOF mass spectrometry analysis was performed. Species were identified using the software Myla 3.2.0-2. We analysed 266 positive blood culture bottles. A microorganism grew in 261 cultures, while five bottles remained sterile after 48h of incubation in subculture. Our method reaches a probability of detection at the species level of 77.8% (203/261) with a positive predictive value of 99.5% (202/203). We developed a new method for the identification of microorganisms using mass spectrometry, directly performed from a positive blood culture. This method has short hands-on time and turnaround time and can easily take place in the workflow of a laboratory, with comparable results in performance with other methods reported in the literature. Copyright © 2016 Elsevier B.V. All rights reserved.

Turnaround Time and Market Capacity in Contract Cheating

ERIC Educational Resources Information Center

Wallace, Melisa J.; Newton, Philip M.

2014-01-01

Contract cheating is the process whereby students auction off the opportunity for others to complete assignments for them. It is an apparently widespread yet under-researched problem. One suggested strategy to prevent contract cheating is to shorten the turnaround time between the release of assignment details and the submission date, thus making…

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

PubMed

Coetzee, L M; Cassim, N; Glencross, D K

2015-12-16

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

Benchmarking, benchmarks, or best practices? Applying quality improvement principles to decrease surgical turnaround time.

PubMed

Mitchell, L

1996-01-01

The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.

Ways to reduce patient turnaround time and improve service quality in emergency departments.

PubMed

Sinreich, David; Marmor, Yariv

2005-01-01

Recent years have witnessed a fundamental change in the function of emergency departments (EDs). The emphasis of the ED shifts from triage to saving the lives of shock-trauma rooms equipped with state-of-the-art equipment. At the same time walk-in clinics are being set up to treat ambulatory type patients. Simultaneously ED overcrowding has become a common sight in many large urban hospitals. This paper recognises that in order to provide quality treatment to all these patient types, ED process operations have to be flexible and efficient. The paper aims to examine one major benchmark for measuring service quality--patient turnaround time, claiming that in order to provide the quality treatment to which EDs aspire, this time needs to be reduced. This study starts by separating the process each patient type goes through when treated at the ED into unique components. Next, using a simple model, the impact each of these components has on the total patient turnaround time is determined. This in turn, identifies the components that need to be addressed if patient turnaround time is to be streamlined. The model was tested using data that were gathered through a comprehensive time study in six major hospitals. The analysis reveals that waiting time comprises 51-63 per cent of total patient turnaround time in the ED. Its major components are: time away for an x-ray examination; waiting time for the first physician's examination; and waiting time for blood work. The study covers several hospitals and analyses over 20,000 process components; as such the common findings may serve as guidelines to other hospitals when addressing this issue.

Total Laboratory Automation and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Improve Turnaround Times in the Clinical Microbiology Laboratory: a Retrospective Analysis.

PubMed

Theparee, Talent; Das, Sanchita; Thomson, Richard B

2018-01-01

Technological advances have changed the practice of clinical microbiology. We implemented Bruker matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and BD Kiestra total laboratory automation (TLA) 4 and 3 years ago, respectively. To assess the impact of these new technologies, we compared turnaround times (TATs) for positive and negative urine cultures before and after implementation. In comparison I, TATs for 61,157 urine cultures were extracted for two periods corresponding to pre-TLA and post-TLA, both using MALDI-TOF MS for organism identification. In comparison II, time to organism identification (ID) and antimicrobial susceptibility (AST) reports were calculated for 5,402 positive culture reports representing four different periods: (i) manual plating and conventional biochemical identification (CONV), (ii) manual plating and MALDI-TOF MS identification (MALDI), (iii) MALDI-TOF MS identification and early phase implementation of TLA (TLA1), and (iv) MALDI-TOF MS identification and late phase implementation of TLA (TLA2). By the comparison I results, median pre- and post-TLA TATs to organism IDs (18.5 to 16.9 h), AST results (41.8 to 40.8 h), and preliminary results for negative cultures (17.7 to 13.6 h), including interquartile ranges for all comparisons, were significantly decreased post-TLA ( P < 0.001). By the comparison II results, MALDI significantly improved TAT to organism ID compared to CONV (21.3 to 18 h). TLA further improved overall TAT to ID (18 to 16.5 h) and AST (42.3 to 40.7 h) results compared to MALDI ( P < 0.001). In summary, TLA significantly improved TAT to organism ID, AST report, and preliminary negative results. MALDI-TOF MS significantly improved TAT for organism ID. Use of MALDI-TOF MS and TLA individually and together results in significant decreases in microbiology report TATs. Copyright © 2017 Theparee et al.

Total Laboratory Automation and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Improve Turnaround Times in the Clinical Microbiology Laboratory: a Retrospective Analysis

PubMed Central

Theparee, Talent; Das, Sanchita

2017-01-01

ABSTRACT Technological advances have changed the practice of clinical microbiology. We implemented Bruker matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and BD Kiestra total laboratory automation (TLA) 4 and 3 years ago, respectively. To assess the impact of these new technologies, we compared turnaround times (TATs) for positive and negative urine cultures before and after implementation. In comparison I, TATs for 61,157 urine cultures were extracted for two periods corresponding to pre-TLA and post-TLA, both using MALDI-TOF MS for organism identification. In comparison II, time to organism identification (ID) and antimicrobial susceptibility (AST) reports were calculated for 5,402 positive culture reports representing four different periods: (i) manual plating and conventional biochemical identification (CONV), (ii) manual plating and MALDI-TOF MS identification (MALDI), (iii) MALDI-TOF MS identification and early phase implementation of TLA (TLA1), and (iv) MALDI-TOF MS identification and late phase implementation of TLA (TLA2). By the comparison I results, median pre- and post-TLA TATs to organism IDs (18.5 to 16.9 h), AST results (41.8 to 40.8 h), and preliminary results for negative cultures (17.7 to 13.6 h), including interquartile ranges for all comparisons, were significantly decreased post-TLA (P < 0.001). By the comparison II results, MALDI significantly improved TAT to organism ID compared to CONV (21.3 to 18 h). TLA further improved overall TAT to ID (18 to 16.5 h) and AST (42.3 to 40.7 h) results compared to MALDI (P < 0.001). In summary, TLA significantly improved TAT to organism ID, AST report, and preliminary negative results. MALDI-TOF MS significantly improved TAT for organism ID. Use of MALDI-TOF MS and TLA individually and together results in significant decreases in microbiology report TATs. PMID:29118171

Laboratory-based clinical audit as a tool for continual improvement: an example from CSF chemistry turnaround time audit in a South-African teaching hospital.

PubMed

Imoh, Lucius C; Mutale, Mubanga; Parker, Christopher T; Erasmus, Rajiv T; Zemlin, Annalise E

2016-01-01

Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory. A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance. A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P < 0.05). CSF chemistry requests without the appropriate number of CSF sample tubes were significantly associated with delays in movement of samples from the labelling area to the technologist's work station (caused by a preference for microbiological testing prior to CSF chemistry). A laboratory-based clinical audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction.

Laboratory-based clinical audit as a tool for continual improvement: an example from CSF chemistry turnaround time audit in a South-African teaching hospital

PubMed Central

Imoh, Lucius C; Mutale, Mubanga; Parker, Christopher T; Erasmus, Rajiv T; Zemlin, Annalise E

2016-01-01

Introduction Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory. Materials and methods A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance. Results A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P < 0.05). CSF chemistry requests without the appropriate number of CSF sample tubes were significantly associated with delays in movement of samples from the labelling area to the technologist’s work station (caused by a preference for microbiological testing prior to CSF chemistry). Conclusion A laboratory-based clinical audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction. PMID:27346964

Computer-aided detection system for chest radiography: reducing report turnaround times of examinations with abnormalities.

PubMed

Kao, E-Fong; Liu, Gin-Chung; Lee, Lo-Yeh; Tsai, Huei-Yi; Jaw, Twei-Shiun

2015-06-01

The ability to give high priority to examinations with pathological findings could be very useful to radiologists with large work lists who wish to first evaluate the most critical studies. A computer-aided detection (CAD) system for identifying chest examinations with abnormalities has therefore been developed. To evaluate the effectiveness of a CAD system on report turnaround times of chest examinations with abnormalities. The CAD system was designed to automatically mark chest examinations with possible abnormalities in the work list of radiologists interpreting chest examinations. The system evaluation was performed in two phases: two radiologists interpreted the chest examinations without CAD in phase 1 and with CAD in phase 2. The time information recorded by the radiology information system was then used to calculate the turnaround times. All chest examinations were reviewed by two other radiologists and were divided into normal and abnormal groups. The turnaround times for the examinations with pathological findings with and without the CAD system assistance were compared. The sensitivity and specificity of the CAD for chest abnormalities were 0.790 and 0.697, respectively, and use of the CAD system decreased the turnaround time for chest examinations with abnormalities by 44%. The turnaround times required for radiologists to identify chest examinations with abnormalities could be reduced by using the CAD system. This system could be useful for radiologists with large work lists who wish to first evaluate the most critical studies. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Identification of blood culture isolates directly from positive blood cultures by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry and a commercial extraction system: analysis of performance, cost, and turnaround time.

PubMed

Lagacé-Wiens, Philippe R S; Adam, Heather J; Karlowsky, James A; Nichol, Kimberly A; Pang, Paulette F; Guenther, Jodi; Webb, Amanda A; Miller, Crystal; Alfa, Michelle J

2012-10-01

Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry represents a revolution in the rapid identification of bacterial and fungal pathogens in the clinical microbiology laboratory. Recently, MALDI-TOF has been applied directly to positive blood culture bottles for the rapid identification of pathogens, leading to reductions in turnaround time and potentially beneficial patient impacts. The development of a commercially available extraction kit (Bruker Sepsityper) for use with the Bruker MALDI BioTyper has facilitated the processing required for identification of pathogens directly from positive from blood cultures. We report the results of an evaluation of the accuracy, cost, and turnaround time of this method for 61 positive monomicrobial and 2 polymicrobial cultures representing 26 species. The Bruker MALDI BioTyper with the Sepsityper gave a valid (score, >1.7) identification for 85.2% of positive blood cultures with no misidentifications. The mean reduction in turnaround time to identification was 34.3 h (P < 0.0001) in the ideal situation where MALDI-TOF was used for all blood cultures and 26.5 h in a more practical setting where conventional identification or identification from subcultures was required for isolates that could not be directly identified by MALDI-TOF. Implementation of a MALDI-TOF-based identification system for direct identification of pathogens from blood cultures is expected to be associated with a marginal increase in operating costs for most laboratories. However, the use of MALDI-TOF for direct identification is accurate and should result in reduced turnaround time to identification.

A strategy for reducing turnaround time in design optimization using a distributed computer system

NASA Technical Reports Server (NTRS)

Young, Katherine C.; Padula, Sharon L.; Rogers, James L.

1988-01-01

There is a need to explore methods for reducing lengthly computer turnaround or clock time associated with engineering design problems. Different strategies can be employed to reduce this turnaround time. One strategy is to run validated analysis software on a network of existing smaller computers so that portions of the computation can be done in parallel. This paper focuses on the implementation of this method using two types of problems. The first type is a traditional structural design optimization problem, which is characterized by a simple data flow and a complicated analysis. The second type of problem uses an existing computer program designed to study multilevel optimization techniques. This problem is characterized by complicated data flow and a simple analysis. The paper shows that distributed computing can be a viable means for reducing computational turnaround time for engineering design problems that lend themselves to decomposition. Parallel computing can be accomplished with a minimal cost in terms of hardware and software.

Possibilities or Paradoxes? How Aspiring Turnaround Principals Conceptualise Turnaround and Their Place within It

ERIC Educational Resources Information Center

Weiner, Jennie

2016-01-01

This study focuses on how a cohort of participants in a programme aimed at producing "turnaround leaders" came to understand this policy and their role within it. Using a theory of action framework, I find that, over time, participants' espoused theories of turnaround shifted in three key areas: (1) the cause of poor school performance,…

A "Neurological Emergency Trolley" reduces turnaround time for high-risk medications in a general intensive care unit.

PubMed

Ajzenberg, Henry; Newman, Paula; Harris, Gail-Anne; Cranston, Marnie; Boyd, J Gordon

2018-02-01

To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses. 33-bed general medical-surgical intensive care unit in an academic teaching hospital. Time to medication administration. In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts. The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 1.

PubMed

Clary, Karen M; Davey, Diane D; Naryshkin, Sonya; Austin, R Marshall; Thomas, Nicole; Chmara, Beth Anne; Sugrue, Chiara; Tworek, Joseph

2013-02-01

The College of American Pathologists (CAP) conducted a national survey of gynecologic cytology quality assurance (QA) practices. Experts in gynecologic cytology were asked to join 5 working groups that studied the survey data on different aspects of QA. Evaluating the survey data and follow-up questions online, together with a review of pertinent literature, the working groups developed a series of preliminary statements on good laboratory practices in cytology QA. These were presented at a consensus conference and electronic voting occurred. To evaluate a set of QA monitors in gynecologic cytology. Working group 1 evaluated (1) monitoring interpretive rate categories for Papanicolaou tests (Pap tests), (2) concordance of cytotechnologist and pathologist interpretations before sign-out, and (3) turnaround time for Pap tests. The statements are based on a survey of gynecologic cytology QA practice patterns and of opinions from working group members and consensus conference attendees. The outcomes of this process demonstrate the current state of practice patterns in gynecologic cytology QA. Monitoring interpretive rates for all Bethesda System categories is potentially useful, and it is most useful to monitor interpretive rates for cytotechnologists individually and in comparison to the entire laboratory. Laboratories need to determine what level of discrepancy between cytotechnologist and pathologist interpretations of Pap tests is important to track. Laboratories should consider formalizing procedures and policies to adjudicate such discrepant interpretations. Turnaround time should be monitored in gynecologic cytology, but individual laboratories should determine how to measure and use turnaround time internally.

Customising turnaround time indicators to requesting clinician: a 10-year study through balanced scorecard indicators.

PubMed

Salinas, Maria; López-Garrigós, Maite; Santo-Quiles, Ana; Gutierrez, Mercedes; Lugo, Javier; Lillo, Rosa; Leiva-Salinas, Carlos

2014-09-01

The purpose of this study is, first to present a 10-year monitoring of postanalytical turnaround time (TAT) adapted to different clinicians and patient situations, second to evaluate and analyse the indicators results during that period of time, and finally to show a synthetic appropriate indicator to be included in the balanced scorecard management system. TAT indicator for routine samples was devised as the percentage of certain key tests that were verified before a specific time on the phlebotomy day. A weighted mean synthetic indicator was also designed. They were calculated for inpatients at 15:00 and 12:00 and for primary care patients only at 15:00. The troponin TAT of emergency department patients, calculated as the difference between the troponin verification and registration time, was selected as the stat laboratory TAT indicator. The routine and stat TAT improved along the 10-year study period. The synthetic indicator showed the same trend. The implementation of systematic and continuous monitoring over years, promoted a continuous improvement in TAT which will probably benefit patient outcome and safety.

No Time to Lose: Turnaround Leader Performance Assessment

ERIC Educational Resources Information Center

Rhim, Lauren Morando

2012-01-01

Effective leadership is critical to successful school turnaround efforts. Yet, district leaders have historically been hesitant to hold leaders accountable for bold change efforts. As federal and state dollars flow to districts and individual schools charged with embarking upon transformative change efforts, districts must adopt a laser-sharp…

Efficiency of an Automated Reception and Turnaround Time Management System for the Phlebotomy Room

PubMed Central

Yun, Soon Gyu; Park, Eun Su; Bang, Hae In; Kang, Jung Gu

2016-01-01

Background Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. Methods The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. Results Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. Conclusions The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room. PMID:26522759

Efficiency of an automated reception and turnaround time management system for the phlebotomy room.

PubMed

Yun, Soon Gyu; Shin, Jeong Won; Park, Eun Su; Bang, Hae In; Kang, Jung Gu

2016-01-01

Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.

Impact of reference change value (RCV) based autoverification on turnaround time and physician satisfaction

PubMed Central

Fernández-Grande, Esther; Valera-Rodriguez, Carolina; Sáenz-Mateos, Luis; Sastre-Gómez, Amparo; García-Chico, Pilar; Palomino-Muñoz, Teodoro J.

2017-01-01

Background For a quicker delivery of laboratory test results to the hospital emergency department (ED), we implemented an autoverification system based on the reference change value (RCV). The aim of this study was to assess how the RCV based autoverification reflected on turnaround time (TAT) and on physician satisfaction. Materials and methods The laboratory information system (LIS) was programmed to autoverify the results as long as they were within the range settled by RCV, so that the autoverified results were reported to the physician as soon as the tests were carried out, without any further intervention. We analyzed the same three-month periods’ TAT and verification time (VFT) from the years prior to and following the implementation of RCV autoverification. The change in physicians’ satisfaction levels was assessed using the hospital’s Annual Physician Satisfaction Survey (APSS). Over sixty percent of physicians completed the questionnaire, and the amount of daily ED test requests (nearly three hundred) did not vary throughout the duration of this study. Results Mann-Whitney U test showed that the VFT was significantly reduced in all the test but troponin I. There were substantial reductions in TAT medians (haemogram, 75%; fibrinogen, 41%; prothrombin time, 40%; sodium, 27%). The percentage of physicians satisfied with the haematological and biochemical tests´ TAT increased from 84% to 93% and from 86% to 91% respectively. Conclusions Our results reveal that VFT and TAT were severely reduced in most emergency tests, greatly improving physicians’ satisfaction with TAT. PMID:28694725

Building a new predictor for multiple linear regression technique-based corrective maintenance turnaround time.

PubMed

Cruz, Antonio M; Barr, Cameron; Puñales-Pozo, Elsa

2008-01-01

This research's main goals were to build a predictor for a turnaround time (TAT) indicator for estimating its values and use a numerical clustering technique for finding possible causes of undesirable TAT values. The following stages were used: domain understanding, data characterisation and sample reduction and insight characterisation. Building the TAT indicator multiple linear regression predictor and clustering techniques were used for improving corrective maintenance task efficiency in a clinical engineering department (CED). The indicator being studied was turnaround time (TAT). Multiple linear regression was used for building a predictive TAT value model. The variables contributing to such model were clinical engineering department response time (CE(rt), 0.415 positive coefficient), stock service response time (Stock(rt), 0.734 positive coefficient), priority level (0.21 positive coefficient) and service time (0.06 positive coefficient). The regression process showed heavy reliance on Stock(rt), CE(rt) and priority, in that order. Clustering techniques revealed the main causes of high TAT values. This examination has provided a means for analysing current technical service quality and effectiveness. In doing so, it has demonstrated a process for identifying areas and methods of improvement and a model against which to analyse these methods' effectiveness.

Setting the Bar for School Turnaround: How Ambitious, Public Goals Can Drive School Turnaround

ERIC Educational Resources Information Center

Stanton, Larry; Segal, Alison

2013-01-01

A state education agency (SEA) can pull a powerful lever for school turnaround by setting goals publicly and releasing reports on progress toward those goals at turnaround schools to build public support for turnaround efforts. SEAs can gather information for reporting from data they already have available. This report clarifies indicators and…

Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

PubMed

Blick, Kenneth E

2013-08-01

To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

Scaling School Turnaround

ERIC Educational Resources Information Center

Herman, Rebecca

2012-01-01

This article explores the research on turning around low performing schools to summarize what we know, what we don't know, and what this means for scaling school turnaround efforts. "School turnaround" is defined here as quick, dramatic gains in academic achievement for persistently low performing schools. The article first considers the…

The Turnaround Fallacy

ERIC Educational Resources Information Center

Smarick, Andy

2010-01-01

For as long as there have been struggling schools in America's cities, there have been efforts to turn them around. But overall, school turnaround efforts have consistently fallen far short of hopes and expectations. Quite simply, turnarounds are not a scalable strategy for fixing America's troubled urban school systems. Fortunately, findings from…

Transforming Turnaround Schools in China: A Review

ERIC Educational Resources Information Center

Liu, Peng

2017-01-01

This article reviews the literature on how Chinese turnaround schools are improved in practice. It starts by defining turnaround schools in the Chinese context, and then discusses the essential reasons why such schools exist. Approaches to improving turnaround schools, successful experiences of transforming turnaround schools, and the challenges…

Reducing turnaround time for laboratory test results does not improve retention of stable HIV-infected adults on POV program: experience from Uganda

PubMed Central

Maselle, Edna; Muhanguzi, Asaph; Muhumuza, Simon; Nansubuga, Jeniffer; Nawavvu, Cecilia; Namusobya, Jeniffer; Kamya, Moses R; Semitala, Fred C

2014-01-01

Introduction HIV/ AIDS clinics in resource limited settings (RLS) face increasing numbers of patients and workforce shortage [1, 2]. To address these challenges, efficient models of care like pharmacy only visits (POV) and nurse only visits (NOV) are recommended [3]. The Makerere University Joint AIDS Program (MJAP), a PEPFAR funded program providing care to over 42,000 HIV infected adults has implemented the POV model since 2009. In this model, stable patients on antiretroviral therapy (ART) with adherence to ART >95% and Karnofsky score >90% are reviewed by a doctor every four months but visit pharmacy for ART re-fills every two months. A study conducted in August 2011 showed low retention on the POV program with symptomatic diseases, pending CD4 count, complete blood count results, and poor adherence to ART as the major reasons for the non-retention in the POV program. To improve retention on POV, the TAT (Turnaround Time) for laboratory results (the main reason for non-retention in the previous study) was reduced from one month to one week. In August 2012, the study was repeated to assess the effect of reducing TAT on improving retention one year after patients were placed on POV. Materials and Methods A cohort analysis of data from patients in August 2011 and in August 2012 on POV was done. We compared retention of POV before and after reducing the TAT for laboratory results. Results Retention on POV was 12.0% (95% CI 9.50–14.7) among 619 patients in 2011, (70% Females), mean age was 33 years, Standard Deviation (SD) 8.5 compared to 11.1% (95% CI 9.15–13.4) among 888 patients (70% Females), mean age 38.3 years, SD 8.9 in 2012 (p=0.59). The main reasons for non-retention on the POV program in 2012 were poor adherence to ART (23%) and missed clinic appointments (14%). Conclusions Reducing TAT for laboratory test results did not improve retention of stable HIV-infected adults on POV in our clinic. Strategies for improving adherence to ART and keeping clinic

Reducing turnaround time for laboratory test results does not improve retention of stable HIV-infected adults on POV program: experience from Uganda.

PubMed

Maselle, Edna; Muhanguzi, Asaph; Muhumuza, Simon; Nansubuga, Jeniffer; Nawavvu, Cecilia; Namusobya, Jeniffer; Kamya, Moses R; Semitala, Fred C

2014-01-01

HIV/ AIDS clinics in resource limited settings (RLS) face increasing numbers of patients and workforce shortage [1, 2]. To address these challenges, efficient models of care like pharmacy only visits (POV) and nurse only visits (NOV) are recommended [3]. The Makerere University Joint AIDS Program (MJAP), a PEPFAR funded program providing care to over 42,000 HIV infected adults has implemented the POV model since 2009. In this model, stable patients on antiretroviral therapy (ART) with adherence to ART >95% and Karnofsky score >90% are reviewed by a doctor every four months but visit pharmacy for ART re-fills every two months. A study conducted in August 2011 showed low retention on the POV program with symptomatic diseases, pending CD4 count, complete blood count results, and poor adherence to ART as the major reasons for the non-retention in the POV program. To improve retention on POV, the TAT (Turnaround Time) for laboratory results (the main reason for non-retention in the previous study) was reduced from one month to one week. In August 2012, the study was repeated to assess the effect of reducing TAT on improving retention one year after patients were placed on POV. A cohort analysis of data from patients in August 2011 and in August 2012 on POV was done. We compared retention of POV before and after reducing the TAT for laboratory results. Retention on POV was 12.0% (95% CI 9.50-14.7) among 619 patients in 2011, (70% Females), mean age was 33 years, Standard Deviation (SD) 8.5 compared to 11.1% (95% CI 9.15-13.4) among 888 patients (70% Females), mean age 38.3 years, SD 8.9 in 2012 (p=0.59). The main reasons for non-retention on the POV program in 2012 were poor adherence to ART (23%) and missed clinic appointments (14%). Reducing TAT for laboratory test results did not improve retention of stable HIV-infected adults on POV in our clinic. Strategies for improving adherence to ART and keeping clinic appointments need to be employed to balance workload and

Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time.

PubMed

Verma, Akash; Lee, Mui Yok; Wang, Chunhong; Hussein, Nurmalah B M; Selvi, Kalai; Tee, Augustine

2014-04-01

The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

Root Cause Analysis and Subsequent Intervention to Improve First Dose Antibiotic Turnaround Time for Hospitalized Pediatric Patients

PubMed Central

Dee, Abigail A.; Kelly, Brian; Hampp, Christian

2010-01-01

OBJECTIVE Antibiotic timing is used as a quality standard for hospital accreditation and is an important quality measure. The study aim was to identify barriers in the process of first dose antibiotic administration on the pediatric floors at a tertiary healthcare center and carry out and test an intervention to improve turnaround time to less than one hour. METHODS We conducted a quasi-experimental pre-post study of hospitalized pediatric patients up to 18 years of age initiated on intravenous antibiotics. Every order for a first dose intravenous antibiotic was assessed on all pediatric floors (10/2008). Orders that did not meet the overall turnaround time goal of ≤ 1 hour were identified. A root cause analysis (RCA) was performed to identify reasons for delayed antibiotic administration. Barriers identified in the RCA were used to develop interventions (03/2009) to improve compliance, and the proportion of orders that met the goal was compared pre- (10/2008–02/2009) and post-intervention (04/2009–05/2009). RESULTS During the pre-intervention assessment period, 32 out of 46 total physician orders for a first dose intravenous antibiotic did not meet the one-hour overall turnaround goal. A main reason for delay was failure to label antibiotic orders as first dose. We designed an intervention that included antibiotic audits and individualized feedback to prescribers. The mean ± SD time from the written physician order to drug administration was 228 ± 58 minutes; timing improved to 55 ± 4 minutes after the intervention. The proportion of antibiotics administered within one hour improved from 42.2% to 63% (p=0.0015). CONCLUSIONS We identified system barriers associated with delayed antibiotic administration. Antibiotic timing was improved after continued surveillance and individualized feedback to providers. PMID:22477810

Expectations Among Academic Clinicians of Inpatient Imaging Turnaround Time: Does it Correlate with Satisfaction?

PubMed

Chan, Keith T; Carroll, Tamara; Linnau, Ken F; Lehnert, Bruce

2015-11-01

Imaging report turnaround time (RTAT) is an important measure of radiology performance and has become the leading priority in customer satisfaction surveys conducted among nonradiologists, who may not be familiar with the imaging workflow. Our aim was to assess physicians' expected RTAT for commonly ordered studies and determine if satisfaction correlates with met expectations. Retrospective review of inpatient imaging was conducted at a single academic institution, and RTAT for 18,414 studies was calculated. Examinations were grouped by study type, priority, and time of day. A cross-sectional survey instrument was completed by 48 internal medicine and surgery resident physicians with questions regarding RTAT and their level of satisfaction with various examinations. Actual RTAT ranged from 1.6 to 26.0 hours, with chest radiographs and computed tomographies generally faster than magnetic resonance images and ultrasounds. Urgent (STAT) examinations and those ordered during business hours have shorter RTAT. The time for image interpretation largely contributed to the RTAT because of the lack of night-time radiology coverage. Referring physician expectations were consistently shorter than actual RTAT, ranging from 30 minutes to 24 hours. Overall satisfaction scores were inversely correlated with RTAT, with a strong correlation to the time from study order to imaging (r(2) = 0.63) and a weak correlation to the image interpretation time (r(2) = 0.17). Satisfaction scores did not correlate with whether the actual RTAT met expectations (r(2) = 0.06). Referring physician satisfaction is likely multifactorial. Although RTAT has been reported as a priority, shortening turnaround time alone may not directly improve clinician satisfaction. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Human Capital in Turnaround Schools

ERIC Educational Resources Information Center

Ferris, Kristen

2012-01-01

Finding, keeping and supporting great educators presents the single biggest challenge to successful school turnarounds. Without teachers and administrators who bring the needed combination of skills and passion, nothing else will achieve the desired effect. The turnaround model supported by the U.S. Department of Education School Improvement Grant…

Factors associated with long turnaround time for early infant diagnosis of HIV in Myanmar.

PubMed

Thiha, Soe; Shewade, Hemant Deepak; Philip, Sairu; Aung, Thet Ko; Kyaw, Nang Thu Thu; Oo, Myo Minn; Kyaw, Khine Wut Yee; Wint War, May; Oo, Htun Nyunt

2017-01-01

A previous review of early infant diagnosis (EID) using polymerase chain reaction technology (PCR) under integrated HIV care (IHC) program in Myanmar revealed a low uptake of timely (within 6 to 8 weeks of babies' age) EID and a long turnaround time (TAT) of receiving results. This study aimed to determine the proportion and factors associated with the composite outcome of a long TAT (≥7 weeks; from sample collection to receipt of result by mother) or nonreceipt of result among HIV-exposed babies whose blood samples were collected for PCR at <9 months of age under the IHC program, Myanmar (2013-15). Cohort study involving record review of routinely collected data. A predictive Poisson regression model with robust variance estimates was fitted for risk factors of long TAT or nonreceipt of result. Blood samples of 1 000 babies were collected; among them, long TAT or nonreceipt of results was seen in 690 (69%), and this was more than 50% across all subgroups. Babies with a mother's CD4 count of 100-350 cells/mm 3 at enrollment [adjusted RR (0.95 confidence intervals, CI): 0.8 (0.7, 0.9)] had a 20% lower risk of long TAT or nonreceipt of results when compared with ≥350 cells/mm 3 . Distance between ART center and PCR facility ≥105 km [adjusted RR (0.95 CI): 1.2 (1.1, 1.4)], when compared with <105 km, was associated with 20% higher risk of long TAT or nonreceipt of results. The proportion of babies with long TAT or nonreceipt of result by the mother was high. Point-of-care testing for EID may reduce TAT/nonreceipt of results by the mother. Health system, laboratory, and logistic factors such as sample transportation, laboratory procedures, and result dispatching associated with long TAT should be further explored.

Combining Quick-Turnaround and Batch Workloads at Scale

NASA Technical Reports Server (NTRS)

Matthews, Gregory A.

2012-01-01

NAS uses PBS Professional to schedule and manage the workload on Pleiades, an 11,000+ node 1B cluster. At this scale the user experience for quick-turnaround jobs can degrade, which led NAS initially to set up two separate PBS servers, each dedicated to a particular workload. Recently we have employed PBS hooks and scheduler modifications to merge these workloads together under one PBS server, delivering sub-1-minute start times for the quick-turnaround workload, and enabling dynamic management of the resources set aside for that workload.

Lead Turnaround Partners: How the Emerging Marketplace of Lead Turnaround Partners Is Changing School Improvement

ERIC Educational Resources Information Center

Corbett, Julie

2011-01-01

This report describes the use of Lead Turnaround Partners (LTPs) in the current School Improvement Grant (SIG) program and provides the results of document review, surveys, and interviews with eight State Education Agencies and seven Lead Turnaround Partner organizations. The study focuses on the implementation of the transformation and turnaround…

Impact of the New Abbott mPLUS Feature on Clinical Laboratory Efficiencies of Abbott RealTime Assays for Detection of HIV-1, Hepatitis C Virus, Hepatitis B Virus, Chlamydia trachomatis, and Neisseria gonorrhoeae

PubMed Central

Jones, Sara; Wiesneth, Russ; Barry, Cathy; Webb, Erika; Belova, Larissa; Dolan, Peggy; Ho, Shiaolan; Abravaya, Klara; Cloherty, Gavin

2013-01-01

Diagnostic laboratories are under increasing pressure to improve and expand their services. Greater flexibility in sample processing is a critical factor that can improve the time to results while reducing reagent waste, making laboratories more efficient and cost-effective. The introduction of the Abbott mPLUS feature, with the capacity for extended use of amplification reagents, significantly increases the flexibility of the m2000 platform and enables laboratories to customize their workflows based on sample arrival patterns. The flexibility in sample batch size offered by mPLUS enables significant reductions in processing times. For hepatitis B virus tests, a reduction in sample turnaround times of up to 30% (105 min) was observed for batches of 12 samples compared with those for batches of 24 samples; for Chlamydia trachomatis/Neisseria gonorrhoeae tests, the ability to run batches of 24 samples reduced the turnaround time by 83% (54 min) compared with that for batches of 48 samples. Excellent correlations between mPLUS and m2000 standard condition results were observed for all RealTime viral load assays evaluated in this study, with correlation r values of 0.998 for all assays tested. For the qualitative RealTime C. trachomatis/N. gonorrhoeae assay, the overall agreements between the two conditions tested were >98% for C. trachomatis and 100% for N. gonorrhoeae. Comparable precision results were observed for the two conditions tested for all RealTime assays. The enhanced mPLUS capability provides clinical laboratories with increased efficiencies to meet increasingly stringent turnaround time requirements without increased costs associated with discarding partially used amplification reagents. PMID:24088850

Impact of the New Abbott mPLUS feature on clinical laboratory efficiencies of abbott RealTime assays for detection of HIV-1, Hepatitis C Virus, Hepatitis B Virus, Chlamydia trachomatis, and Neisseria gonorrhoeae.

PubMed

Lucic, Danijela; Jones, Sara; Wiesneth, Russ; Barry, Cathy; Webb, Erika; Belova, Larissa; Dolan, Peggy; Ho, Shiaolan; Abravaya, Klara; Cloherty, Gavin

2013-12-01

Diagnostic laboratories are under increasing pressure to improve and expand their services. Greater flexibility in sample processing is a critical factor that can improve the time to results while reducing reagent waste, making laboratories more efficient and cost-effective. The introduction of the Abbott mPLUS feature, with the capacity for extended use of amplification reagents, significantly increases the flexibility of the m2000 platform and enables laboratories to customize their workflows based on sample arrival patterns. The flexibility in sample batch size offered by mPLUS enables significant reductions in processing times. For hepatitis B virus tests, a reduction in sample turnaround times of up to 30% (105 min) was observed for batches of 12 samples compared with those for batches of 24 samples; for Chlamydia trachomatis/Neisseria gonorrhoeae tests, the ability to run batches of 24 samples reduced the turnaround time by 83% (54 min) compared with that for batches of 48 samples. Excellent correlations between mPLUS and m2000 standard condition results were observed for all RealTime viral load assays evaluated in this study, with correlation r values of 0.998 for all assays tested. For the qualitative RealTime C. trachomatis/N. gonorrhoeae assay, the overall agreements between the two conditions tested were >98% for C. trachomatis and 100% for N. gonorrhoeae. Comparable precision results were observed for the two conditions tested for all RealTime assays. The enhanced mPLUS capability provides clinical laboratories with increased efficiencies to meet increasingly stringent turnaround time requirements without increased costs associated with discarding partially used amplification reagents.

Assessing School Turnaround: Evidence from Ohio

ERIC Educational Resources Information Center

Player, Daniel; Katz, Veronica

2016-01-01

Policy makers have struggled to find successful approaches to address concentrated, persistent low school achievement. While NCLB and the School Improvement Grant (SIG) program have devoted significant time and attention to turnaround, very little empirical evidence substantiates whether and how these efforts work. This study employs a comparative…

Process configuration of Liquid-nitrogen Energy Storage System (LESS) for maximum turnaround efficiency

NASA Astrophysics Data System (ADS)

Dutta, Rohan; Ghosh, Parthasarathi; Chowdhury, Kanchan

2017-12-01

Diverse power generation sector requires energy storage due to penetration of variable renewable energy sources and use of CO2 capture plants with fossil fuel based power plants. Cryogenic energy storage being large-scale, decoupled system with capability of producing large power in the range of MWs is one of the options. The drawback of these systems is low turnaround efficiencies due to liquefaction processes being highly energy intensive. In this paper, the scopes of improving the turnaround efficiency of such a plant based on liquid Nitrogen were identified and some of them were addressed. A method using multiple stages of reheat and expansion was proposed for improved turnaround efficiency from 22% to 47% using four such stages in the cycle. The novelty here is the application of reheating in a cryogenic system and utilization of waste heat for that purpose. Based on the study, process conditions for a laboratory-scale setup were determined and presented here.

Keys to Sustaining Successful School Turnarounds

ERIC Educational Resources Information Center

Duke, Daniel L.

2006-01-01

To identify the changes associated with the school turnaround process, this article reviewed 15 case studies of elementary school turnaround initiatives that sustained improvements for at least two years. Changes were clustered into eight categories: leadership, school policy, programs, organizational processes, staffing, classroom practices,…

Developing a lean culture in the laboratory.

PubMed

Napoles, Leyda; Quintana, Maria

2006-07-25

The Director of Pathology at Jackson Memorial Hospital was interested in improving the operational efficiencies of the department in order to enhance the department's level of service in conjunction with the expansion of the overall health system. The decision was made to implement proven Lean practices in the laboratory under the direction of a major consulting firm. This article details the scope of the initial project as well as the operating principles of Lean manufacturing practices as applied to the clinical laboratory. The goals of the project were to improve turnaround times of laboratory results, reduce inventory and supply costs, improve staff productivity, maximize workflow, and eliminate waste. Extensive data gathering and analysis guided the work process by highlighting the areas of highest opportunity. This systematic approach resulted in recommendations for the workflow and physical layout of the laboratory. It also included the introduction of "standard workflow" and "visual controls" as critical items that streamlined operational efficiencies. The authors provide actual photographs and schematics of the reorganization and improvements to the physical layout of the laboratory. In conclusion, this project resulted in decreased turnaround times and increased productivity, as well as significant savings in the overall laboratory operations.

Laboratory Automation and Middleware.

PubMed

Riben, Michael

2015-06-01

The practice of surgical pathology is under constant pressure to deliver the highest quality of service, reduce errors, increase throughput, and decrease turnaround time while at the same time dealing with an aging workforce, increasing financial constraints, and economic uncertainty. Although not able to implement total laboratory automation, great progress continues to be made in workstation automation in all areas of the pathology laboratory. This report highlights the benefits and challenges of pathology automation, reviews middleware and its use to facilitate automation, and reviews the progress so far in the anatomic pathology laboratory. Copyright © 2015 Elsevier Inc. All rights reserved.

Role of Superintendent in District Turnaround

ERIC Educational Resources Information Center

Evans, James, Jr.

2014-01-01

The purpose of this research study was to evaluate the role of the superintendent in the turnaround process in persistently low achieving school districts. This research identified common threads, principles, and suggestions on turnaround processes and the role of the superintendent through examination of research on leadership and school…

Real time application of whole genome sequencing for outbreak investigation - What is an achievable turnaround time?

PubMed

McGann, Patrick; Bunin, Jessica L; Snesrud, Erik; Singh, Seema; Maybank, Rosslyn; Ong, Ana C; Kwak, Yoon I; Seronello, Scott; Clifford, Robert J; Hinkle, Mary; Yamada, Stephen; Barnhill, Jason; Lesho, Emil

2016-07-01

Whole genome sequencing (WGS) is increasingly employed in clinical settings, though few assessments of turnaround times (TAT) have been performed in real-time. In this study, WGS was used to investigate an unfolding outbreak of vancomycin resistant Enterococcus faecium (VRE) among 3 patients in the ICU of a tertiary care hospital. Including overnight culturing, a TAT of just 48.5 h for a comprehensive report was achievable using an Illumina Miseq benchtop sequencer. WGS revealed that isolates from patient 2 and 3 differed from that of patient 1 by a single nucleotide polymorphism (SNP), indicating nosocomial transmission. However, the unparalleled resolution provided by WGS suggested that nosocomial transmission involved two separate events from patient 1 to patient 2 and 3, and not a linear transmission suspected by the time line. Rapid TAT's are achievable using WGS in the clinical setting and can provide an unprecedented level of resolution for outbreak investigations. Published by Elsevier Inc.

A Sensitive Branched DNA HIV-1 Signal Amplification Viral Load Assay with Single Day Turnaround

PubMed Central

Baumeister, Mark A.; Zhang, Nan; Beas, Hilda; Brooks, Jesse R.; Canchola, Jesse A.; Cosenza, Carlo; Kleshik, Felix; Rampersad, Vinod; Surtihadi, Johan; Battersby, Thomas R.

2012-01-01

Branched DNA (bDNA) is a signal amplification technology used in clinical and research laboratories to quantitatively detect nucleic acids. An overnight incubation is a significant drawback of highly sensitive bDNA assays. The VERSANT® HIV-1 RNA 3.0 Assay (bDNA) (“Versant Assay”) currently used in clinical laboratories was modified to allow shorter target incubation, enabling the viral load assay to be run in a single day. To dramatically reduce the target incubation from 16–18 h to 2.5 h, composition of only the “Lysis Diluent” solution was modified. Nucleic acid probes in the assay were unchanged. Performance of the modified assay (assay in development; not commercially available) was evaluated and compared to the Versant Assay. Dilution series replicates (>950 results) were used to demonstrate that analytical sensitivity, linearity, accuracy, and precision for the shorter modified assay are comparable to the Versant Assay. HIV RNA-positive clinical specimens (n = 135) showed no significant difference in quantification between the modified assay and the Versant Assay. Equivalent relative quantification of samples of eight genotypes was demonstrated for the two assays. Elevated levels of several potentially interfering endogenous substances had no effect on quantification or specificity of the modified assay. The modified assay with drastically improved turnaround time demonstrates the viability of signal-amplifying technology, such as bDNA, as an alternative to the PCR-based assays dominating viral load monitoring in clinical laboratories. Highly sensitive bDNA assays with a single day turnaround may be ideal for laboratories with especially stringent cost, contamination, or reliability requirements. PMID:22479381

A sensitive branched DNA HIV-1 signal amplification viral load assay with single day turnaround.

PubMed

Baumeister, Mark A; Zhang, Nan; Beas, Hilda; Brooks, Jesse R; Canchola, Jesse A; Cosenza, Carlo; Kleshik, Felix; Rampersad, Vinod; Surtihadi, Johan; Battersby, Thomas R

2012-01-01

Branched DNA (bDNA) is a signal amplification technology used in clinical and research laboratories to quantitatively detect nucleic acids. An overnight incubation is a significant drawback of highly sensitive bDNA assays. The VERSANT® HIV-1 RNA 3.0 Assay (bDNA) ("Versant Assay") currently used in clinical laboratories was modified to allow shorter target incubation, enabling the viral load assay to be run in a single day. To dramatically reduce the target incubation from 16-18 h to 2.5 h, composition of only the "Lysis Diluent" solution was modified. Nucleic acid probes in the assay were unchanged. Performance of the modified assay (assay in development; not commercially available) was evaluated and compared to the Versant Assay. Dilution series replicates (>950 results) were used to demonstrate that analytical sensitivity, linearity, accuracy, and precision for the shorter modified assay are comparable to the Versant Assay. HIV RNA-positive clinical specimens (n = 135) showed no significant difference in quantification between the modified assay and the Versant Assay. Equivalent relative quantification of samples of eight genotypes was demonstrated for the two assays. Elevated levels of several potentially interfering endogenous substances had no effect on quantification or specificity of the modified assay. The modified assay with drastically improved turnaround time demonstrates the viability of signal-amplifying technology, such as bDNA, as an alternative to the PCR-based assays dominating viral load monitoring in clinical laboratories. Highly sensitive bDNA assays with a single day turnaround may be ideal for laboratories with especially stringent cost, contamination, or reliability requirements.

The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes.

PubMed

Petrides, Athena K; Bixho, Ida; Goonan, Ellen M; Bates, David W; Shaykevich, Shimon; Lipsitz, Stuart R; Landman, Adam B; Tanasijevic, Milenko J; Melanson, Stacy E F

2017-03-01

- A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). - To determine the impact of an interfaced EHR-LIS on laboratory processes. - We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. - The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. - An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

Progress Report 2013. Turnaround Arts Initiative

ERIC Educational Resources Information Center

Stoelinga, Sara Ray; Joyce, Katie; Silk, Yael

2013-01-01

This interim progress report provides a look at Turnaround Arts schools in their first year, including: (1) a summary of the evaluation design and research questions; (2) a preliminary description of strategies used to introduce the arts in Turnaround Arts schools; and (3) a summary of school reform indicators and student achievement data at…

Hospital turnaround strategies.

PubMed

Langabeer, James

2008-01-01

Despite reports of higher profitability in recent years, hospitals are failing at a faster rate than ever before. Although many hospitals leave decisions regarding revenues and costs to chief financial officers and their staff, this is a recipe for disaster. From research conducted over the last 4 years on hospital bankruptcies and turnarounds, the author found that a common series of actions will help organizations evade collapse. The author explored these turnaround strategies through research and analysis of a variety of hospitals and health systems that had a high probability of immediate financial crisis or collapse. His continued observation and analysis of these hospitals in subsequent years showed that most hospitals never emerge from their bleak financial conditions. However, a few hospital administrations have successfully turned around their organizations.

Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana.

PubMed

Ntshambiwa, Keoratile; Ntabe-Jagwer, Winnie; Kefilwe, Chandapiwa; Samuel, Fredrick; Moyo, Sikhulile

2014-01-01

The Ministry of Health (MOH) of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnoses. This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL) in Serowe, Botswana. SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale. Turnaround times, customer satisfaction, and several other health service indicators were tracked. The laboratory scored 53% (zero stars) at the baseline audit and 80% (three stars) at exit. Nearly three years later, the laboratory scored 85% (four stars) in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducing losses from US $18 000 in 2011 to $40 in 2013. The SLMTA programme contributed to enhanced performance of the laboratory, which in turn yielded potential positive impacts for patient care at the hospital.

Turnaround Arts Initiative: Summary of Key Findings

ERIC Educational Resources Information Center

Stoelinga, Sara Ray; Silk, Yael; Reddy, Prateek; Rahman, Nadiv

2015-01-01

Turnaround Arts is a public-private partnership that aims to test the hypothesis that strategically implementing high-quality and integrated arts education programming in high-poverty, chronically underperforming schools adds significant value to school-wide reform. In 2014, the Turnaround Arts initiative completed an evaluation report covering…

School Turnaround: Cristo Rey Boston High School Case Study

ERIC Educational Resources Information Center

Thielman, Jeff

2012-01-01

The mandates of the federal No Child Left Behind Law, including the threat of closing a school for underperformance, have led to multiple public school turnaround attempts. Because turnaround is a relatively new area of focus in education, there is limited research on what does and does not work, and even the definition of turnaround is a work in…

Windows of National Opportunity: An Excerpt from the Center on School Turnaround's Report on State Supports for Turnaround

ERIC Educational Resources Information Center

Scott, Caitlin; Lasley, Nora

2014-01-01

In 2014, state and national leaders found many aspects of turning around America's low-performing schools even more daunting than in the previous year. These views were revealed in the Center on School Turnaround's (CST's) 2014 February/March survey of school turnaround leaders in State Education Agencies (SEA) and directors of the nation's…

Effect of ADAMTS13 activity turnaround time on plasma utilization for suspected thrombotic thrombocytopenic purpura.

PubMed

Connell, Nathan T; Cheves, Tracey; Sweeney, Joseph D

2016-02-01

Thrombotic thrombocytopenic purpura (TTP) due to deficiency of the von Willebrand-cleaving protease ADAMTS13 is a hematologic emergency that requires prompt initiation of therapeutic plasma exchange (TPE). Long turnaround times (TATs) have precluded the use of pre-TPE measurement of ADAMTS13 activity for the initial diagnosis in most institutions. An in-house rapid TAT (r-TAT) assay for ADAMTS13 activity was implemented after 18 months of validation. In a quasi-experimental design using interrupted time series analysis, patterns of plasma utilization in patients with suspected TTP were assessed after implementation of this assay for ADAMTS13 activity and compared to utilization patterns for patients who received plasma exchange before r-TAT assay implementation designated the standard TAT period. In the 18 months after implementation of the r-TAT ADAMTS13 assay, there was a significant reduction in plasma utilization per patient suspected of having TTP (mean, 144.5 units vs. 63.3 units of plasma per patients suspected of having TTP; p = 0.002). The mean number of exchanges per patient and mean number of exchanges after achieving a platelet count of at least 150 × 10(9) /L were lower in the r-TAT cohort (p < 0.001 for both). There was no significant difference in 30-day mortality. Implementation of a rapid turnaround assay for ADAMTS13 resulted in a significant reduction in plasma utilization for patients with suspected TTP, without an increase in mortality. This study demonstrates that these data, provided in a timely fashion, can avoid unnecessary plasma exchange in patients who do not have TTP. © 2015 AABB.

Relegation and Reversion: Longitudinal Analysis of School Turnaround and Decline

ERIC Educational Resources Information Center

Hochbein, Craig

2012-01-01

School turnaround has become a popular strategy for improvement of chronically low-performing schools. Research related to school turnaround has relied substantially upon case studies. These case studies often focus on successful turnarounds and report immediate outcomes, failing to provide information about the sustainability of the results. In…

Improving Autopsy Report Turnaround Times by Implementing Lean Management Principles.

PubMed

Cromwell, Susan; Chiasson, David A; Cassidy, Debra; Somers, Gino R

2018-01-01

The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report. Two areas of delay were noted: examination of the microscopy and time taken to sign-out the report after the weekly autopsy conference. Several measures were implemented to address these delays, including visual tracking using a whiteboard and individualized tracking sheets, weekly whiteboard huddles, and timelier scheduling of clinicopathologic conference rounds. All measures resulted in an improvement of TATs. In the 30 months prior to the institution of lean, 37% of autopsies (53/144) were signed out in 90 days, with a wide variation in reporting times. In the 30 months following the institution of lean, this improved to 74% (136/185) ( P < .0001, Fisher exact test), with a marked reduction in variability. Further, the time from autopsy to presentation at weekly clinicopathological rounds was also reduced (median: 73 days prior to lean; 63 days post-lean). The application of lean principles to autopsy sign-out workflow can significantly improve TATs and reduce variability, without changing staffing levels or significantly altering scheduling structure.

The role of total laboratory automation in a consolidated laboratory network.

PubMed

Seaberg, R S; Stallone, R O; Statland, B E

2000-05-01

In an effort to reduce overall laboratory costs and improve overall laboratory efficiencies at all of its network hospitals, the North Shore-Long Island Health System recently established a Consolidated Laboratory Network with a Core Laboratory at its center. We established and implemented a centralized Core Laboratory designed around the Roche/Hitachi CLAS Total Laboratory Automation system to perform the general and esoteric laboratory testing throughout the system in a timely and cost-effective fashion. All remaining STAT testing will be performed within the Rapid Response Laboratories (RRLs) at each of the system's hospitals. Results for this laboratory consolidation and implementation effort demonstrated a decrease in labor costs and improved turnaround time (TAT) at the core laboratory. Anticipated system savings are approximately $2.7 million. TATs averaged 1.3 h within the Core Laboratory and less than 30 min in the RRLs. When properly implemented, automation systems can reduce overall laboratory expenses, enhance patient services, and address the overall concerns facing the laboratory today: job satisfaction, decreased length of stay, and safety. The financial savings realized are primarily a result of labor reductions.

Manned Orbital Transfer Vehicle (MOTV). Volume 5: Turnaround analysis

NASA Technical Reports Server (NTRS)

Boyland, R. E.; Sherman, S. W.; Morfin, H. W.

1979-01-01

The development of a low-cost reliable turnaround process to employ the MOTV in enhancing the utilization of the geosynchronous space region is analyzed. It is indicated that a routine effective turnaround/maintenance plan must make maximum use of flight data for maintenance planning, a high degree of test automation, and MOTV maintainability features in order to minimize tests, facilitate repair, and reduce manpower requirements. An effective turnaround plan provides a payback of reduced risks.

Sample Language of Modified Contract Elements from Existing CBAs, MOUs, or EWAs to Support Turnaround

ERIC Educational Resources Information Center

Mass Insight Education (NJ1), 2011

2011-01-01

Organized by the key conditions areas for turnaround, "People, Program, Time and Money," this tool offers sample language for each contract element to serve as a model for modifications from a traditional CBA that may support a district's turnaround efforts. Sample language is offered from existing provisions in district-wide collective bargaining…

Making sense from space-time data in laboratory experiments on space plasma processes

NASA Technical Reports Server (NTRS)

Gekelman, Walter; Bamber, James; Leneman, David; Vincena, Steve; Maggs, James; Rosenberg, Steve

1995-01-01

A number of visualization techniques are discussed in a laboratory experiment designed to study phenomena that occur in space. Visualization tools are used to design the apparatus, collect data, and make one-, two-, and three-dimensional plots of the results. These tools are an indispensable part of the experiment because the data sets are hundreds of megabytes in size and rapid turnaround is required.

Strategies for laboratory cost containment and for pathologist shortage: centralised pathology laboratories with microwave-stimulated histoprocessing and telepathology.

PubMed

Leong, Anthony S Y; Leong, F Joel W M

2005-02-01

The imposition of laboratory cost containment, often from external forces, dictates the necessity to develop strategies to meet laboratory cost savings. In addition, the national and worldwide shortage of anatomical pathologists makes it imperative to examine our current practice and laboratory set-ups. Some of the strategies employed in other areas of pathology and laboratory medicine include improvements in staff productivity and the adoption of technological developments that reduce manual intervention. However, such opportunities in anatomical pathology are few and far between. Centralisation has been an effective approach in bringing economies of scale, the adoption of 'best practices' and the consolidation of pathologists, but this has not been possible in anatomical pathology because conventional histoprocessing takes a minimum of 14 hours and clinical turnaround time requirements necessitate that the laboratory and pathologist be in proximity and on site. While centralisation of laboratories for clinical chemistry, haematology and even microbiology has been successful in Australia and other countries, the essential requirements for anatomical pathology laboratories are different. In addition to efficient synchronised courier networks, a method of ultra-rapid tissue processing and some expedient system of returning the prepared tissue sections to the remote laboratory are essential to maintain the turnaround times mandatory for optimal clinical management. The advent of microwave-stimulated tissue processing that can be completed in 30-60 minutes and the immediate availability of compressed digital images of entire tissue sections via telepathology completes the final components of the equation necessary for making centralised anatomical pathology laboratories a reality.

Testing ΛCDM cosmology at turnaround: where to look for violations of the bound?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tanoglidis, D.; Pavlidou, V.; Tomaras, T.N., E-mail: dtanogl@physics.uoc.gr, E-mail: pavlidou@physics.uoc.gr, E-mail: tomaras@physics.uoc.gr

In ΛCDM cosmology, structure formation is halted shortly after dark energy dominates the mass/energy budget of the Universe. A manifestation of this effect is that in such a cosmology the turnaround radius—the non-expanding mass shell furthest away from the center of a structure— has an upper bound. Recently, a new, local, test for the existence of dark energy in the form of a cosmological constant was proposed based on this turnaround bound. Before designing an experiment that, through high-precision determination of masses and —independently— turnaround radii, will challenge ΛCDM cosmology, we have to answer two important questions: first, when turnaround-scalemore » structures are predicted to be close enough to their maximum size, so that a possible violation of the bound may be observable. Second, which is the best mass scale to target for possible violations of the bound. These are the questions we address in the present work. Using the Press-Schechter formalism, we find that turnaround structures have in practice already stopped forming, and consequently, the turnaround radius of structures must be very close to the maximum value today. We also find that the mass scale of ∼ 10{sup 13} M{sub ⊙} characterizes the turnaround structures that start to form in a statistically important number density today —and even at an infinite time in the future, since structure formation has almost stopped. This mass scale also separates turnaround structures with qualitatively different cosmological evolution: smaller structures are no longer readjusting their mass distribution inside the turnaround scale, they asymptotically approach their ultimate abundance from higher values, and they are common enough to have, at some epoch, experienced major mergers with structures of comparable mass; larger structures exhibit the opposite behavior. We call this mass scale the transitional mass scale and we argue that it is the optimal for the purpose outlined above

Five Myths of School Turnaround Policy and Practice

ERIC Educational Resources Information Center

Meyers, Coby V.; Smylie, Mark A.

2017-01-01

Despite the intensity of funding and numerous intervention efforts in recent school turnaround initiatives, many perspectives, practices, and policies specific to school turnaround appear to be at odds with organizational theory. Yet, many actors in research, policy, and practice arenas appear convinced that their steadfastness will eventually be…

Using Competencies to Improve School Turnaround Principal Success

ERIC Educational Resources Information Center

Steiner, Lucy; Hassel, Emily Ayscue

2011-01-01

This paper aims first to shed light on one element of leadership: the characteristics--or "competencies"--of turnaround leaders who succeed in driving rapid, dramatic change. Second, it recounts the elements of support that districts must provide these leaders to enable and sustain a portfolio of successful school turnarounds.…

An Integrated Gate Turnaround Management Concept Leveraging Big Data Analytics for NAS Performance Improvements

NASA Technical Reports Server (NTRS)

Chung, William W.; Ingram, Carla D.; Ahlquist, Douglas Kurt; Chachad, Girish H.

2016-01-01

unique airport attributes (e.g., runway, taxiway, terminal, and gate configurations and tenants), and combined statistics from past data and live data based on a specific set of ATM concept-of-operations (ConOps) and operational parameters via systems analysis using an analytic network learning model. The IGTM tool will then bound the uncertainties that arise from nominal and off-nominal operational conditions with direct assessment of the gate turnaround status and the impact of a certain operational decision on the NAS performance, and provide a set of recommended actions to optimize the NAS performance by allowing stakeholders to take mitigation actions to reduce uncertainty and time deviation of planned operational events. An IGTM prototype was developed at NASA Ames Simulation Laboratories (SimLabs) to demonstrate the benefits and applicability of the concept. A data network, using the System Wide Information Management (SWIM)-like messaging application using the ActiveMQ message service, was connected to the simulated data warehouse, scheduled flight plans, a fast-time airport simulator, and a graphic UI. A fast-time simulation was integrated with the data warehouse or Big Data/Analytics (BAI), scheduled flight plans from Aeronautical Operational Control AOC, IGTM Controller, and a UI via a SWIM-like data messaging network using the ActiveMQ message service, illustrated in Figure 1, to demonstrate selected use-cases showing the benefits of the IGTM concept on the NAS performance.

Effectiveness of Specimen Collection Technology in the Reduction of Collection Turnaround Time and Mislabeled Specimens in Emergency, Medical-Surgical, Critical Care, and Maternal Child Health Departments.

PubMed

Saathoff, April M; MacDonald, Ryan; Krenzischek, Erundina

2018-03-01

The objective of this study was to evaluate the impact of specimen collection technology implementation featuring computerized provider order entry, positive patient identification, bedside specimen label printing, and barcode scanning on the reduction of mislabeled specimens and collection turnaround times in the emergency, medical-surgical, critical care, and maternal child health departments at a community teaching hospital. A quantitative analysis of a nonrandomized, pre-post intervention study design evaluated the statistical significance of reduction of mislabeled specimen percentages and collection turnaround times affected by the implementation of specimen collection technology. Mislabeled specimen percentages in all areas decreased from an average of 0.020% preimplementation to an average of 0.003% postimplementation, with a P < .001. Collection turnaround times longer than 60 minutes decreased after the implementation of specimen collection technology by an average of 27%, with a P < .001. Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, and patient injury or death. Collection errors can also contribute to an increased length of stay, increased healthcare costs, and decreased patient satisfaction. Specimen collection technology has structures in place to prevent collection errors and improve the overall efficiency of the specimen collection process.

The makeover of the Lakeshore General Hospital laboratories.

PubMed

Estioko-Taimuri, Teresa

2006-01-31

This article describes the expansion and reorganization of a moderate-sized Canadian laboratory from Day One to "Live Day." The key factors to the success of this project were organized planning by the laboratory staff and the introduction of core lab theories, team building, and organized training sessions. The successful makeover resulted in improved turnaround time for STAT tests, especially those coming from the Emergency Unit. The efforts of the laboratory personnel toward the improvement of laboratory services, in spite of budget, human resources constraints, and resistance to change, are addressed.

Estimating the Turn-around Radii of Six Isolated Galaxy Groups in the Local Universe

NASA Astrophysics Data System (ADS)

Lee, Jounghun

2018-03-01

Estimates of the turn-around radii of six isolated galaxy groups in the nearby universe are presented. From the Tenth Data Release of the Sloan Digital Sky Survey, we first select those isolated galaxy groups at redshifts z ≤ 0.05 in the mass range [0.3–1] × {10}14 {h}-1 {M}ȯ whose nearest-neighbor groups are located at distances larger than 15 times their virial radii. Then, we search for a gravitationally interacting web-like structure around each isolated group, which appears as an inclined streak pattern in the anisotropic spatial distribution of the neighboring field galaxies. Out of 59 isolated groups, only seven are found to possess such web-like structures in their neighbor zones, but one of them turns out to be NGC 5353/4, whose turn-around radius was already measured in a previous work and was thus excluded from our analysis. Applying the Turn-around Radius Estimator algorithm devised by Lee et al. to the identified web-like structures of the remaining six target groups, we determine their turn-around radii and show that three out of the six targets have larger turn-around radii than the spherical bound limit predicted by Planck cosmology. We discuss possible sources of the apparent violations of the three groups, including the underestimated spherical bound limit due to the approximation of the turn-around mass by the virial mass.

Application of the Toyota Production System improves core laboratory operations.

PubMed

Rutledge, Joe; Xu, Min; Simpson, Joanne

2010-01-01

To meet the increased clinical demands of our hospital expansion, improve quality, and reduce costs, our tertiary care, pediatric core laboratory used the Toyota Production System lean processing to reorganize our 24-hour, 7 d/wk core laboratory. A 4-month, consultant-driven process removed waste, led to a physical reset of the space to match the work flow, and developed a work cell for our random access analyzers. In addition, visual controls, single piece flow, standard work, and "5S" were instituted. The new design met our goals as reflected by achieving and maintaining improved turnaround time (TAT; mean for creatinine reduced from 54 to 23 minutes) with increased testing volume (20%), monetary savings (4 full-time equivalents), decreased variability in TAT, and better space utilization (25% gain). The project had the unanticipated consequence of eliminating STAT testing because our in-laboratory TAT for routine testing was less than our prior STAT turnaround goal. The viability of this approach is demonstrated by sustained gains and further PDCA (Plan, Do, Check, Act) improvements during the 4 years after completion of the project.

Improving medical imaging report turnaround times: the role of technolgy.

PubMed

Marquez, Luis O; Stewart, Howard

2005-01-01

At Southern Ohio Medical Center (SOMC), the medical imaging department and the radiologists expressed a strong desire to improve workflow. The improved workflow was a major motivating factor toward implementing a new RIS and speech recognition technology. The need to monitor workflow in a real-time fashion and to evaluate productivity and resources necessitated that a new solution be found. A decision was made to roll out both the new RIS product and speech recognition to maximize the resources to interface and implement the new solution. Prior to implementation of the new RIS, the medical imaging department operated in a conventional electronic-order-entry to paper request manner. The paper request followed the study through exam completion to the radiologist. SOMC entered into a contract with its PACS vendor to participate in beta testing and clinical trials for a new RIS product for the US market. Backup plans were created in the event the product failed to function as planned--either during the beta testing period or during clinical trails. The last piece of the technology puzzle to improve report turnaround time was voice recognition technology. Speech recognition enhanced the RIS technology as soon as it was implemented. The results show that the project has been a success. The new RIS, combined with speech recognition and the PACS, makes for a very effective solution to patient, exam, and results management in the medical imaging department.

Adoption of Lean Principles in a High-Volume Molecular Diagnostic Microbiology Laboratory

PubMed Central

Mitchell, P. Shawn; Mandrekar, Jayawant N.

2014-01-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. PMID:24829247

"Turnaround" as Shock Therapy: Race, Neoliberalism, and School Reform

ERIC Educational Resources Information Center

Johnson, Amanda Walker

2013-01-01

"Turnaround" strategies of educational reform promise that school closure, reconstitution, privatizing, and reopening them will bring miraculous results. Questioning the implications, this article situates "turnaround" strategies locally, following the closure of a predominantly minority high school in 2008, in Austin, Texas.…

Turnaround Necessities: Basic Conditions for an Effective, Sustainable, and Scalable School Turnaround

ERIC Educational Resources Information Center

Robinson, William S.; Buntrock, LeAnn M.

2011-01-01

Turning around chronically low-performing schools is challenging work requiring fundamental rethinking of the change process, and a systemic rather than school-by-school approach. Without a doubt, high-impact school leaders are critical to turnaround success, and pockets of success around the country demonstrate this. However, transformational and…

Series Overview. Sustaining School Turnaround at Scale. Brief 1

ERIC Educational Resources Information Center

Education Resource Strategies, 2012

2012-01-01

Members of the non-profit organization Education Resource Strategies (ERS) have worked for over a decade with leaders of urban school systems to help them organize talent, time and technology to support great schools at scale. One year into the Federal program they are noticing significant differences in district turnaround approaches, engagement…

Turnaround operations analysis for OTV. Volume 2: Detailed technical report

NASA Technical Reports Server (NTRS)

1988-01-01

The objectives and accomplishments were to adapt and apply the newly created database of Shuttle/Centaur ground operations. Previously defined turnaround operations analyses were to be updated for ground-based OTVs (GBOTVs) and space-based OTVs (SBOTVs), design requirements identified for both OTV and Space Station accommodations hardware, turnaround operations costs estimated, and a technology development plan generated to develop the required capabilities. Technical and programmatic data were provided for NASA pertinent to OTV round and space operations requirements, turnaround operations, task descriptions, timelines and manpower requirements, OTV modular design and booster and Space Station interface requirements. SBOTV accommodations development schedule, cost and turnaround operations requirements, and a technology development plan for ground and space operations and space-based accommodations facilities and support equipment. Significant conclusion are discussed.

The State Role in School Turnaround: Emerging Best Practices

ERIC Educational Resources Information Center

Rhim, Lauren Morando, Ed.; Redding, Sam, Ed.

2014-01-01

This publication explores the role of the state education agency (SEA) in school turnaround efforts. An emphasis is placed on practical application of research and best practices related to the SEA's critical leadership role in driving and supporting successful school turnaround efforts. The publication is organized around the four goals of…

The Impact of Turnaround Reform on Student Outcomes: Evidence and Insights from the Los Angeles Unified School District

ERIC Educational Resources Information Center

Strunk, Katharine O.; Marsh, Julie A.; Hashim, Ayesha K.; Bush-Mecenas, Susan; Weinstein, Tracey

2016-01-01

We examine the Los Angeles Unified School District's Public School Choice Initiative (PSCI), which sought to turnaround the district's lowest-performing schools. We ask whether school turnaround impacted student outcomes, and what explains variations in outcomes across reform cohorts. We use a Comparative Interrupted Time Series approach using…

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time.

PubMed

Thiha, Soe; Shewade, Hemant Deepak; Philip, Sairu; Aung, Thet Ko; Kyaw, Nang Thu Thu; Oo, Myo Minn; Kyaw, Khine Wut Yee; War, May Wint; Oo, Htun Nyunt

2017-01-01

In collaboration with the national AIDS program, early infant diagnosis (EID) is implemented by Integrated HIV Care (IHC) program through its anti-retroviral therapy (ART) centers across 10 cities in five states and regions of Myanmar. Blood samples from the ART centers are sent using public transport to a centralized PCR facility. Among HIV-exposed babies <9 months at enrolment into IHC program (2013-15), to describe the EID cascade (enrolment, sample collection for PCR, result receipt by mother, HIV diagnosis and ART initiation) and factors associated with delayed (>8 weeks of age) or no blood sample collection for EID. Retrospective cohort study involving record review. A predictive poisson regression model with robust variance estimates was fitted for risk factors of delayed or no sample collection. Of 1349 babies, 523 (39%) of the babies' mothers were on ART before pregnancy. Timely uptake of EID (<8 weeks of age) was 47% (633/1349); sample collection was delayed in 27% (367/1349) and not done in 26% (349/1349) babies. Among samples collected (n = 1000), 667 results were received by the mother; 52 (5%) were HIV-infected; among them 42 (81%) were initiated on ART. Median (IQR) turnaround time from sample collection to result receipt by mother and time to initiate ART from result receipt by mother was 7 (4,12) and 8.5 (6,16) weeks, respectively. Mothers not on ART before pregnancy and distance of ART center from PCR facility (more than 128 km) were the risk factors of delayed or no sample collection. Improving provision of ART to mothers (through universal 'test and treat') is urgently required, which has the potential to improve the timely uptake of EID as well. Interventions to reduce turnaround times, like point of care EID testing and/or systematic use of mobile technology to communicate results, are needed.

Theoretical Considerations and Standards for the Use of Turnarounds.

ERIC Educational Resources Information Center

Olson, Clark D.

The term "turnaround" has taken a permanent place among the intercollegiate debate jargon. All too often, the first affirmative rebuttalists charge "turnaround" for every plan or response they do not know how to label properly. After so many "false alarms," judges are too weary or aggravated to notice the real thing,…

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions.

PubMed

McCall, Shannon J; Souers, Rhona J; Blond, Barbara; Massie, Larry

2016-10-01

-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. -To survey the level of physician satisfaction with hospital clinical laboratory services. -Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). -Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient "STAT" (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). -There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.

The Effect of Locus of Control on School Turnaround

ERIC Educational Resources Information Center

Walston, Bradford

2012-01-01

This research focused on the school turnaround process in six turnaround elementary schools located in urban and rural areas of the state of North Carolina. The purpose of the study was to learn about the challenges facing the six schools, the process of improving student achievement, and, more specifically, the degree to which adaptive leadership…

Adoption of lean principles in a high-volume molecular diagnostic microbiology laboratory.

PubMed

Mitchell, P Shawn; Mandrekar, Jayawant N; Yao, Joseph D C

2014-07-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Turnaround Momentum Still Fragile

ERIC Educational Resources Information Center

Klein, Alyson

2012-01-01

The federal program providing billions of dollars to help states and districts close or remake some of their worst-performing schools remains a work in progress after two years, with more than 1,200 turnaround efforts under way but still no definitive verdict on its effectiveness. The School Improvement Grant (SIG) program, supercharged by a…

Common Leadership Responsibilities of Principals of Successful Turnaround Model Schools

ERIC Educational Resources Information Center

Fullwood, Jezelle

2016-01-01

Purpose: The purpose of this qualitative study was to discover which leadership responsibilities, within the domains of trust, communication, learning, and shared leadership, did elementary and middle school principals of successful turnaround schools commonly perceive as most necessary to lead a turnaround intervention model school. Themes were…

Ditching the Disc: The Effects of Cloud-Based Image Sharing on Department Efficiency and Report Turnaround Times in Mammography.

PubMed

Morgan, Matthew B; Young, Elizabeth; Harada, Scott; Winkler, Nicole; Riegert, Joanna; Jones, Tony; Hu, Nan; Stein, Matthew

2017-12-01

In screening mammography, accessing prior examination images is crucial for accurate diagnosis and avoiding false-positives. When women visit multiple institutions for their screens, these "outside" examinations must be retrieved for comparison. Traditionally, prior images are obtained by faxing requests to other institutions and waiting for standard mail (film or CD-ROM), which can greatly delay report turnaround times. Recently, advancements in cloud-based image transfer technology have opened up more efficient options for examination transfer between institutions. The objective of this study was to evaluate the effect of cloud-based image transfer on mammography department workflow, time required to obtain prior images, and report turnaround times. Sixty screening examinations requiring prior images were placed into two groups (30 each). The control group used the standard institutional protocol for requesting prior images: faxing requests and waiting for mailed examinations. The experimental group used a cloud-based transfer for both requesting and receiving examinations. The mean number of days between examination request and examination receipt was measured for both groups and compared. The mean number of days from examination request to receipt was 6.08 days (SD 3.50) in the control group compared with 3.16 days (SD 3.95) in the experimental group. Using a cloud-based image transfer to obtain prior mammograms resulted in an average reduction of 2.92 days (P = .0361; 95% confidence interval 0.20-5.65) between examination request and receipt. This improvement in system efficiency is relevant for interpreting radiologists working to improve reporting times and for patients anxious to receive their mammography results. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Ozone impact minimization through coordinated scheduling of turnaround operations from multiple olefin plants in an ozone nonattainment area

NASA Astrophysics Data System (ADS)

Ge, Sijie; Wang, Sujing; Xu, Qiang; Ho, Thomas

2018-03-01

Turnaround operations (start-up and shutdown) are critical operations in olefin plants, which emit large quantities of VOCs, NOx and CO. The emission has great potentials to impact the ozone level in ozone nonattainment areas. This study demonstrates a novel practice to minimize the ozone impact through coordinated scheduling of turnaround operations from multiple olefin plants located in Houston, Texas, an ozone nonattainment area. The study considered two olefin plants scheduled to conduct turnaround operations: one start-up and one shutdown, simultaneously on the same day within a five-hour window. Through dynamic simulations of the turnaround operations using ASPEN Plus Dynamics and air quality simulations using CAMx, the study predicts the ozone impact from the combined effect of the two turnaround operations under different starting-time scenarios. The simulations predict that the ozone impact from planned turnaround operations ranges from a maximum of 11.4 ppb to a minimum of 1.4 ppb. Hence, a reduction of up to 10.0 ppb can be achieved on a single day based on the selected two simulation days. This study demonstrates a cost-effective and environmentally benign ozone control practice for relevant stakeholders, including environmental agencies, regional plant operators, and local communities.

Turnaround as Reform: Opportunity for Meaningful Change or Neoliberal Posturing?

ERIC Educational Resources Information Center

Mette, Ian M.

2013-01-01

This study explores the neoliberal agenda of turnaround school reform efforts in America by examining the application and transformation of a Midwest State Turnaround Schools Project for the public school system. Perceptions of administrators and state-level policy actors are considered. Data were collected from 13 participants during the…

Reengineering the laboratory: strategic process and systems innovation to improve performance. Recreating our role on the health-care team.

PubMed

Johnson, E

1995-01-01

The author describes reengineering efforts in the laboratory of a 550-bed hospital. Key benefits include reduced costs, improved turnaround time, and redirection of staff into new roles in information management and outreach.

School Turnaround Teachers: Selection Toolkit. Part of the School Turnaround Collection from Public Impact

ERIC Educational Resources Information Center

Public Impact, 2008

2008-01-01

This toolkit includes these separate sections: (1) Selection Preparation Guide; (2) Day-of-Interview Tools; (3) Candidate Rating Tools; and (4) Candidate Comparison and Decision Tools. Each of the sections is designed to be used at different stages of the selection process. The first section provides turnaround teacher competencies that are the…

The Henry Ford Production System: LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory

PubMed Central

Cankovic, Milena; Varney, Ruan C.; Whiteley, Lisa; Brown, Ron; D'Angelo, Rita; Chitale, Dhananjay; Zarbo, Richard J.

2009-01-01

Accurate and timely molecular test results play an important role in patient management; consequently, there is a customer expectation of short testing turnaround times. Baseline data analysis revealed that the greatest challenge to timely result generation occurred in the preanalytic phase of specimen collection and transport. Here, we describe our efforts to improve molecular testing turnaround times by focusing primarily on redesign of preanalytic processes using the principles of LEAN production. Our goal was to complete greater than 90% of the molecular tests in less than 3 days. The project required cooperation from different laboratory disciplines as well as individuals outside of the laboratory. The redesigned processes involved defining and standardizing the protocols and approaching blood and tissue specimens as analytes for molecular testing. The LEAN process resulted in fewer steps, approaching the ideal of a one-piece flow for specimens through collection/retrieval, transport, and different aspects of the testing process. The outcome of introducing the LEAN process has been a 44% reduction in molecular test turnaround time for tissue specimens, from an average of 2.7 to 1.5 days. In addition, extending LEAN work principles to the clinician suppliers has resulted in a markedly increased number of properly collected and shipped blood specimens (from 50 to 87%). These continuous quality improvements were accomplished by empowered workers in a blame-free environment and are now being sustained with minimal management involvement. PMID:19661386

Making Sense of School Turnarounds

ERIC Educational Resources Information Center

Hess, Frederick M.

2012-01-01

Today, in a sector flooded with $3.5 billion in School Improvement Grant funds and the resulting improvement plans, there's great faith that "turnaround" strategies are a promising way to tackle stubborn problems with persistently low-performing schools. Unlike traditional reform efforts, with their emphasis on incremental improvement, turnarounds…

Trends in Testing for Mycobacterium tuberculosis Complex From US Public Health Laboratories, 2009-2013.

PubMed

Tyrrell, Frances; Stafford, Cortney; Yakrus, Mitchell; Youngblood, Monica; Hill, Andrew; Johnston, Stephanie

We investigated data from US public health laboratories funded through the Centers for Disease Control and Prevention's Tuberculosis Elimination and Laboratory Cooperative Agreement to document trends and challenges in meeting national objectives in tuberculosis (TB) laboratory diagnoses. We examined data on workload and turnaround time from public health laboratories' progress reports during 2009-2013. We reviewed methodologies, laboratory roles, and progress toward rapid detection of Mycobacterium tuberculosis complex through nucleic acid amplification (NAA) testing. We compared selected data with TB surveillance reports to estimate public health laboratories' contribution to national diagnostic services. During the study period, culture and drug susceptibility tests decreased, but NAA testing increased. Public health laboratories achieved turnaround time benchmarks for drug susceptibility tests at lower levels than for acid-fast bacilli smear and identification from culture. NAA positivity in laboratories among surveillance-reported culture-positive TB cases increased from 26.6% (2355 of 8876) in 2009 to 40.0% (2948 of 7358) in 2013. Public health laboratories provided an estimated 50.9% (4285 of 8413 in 2010) to 57.2% (4210 of 7358 in 2013) of culture testing and 88.3% (6822 of 7727 in 2011) to 94.4% (6845 of 7250 in 2012) of drug susceptibility tests for all US TB cases. Public health laboratories contribute substantially to TB diagnoses in the United States. Although testing volumes mostly decreased, the increase in NAA testing indicates continued progress in rapid M tuberculosis complex detection.

Impact of SMS/GPRS Printers in Reducing Time to Early Infant Diagnosis Compared With Routine Result Reporting: A Systematic Review and Meta-Analysis

PubMed Central

Markby, Jessica; Boeke, Caroline; Penazzato, Martina; Urick, Brittany; Ghadrshenas, Anisa; Harris, Lindsay; Ford, Nathan; Peter, Trevor

2017-01-01

Background: Despite significant gains made toward improving access, early infant diagnosis (EID) testing programs suffer from long test turnaround times that result in substantial loss to follow-up and mortality associated with delays in antiretroviral therapy initiation. These delays in treatment initiation are particularly impactful because of significant HIV-related infant mortality observed by 2–3 months of age. Short message service (SMS) and general packet radio service (GPRS) printers allow test results to be transmitted immediately to health care facilities on completion of testing in the laboratory. Methods: We conducted a systematic review and meta-analysis to assess the benefit of using SMS/GPRS printers to increase the efficiency of EID test result delivery compared with traditional courier paper–based results delivery methods. Results: We identified 11 studies contributing data for over 16,000 patients from East and Southern Africa. The test turnaround time from specimen collection to result received at the health care facility with courier paper–based methods was 68.0 days (n = 6835), whereas the test turnaround time with SMS/GPRS printers was 51.1 days (n = 6711), resulting in a 2.5-week (25%) reduction in the turnaround time. Conclusions: Courier paper–based EID test result delivery methods are estimated to add 2.5 weeks to EID test turnaround times in low resource settings and increase the risk that infants receive test results during or after the early peak of infant mortality. SMS/GPRS result delivery to health care facility printers significantly reduced test turnaround time and may reduce this risk. SMS/GPRS printers should be considered for expedited delivery of EID and other centralized laboratory test results. PMID:28825941

Evolution of a residue laboratory network and the management tools for monitoring its performance.

PubMed

Lins, E S; Conceição, E S; Mauricio, A De Q

2012-01-01

Since 2005 the National Residue & Contaminants Control Plan (NRCCP) in Brazil has been considerably enhanced, increasing the number of samples, substances and species monitored, and also the analytical detection capability. The Brazilian laboratory network was forced to improve its quality standards in order to comply with the NRCP's own evolution. Many aspects such as the limits of quantification (LOQs), the quality management systems within the laboratories and appropriate method validation are in continuous improvement, generating new scenarios and demands. Thus, efficient management mechanisms for monitoring network performance and its adherence to the established goals and guidelines are required. Performance indicators associated to computerised information systems arise as a powerful tool to monitor the laboratories' activity, making use of different parameters to describe this activity on a day-to-day basis. One of these parameters is related to turnaround times, and this factor is highly affected by the way each laboratory organises its management system, as well as the regulatory requirements. In this paper a global view is presented of the turnaround times related to the type of analysis, laboratory, number of samples per year, type of matrix, country region and period of the year, all these data being collected from a computerised system called SISRES. This information gives a solid background to management measures aiming at the improvement of the service offered by the laboratory network.

Improving quality management systems of laboratories in developing countries: an innovative training approach to accelerate laboratory accreditation.

PubMed

Yao, Katy; McKinney, Barbara; Murphy, Anna; Rotz, Phil; Wafula, Winnie; Sendagire, Hakim; Okui, Scolastica; Nkengasong, John N

2010-09-01

The Strengthening Laboratory Management Toward Accreditation (SLMTA) program was developed to promote immediate, measurable improvement in laboratories of developing countries. The laboratory management framework, a tool that prescribes managerial job tasks, forms the basis of the hands-on, activity-based curriculum. SLMTA is implemented through multiple workshops with intervening site visits to support improvement projects. To evaluate the effectiveness of SLMTA, the laboratory accreditation checklist was developed and subsequently adopted by the World Health Organization Regional Office for Africa (WHO AFRO). The SLMTA program and the implementation model were validated through a pilot in Uganda. SLMTA yielded observable, measurable results in the laboratories and improved patient flow and turnaround time in a laboratory simulation. The laboratory staff members were empowered to improve their own laboratories by using existing resources, communicate with clinicians and hospital administrators, and advocate for system strengthening. The SLMTA program supports laboratories by improving management and building preparedness for accreditation.

School Turnaround Principals: What Does Initial Research Literature Suggest They Are Doing to Be Successful?

ERIC Educational Resources Information Center

Meyers, Coby V.; Hambrick Hitt, Dallas

2017-01-01

As the research literature on principals leading school turnaround grows, determining whether or not real differences between good, even effective, principals and turnaround principals becomes increasingly important. Recent federal government policy and investment established turnaround models that emphasize the role of the school principal,…

Shuttle's 160 hour ground turnaround - A design driver

NASA Technical Reports Server (NTRS)

Widick, F.

1977-01-01

Turnaround analysis added a new dimension to the Space Program with the advent of the Space Shuttle. The requirement to turn the flight hardware around in 160 working hours from landing to launch was a significant design driver and a useful tool in forcing the integration of flight and ground systems design to permit an efficient ground operation. Although there was concern that time constraints might increase program costs, the result of the analysis was to minimize facility requirements and simplify operations with resultant cost savings.

DB4US: A Decision Support System for Laboratory Information Management

PubMed Central

Hortas, Maria Luisa; Baena-García, Manuel; Lana-Linati, Jorge; González, Carlos; Redondo, Maximino; Morales-Bueno, Rafael

2012-01-01

Background Until recently, laboratory automation has focused primarily on improving hardware. Future advances are concentrated on intelligent software since laboratories performing clinical diagnostic testing require improved information systems to address their data processing needs. In this paper, we propose DB4US, an application that automates information related to laboratory quality indicators information. Currently, there is a lack of ready-to-use management quality measures. This application addresses this deficiency through the extraction, consolidation, statistical analysis, and visualization of data related to the use of demographics, reagents, and turn-around times. The design and implementation issues, as well as the technologies used for the implementation of this system, are discussed in this paper. Objective To develop a general methodology that integrates the computation of ready-to-use management quality measures and a dashboard to easily analyze the overall performance of a laboratory, as well as automatically detect anomalies or errors. The novelty of our approach lies in the application of integrated web-based dashboards as an information management system in hospital laboratories. Methods We propose a new methodology for laboratory information management based on the extraction, consolidation, statistical analysis, and visualization of data related to demographics, reagents, and turn-around times, offering a dashboard-like user web interface to the laboratory manager. The methodology comprises a unified data warehouse that stores and consolidates multidimensional data from different data sources. The methodology is illustrated through the implementation and validation of DB4US, a novel web application based on this methodology that constructs an interface to obtain ready-to-use indicators, and offers the possibility to drill down from high-level metrics to more detailed summaries. The offered indicators are calculated beforehand so that they

DB4US: A Decision Support System for Laboratory Information Management.

PubMed

Carmona-Cejudo, José M; Hortas, Maria Luisa; Baena-García, Manuel; Lana-Linati, Jorge; González, Carlos; Redondo, Maximino; Morales-Bueno, Rafael

2012-11-14

Until recently, laboratory automation has focused primarily on improving hardware. Future advances are concentrated on intelligent software since laboratories performing clinical diagnostic testing require improved information systems to address their data processing needs. In this paper, we propose DB4US, an application that automates information related to laboratory quality indicators information. Currently, there is a lack of ready-to-use management quality measures. This application addresses this deficiency through the extraction, consolidation, statistical analysis, and visualization of data related to the use of demographics, reagents, and turn-around times. The design and implementation issues, as well as the technologies used for the implementation of this system, are discussed in this paper. To develop a general methodology that integrates the computation of ready-to-use management quality measures and a dashboard to easily analyze the overall performance of a laboratory, as well as automatically detect anomalies or errors. The novelty of our approach lies in the application of integrated web-based dashboards as an information management system in hospital laboratories. We propose a new methodology for laboratory information management based on the extraction, consolidation, statistical analysis, and visualization of data related to demographics, reagents, and turn-around times, offering a dashboard-like user web interface to the laboratory manager. The methodology comprises a unified data warehouse that stores and consolidates multidimensional data from different data sources. The methodology is illustrated through the implementation and validation of DB4US, a novel web application based on this methodology that constructs an interface to obtain ready-to-use indicators, and offers the possibility to drill down from high-level metrics to more detailed summaries. The offered indicators are calculated beforehand so that they are ready to use when the user

Turnaround Schools as a U-Turn for Student Achievement: The Rotary of School Reform Efforts

ERIC Educational Resources Information Center

Mette, Ian M.

2012-01-01

This case study presents data to support the notion that turnaround school policy can improve the efficiency of how traditionally low-performing schools function. The schools that were successful in implementing the UVA Turnaround Program training developed a clear understanding of the expectations for participating in the UVA Turnaround Program…

Service quality framework for clinical laboratories.

PubMed

Ramessur, Vinaysing; Hurreeram, Dinesh Kumar; Maistry, Kaylasson

2015-01-01

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement. The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework. The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour. The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners. This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

Rebuilding Organizational Capacity in Turnaround Schools: Insights from the Corporate, Government, and Non-Profit Sectors

ERIC Educational Resources Information Center

Murphy, Joseph; Meyers, Coby V.

2009-01-01

In this article, we provide a grounded narrative of capacity building in the turnaround equation by exploring the turnaround literature outside of education and applying it to troubled schools. Our analysis is based upon reviews of: (1) 14 comprehensive, historical volumes that examine the turnaround phenomenon; (2) 16 book-length analyses of…

School Turnarounds: Resisting the Hype, Giving Them Hope. Education Outlook No. 2

ERIC Educational Resources Information Center

Hess, Frederick M.; Gift, Thomas

2009-01-01

Education reformers are abuzz over school "turnarounds," a simple idea that has undeniable appeal. School turnarounds offer the opportunity to take familiar educational institutions and improve them through coaching, mentoring, capacity building, best practices, and other existing tools. Unlike most reform efforts, which focus on incremental…

A model for consolidation of clinical microbiology laboratory services within a multihospital health-care system.

PubMed

Carter, Elliot; Stubbs, James R; Bennett, Betsy

2004-01-01

To determine the cost-effectiveness of consolidating clinical microbiology services in a three-hospital health-care network while maintaining high-quality laboratory services, a retrospective review of the total costs of maintaining separate clinical microbiology laboratories within our health-care system was compared to the cost of providing these services after consolidation. Turnaround times before and after consolidation were compared to assess efficiency of the consolidated services. Input of clinicians was also solicited to ensure that quality of services and customer satisfaction remained high. The results of the consolidation project show that the net fiscal saving because of consolidation of clinical microbiology services within our health-care system will be approximately 100,000 dollars per fiscal year. This value includes increased courier charges as well as personnel savings. Although fiscal savings are an integral part of any laboratory consolidation plan, the financial considerations must be balanced by quality of service. The response to consolidation from clinicians was decidedly mixed before implementation of the plan because of fear of increased turnaround times and limited access to laboratory information. The consolidation process, however, was smooth with few physician complaints. The consolidation of our clinical microbiology services illustrates that significant financial savings can be achieved without compromise of efficiency or quality of service.

Clinical Laboratory Automation: A Case Study.

PubMed

Archetti, Claudia; Montanelli, Alessandro; Finazzi, Dario; Caimi, Luigi; Garrafa, Emirena

2017-04-13

This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs.

Dancing in a Minefield: An Analysis of Turnaround Specialists in Arizona Schools

ERIC Educational Resources Information Center

McMillie, Kyann L.

2010-01-01

In 2008, educational leaders from the Arizona Department of Education (ADE) assigned a group of turnaround specialists to work in four failing public schools in a large, urban school district in Phoenix, Arizona in hopes of improving those schools. The utilization of turnaround specialists in failing schools was Arizona's method of enacting…

Pre-K as School Turnaround Strategy

ERIC Educational Resources Information Center

Buenafe, Anthony Q.

2011-01-01

Both state and local school systems, recognizing the strong and growing evidence of pre-kindergarten's effectiveness in closing achievement gaps, are implementing early learning programs as part of their education reform efforts. In low-performing districts, pre-k has emerged as a promising turnaround strategy, reaching children before they become…

Utilization of stat test priority in the clinical laboratory: a College of American Pathologists q-probes study of 52 institutions.

PubMed

Volmar, Keith E; Wilkinson, David S; Wagar, Elizabeth A; Lehman, Christopher M

2013-02-01

Utilization of stat testing priority is a balance between safe, efficient patient management and resource expenditure. To determine the rate of stat testing, compare rates among institutions, and determine the distribution of turnaround time expectations for different turnaround time priorities. During a 7-day period, participants prospectively determined the total number of chemistry, hematology, and coagulation billable tests from inpatients and emergency department patients. Among these, the total numbers of billable tests performed stat were identified. Laboratories also reported the levels of test priority they offered and turnaround expectations for each level of test priority. Fifty institutions submitted data for the study, with 2 additional participants submitting partial results. Participants identified 639 589 chemistry, hematology, and coagulation billable tests, with 229 896 (35.9%) performed stat. The stat rate varied from 21.3% at the 10th percentile to 55.4% at the 90th percentile, with a median of 37.0% of participants' tests performed stat. Laboratories include a mean of 206 tests in chemistry, hematology, and coagulation test menus, with 67% of these tests offered stat. The fraction of the test menu offered stat varied from 29.0% at the 10th percentile to 97.8% at the 90th percentile, with a median of 73.3% of tests on the menu offered stat. The most common number of testing priorities offered by participating laboratories was 3 (44.2%). Among the 52 participating laboratories, the median stat testing rate was 37.0% and a median 73.3% of the test menu was offered stat.

School Turnaround in North Carolina: A Regression Discontinuity Analysis. Working Paper 156

ERIC Educational Resources Information Center

Heissel, Jennifer A.; Ladd, Helen F.

2016-01-01

This paper examines the effect of school turnaround in North Carolina elementary and middle schools. Using a regression discontinuity design, we find that turnaround led to a drop in average school-level math and reading passing rates and an increased concentration of low-income students in treated schools. We use teacher survey data to examine…

Apollo/Saturn 5 space vehicle countdown. Volume 2: Turnaround from scrub

NASA Technical Reports Server (NTRS)

1972-01-01

The procedures required to prepare a space vehicle for subsequent launch attempt after cancelling lift-off activities are presented. The cancellation must occur after the start of cryogenic loading, but prior to initiation of ignition sequences. The sequence of operations necessary to return the space vehicle to a predetermined configuration at which time the launch count can be resumed or rescheduled for following launch opportunities is developed. The considerations and constraints that are the basis for the scrub/turnaround times are described.

Turnaround Arts Initiative: Final Evaluatiion Report

ERIC Educational Resources Information Center

Stoelinga, Sara Ray; Silk, Yael; Reddy, Prateek; Rahman, Nadiv

2015-01-01

The President's Committee on the Arts and the Humanities (PCAH) released the results of an independent study that shows substantial gains in student achievement at schools participating in its Turnaround Arts initiative. The eight schools' in the pilot phase of the initiative, showing increases in reading and math scores, as well as an increase in…

A Simulation Based Approach for Contingency Planning for Aircraft Turnaround Operation System Activities in Airline Hubs

NASA Technical Reports Server (NTRS)

Adeleye, Sanya; Chung, Christopher

2006-01-01

Commercial aircraft undergo a significant number of maintenance and logistical activities during the turnaround operation at the departure gate. By analyzing the sequencing of these activities, more effective turnaround contingency plans may be developed for logistical and maintenance disruptions. Turnaround contingency plans are particularly important as any kind of delay in a hub based system may cascade into further delays with subsequent connections. The contingency sequencing of the maintenance and logistical turnaround activities were analyzed using a combined network and computer simulation modeling approach. Experimental analysis of both current and alternative policies provides a framework to aid in more effective tactical decision making.

ATS simultaneous and turnaround ranging experiments

NASA Technical Reports Server (NTRS)

Watson, J. S.; Putney, B. H.

1971-01-01

This report explains the data reduction and spacecraft position determination used in conjunction with two ATS experiments - Trilateration and Turnaround Ranging - and describes in detail a multilateration program that is used for part of the data reduction process. The process described is for the determination of the inertial position of the satellite, and for formating input for related programs. In the trilateration procedure, a geometric determination of satellite position is made from near simultaneous range measurements made by three different tracking stations. Turnaround ranging involves two stations; one, the master station, transmits the signal to the satellite and the satellite retransmits the signal to the slave station which turns the signal around to the satellite which in turn retransmits the signal to the master station. The results of the satellite position computations using the multilateration program are compared to results of other position determination programs used at Goddard. All programs give nearly the same results which indicates that because of its simplicity and computational speed the trilateration technique is useful in obtaining spacecraft positions for near synchronous satellites.

Implementing a laboratory automation system: experience of a large clinical laboratory.

PubMed

Lam, Choong Weng; Jacob, Edward

2012-02-01

Laboratories today face increasing pressure to automate their operations as they are challenged by a continuing increase in workload, need to reduce expenditure, and difficulties in recruitment of experienced technical staff. Was the implementation of a laboratory automation system (LAS) in the Clinical Biochemistry Laboratory at Singapore General Hospital successful? There is no simple answer, so the following topics comparing and contrasting pre- and post-LAS have been explored: turnaround time (TAT), laboratory errors, and staff satisfaction. The benefits and limitations of LAS from the laboratory experience were also reviewed. The mean TAT for both stat and routine samples decreased post-LAS (30% and 13.4%, respectively). In the 90th percentile TAT chart, a 29% reduction was seen in the processing of stat samples on the LAS. However, no significant difference in the 90th percentile TAT was observed with routine samples. It was surprising to note that laboratory errors increased post-LAS. Considerable effort was needed to overcome the initial difficulties associated with adjusting to a new system, new software, and new working procedures. Although some of the known advantages and limitations of LAS have been validated, the claimed benefits such as improvements in TAT, laboratory errors, and staff morale were not evident in the initial months.

Textiles, Tariffs, and Turnarounds: Profits Improved.

ERIC Educational Resources Information Center

Aronoff, Craig

1986-01-01

The U.S. textile industry may serve as a classic study on regeneration through market forces. The industry has recently made a turnaround in profits after having been recognized as an industry that was losing most of its profits to overseas producers. The reasons for the emerging strength of the industry is that it began to innovate after a…

Physician satisfaction with clinical laboratory services: a College of American Pathologists Q-probes study of 138 institutions.

PubMed

Jones, Bruce A; Bekeris, Leonas G; Nakhleh, Raouf E; Walsh, Molly K; Valenstein, Paul N

2009-01-01

Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. To survey the level of physician satisfaction with hospital clinical laboratory services. Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

An Integrated Gate Turnaround Management Concept Leveraging Big Data/Analytics for NAS Performance Improvements

NASA Technical Reports Server (NTRS)

Chung, William; Chachad, Girish; Hochstetler, Ronald

2016-01-01

The Integrated Gate Turnaround Management (IGTM) concept was developed to improve the gate turnaround performance at the airport by leveraging relevant historical data to support optimization of airport gate operations, which include: taxi to the gate, gate services, push back, taxi to the runway, and takeoff, based on available resources, constraints, and uncertainties. By analyzing events of gate operations, primary performance dependent attributes of these events were identified for the historical data analysis such that performance models can be developed based on uncertainties to support descriptive, predictive, and prescriptive functions. A system architecture was developed to examine system requirements in support of such a concept. An IGTM prototype was developed to demonstrate the concept using a distributed network and collaborative decision tools for stakeholders to meet on time pushback performance under uncertainties.

4th generation HIV screening in Massachusetts: a partnership between laboratory and program.

PubMed

Goodhue, Tammy; Kazianis, Arthur; Werner, Barbara G; Stiles, Tracy; Callis, Barry P; Dawn Fukuda, H; Cranston, Kevin

2013-12-01

The Massachusetts Department of Public Health's (MDPH) Office of HIV/AIDS (OHA) and Hinton State Laboratory Institute (HSLI) have offered HIV screening since 1985. Point-of-care screening and serum collection for laboratory-based testing is conducted at clinic and non-clinic-based sites across Massachusetts as part of an integrated communicable disease screening intervention. MDPH aimed to transition to a 4th generation HIV screening-based algorithm for testing all serum specimens collected at OHA-funded programs and submitted to the HSLI to detect acute HIV infections, detect and differentiate HIV-1 and HIV-2 infections, eliminate indeterminate results, reduce cost and turnaround time, and link newly diagnosed HIV+ individuals to care. The HSLI and OHA created a joint project management team to plan and lead the transition. The laboratory transitioned successfully to a 4th generation screening assay as part of a revised diagnostic algorithm. In the 12 months since implementation, a total of 7984 serum specimens were tested with 258 (3.2%) positive for HIV-1 and one positive for HIV-2. Eight were reported as acute HIV-1 infections. These individuals were linked to medical care and partner services in a timely manner. Turnaround time was reduced and the laboratory realized an overall cost savings of approximately 15%. The identification of eight acute HIV infections in the first year underscores the importance of using the most sensitive screening tests available. A multi-disciplinary program and laboratory team was critical to the success of the transition, and the lessons learned may be useful for other jurisdictions. Published by Elsevier B.V.

Clinical Laboratories – Production Factories or Specialized Diagnostic Centers

PubMed Central

Tóth, Judit

2016-01-01

Since a large proportion of medical decisions are based on laboratory results, clinical laboratories should meet the increasing demand of clinicians and their patients. Huge central laboratories may process over 10 million tests annually; they act as production factories, measuring emergency and routine tests with sufficient speed and accuracy. At the same time, they also serve as specialized diagnostic centers where well-trained experts analyze and interpret special test results. It is essential to improve and constantly monitor this complex laboratory service, by several methods. Sample transport by pneumatic tube system, use of an advanced laboratory information system and point-of-care testing may result in decreased total turnaround time. The optimization of test ordering may result in a faster and more cost-effective laboratory service. Autovalidation can save time for laboratory specialists, when the analysis of more complex results requires their attention. Small teams of experts responsible for special diagnostic work, and their interpretative reporting according to predetermined principles, may help to minimize subjectivity of these special reports. Although laboratory investigations have become so diversely developed in the past decades, it is essential that the laboratory can provide accurate results relatively quickly, and that laboratory specialists can support the diagnosis and monitoring of patients by adequate interpretation of esoteric laboratory methods. PMID:27683528

School Turnaround Fever: The Paradoxes of a Historical Practice Promoted as a New Reform

ERIC Educational Resources Information Center

Peck, Craig; Reitzug, Ulrich C.

2014-01-01

School "turnaround" has received significant attention recently in education literature and policy action, especially as a means to dramatically improve urban education. In current common education usage, "turnaround" refers to the rapid, significant improvement in the academic achievement of persistently low-achieving schools.…

Extending laboratory automation to the wards: effect of an innovative pneumatic tube system on diagnostic samples and transport time.

PubMed

Suchsland, Juliane; Winter, Theresa; Greiser, Anne; Streichert, Thomas; Otto, Benjamin; Mayerle, Julia; Runge, Sören; Kallner, Anders; Nauck, Matthias; Petersmann, Astrid

2017-02-01

The innovative pneumatic tube system (iPTS) transports one sample at a time without the use of cartridges and allows rapid sending of samples directly into the bulk loader of a laboratory automation system (LAS). We investigated effects of the iPTS on samples and turn-around time (TAT). During transport, a mini data logger recorded the accelerations in three dimensions and reported them in arbitrary area under the curve (AUC) units. In addition representative quantities of clinical chemistry, hematology and coagulation were measured and compared in 20 blood sample pairs transported by iPTS and courier. Samples transported by iPTS were brought to the laboratory (300 m) within 30 s without adverse effects on the samples. The information retrieved from the data logger showed a median AUC of 7 and 310 arbitrary units for courier and iPTS transport, respectively. This is considerably below the reported limit for noticeable hemolysis of 500 arbitrary units. iPTS reduces TAT by reducing the hands-on time and a fast transport. No differences in the measurement results were found for any of the investigated 36 analytes between courier and iPTS transport. Based on these findings the iPTS was cleared for clinical use in our hospital.

Faculty Stakeholders' Perceptions of Leadership and Engagement in an Organizational Turnaround in Higher Education

ERIC Educational Resources Information Center

Brownell, Eileen Vlacancich

2016-01-01

This qualitative study represents an exploration into how faculty stakeholders in higher education experienced leadership actions and their own engagement with an organizational turnaround. Turnaround efforts were aimed at revitalization throughout the institution but little has been studied about faculty experience in this context. An interview…

Turnarounds to Transfer: Design beyond the Modes

ERIC Educational Resources Information Center

Eddy, Jennifer

2014-01-01

In "Turnarounds to Transfer," teachers design a collection of tasks toward the summative performance goal but go beyond the Communicative mode criteria: they must assess for transfer. Transfer design criteria must include a complexity or variation that make learners engage critical thinking skills and call upon a repertoire of knowledge…

Using Federal Education Formula Funds for School Turnaround Initiatives: Opportunities for State Education Agencies

ERIC Educational Resources Information Center

Junge, Melissa; Krvaric, Sheara

2016-01-01

Much has been written on the subject of school turnaround, but relatively little about how to "pay for" turnaround-related work. Turning around low-performing schools not only requires changing instructional and related practices, but changing spending patterns as well. Too often education dollars are spent on the same costs from…

Teacher Pay-for-Performance in School Turnaround: How Bonuses and Differentiated Pay Scales Can Help Support School Turnaround. Meeting the Turnaround Challenge: Strategies, Resources & Tools to Transform a Framework into Practice

ERIC Educational Resources Information Center

Mass Insight Education (NJ1), 2009

2009-01-01

Given the importance of good teaching and leadership for school success, turnaround schools should think carefully about how to structure professional environments that reward and motivate excellence. A system of "Pay-for-Contribution" that includes tools such as hard-to-staff and skill shortage pay, performance pay, and/or retention…

A Software Engineering Paradigm for Quick-turnaround Earth Science Data Projects

NASA Astrophysics Data System (ADS)

Moore, K.

2016-12-01

As is generally the case with applied sciences professional and educational programs, the participants of such programs can come from a variety of technical backgrounds. In the NASA DEVELOP National Program, the participants constitute an interdisciplinary set of backgrounds, with varying levels of experience with computer programming. DEVELOP makes use of geographically explicit data sets, and it is necessary to use geographic information systems and geospatial image processing environments. As data sets cover longer time spans and include more complex sets of parameters, automation is becoming an increasingly prevalent feature. Though platforms such as ArcGIS, ERDAS Imagine, and ENVI facilitate the batch-processing of geospatial imagery, these environments are naturally constricting to the user in that they limit him or her to the tools that are available. Users must then turn to "homemade" scripting in more traditional programming languages such as Python, JavaScript, or R, to automate workflows. However, in the context of quick-turnaround projects like those in DEVELOP, the programming learning curve may be prohibitively steep. In this work, we consider how to best design a software development paradigm that addresses two major constants: an arbitrarily experienced programmer and quick-turnaround project timelines.

District Readiness to Support School Turnaround: A Users' Guide to Inform the Work of State Education Agencies and Districts

ERIC Educational Resources Information Center

Player, Daniel; Hambrick Hitt, Dallas; Robinson, William

2014-01-01

This guide provides state education agencies (SEAs) and districts (LEAs) with guidance about how to assess the district's readiness to support school turnaround initiatives. Often, school turnaround efforts focus only on the school's structure and leadership. Rarely do policymakers or practitioners think about school turnaround as a system-level…

Total laboratory automation: Do stat tests still matter?

PubMed

Dolci, Alberto; Giavarina, Davide; Pasqualetti, Sara; Szőke, Dominika; Panteghini, Mauro

2017-07-01

During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Importing Leaders for School Turnarounds: Lessons and Opportunities

ERIC Educational Resources Information Center

Kowal, Julie; Hassel, Emily Ayscue

2011-01-01

One of the biggest challenges in education today is identifying talented candidates to successfully lead turnarounds of persistently low-achieving schools. Evidence suggests that the traditional principal pool is already stretched to capacity and cannot supply enough leaders to fix failing schools. But potentially thousands of leaders capable of…

Laboratory diagnosis of Chlamydia pneumoniae infections

PubMed Central

Peeling, Rosanna W

1995-01-01

Chlamydia pneumoniae is an important cause of respiratory illness. There is a need for accurate and rapid laboratory diagnostic methods that will lead to improved patient care, appropriate use of antimicrobial therapy and a better understanding of the epidemiology of this emerging pathogen. Culture is highly specific but is technically demanding, expensive, has a long turnaround time and its sensitivity is highly dependent on transport conditions. Antigen detection tests such as enzyme immunoassay and direct fluorescent antibody assay, and molecular detection methods such as the polymerase chain reaction assay, may provide a rapid diagnosis without the requirement for stringent transport conditions. The results of these tests should be interpreted with caution until more thorough evaluation is available. Serology remains the method of choice. The limitations of different serological methods for the laboratory diagnosis of C pneumoniae are discussed. PMID:22514397

Key Decisions of a First-Year "Turnaround" Principal

ERIC Educational Resources Information Center

Duke, Daniel; Salmonowicz, Michael

2010-01-01

This article examines the decisions made by one principal in her first year as a school turnaround specialist in a low-performing urban elementary school. Researchers focused on decisions related to the principal's three high-priority concerns: (1) elimination of an ineffective instructional program; (2) creation of a culture of teacher…

Turnaround: Leading Stressed Colleges and Universities to Excellence

ERIC Educational Resources Information Center

Martin, James; Samels, James E.

2008-01-01

Nearly one thousand colleges and universities in the United States face major challenges--from catastrophic hurricanes to loss of accreditation to sagging enrollment. What can leaders of such at-risk institutions do to improve their situation? "Turnaround" gives college and university leaders the tools they need to put their fragile institutions…

Assessing Very Early Infant Diagnosis Turnaround Times: Findings from a Birth Testing Pilot in Lesotho

PubMed Central

Hoffman, Heather J.; Mokone, Majoalane; Tukei, Vincent J.; Nchephe, Matsepeli; Phalatse, Mamakhetha; Tiam, Appolinaire; Guay, Laura; Mofenson, Lynne

2017-01-01

Very early infant diagnosis (VEID) (testing within two weeks of life), combined with rapid treatment initiation, could reduce early infant mortality. Our study evaluated turnaround time (TAT) to receipt of infants' HIV test results and ART initiation if HIV-infected, with and without birth testing availability. Data from facility records and national databases were collected for 12 facilities offering VEID, as part of an observational prospective cohort study, and 10 noncohort facilities. HIV-exposed infants born in January–June 2016 and any cohort infant diagnosed as HIV-infected at birth or six weeks were included. The median TAT from blood draw to caregiver result receipt was 76.5 days at birth and 63 and 70 days at six weeks at cohort and noncohort facilities, respectively. HIV-exposed infants tested at birth were approximately one month younger when their caregivers received results versus those tested at six weeks. Infants diagnosed at birth initiated ART about two months earlier (median 6.4 weeks old) than those identified at six weeks (median 14.8 weeks). However, the long TAT for testing at both birth and six weeks illustrates the prolonged process for specimen transport and result return that could compromise the effectiveness of adding VEID to existing overburdened EID systems. PMID:29410914

Customized laboratory information management system for a clinical and research leukemia cytogenetics laboratory.

PubMed

Bakshi, Sonal R; Shukla, Shilin N; Shah, Pankaj M

2009-01-01

We developed a Microsoft Access-based laboratory management system to facilitate database management of leukemia patients referred for cytogenetic tests in regards to karyotyping and fluorescence in situ hybridization (FISH). The database is custom-made for entry of patient data, clinical details, sample details, cytogenetics test results, and data mining for various ongoing research areas. A number of clinical research laboratoryrelated tasks are carried out faster using specific "queries." The tasks include tracking clinical progression of a particular patient for multiple visits, treatment response, morphological and cytogenetics response, survival time, automatic grouping of patient inclusion criteria in a research project, tracking various processing steps of samples, turn-around time, and revenue generated. Since 2005 we have collected of over 5,000 samples. The database is easily updated and is being adapted for various data maintenance and mining needs.

Diagnostic accuracy and turnaround time of the Xpert MTB/RIF assay in routine clinical practice.

PubMed

Kwak, Nakwon; Choi, Sun Mi; Lee, Jinwoo; Park, Young Sik; Lee, Chang-Hoon; Lee, Sang-Min; Yoo, Chul-Gyu; Kim, Young Whan; Han, Sung Koo; Yim, Jae-Joon

2013-01-01

The Xpert MTB/RIF assay was introduced for timely and accurate detection of tuberculosis (TB). The aim of this study was to determine the diagnostic accuracy and turnaround time (TAT) of Xpert MTB/RIF assay in clinical practice in South Korea. We retrospectively reviewed the medical records of patients in whom Xpert MTB/RIF assay using sputum were requested. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of pulmonary tuberculosis (PTB) and detection of rifampicin resistance were calculated. In addition, TAT of Xpert MTB/RIF assay was compared with those of other tests. Total 681 patients in whom Xpert MTB/RIF assay was requested were included in the analysis. The sensitivity, specificity, PPV and NPV of Xpert MTB/RIF assay for diagnosis of PTB were 79.5% (124/156), 100.0% (505/505), 100.0% (124/124) and 94.0% (505/537), respectively. Those for the detection of rifampicin resistance were 57.1% (8/14), 100.0% (113/113), 100.0% (8/8) and 94.9% (113/119), respectively. The median TAT of Xpert MTB/RIF assay to the report of results and results confirmed by physicians in outpatient settings were 0 (0-1) and 6 (3-7) days, respectively. Median time to treatment after initial evaluation was 7 (4-9) days in patients with Xpert MTB/RIF assay, but was 21 (7-33.5) days in patients without Xpert MTB/RIF assay. Xpert MTB/RIF assay showed acceptable sensitivity and excellent specificity for the diagnosis of PTB and detection of rifampicin resistance in areas with intermediate TB burden. Additionally, the assay decreased time to the initiation of anti-TB drugs through shorter TAT.

Diagnostic Accuracy and Turnaround Time of the Xpert MTB/RIF Assay in Routine Clinical Practice

PubMed Central

Kwak, Nakwon; Choi, Sun Mi; Lee, Jinwoo; Park, Young Sik; Lee, Chang-Hoon; Lee, Sang-Min; Yoo, Chul-Gyu; Kim, Young Whan; Han, Sung Koo; Yim, Jae-Joon

2013-01-01

The Xpert MTB/RIF assay was introduced for timely and accurate detection of tuberculosis (TB). The aim of this study was to determine the diagnostic accuracy and turnaround time (TAT) of Xpert MTB/RIF assay in clinical practice in South Korea. We retrospectively reviewed the medical records of patients in whom Xpert MTB/RIF assay using sputum were requested. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of pulmonary tuberculosis (PTB) and detection of rifampicin resistance were calculated. In addition, TAT of Xpert MTB/RIF assay was compared with those of other tests. Total 681 patients in whom Xpert MTB/RIF assay was requested were included in the analysis. The sensitivity, specificity, PPV and NPV of Xpert MTB/RIF assay for diagnosis of PTB were 79.5% (124/156), 100.0% (505/505), 100.0% (124/124) and 94.0% (505/537), respectively. Those for the detection of rifampicin resistance were 57.1% (8/14), 100.0% (113/113), 100.0% (8/8) and 94.9% (113/119), respectively. The median TAT of Xpert MTB/RIF assay to the report of results and results confirmed by physicians in outpatient settings were 0 (0–1) and 6 (3–7) days, respectively. Median time to treatment after initial evaluation was 7 (4–9) days in patients with Xpert MTB/RIF assay, but was 21 (7–33.5) days in patients without Xpert MTB/RIF assay. Xpert MTB/RIF assay showed acceptable sensitivity and excellent specificity for the diagnosis of PTB and detection of rifampicin resistance in areas with intermediate TB burden. Additionally, the assay decreased time to the initiation of anti-TB drugs through shorter TAT. PMID:24204834

From customer satisfaction survey to corrective actions in laboratory services in a university hospital.

PubMed

Oja, Paula I; Kouri, Timo T; Pakarinen, Arto J

2006-12-01

To find out the satisfaction of clinical units with laboratory services in a university hospital, to point out the most important problems and defects in services, to carry out corrective actions, and thereafter to identify the possible changes in satisfaction. and Senior physicians and nurses-in-charge of the clinical units at Oulu University Hospital, Finland. Customer satisfaction survey using a questionnaire was carried out in 2001, indicating the essential aspects of laboratory services. Customer-specific problems were clarified, corrective actions were performed, and the survey was repeated in 2004. In 2001, the highest dissatisfaction rates were recorded for computerized test requesting and reporting, turnaround times of tests, and the schedule of phlebotomy rounds. The old laboratory information system was not amenable to major improvements, and it was renewed in 2004-05. Several clinical units perceived turnaround times to be long, because the tests were ordered as routine despite emergency needs. Instructions about stat requesting were given to these units. However, no changes were evident in the satisfaction level in the 2004 survey. Following negotiations with the clinics, phlebotomy rounds were re-scheduled. This resulted in a distinct increase in satisfaction in 2004. Satisfaction survey is a screening tool that identifies topics of dissatisfaction. Without further clarifications, it is not possible to find out the specific problems of customers and to undertake targeted corrective actions. Customer-specific corrections are rarely seen as improvements in overall satisfaction rates.

On the Edge: A Study of Small Private Colleges That Have Made a Successful Financial Turnaround

ERIC Educational Resources Information Center

Carey, Amy Bragg

2013-01-01

This dissertation was a qualitative research study regarding two small private universities and their process of transformation from an institution headed toward closure to a successful turnaround. The primary questions that guided the study included the factors and persons that contributed to the institutional turnaround, the issues and…

A new multiplex real-time PCR test for HSV1/2 and syphilis: an evaluation of its impact in the laboratory and clinical setting.

PubMed

Scott, Laura Jane; Gunson, Rory N; Carman, William F; Winter, Andrew J

2010-12-01

To develop, evaluate and implement a new multiplex real-time PCR test for the detection of herpes simplex virus (HSV)1, HSV2 and syphilis in a single sample using a single test. A multiplex real-time PCR test detecting HSV1, HSV2 and Treponema pallidum was designed, validated and evaluated for a period of 6 months on patients attending the Sandyford Initiative (a series of genitourinary medicine clinics in and around Glasgow). A total of 692 samples were tested, and T pallidum PCR positives were confirmed by a second PCR at the Scottish Reference Laboratory (SBSTIRL). All PCR results were aligned with dark ground microscopy findings and serological results where available and compared. The laboratory validation of the multiplex assay showed the test to be sensitive, specific and robust. Of the 692 samples, 139 were positive for HSV1, 136 for HSV2, 15 for syphilis, one for both syphilis and HSV1, and 401 were negative; the reference laboratory confirmed all T pallidum PCR-positive samples. The PCR test was more sensitive than both dark ground microscopy and serological testing for the diagnosis of primary syphilis. The introduction of this new test has led to a better turnaround time for the diagnosis of genital ulcer disease, better detection of primary syphilis infection, and the detection of unexpected cases of syphilis where the aetiological agent suspected was HSV.

On the Edge: A Study of Small Private Colleges That Have Made a Successful Financial Turnaround

ERIC Educational Resources Information Center

Carey, Amy Bragg

2014-01-01

This article describes a qualitative study that involved two small private universities, examining their process of transformation from institutions headed toward closure to institutions that underwent a successful turnaround. The primary questions that guided the study included the issues and circumstances that led to the need for a turnaround,…

Mixing Metaphors: Building Infrastructure for Large Scale School Turnaround

ERIC Educational Resources Information Center

Peurach, Donald J.; Neumerski, Christine M.

2015-01-01

The purpose of this analysis is to increase understanding of the possibilities and challenges of building educational infrastructure--the basic, foundational structures, systems, and resources--to support large-scale school turnaround. Building educational infrastructure often exceeds the capacity of schools, districts, and state education…

The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times

PubMed Central

Georgiou, A.; Lymer, S.; Hordern, A.; Ridley, L.; Westbrook, J.

2015-01-01

Summary Objectives To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes; and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED). Methods We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff; and (ii) retrospectively extracted ED data before (March/April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report). Results Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS; from a median of 76 hours to 38 hours per order (p<.0001) for patients discharged from the ED, and from 84 hours to 35 hours (p<.0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers). Conclusions The introduction of new health IT can be a “double-edged sword” providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department. PMID:26448790

The Turnaround Mindset: Aligning Leadership for Student Success

ERIC Educational Resources Information Center

Fairchild, Tierney Temple; DeMary, Jo Lynne

2011-01-01

This book provides a valuable balance between what one must know and what one must do to turn around low-performing schools. The 3-E framework simplifies this complex process by focusing resources on the environment, the executive, and the execution of the turnaround plan. Central to each of these components is a spotlight on the values supporting…

Operational Efficiency and Productivity Improvement Initiatives in a Large Cardiac Catheterization Laboratory.

PubMed

Reed, Grant W; Hantz, Scott; Cunningham, Rebecca; Krishnaswamy, Amar; Ellis, Stephen G; Khot, Umesh; Rak, Joe; Kapadia, Samir R

2018-02-26

This study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab. Operational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity. In this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative. The principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p < 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p < 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction. A systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

78 FR 48464 - Comment request for Information Collection for Quick Turnaround Surveys of All Statutes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... employment and training or related activities. Each survey will be designed on an ad hoc basis and will focus... basis. ETA will make every effort to coordinate the quick turnaround surveys with other research it is... Collection for Quick Turnaround Surveys of All Statutes and Programs for Which the Employment and Training...

Sustaining Turnaround at the School and District Levels: The High Reliability Schools Project at Sandfields Secondary School

ERIC Educational Resources Information Center

Schaffer, Eugene; Reynolds, David; Stringfield, Sam

2012-01-01

Beginning from 1 high-poverty, historically low-achieving secondary school's successful turnaround work, this article provides data relative to a successful school turnaround, the importance of external and system-level supports, and the importance of building for sustainable institutionalization of improvements. The evidence suggests the…

The "hospital central laboratory": automation, integration and clinical usefulness.

PubMed

Zaninotto, Martina; Plebani, Mario

2010-07-01

Recent technological developments in laboratory medicine have led to a major challenge, maintaining a close connection between the search of efficiency through automation and consolidation and the assurance of effectiveness. The adoption of systems that automate most of the manual tasks characterizing routine activities has significantly improved the quality of laboratory performance; total laboratory automation being the paradigm of the idea that "human-less" robotic laboratories may allow for better operation and insuring less human errors. Furthermore, even if ongoing technological developments have considerably improved the productivity of clinical laboratories as well as reducing the turnaround time of the entire process, the value of qualified personnel remains a significant issue. Recent evidence confirms that automation allows clinical laboratories to improve analytical performances only if trained staff operate in accordance with well-defined standard operative procedures, thus assuring continuous monitoring of the analytical quality. In addition, laboratory automation may improve the appropriateness of test requests through the use of algorithms and reflex testing. This should allow the adoption of clinical and biochemical guidelines. In conclusion, in laboratory medicine, technology represents a tool for improving clinical effectiveness and patient outcomes, but it has to be managed by qualified laboratory professionals.

Academic Turnarounds: Restoring Vitality to Challenged American Colleges and Universities. ACE/Praeger Series on Higher Education

ERIC Educational Resources Information Center

MacTaggart, Terrence, Ed.

2007-01-01

This book discusses the early indicators of a college or university's need for a turnaround. It outlines financial trends and other indicators of distress, as well as benchmarks for the various stages of an effective turnaround strategy. The book will help trustees, presidents, and faculty members diagnose whether they are in denial about the true…

Communication gaps in nursing home transfers to the ED: impact on turnaround time, disposition, and diagnostic testing.

PubMed

Nelson, Drew; Washton, Danae; Jeanmonod, Rebecca

2013-04-01

This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing. A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered. One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0). Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing. Copyright © 2013 Elsevier Inc. All rights reserved.

Collection, transport and general processing of clinical specimens in Microbiology laboratory.

PubMed

Sánchez-Romero, M Isabel; García-Lechuz Moya, Juan Manuel; González López, Juan José; Orta Mira, Nieves

2018-02-06

The interpretation and the accuracy of the microbiological results still depend to a great extent on the quality of the samples and their processing within the Microbiology laboratory. The type of specimen, the appropriate time to obtain the sample, the way of sampling, the storage and transport are critical points in the diagnostic process. The availability of new laboratory techniques for unusual pathogens, makes necessary the review and update of all the steps involved in the processing of the samples. Nowadays, the laboratory automation and the availability of rapid techniques allow the precision and turn-around time necessary to help the clinicians in the decision making. In order to be efficient, it is very important to obtain clinical information to use the best diagnostic tools. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

34. BOILER HOUSE, COAL CONVEYOR AND TURNAROUND TRACK FOR COAL ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

34. BOILER HOUSE, COAL CONVEYOR AND TURN-AROUND TRACK FOR COAL CARS (NOTE: COAL CAR No. 6 IN FAR BACK GROUND) - Delaware County Electric Company, Chester Station, Delaware River at South end of Ward Street, Chester, Delaware County, PA

External quality assessment of medical laboratories in Croatia: preliminary evaluation of post-analytical laboratory testing.

PubMed

Krleza, Jasna Lenicek; Dorotic, Adrijana; Grzunov, Ana

2017-02-15

Proper standardization of laboratory testing requires assessment of performance after the tests are performed, known as the post-analytical phase. A nationwide external quality assessment (EQA) scheme implemented in Croatia in 2014 includes a questionnaire on post-analytical practices, and the present study examined laboratory responses in order to identify current post-analytical phase practices and identify areas for improvement. In four EQA exercises between September 2014 and December 2015, 145-174 medical laboratories across Croatia were surveyed using the Module 11 questionnaire on the post-analytical phase of testing. Based on their responses, the laboratories were evaluated on four quality indicators: turnaround time (TAT), critical values, interpretative comments and procedures in the event of abnormal results. Results were presented as absolute numbers and percentages. Just over half of laboratories (56.3%) monitored TAT. Laboratories varied substantially in how they dealt with critical values. Most laboratories (65-97%) issued interpretative comments with test results. One third of medical laboratories (30.6-33.3%) issued abnormal test results without confirming them in additional testing. Our results suggest that the nationwide post-analytical EQA scheme launched in 2014 in Croatia has yet to be implemented to the full. To close the gaps between existing recommendations and laboratory practice, laboratory professionals should focus on ensuring that TAT is monitored and lists of critical values are established within laboratories. Professional bodies/institutions should focus on clarify and harmonized rules to standardized practices and applied for adding interpretative comments to laboratory test results and for dealing with abnormal test results.

Democratic School Turnarounds: Pursuing Equity and Learning from Evidence

ERIC Educational Resources Information Center

Trujillo, Tina; Renée, Michelle

2013-01-01

the report "Democratic School Turnarounds" considers the democratic tensions inherent in the federal School Improvement Grant (SIG) policy's market-based school reforms and critiques the research base that many of these reforms are based on. It concludes with a set of recommendations that re-center the purposes of public education…

Computerized provider order entry in the clinical laboratory

PubMed Central

Baron, Jason M.; Dighe, Anand S.

2011-01-01

Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE) systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption. PMID:21886891

Regional and supraregional biochemistry services in Scotland: a survey of hospital laboratory users.

PubMed Central

Murphy, M J; Dryburgh, F J; Shepherd, J

1994-01-01

AIM--To ascertain the views of Scottish hospital laboratory users on aspects of regional and supraregional biochemical services offered by the Institute of Biochemistry at Glasgow Royal Infirmary. METHODS--A questionnaire was circulated asking questions or inviting opinions under various headings, including current patterns of usage of the services provided, availability of information on specimen collection requirements and reference ranges, current arrangements for transport of specimens, turnaround times for delivery of reports, layout and content of request and report forms, quantity and quality of interpretive advice, potential changes in laboratory services, and overall impression of the services provided. Opportunities were provided for free text comment. The questionnaire was circulated in 1992 to heads of department in 23 Scottish hospital biochemistry laboratories. RESULTS--Twenty one replies were received. Services used widely included trace metals/vitamins (n = 20) and specialised endocrine tests (n = 19). Other services also used included specialised lipid tests (n = 13), toxicology (n = 12), thyroid function tests (n = nine), and tumour markers (n = eight). Fifteen laboratories used one or more of the services at least weekly. Most (n = 20) welcomed the idea of a handbook providing information on specimen collection and reference ranges. Nine identified loss of specimens as a problem. Other perceived problems included the absence of reference ranges from report forms, quantity and quality of interpretive advice, and turnaround times of some tests. Overall impressions of the service(s) offered were very good (n = 12); adequate (n = seven); poor (n = one). CONCLUSIONS--Useful information was obtained about patterns of use and transport arrangements. Areas identified as requiring follow up included provision of information, alternative ways of communicating reports, and improvement in quantity and quality of interpretive advice. PMID:8027390

The effects of total laboratory automation on the management of a clinical chemistry laboratory. Retrospective analysis of 36 years.

PubMed

Sarkozi, Laszlo; Simson, Elkin; Ramanathan, Lakshmi

2003-03-01

Thirty-six years of data and history of laboratory practice at our institution has enabled us to follow the effects of analytical automation, then recently pre-analytical and post-analytical automation on productivity, cost reduction and enhanced quality of service. In 1998, we began the operation of a pre- and post-analytical automation system (robotics), together with an advanced laboratory information system to process specimens prior to analysis, deliver them to various automated analytical instruments, specimen outlet racks and finally to refrigerated stockyards. By the end of 3 years of continuous operation, we compared the chemistry part of the system with the prior 33 years and quantitated the financial impact of the various stages of automation. Between 1965 and 2000, the Consumer Price Index increased by a factor of 5.5 in the United States. During the same 36 years, at our institution's Chemistry Department the productivity (indicated as the number of reported test results/employee/year) increased from 10,600 to 104,558 (9.3-fold). When expressed in constant 1965 dollars, the total cost per test decreased from 0.79 dollars to 0.15 dollars. Turnaround time for availability of results on patient units decreased to the extent that Stat specimens requiring a turnaround time of <1 h do not need to be separately prepared or prioritized on the system. Our experience shows that the introduction of a robotics system for perianalytical automation has brought a large improvement in productivity together with decreased operational cost. It enabled us to significantly increase our workload together with a reduction of personnel. In addition, stats are handled easily and there are benefits such as safer working conditions and improved sample identification, which are difficult to quantify at this stage.

Developing a gate-array capability at a research and development laboratory

NASA Astrophysics Data System (ADS)

Balch, J. W.; Current, K. W.; Magnuson, W. G., Jr.; Pocha, M. D.

1983-03-01

Experiences in developing a gate array capability for low volume applications in a research and development (R and D) laboratory are described. By purchasing unfinished wafers and doing the customization steps in-house. Turnaround time was shortened to as little as one week and the direct costs reduced to as low as $5K per design. Designs generally require fast turnaround (a few weeks to a few months) and very low volumes (1 to 25). Design costs must be kept at a minimum. After reviewing available commercial gate array design and fabrication services, it was determined that objectives would best be met by using existing internal integrated circuit fabrication facilities, the COMPUTERVISION interactive graphics layout system, and extensive computational capabilities. The reasons and the approach taken for; selection for a particular gate array wafer, adapting a particular logic simulation program, and how layout aids were enhanced are discussed. Testing of the customized chips is described. The content, schedule, and results of the internal gate array course recently completed are discussed. Finally, problem areas and near term plans are presented.

Transforming Turnaround Schools in China: Strategies, Achievements, and Challenges

ERIC Educational Resources Information Center

Liu, Peng

2016-01-01

The existence of turnaround schools has been a problem in the Chinese education system. There are diverse causes including the education system itself, the financial system, and other issues. However, there has been a lack of research to help us fully understand this phenomenon. This article provides a holistic perspective on the strategies the…

Emergency radiobioassay preparedness exercises through the NIST radiochemistry intercomparison program.

PubMed

Nour, Svetlana; LaRosa, Jerry; Inn, Kenneth G W

2011-08-01

The present challenge for the international emergency radiobioassay community is to analyze contaminated samples rapidly while maintaining high quality results. The National Institute of Standards and Technology (NIST) runs a radiobioassay measurement traceability testing program to evaluate the radioanalytical capabilities of participating laboratories. The NIST Radiochemistry Intercomparison Program (NRIP) started more than 10 years ago, and emergency performance testing was added to the program seven years ago. Radiobioassay turnaround times under the NRIP program for routine production and under emergency response scenarios are 60 d and 8 h, respectively. Because measurement accuracy and sample turnaround time are very critical in a radiological emergency, response laboratories' analytical systems are best evaluated and improved through traceable Performance Testing (PT) programs. The NRIP provides participant laboratories with metrology tools to evaluate their performance and to improve it. The program motivates the laboratories to optimize their methodologies and minimize the turnaround time of their results. Likewise, NIST has to make adjustments and periodical changes in the bioassay test samples in order to challenge the participating laboratories continually. With practice, radioanalytical measurements turnaround time can be reduced to 3-4 h.

Laboratory Diagnosis of Infections in Cancer Patients: Challenges and Opportunities

PubMed Central

2016-01-01

Infections remain a significant cause of morbidity and mortality in cancer patients. The differential diagnosis for these patients is often wide, and the timely selection of the right clinical tests can have a significant impact on their survival. However, laboratory findings with current methodologies are often negative, challenging clinicians and laboratorians to continue the search for the responsible pathogen. Novel methodologies are providing increased sensitivity and rapid turnaround time to results but also challenging our interpretation of what is a clinically significant pathogen in cancer patients. This minireview provides an overview of the most common infections in cancer patients and discusses some of the challenges and opportunities for the clinical microbiologist supporting the care of cancer patients. PMID:27280421

Rapid-cycle testing cuts bed turnaround by 85%.

PubMed

2004-11-01

You can use rapid-cycle testing to try out new approaches to overcrowding much more frequently than with more traditional process improvement strategies. Improving bed turnaround notification can yield dramatic improvements. Telling staff they have to try a new process only for three days makes it easier to gain buy-in. Look for old policies that are no longer needed, yet continue to keep your staff bogged down.

SLIPTA e-Tool improves laboratory audit process in Vietnam and Cambodia.

PubMed

Nguyen, Thuong T; McKinney, Barbara; Pierson, Antoine; Luong, Khue N; Hoang, Quynh T; Meharwal, Sandeep; Carvalho, Humberto M; Nguyen, Cuong Q; Nguyen, Kim T; Bond, Kyle B

2014-01-01

The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors' feedback about usability. The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries.

SLIPTA e-Tool improves laboratory audit process in Vietnam and Cambodia

PubMed Central

Nguyen, Thuong T.; McKinney, Barbara; Pierson, Antoine; Luong, Khue N.; Hoang, Quynh T.; Meharwal, Sandeep; Carvalho, Humberto M.; Nguyen, Cuong Q.; Nguyen, Kim T.

2014-01-01

Background The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist is used worldwide to drive quality improvement in laboratories in developing countries and to assess the effectiveness of interventions such as the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. However, the paper-based format of the checklist makes administration cumbersome and limits timely analysis and communication of results. Development of e-Tool In early 2012, the SLMTA team in Vietnam developed an electronic SLIPTA checklist tool. The e-Tool was pilot tested in Vietnam in mid-2012 and revised. It was used during SLMTA implementation in Vietnam and Cambodia in 2012 and 2013 and further revised based on auditors’ feedback about usability. Outcomes The SLIPTA e-Tool enabled rapid turn-around of audit results, reduced workload and language barriers and facilitated analysis of national results. Benefits of the e-Tool will be magnified with in-country scale-up of laboratory quality improvement efforts and potential expansion to other countries. PMID:29043190

Development of Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education.

PubMed

Albrecht, Liane; Maurer, Martin H; Seithe, Tim; Braun, Joachim; Gummert, Richard; Auer, Jonas; Sponheuer, Keno; Meyl, Tobias Philipp; Hamm, Bernd; de Bucourt, Maximilian

2018-03-01

 The implementation of a reformed curriculum for undergraduate medical education with a problem-oriented focus and more bedside teaching in small groups increases the academic teaching workload. The aim of this study was to investigate whether this increase in teaching duties is associated with an increase in report turnaround times of radiologists or increased unplanned absence during term times compared with term breaks (lecture-free periods) and over the whole period under investigation.  The database of all radiological examinations performed at a large German university hospital was retrospectively analyzed for a two-year period from the winter term 2011/12 to the summer term 2013. A total of 192 984 radiological examinations performed during this period were included in an analysis of reporting times (i. e., time from end of examination to completion of report) during term times versus term breaks. Reporting times were analyzed for all radiological examinations and for intensive care unit (ICU) patients. In addition, radiologists' schedules were analyzed in terms of teaching duties, unplanned absence, vacation days, and days away from work for education and training.  During the period under investigation, the teaching load increased from overall 1.75 hours/day in the winter term 2011/12 to 6.49 hours/day in the summer term 2013 and in the term break from overall 0.10 hours/day in the winter term 2011/12 to 0.71 hours/day in the summer term 2013. Reporting time increased during this period (p < 0.05) but remained shorter during term times than during term breaks. The difference between term and term break for ICU patients was not significant. There was no increase in unplanned absences during term times.  Overall, radiologists' reporting times increased during the period when the reformed curriculum for undergraduate medical education was implemented. As this was observed both during term and during term breaks, increased teaching duties alone

Benchmarking and the laboratory

PubMed Central

Galloway, M; Nadin, L

2001-01-01

This article describes how benchmarking can be used to assess laboratory performance. Two benchmarking schemes are reviewed, the Clinical Benchmarking Company's Pathology Report and the College of American Pathologists' Q-Probes scheme. The Clinical Benchmarking Company's Pathology Report is undertaken by staff based in the clinical management unit, Keele University with appropriate input from the professional organisations within pathology. Five annual reports have now been completed. Each report is a detailed analysis of 10 areas of laboratory performance. In this review, particular attention is focused on the areas of quality, productivity, variation in clinical practice, skill mix, and working hours. The Q-Probes scheme is part of the College of American Pathologists programme in studies of quality assurance. The Q-Probes scheme and its applicability to pathology in the UK is illustrated by reviewing two recent Q-Probe studies: routine outpatient test turnaround time and outpatient test order accuracy. The Q-Probes scheme is somewhat limited by the small number of UK laboratories that have participated. In conclusion, as a result of the government's policy in the UK, benchmarking is here to stay. Benchmarking schemes described in this article are one way in which pathologists can demonstrate that they are providing a cost effective and high quality service. Key Words: benchmarking • pathology PMID:11477112

A review of aircraft turnaround operations and simulations

NASA Astrophysics Data System (ADS)

Schmidt, Michael

2017-07-01

The ground operational processes are the connecting element between aircraft en-route operations and airport infrastructure. An efficient aircraft turnaround is an essential component of airline success, especially for regional and short-haul operations. It is imperative that advancements in ground operations, specifically process reliability and passenger comfort, are developed while dealing with increasing passenger traffic in the next years. This paper provides an introduction to aircraft ground operations focusing on the aircraft turnaround and passenger processes. Furthermore, key challenges for current aircraft operators, such as airport capacity constraints, schedule disruptions and the increasing cost pressure, are highlighted. A review of the conducted studies and conceptual work in this field shows pathways for potential process improvements. Promising approaches attempt to reduce apron traffic and parallelize passenger processes and taxiing. The application of boarding strategies and novel cabin layouts focusing on aisle, door and seat, are options to shorten the boarding process inside the cabin. A summary of existing modeling and simulation frameworks give an insight into state-of-the-art assessment capabilities as it concerns advanced concepts. They are the prerequisite to allow a holistic assessment during the early stages of the preliminary aircraft design process and to identify benefits and drawbacks for all involved stakeholders.

Policy Perspective: School Turnaround in England. Utilizing the Private Sector

ERIC Educational Resources Information Center

Corbett, Julie

2014-01-01

This paper, written by strategic partner of the Center on School Turnaround (CST), Julie Corbett, provides research and examples on England's approach to turning around its lowest performing schools. The English education system utilizes private vendors to support chronically low-performing schools and districts. The introduction is followed by…

CAD/CAM, Creativity, and Discipline Lead to Turnaround School Success

ERIC Educational Resources Information Center

Gorman, Lynn

2012-01-01

Miami Central High School technology teacher Frank Houghtaling thinks the connection between theory and application is one reason his students perform better on the Florida Comprehensive Assessment Test (FCAT). The impressive turnaround school drew local and national attention last spring when one of Houghtaling's students, Dagoberto Cruz, won…

Chronically Low-Performing Schools and Turnaround: Evidence from Three States

ERIC Educational Resources Information Center

Hansen, Michael; Choi, Kilchan

2012-01-01

The criteria for determining the student outcomes that define a school as having "turned around" are not well defined, and the definition of turnaround performance varies across studies. Although current policy initiatives offer guidelines for identifying CLP schools, there is no standard definition or methodology in common usage. This…

"I've Never Seen People Work So Hard!" Teachers' Working Conditions in the Early Stages of School Turnaround

ERIC Educational Resources Information Center

Cucchiara, Maia Bloomfield; Rooney, Erin; Robertson-Kraft, Claire

2015-01-01

School turnaround--a reform strategy that strives for quick and dramatic transformation of low-performing schools--has gained prominence in recent years. This study uses interviews and focus groups conducted with 86 teachers in 13 schools during the early stages of school turnaround in a large urban district to examine teachers' perceptions of the…

California Turnaround Schools: An Analysis of School Improvement Grant Effectiveness

ERIC Educational Resources Information Center

Graham, Khalil N.

2013-01-01

The purpose of this study was to evaluate the effectiveness of School Improvement Grants (SIGs) in the state of California (CA) in increasing student achievement using the turnaround implementation model. The American Recovery and Reinvestment Act of 2009 (ARRA) included educational priorities focused on fixing America's lowest achieving schools.…

Portrait of a Turnaround Leader in a High Needs District

ERIC Educational Resources Information Center

Hewitt, Kimberly Kappler; Reitzug, Ulrich

2015-01-01

Using portraiture methodology involving interview, observation, and artifact data, this study portrays a turnaround leader, Dr. Susan Gray, in a high needs, rural district in the Southeast. In three years, Gray led Lincoln Elementary from nearly being reconstituted to being an award-winning school. Gray has subsequently been assigned other…

Anatomy of a public health agency turnaround: the case of the general health district in Mahoning County.

PubMed

Honoré, Peggy A; Stefanak, Matthew; Dessens, Scott

2012-01-01

A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.

Turnaround, Transformational, or Transactional Leadership: An Ethical Dilemma in School Reform

ERIC Educational Resources Information Center

Mette, Ian M.; Scribner, Jay P.

2014-01-01

This case was written for school leaders, specifically building-level principals and central office administrators attempting to implement school turnaround reform efforts. Often, leaders who embark on this type of organizational change work in intense environments that produce high levels of pressure to demonstrate improvement in student…

The Rural Turnaround in Ohio: Some Evidence Related to Implications.

ERIC Educational Resources Information Center

Thomas, Donald W.; Bachtel, Douglas C.

Limited to residents of small towns, villages and the rural open country, the study assessed the implications of the rural turnaround in the southern Ohio counties of Athens, Gallia, Jackson, Meigs, and Vinton. All five counties experienced outmigration in the 1950s, and all but Athens County lost population through outmigration in the 1960s. In…

Differences in the Policies, Programs, and Practices (PPPs) and Combination of PPPs across Turnaround, Moderately Improving, and Not Improving Schools

ERIC Educational Resources Information Center

Herman, Rebecca; Huberman, Mette

2012-01-01

The TALPS study aims to build on the existing research base to develop promising methodologies to identify chronically low-performing and turnaround schools, as well as to identify promising strategies for turning around chronically low-performing schools. By looking specifically at schools identified as turnaround, in comparison to nonturnaround…

Cost analysis in the toxicology laboratory.

PubMed

Travers, E M

1990-09-01

The process of determining laboratory sectional and departmental costs and test costs for instrument-generated and manually generated reportable results for toxicology laboratories has been outlined in this article. It is hoped that the basic principles outlined in the preceding text will clarify and elucidate one of the most important areas needed for laboratory fiscal integrity and its survival in these difficult times for health care providers. The following general principles derived from this article are helpful aids for managers of toxicology laboratories. 1. To manage a cost-effective, efficient toxicology laboratory, several factors must be considered: the laboratory's instrument configuration, test turnaround time needs, the test menu offered, the analytic methods used, the cost of labor based on time expended and the experience and educational level of the staff, and logistics that determine specimen delivery time and costs. 2. There is a wide variation in costs for toxicologic methods, which requires that an analysis of capital (equipment) purchase and operational (test performance) costs be performed to avoid waste, purchase wisely, and determine which tests consume the majority of the laboratory's resources. 3. Toxicologic analysis is composed of many complex steps. Each step must be individually cost-accounted. Screening test results must be confirmed, and the cost for both steps must be included in the cost per reportable result. 4. Total costs will vary in the same laboratory and between laboratories based on differences in salaries paid to technical staff, differences in reagent/supply costs, the number of technical staff needed to operate the analyzer or perform the method, and the inefficient use of highly paid staff to operate the analyzer or perform the method. 5. Since direct test costs vary directly with the type and number of analyzers or methods and are dependent on the operational mode designed by the manufacturer, laboratory managers

Strategies of organization and service for the critical-care laboratory.

PubMed

Fleisher, M; Schwartz, M K

1990-08-01

Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

[Role of medium-sized independent laboratories in control of healthcare-associated infection].

PubMed

Anzai, Eiko; Fukui, Toru

2009-05-01

In 2006, the Ministry of Health and Welfare revised the regulations regarding the Medical Service Law. The amendments stipulate that all healthcare institutions are required to implement infection control programs. However, small hospitals and clinics have no clinical microbiology laboratories, whereas medium-sized hospitals have few medical technologists and the outsourcing of microbiology tests to independent laboratories is common. The decreasing number of laboratories and recent outsourcing tendency reflect the increasing commercialization, and, with it, the escalating number of commercially operating chains. Each independent laboratory is responsible for supporting activities related to the surveillance, control, and prevention of healthcare-associated infections in the associated small and medium-sized hospitals. The people responsible for infection control in these hospitals usually do not have a background in microbiology. The evaluation of communication between independent laboratory staff and hospital personnel, and rapid turnaround time of microbiology laboratory test reports are important elements ensuring the quality of independent laboratory work. With the pressures of financial constraints in the Japanese medical insurance system, the development of a cost-effective and practical protocol for quality assurance is a real dilemma.

RealTime Physics: Active learning laboratory

NASA Astrophysics Data System (ADS)

Thornton, Ronald K.; Sokoloff, David R.

1997-03-01

Our research shows that student learning of physics concepts in introductory physics courses is enhanced by the use of special guided discovery laboratory curricula which embody the results of educational research and which are supported by the use of the Tools for Scientific Thinking microcomputer-based laboratory (MBL) tools. In this paper we first describe the general characteristics of the research-based RealTime Physics laboratory curricula developed for use in introductory physics classes in colleges, universities and high schools. We then describe RealTime Physics Mechanics in detail. Finally we examine student learning of dynamics in traditional physics courses and in courses using RealTime Physics Mechanics, primarily by the use of correlated questions on the Force and Motion Conceptual Evaluation. We present considerable evidence that students who use the new laboratory curricula demonstrate significantly improved learning and retention of dynamics concepts compared to students taught by traditional methods.

Choosing a School Turnaround Provider. Lessons Learned. Volume 1, Issue 3

ERIC Educational Resources Information Center

Lockwood, Anne Turnbaugh; Fleischman, Steve

2010-01-01

Droves of school turnaround providers are chasing the massive federal infusion of funds flowing into failing schools. They arrive armed with glossy materials, impressive sounding claims, and, often, citing their prior relationships or experiences with one's school to support their promises of great service and impressive outcomes. But, are their…

High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs.

PubMed

Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace

2015-02-15

Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants <12 months old were recruited from 9 PMTCT sites in public maternal child health (MCH) clinics or from an inpatient setting in Nairobi, Kenya and tested for HIV using HIV DNA assays. A subset of HIV-infected infants <4.5 months of age was enrolled in a research study and followed for 2 years. HIV prevalence, number needed to test, infant age at testing, and turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p < 0.001); the number of HIV-exposed infants needed to test to diagnose one infection was 2.4 in the hospital vs. 9.1 in PMTCT. Receipt of HIV test results was faster among hospitalized infants (7 vs. 25 days, p < 0.001). Infants diagnosed in hospital were older at the time of testing than PMTCT diagnosed infants (5.0 vs. 1.6 months, respectively, p < 0.001). In the subset of 99 HIV-infected infants <4.5 months old followed longitudinally, hospital-diagnosed infants did not differ from PMTCT-diagnosed infants in time to ART initiation; however, hospital-diagnosed infants were >3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made

Where the world stands still: turnaround as a strong test of ΛCDM cosmology

NASA Astrophysics Data System (ADS)

Pavlidou, V.; Tomaras, T. N.

2014-09-01

Our intuitive understanding of cosmic structure formation works best in scales small enough so that isolated, bound, relaxed gravitating systems are no longer adjusting their radius; and large enough so that space and matter follow the average expansion of the Universe. Yet one of the most robust predictions of ΛCDM cosmology concerns the scale that separates these limits: the turnaround radius, which is the non-expanding shell furthest away from the center of a bound structure. We show that the maximum possible value of the turnaround radius within the framework of the ΛCDM model is, for a given mass M, equal to (3GM/Λ c2)1/3, with G Newton's constant and c the speed of light, independently of cosmic epoch, exact nature of dark matter, or baryonic effects. We discuss the possible use of this prediction as an observational test for ΛCDM cosmology. Current data appear to favor ΛCDM over alternatives with local inhomogeneities and no Λ. However there exist several local-universe structures that have, within errors, reached their limiting size. With improved determinations of their turnaround radii and the enclosed mass, these objects may challenge the limit and ΛCDM cosmology.

Where the world stands still: turnaround as a strong test of ΛCDM cosmology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pavlidou, V.; Tomaras, T.N., E-mail: pavlidou@physics.uoc.gr, E-mail: tomaras@physics.uoc.gr

Our intuitive understanding of cosmic structure formation works best in scales small enough so that isolated, bound, relaxed gravitating systems are no longer adjusting their radius; and large enough so that space and matter follow the average expansion of the Universe. Yet one of the most robust predictions of ΛCDM cosmology concerns the scale that separates these limits: the turnaround radius, which is the non-expanding shell furthest away from the center of a bound structure. We show that the maximum possible value of the turnaround radius within the framework of the ΛCDM model is, for a given mass M, equalmore » to (3GM/Λ c{sup 2}){sup 1/3}, with G Newton's constant and c the speed of light, independently of cosmic epoch, exact nature of dark matter, or baryonic effects. We discuss the possible use of this prediction as an observational test for ΛCDM cosmology. Current data appear to favor ΛCDM over alternatives with local inhomogeneities and no Λ. However there exist several local-universe structures that have, within errors, reached their limiting size. With improved determinations of their turnaround radii and the enclosed mass, these objects may challenge the limit and ΛCDM cosmology.« less

An examination of the usefulness of repeat testing practices in a large hospital clinical chemistry laboratory.

PubMed

Deetz, Carl O; Nolan, Debra K; Scott, Mitchell G

2012-01-01

A long-standing practice in clinical laboratories has been to automatically repeat laboratory tests when values trigger automated "repeat rules" in the laboratory information system such as a critical test result. We examined 25,553 repeated laboratory values for 30 common chemistry tests from December 1, 2010, to February 28, 2011, to determine whether this practice is necessary and whether it may be possible to reduce repeat testing to improve efficiency and turnaround time for reporting critical values. An "error" was defined to occur when the difference between the initial and verified values exceeded the College of American Pathologists/Clinical Laboratory Improvement Amendments allowable error limit. The initial values from 2.6% of all repeated tests (668) were errors. Of these 668 errors, only 102 occurred for values within the analytic measurement range. Median delays in reporting critical values owing to repeated testing ranged from 5 (blood gases) to 17 (glucose) minutes.

Use of matrix-assisted laser desorption/ionisation-time of flight mass spectrometry analyser in a diagnostic microbiology laboratory in a developing country.

PubMed

Bulane, Atang; Hoosen, Anwar

2017-01-01

Rapid and accurate identification of pathogens is of utmost importance for management of patients. Current identification relies on conventional phenotypic methods which are time consuming. Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS) is based on proteomic profiling and allows for rapid identification of pathogens. We compared MALDI-TOF MS against two commercial systems, MicroScan Walkaway and VITEK 2 MS. Over a three-month period from July 2013 to September 2013, a total of 227 bacteria and yeasts were collected from an academic microbiology laboratory ( N = 121; 87 Gram-negatives, seven Gram-positives, 27 yeasts) and other laboratories ( N = 106; 35 Gram-negatives, 34 Gram-positives, 37 yeasts). Sixty-five positive blood cultures were initially processed with Bruker Sepsityper kit for direct identification. From the 65 blood culture bottles, four grew more than one bacterial pathogen and MALDI-TOF MS identified only one isolate. The blood cultures yielded 21 Gram-negatives, 43 Gram-positives and one Candida . There were 21 Escherirchia coli isolates which were reported by the MALDI-TOF MS as E. coli / Shigella . Of the total 292 isolates, discrepant results were found for one bacterial and three yeast isolates. Discrepant results were resolved by testing with the API system with MALDI-TOF MS showing 100% correlation. The MALDI-TOF MS proved to be very useful for rapid and reliable identification of bacteria and yeasts directly from blood cultures and after culture of other specimens. The difference in time to identification was significant for all isolates. However, for positive blood cultures with minimal sample preparation time there was a massive difference in turn-around time with great appreciation by clinicians.

Turnaround High School Principals: Recruit, Prepare and Empower Leaders of Change.

ERIC Educational Resources Information Center

Schmidt-Davis, Jon; Bottoms, Gene

2012-01-01

Recent studies make one reality clear: While multiple factors can cause a low-performing high school to be in a turnaround situation, every high school that makes dramatic academic improvement has strong, effective school leadership. Turning a school around is no work for novices. It takes a skilled, visionary and proactive principal to pull apart…

Clinical Laboratory Automation: A Case Study

PubMed Central

Archetti, Claudia; Montanelli, Alessandro; Finazzi, Dario; Caimi, Luigi; Garrafa, Emirena

2017-01-01

Background This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. Materials and Methods The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. Results The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. Conclusions The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs. Significance for public health Automation is an emerging trend in modern clinical laboratories with a positive impact on service level to patients and on staff safety as shown by different studies. In fact, it allows process standardization which, in turn, decreases the frequency of outliers and errors. In addition, it induces faster processing times, thus improving the service level. On the other side, automation decreases the staff exposition to accidents strongly improving staff safety. In this study, we analyse a further potential benefit of automation, that is economic convenience. We study the case of the automated laboratory of one of the biggest hospital in Italy and compare the cost related to the pre and post automation situation. Introducing automation lead to a cost decrease without affecting the service level to patients

Turnarounds require team building and rebuilding. Interview by Donald E. L. Johnson.

PubMed

Knoble, J K

1989-11-01

James K. Knoble, president of the 369-bed JFK Medical Center, Atlantis, Fla., and former president of Methodist Medical Center of Illinois, Peoria, is in the midst of his third turnaround situation since he became a hospital CEO in 1965. Knoble is known as a CEO who keeps close track of the business environment, works closely with his board and medical staff and is effective at building a staff and delegating significant operating responsibilities. At JFK, whose previous administrator stole large sums of money and left it with serious financial and operating problems, Knoble is back in the operating mode. He is again a hands-on hospital operator, working closely with department heads as well as with the board and medical staff. In this interview with Health Care Strategic Management's editor and publisher, Donald E.L. Johnson, Knoble discusses his team building and turnaround strategy and JFK's progress during the last 18 months.

Reflight of the First Microgravity Science Laboratory: Quick Turnaround of a Space Shuttle Mission

NASA Technical Reports Server (NTRS)

Simms, Yvonne

1998-01-01

Due to the short flight of Space Shuttle Columbia, STS-83, in April 1997, NASA chose to refly the same crew, shuttle, and payload on STS-94 in July 1997. This was the first reflight of an entire mission complement. The reflight of the First Microgravity Science Laboratory (MSL-1) on STS-94 required an innovative approach to Space Shuttle payload ground processing. Ground processing time for the Spacelab Module, which served as the laboratory for MSL-1 experiments, was reduced by seventy-five percent. The Spacelab Module is a pressurized facility with avionics and thermal cooling and heating accommodations. Boeing-Huntsville, formerly McDonnell Douglas Aerospace, has been the Spacelab Integration Contractor since 1977. The first Spacelab Module flight was in 1983. An experienced team determined what was required to refurbish the Spacelab Module for reflight. Team members had diverse knowledge, skills, and background. An engineering assessment of subsystems, including mechanical, electrical power distribution, command and data management, and environmental control and life support, was performed. Recommendations for resolution of STS-83 Spacelab in-flight anomalies were provided. Inspections and tests that must be done on critical Spacelab components were identified. This assessment contributed to the successful reflight of MSL-1, the fifteenth Spacelab Module mission.

Meeting the challenge of a group practice turnaround.

PubMed

Porn, L M

2001-03-01

Many healthcare organizations that acquired group practices to enhance their market share have found that the practices have not met their financial goals. Turning around a financially troubled, hospital-owned group practice is challenging but not impossible for healthcare organizations that take certain basic actions. Direction, data, desire, dedication, and drive must be present to effect the financial turnaround of a group practice. The healthcare organization needs to evaluate the practice's strategy and operations and identify the issues that are hindering the practice's ability to optimize revenues. Efforts to achieve profitable operations have to be ongoing.

Applying Total Quality Management in Cooperative Extension.

ERIC Educational Resources Information Center

Fredendall, Lawrence D.; Lippert, Robert M.

1995-01-01

South Carolina's Agricultural Service Laboratory received responses from 252 of 500 farmers who currently use the soil testing service; 97% were pleased with accuracy, 89% with turnaround time, 18% thought the fee too high. Nonusers (100 of 520) were mainly dissatisfied with turnaround time. Total quality management methods were used to improve…

Nonanalytic Laboratory Automation: A Quarter Century of Progress.

PubMed

Hawker, Charles D

2017-06-01

Clinical laboratory automation has blossomed since the 1989 AACC meeting, at which Dr. Masahide Sasaki first showed a western audience what his laboratory had implemented. Many diagnostics and other vendors are now offering a variety of automated options for laboratories of all sizes. Replacing manual processing and handling procedures with automation was embraced by the laboratory community because of the obvious benefits of labor savings and improvement in turnaround time and quality. Automation was also embraced by the diagnostics vendors who saw automation as a means of incorporating the analyzers purchased by their customers into larger systems in which the benefits of automation were integrated to the analyzers.This report reviews the options that are available to laboratory customers. These options include so called task-targeted automation-modules that range from single function devices that automate single tasks (e.g., decapping or aliquoting) to multifunction workstations that incorporate several of the functions of a laboratory sample processing department. The options also include total laboratory automation systems that use conveyors to link sample processing functions to analyzers and often include postanalytical features such as refrigerated storage and sample retrieval.Most importantly, this report reviews a recommended process for evaluating the need for new automation and for identifying the specific requirements of a laboratory and developing solutions that can meet those requirements. The report also discusses some of the practical considerations facing a laboratory in a new implementation and reviews the concept of machine vision to replace human inspections. © 2017 American Association for Clinical Chemistry.

Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study.

PubMed

Sutcliffe, Catherine G; Thuma, Philip E; van Dijk, Janneke H; Sinywimaanzi, Kathy; Mweetwa, Sydney; Hamahuwa, Mutinta; Moss, William J

2017-03-08

Early infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated. The study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results. Four hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests. Mobile phone and text messaging technology has the

SSME 3-D Turnaround Duct flow analysis - CFD predictions

NASA Technical Reports Server (NTRS)

Brankovic, Andreja; Stowers, Steven T.; Mcconnaughey, Paul

1988-01-01

CFD analysis is presently employed to obtain an improved flowfield for an individual flowpath in the case of the Space Shuttle Main Engine's High Pressure Fuel Turbopump Turn-Around Duct (TAD), which conducts the flow exiting from the gas turbines into the fuel bowl. It is demonstrated that the application of CFD to TAD flow analysis, giving attention to the duct's configuration and to the number, shape, and alignment of the diffuser struts, can enhance understanding of flow physics and result in improved duct design and performance.

Tinkering and Turnarounds: Understanding the Contemporary Campaign to Improve Low-Performing Schools

ERIC Educational Resources Information Center

Duke, Daniel L.

2012-01-01

An unprecedented amount of attention in recent years has been focused on turning around low-performing schools. Drawing on insights from Tyack and Cuban's (1995) "Tinkering Toward Utopia," the article analyzes the forces behind the school turnaround phenomenon and how they have evolved since passage of the No Child Left Behind Act. The…

Rural Economic Development Consequences of the Population Turnaround in Northern Lower Michigan.

ERIC Educational Resources Information Center

West, Patrick C.; And Others

Consequences of population turnaround for rural economic development are examined in a 9-county region of Northern Lower Michigan. Data from census reports and 374 usable responses to a questionnaire mailed to a random sample of property owners drawn from 1982 county tax assessment rolls were used to test competing hypotheses about rural…

Turnaround Principals: An Unmistakable Conclusion--Site-Level Success Stems from Superintendent Support

ERIC Educational Resources Information Center

Burbach, Harold J.; Butler, Alfred R., IV

2005-01-01

The authors of this article were recently privileged to spend five days with a group of 10 talented principals who have been charged with turning around academically low-performing schools in their respective districts. These principals were selected as participants in a Turnaround Specialist Program initiated by Gov. Mark R. Warner of Virginia…

Participatory Democracy and Struggling Schools: Making Space for Youth in School Turnarounds

ERIC Educational Resources Information Center

Kirshner, Ben; Jefferson, Anton

2015-01-01

Background/Context:Federal policy, as codified in Race to the Top (RTT) funding guidelines, outlines four types of intervention: turnaround, restart, closure, and transformation. RTT has embraced a technocratic paradigm for school reform that frames choice less as the opportunity for the public to deliberate about what it wants from its schools…

17 CFR 240.17Ad-2 - Turnaround, processing, and forwarding of items.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Turnaround, processing, and forwarding of items. 240.17Ad-2 Section 240.17Ad-2 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... be filed with the Comptroller of the Currency shall be filed with the Office of the Comptroller of...

17 CFR 240.17Ad-2 - Turnaround, processing, and forwarding of items.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Turnaround, processing, and forwarding of items. 240.17Ad-2 Section 240.17Ad-2 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... be filed with the Comptroller of the Currency shall be filed with the Office of the Comptroller of...

Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?

PubMed Central

Hoffman, Heather J.; Isavwa, Anthony; Mokone, Mafusi; Foso, Matokelo; Safrit, Jeffrey T.; Mofenson, Lynne M.; Tylleskär, Thorkild

2017-01-01

Introduction Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade. Methods We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models. Results 1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95%CI: 55.3–68.7). Mean time from specimen collection to district laboratory was 14 days (95%CI: 12.1–16.1); from district to central laboratory, 2 days (95%CI 0.8–5.2); results from central laboratory to district hospital, 23.3 days (95%CI: 18.7–29.0); from district hospital to health facility, 3.2 days (95%CI 1.9–5.5); and from health facility to caregiver, 10.4 days (95%CI, 7.9–13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95%CI: 38.9–56.9) and 62 days (95%CI: 55.9–68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95%CI: 0.3, 5

A Case Study of Change Strategies Implemented in a Turnaround Elementary School

ERIC Educational Resources Information Center

Colson, Jo Ann

2012-01-01

This case study examined the change strategies in a turnaround school at the elementary level to understand and describe how change occurred and was sustained at this campus. This study examined the factors which contributed to the change in academic success of students, examined beliefs about change that led to the change process, identified the…

The Turnaround Challenge: Why America's Best Opportunity to Dramatically Improve Student Achievement Lies in Our Worst-Performing Schools. Supplement to the Main Report

ERIC Educational Resources Information Center

Calkins, Andrew; Guenther, William; Belfiore, Grace; Lash, Dave

2007-01-01

The turnaround recommendations and framework in "The Turnaround Challenge" grew out of both new research and synthesis of extensive existing research, as carried out by Mass Insight Education & Research Institute and its partners since September 2005. If the main report is the tip of the proverbial iceberg, this supplement represents…

Guidance for laboratories performing molecular pathology for cancer patients

PubMed Central

Cree, Ian A; Deans, Zandra; Ligtenberg, Marjolijn J L; Normanno, Nicola; Edsjö, Anders; Rouleau, Etienne; Solé, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J Han

2014-01-01

Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here. PMID:25012948

State Capacity to Support School Turnaround. NCEE Evaluation Brief. NCEE 2015-4012

ERIC Educational Resources Information Center

Tanenbaum, Courtney; Boyle, Andrea; Graczewski, Cheryl; James-Burdumy, Susanne; Dragoset, Lisa; Hallgren, Kristin

2015-01-01

One objective of the U.S. Department of Education's (ED) School Improvement Grants (SIG) and Race to the Top (RTT) program is to help states enhance their capacity to support the turnaround of low-performing schools. This capacity may be important, given how difficult it is to produce substantial and sustained achievement gains in low-performing…

Into the black. 1993 Hospital Turnaround Contest winners.

PubMed

Cerne, F; Bergman, R

1993-07-20

Turning a hospital around takes a lot more than adjusting the financials, as the winners and finalists in the Great Comebacks 1993: The Hospital Turnaround Contest demonstrate. In every case we report on, the hospital being recognized has worked intensively with its community to reassess the services needed by its patients, build support for major management and delivery changes, and articulate the reasons for the strategies being used. Each of the eight hospital organizations we profile, which are spread across the country from Texas to Wisconsin to Maine to North Carolina--has put together its own version of success--in other words, eight lessons in innovation and progress.

Technical evaluation of the novel preanalytical module on instrumentation laboratory ACL TOP: advancing automation in hemostasis testing.

PubMed

Lippi, Giuseppe; Ippolito, Luigi; Favaloro, Emmanuel J

2013-10-01

Automation in hemostasis testing is entering an exciting and unprecedented phase. This study was planned to assess the performance of the new preanalytical module on the hemostasis testing system Instrumentation Laboratory ACL TOP. The evaluation included interference studies to define reliable thresholds for rejecting samples with significant concentrations of interfering substances; within-run imprecision studies of plasma indices on four different interference degrees for each index; comparison studies with reference measures of hemolysis index, bilirubin, and triglycerides on clinical chemistry analyzers; and calculation of turnaround time with and without automatic performance of preanalytical check. The upper limits for sample rejection according to our interference studies were 3.6 g/L for hemoglobin, 13.6 mg/dL for bilirubin, and 1454 mg/dL for triglycerides. We found optimal precision for all indices (0.6% to 3.1% at clinically relevant thresholds) and highly significant correlations with reference measures on clinical chemistry analyzers (from 0.985 to 0.998). The limited increase of turnaround time (i.e., +3% and +5% with or without cap-piercing), coupled with no adjunctive costs over performance of normal coagulation assays, contribute to make the automatic check of plasma indices on ACL TOP a reliable and practical approach for improving testing quality and safeguarding patient safety.

Investigating the Role of Human Resources in School Turnaround: Evidence from Two States

ERIC Educational Resources Information Center

Hansen, Michael

2012-01-01

Teachers are generally recognized as the schooling factor accounting for the highest proportion of student learning outcomes (Aaronson et al., 2007; Hanushek, 1986). This implies the quick and dramatic improvement in school performance observed in turnaround (TA) schools was associated with a major change in the performance of its teachers. This…

Quality of the clinical laboratory department in a specialized hospital in Alexandria, Egypt.

PubMed

Elhoseeny, T A; Mohammad, E K

2013-01-01

Assessment and improvement of turnaround times (TAT) as well as customer satisfaction is essential for laboratory quality management. This study in a specialized hospital in Alexandria, Egypt measured the current TAT for outpatient department bilirubin samples and evaluated the satisfaction of physicians with aspects of clinical laboratory services. While the mean TAT for 110 bilirubin tests [58.1 (SD 31.8) min] was within the College of American Pathologists' benchmark, the 90th percentile was long (96.7 min); 62.7% of tests were reported within 60 min. The mean overall satisfaction score of physicians (range 1-5) was 3.46 (SD 0.49). The highest satisfaction rating was for staff courtesy while the lowest ratings were for laboratory management responsiveness, outpatient stat TAT and critical value notification. Quality or reliability of results was judged by physicians as the most important factor (32.3%), followed by routine test TAT (18.5%). Further analysis of the different steps of the TAT would be helpful and follow-up through examining outliers is recommended

The role of technology in the clinical laboratory of the future.

PubMed

Wilkinson, D S

1997-01-01

Advances in automation and informatics will drive the implementation of new technology as we enter the 21st century. Five technologies which will have the greatest impact on the practice of laboratory medicine during the next decade include molecular diagnostics, near patient testing, image analysis, robotics, and information management. The list of molecular pathology tests with potential clinical utility expands daily. Some, such as tests for human immune deficiency virus (HIV) and hepatitis C virus, already are available as commercial kits. Quality assessment and proficiency testing programs still are evolving. DNA tests in oncology, such as T- and B-cell gene rearrangements and t(9;22) translocation, have proven useful in detecting small numbers of tumor cells and have demonstrated clinical utility in some circumstances. Tests for monogenetic diseases, such as sickle cell disease, are useful in planning antenatal management of mothers at risk. Screening tests for the genetic predisposition for certain forms of colon and breast cancer and Alzheimer's Disease are now possible. This suggests the potential for large scale screening of populations at risk. Continued improvements in biosensor technology and miniaturization will increase the ability to test for many analytes at or near the patient. The generally increased cost per test must be reconciled with the potential to decrease the overall cost of care by improved turnaround time. Computerized image analysis will radically change, and in some cases eliminate, manual clinical microscopy in urinalysis, hematology, immunohistochemistry, and cytology. Robotics will greatly decrease personnel requirements for repetitive tasks, such as specimen transport, processing, and aliquoting. We will process many specimens from start to finish without human intervention. Image management systems will allow archiving of diagnostic gross and microscopic images along with the traditional text descriptions and diagnosis

A Case Study of Essential Components of School Success in a Turnaround School

ERIC Educational Resources Information Center

Cronin, Jodi Lynn

2016-01-01

School reform and turnaround efforts have been in the public eye since the signing of the Elementary and Secondary Act (ESEA) into law by President Lyndon Baines Johnson in 1965. Research has been focused on the School Improvement Grant, as well as the essential components that improve performance of schools. This qualitative case examines one…

MALDI-TOF mass spectrometry in the clinical mycology laboratory: identification of fungi and beyond.

PubMed

Posteraro, Brunella; De Carolis, Elena; Vella, Antonietta; Sanguinetti, Maurizio

2013-04-01

MALDI-TOF mass spectrometry (MS) is becoming essential in most clinical microbiology laboratories throughout the world. Its successful use is mainly attributable to the low operational costs, the universality and flexibility of detection, as well as the specificity and speed of analysis. Based on characteristic protein spectra obtained from intact cells - by means of simple, rapid and reproducible preanalytical and analytical protocols - MALDI-TOF MS allows a highly discriminatory identification of yeasts and filamentous fungi starting from colonies. Whenever used early, direct identification of yeasts from positive blood cultures has the potential to greatly shorten turnaround times and to improve laboratory diagnosis of fungemia. More recently, but still at an infancy stage, MALDI-TOF MS is used to perform strain typing and to determine antifungal drug susceptibility. In this article, the authors discuss how the MALDI-TOF MS technology is destined to become a powerful tool for routine mycological diagnostics.

Massive metrology using fast e-beam technology improves OPC model accuracy by >2x at faster turnaround time

NASA Astrophysics Data System (ADS)

Zhao, Qian; Wang, Lei; Wang, Jazer; Wang, ChangAn; Shi, Hong-Fei; Guerrero, James; Feng, Mu; Zhang, Qiang; Liang, Jiao; Guo, Yunbo; Zhang, Chen; Wallow, Tom; Rio, David; Wang, Lester; Wang, Alvin; Wang, Jen-Shiang; Gronlund, Keith; Lang, Jun; Koh, Kar Kit; Zhang, Dong Qing; Zhang, Hongxin; Krishnamurthy, Subramanian; Fei, Ray; Lin, Chiawen; Fang, Wei; Wang, Fei

2018-03-01

new computational software enables users to generate large quantity of highly accurate EP (Edge Placement) gauges and significantly improve design pattern coverage with up to 5X gain in model prediction accuracy on complex 2D patterns. Overall, this work showed >2x improvement in OPC model accuracy at a faster model turn-around time.

Perceptions of a medical microbiology service: a survey of laboratory users.

PubMed Central

Morgan, M S

1995-01-01

AIM--To ascertain the perception of laboratory users regarding the quality of the medical microbiology services in a district general hospital. METHODS--Detailed questionnaires were circulated to all clinicians in the locality, with headings covering the quality of medical advice provided, the availability of information on specimen collection, format of request forms, specimen transport arrangements, turnaround times, the quality and need for interpretative advice, and the overall impression of the quality of the services provided. RESULTS--Two hundred and thirty five replies were received, giving a response rate of 69%. Transportation of specimens and communication of reports were identified as priority areas for improvement. The overall quality of the service was perceived as satisfactory, although areas were identified where substantial improvements could be made, some at little or no cost to the laboratory. CONCLUSIONS--The survey focused clinicians' attention on the service, raised the profile of the laboratory, and resulted in improved communications and a better understanding of customer needs. Overall, the exercise was felt to be extremely useful, and worthwhile repeating to gauge the effect of the changes instituted as a result. PMID:8537489

Turnaround in an aged persons' mental health service in crisis: a case study of organisational renewal.

PubMed

Stafrace, Simon; Lilly, Alan

2008-08-01

This case study demonstrates how leadership was harnessed to turn around a decline in the performance of an aged persons' mental health service - the Namarra Nursing Home at Caulfield General Medical Centre in Melbourne, Australia. In 2000 the nursing home faced a crisis of public confidence due to failings in the management of quality, clinical risk and human resources within the service. These problems reflected structural and operational shortcomings in the clinical directorate and wider organisation. In this article, we detail the process of turnaround from the perspective of senior executive managers with professional and operational responsibility for the service. This turnaround required attention to local clinical accountability and transformation of the mental health program from a collocated but operationally isolated service to one integrated within the governance structures of the auspicing organisation.

The First 90 Days of the New Middle School Principal in a Turnaround School: In-Depth Case Study of the Transition Period (First 90 Days)

ERIC Educational Resources Information Center

Baeza, Marco A.

2010-01-01

This study analyzed skills, strategies, and theories that new middle school principals used to be successful during their transition period (the first 90 days) in turnaround schools. Based on research on transitions, three research questions guided the study: 1. Do middle school principals in a turnaround school situation find the transition…

How to Know when Dramatic Change Is on Track: Leading Indicators of School Turnarounds

ERIC Educational Resources Information Center

Kowal, Julie; Ableidinger, Joe

2011-01-01

In recent years, national policymakers have placed new emphasis on "school turnarounds" as a strategy for rapid, dramatic improvement in chronically failing schools, calling on education leaders to turn around performance in the 5,000 lowest-achieving schools nationwide. This goal may seem daunting, given the dismal success rates of…

Closing the brain-to-brain loop in laboratory testing.

PubMed

Plebani, Mario; Lippi, Giuseppe

2011-07-01

Abstract The delivery of laboratory services has been described 40 years ago and defined with the foremost concept of "brain-to-brain turnaround time loop". This concept consists of several processes, including the final step which is the action undertaken on the patient based on laboratory information. Unfortunately, the need for systematic feedback to improve the value of laboratory services has been poorly understood and, even more risky, poorly applied in daily laboratory practice. Currently, major problems arise from the unavailability of consensually accepted quality specifications for the extra-analytical phase of laboratory testing. This, in turn, does not allow clinical laboratories to calculate a budget for the "patient-related total error". The definition and use of the term "total error" refers only to the analytical phase, and should be better defined as "total analytical error" to avoid any confusion and misinterpretation. According to the hierarchical approach to classify strategies to set analytical quality specifications, the "assessment of the effect of analytical performance on specific clinical decision-making" is comprehensively at the top and therefore should be applied as much as possible to address analytical efforts towards effective goals. In addition, an increasing number of laboratories worldwide are adopting risk management strategies such as FMEA, FRACAS, LEAN and Six Sigma since these techniques allow the identification of the most critical steps in the total testing process, and to reduce the patient-related risk of error. As a matter of fact, an increasing number of laboratory professionals recognize the importance of understanding and monitoring any step in the total testing process, including the appropriateness of the test request as well as the appropriate interpretation and utilization of test results.

Outsourcing of Academic Clinical Laboratories

PubMed Central

Mrak, Robert E.; Parslow, Tristram G.; Tomaszewski, John E.

2018-01-01

American hospitals are increasingly turning to service outsourcing to reduce costs, including laboratory services. Studies of this practice have largely focused on nonacademic medical centers. In contrast, academic medical centers have unique practice environments and unique mission considerations. We sought to elucidate and analyze clinical laboratory outsourcing experiences in US academic medical centers. Seventeen chairs of pathology with relevant experience were willing to participate in in-depth interviews about their experiences. Anticipated financial benefits from joint venture arrangements often eroded after the initial years of the agreement, due to increased test pricing, management fees, duplication of services in support of inpatients, and lack of incentive for utilization control on the part of the for-profit partner. Outsourcing can preclude development of lucrative outreach programs; such programs were successfully launched in several cases after joint ventures were either avoided or terminated. Common complaints included poor test turnaround time and problems with test quality (especially in molecular pathology, microbiology, and flow cytometry), leading to clinician dissatisfaction. Joint ventures adversely affected retention of academically oriented clinical pathology faculty, with adverse effects on research and education, which further exacerbated clinician dissatisfaction due to lack of available consultative expertise. Resident education in pathology and in other disciplines (especially infectious disease) suffered both from lack of on-site laboratory capabilities and from lack of teaching faculty. Most joint ventures were initiated with little or no input from pathology leadership, and input from pathology leadership was seen to have been critical in those cases where such arrangements were declined or terminated. PMID:29637086

[Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage].

PubMed

Kino, Shuichi; Suwabe, Akira

2014-12-01

In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

Operational Authority, Support, and Monitoring of School Turnaround. NCEE Evaluation Brief. NCEE 2014-4008

ERIC Educational Resources Information Center

Herman, Rebecca; Graczewski, Cheryl; James-Burdumy, Susanne; Murray, Matthew; Perez-Johnson, Irma; Tanenbaum, Courtney

2013-01-01

The federal School Improvement Grants (SIG) program, to which $3 billion were allocated under the American Recovery and Reinvestment Act of 2009 (ARRA), supports schools attempting to turn around a history of low performance. School turnaround also is a focus of Race to the Top (RTT), another ARRA-supported initiative, which involved a roughly $4…

Autovalidation and automation of the postanalytical phase of routine hematology and coagulation analyses in a university hospital laboratory.

PubMed

Mlinaric, Ana; Milos, Marija; Coen Herak, Désirée; Fucek, Mirjana; Rimac, Vladimira; Zadro, Renata; Rogic, Dunja

2018-02-23

The need to satisfy high-throughput demands for laboratory tests continues to be a challenge. Therefore, we aimed to automate postanalytical phase in hematology and coagulation laboratory by autovalidation of complete blood count (CBC) and routine coagulation test results (prothrombin time [PT], international normalized ratio [PT-INR], activated partial thromboplastin time [APTT], fibrinogen, antithrombin activity [AT] and thrombin time [TT]). Work efficacy and turnaround time (TAT) before and after implementation of automated solutions will be compared. Ordering panels tailored to specific patient populations were implemented. Rerun and reflex testing rules were set in the respective analyzers' software (Coulter DxH Connectivity 1601, Beckman Coulter, FL, USA; AutoAssistant, Siemens Healthcare Diagnostics, Germany), and sample status information was transferred into the laboratory information system. To evaluate if the automation improved TAT and efficacy, data from manually verified results in September and October of 2015 were compared with the corresponding period in 2016 when autovalidation was implemented. Autovalidation rates of 63% for CBC and 65% for routine coagulation test results were achieved. At the TAT of 120 min, the percentage of reported results increased substantially for all analyzed tests, being above 90% for CBC, PT, PT-INR and fibrinogen and 89% for APTT. This output was achieved with three laboratory technicians less compared with the period when the postanalytical phase was not automated. Automation allowed optimized laboratory workflow for specific patient populations, thereby ensuring standardized results reporting. Autovalidation of test results proved to be an efficient tool for improvement of laboratory work efficacy and TAT.

The Effects of School Turnaround in Tennessee's Achievement School District and Innovation Zones

ERIC Educational Resources Information Center

Zimmer, Ron; Henry, Gary T.; Kho, Adam

2017-01-01

In recent years, the federal government has invested billions of dollars to reform chronically low-performing schools. To fulfill their federal Race to the Top grant agreement, Tennessee implemented three turnaround strategies that adhered to the federal restart and transformation models: (a) placed schools under the auspices of the Achievement…

Guidance for laboratories performing molecular pathology for cancer patients.

PubMed

Cree, Ian A; Deans, Zandra; Ligtenberg, Marjolijn J L; Normanno, Nicola; Edsjö, Anders; Rouleau, Etienne; Solé, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J Han

2014-11-01

Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study

PubMed Central

Skodvin, Brita; Aase, Karina; Brekken, Anita Løvås; Charani, Esmita; Lindemann, Paul Christoffer; Smith, Ingrid

2017-01-01

Abstract Background Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Methods Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. Results The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other’s area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Conclusions Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other’s area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures. PMID:28633405

Flexibility of mobile laboratory unit in support of patient management during the 2007 Ebola-Zaire outbreak in the Democratic Republic of Congo.

PubMed

Grolla, A; Jones, S; Kobinger, G; Sprecher, A; Girard, G; Yao, M; Roth, C; Artsob, H; Feldmann, H; Strong, J E

2012-09-01

The mobile laboratory provides a safe, rapid and flexible platform to provide effective diagnosis of Ebola virus as well as additional differential diagnostic agents in remote settings of equatorial Africa. During the 2007 Democratic Republic of Congo outbreak of Ebola-Zaire, the mobile laboratory was set up in two different locations by two separate teams within a day of equipment arriving in each location. The first location was in Mweka where our laboratory took over the diagnostic laboratory space of the local hospital, whereas the second location, approximately 50 km south near Kampungu at the epicentre of the outbreak, required local labour to fabricate a tent structure as a suitable pre-existing structure was not available. In both settings, the laboratory was able to quickly set up, providing accurate and efficient molecular diagnostics (within 3 h of receiving samples) for 67 individuals, including four cases of Ebola, seven cases of Shigella and 13 cases of malaria. This rapid turn-around time provides an important role in the support of patient management and epidemiological surveillance. © 2012 Blackwell Verlag GmbH.

MODULAR ANALYTICS: A New Approach to Automation in the Clinical Laboratory.

PubMed

Horowitz, Gary L; Zaman, Zahur; Blanckaert, Norbert J C; Chan, Daniel W; Dubois, Jeffrey A; Golaz, Olivier; Mensi, Noury; Keller, Franz; Stolz, Herbert; Klingler, Karl; Marocchi, Alessandro; Prencipe, Lorenzo; McLawhon, Ronald W; Nilsen, Olaug L; Oellerich, Michael; Luthe, Hilmar; Orsonneau, Jean-Luc; Richeux, Gérard; Recio, Fernando; Roldan, Esther; Rymo, Lars; Wicktorsson, Anne-Charlotte; Welch, Shirley L; Wieland, Heinrich; Grawitz, Andrea Busse; Mitsumaki, Hiroshi; McGovern, Margaret; Ng, Katherine; Stockmann, Wolfgang

2005-01-01

MODULAR ANALYTICS (Roche Diagnostics) (MODULAR ANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughput up to 2400 tests/h). MODULAR ANALYTICS allows customised configurations for various laboratory workloads. The performance and practicability of MODULAR ANALYTICS were evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULAR ANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULAR ANALYTICS was less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULAR ANALYTICS met diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving) quality.

MODULAR ANALYTICS: A New Approach to Automation in the Clinical Laboratory

PubMed Central

Zaman, Zahur; Blanckaert, Norbert J. C.; Chan, Daniel W.; Dubois, Jeffrey A.; Golaz, Olivier; Mensi, Noury; Keller, Franz; Stolz, Herbert; Klingler, Karl; Marocchi, Alessandro; Prencipe, Lorenzo; McLawhon, Ronald W.; Nilsen, Olaug L.; Oellerich, Michael; Luthe, Hilmar; Orsonneau, Jean-Luc; Richeux, Gérard; Recio, Fernando; Roldan, Esther; Rymo, Lars; Wicktorsson, Anne-Charlotte; Welch, Shirley L.; Wieland, Heinrich; Grawitz, Andrea Busse; Mitsumaki, Hiroshi; McGovern, Margaret; Ng, Katherine; Stockmann, Wolfgang

2005-01-01

MODULAR ANALYTICS (Roche Diagnostics) (MODULAR ANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group) represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h), and a D2400 module (16 photometric tests, throughput up to 2400 tests/h). MODULAR ANALYTICS allows customised configurations for various laboratory workloads. The performance and practicability of MODULAR ANALYTICS were evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULAR ANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULAR ANALYTICS was less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULAR ANALYTICS met diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving) quality. PMID:18924721

Three-year customer satisfaction survey in laboratory medicine in a Chinese university hospital.

PubMed

Guo, Siqi; Duan, Yifei; Liu, Xiaojuan; Jiang, Yongmei

2018-04-25

Customer satisfaction is a key quality indicator of laboratory service. Patients and physicians are the ultimate customers in medical laboratory, and their opinions are essential components in developing a customer-oriented laboratory. A longitudinal investigation of customer satisfaction was conducted through questionnaires. We designed two different questionnaires and selected 1200 customers (600 outpatients and 600 physicians) to assess customer satisfaction every other year from 2012 to 2016. Items with scores <4 were considered unsatisfactory, and corrective actions should be taken. The completion rates of physicians were 96.8% in 2012, 97% in 2014 and 96.5% in 2016, whereas the rates of patients were 95.3%, 96.2% and 95.2%, respectively. In 2012, the most dissatisfaction items were test turnaround time (3.77 points) and service attitude (3.87 points) from physicians, whereas waiting time (3.58 points) and examination environment (3.64 points) were the most dissatisfaction items from patients. After corrective actions were taken, the result of satisfaction in 2014 was better, which illustrated our strategy was effective. However, some items remained to be less than 4, so we repeated the survey after modifying questionnaires in 2016. However, the general satisfaction points of the physicians and patients reduced in 2016, which reminded us of some influential factors we had neglected. By using dynamic survey of satisfaction, we can continuously find deficiencies in our laboratory services and take suitable corrective actions, thereby improving our service quality.

Key Performance Indicators to Measure Improvement After Implementation of Total Laboratory Automation Abbott Accelerator a3600.

PubMed

Miler, Marijana; Nikolac Gabaj, Nora; Dukic, Lora; Simundic, Ana-Maria

2017-12-27

The aim of the study was to estimate improvement of work efficiency in the laboratory after implementation of total laboratory automation (TLA) by Abbott Accelerator a3600 in the laboratory with measuring different key performance indicators (KPIs) before and after TLA implementation. The objective was also to recommend steps for defining KPIs in other laboratories. For evaluation of improvement 10 organizational and/or technical KPIs were defined for all phases of laboratory work and measured before (November 2013) and after (from 2015 to 2017) TLA implementation. Out of 10 defined KPIs, 9 were successfully measured and significantly improved. Waiting time for registration of samples in the LIS was significantly reduced from 16 (9-28) to 9 (6-16) minutes after TLA (P < 0.001). After TLA all tests were performed at core biochemistry analyzers which significantly reduced walking distance for sample management (for more than 800 m per worker) and number of tube touches (for almost 50%). Analyzers downtime and engagement time for analyzers maintenance was reduced for 50 h and 28 h per month, respectively. TLA eliminated manual dilution of samples with extreme results with sigma values increment from 3.4 to >6 after TLA. Although median turnaround time TAT for potassium and troponin was higher (for approximately 20 min), number of outliers with TAT >60 min expressed as sigma values were satisfying (>3). Implementation of the TLA improved the most of the processes in our laboratory with 9 out of 10 properly defined and measured KPIs. With proper planning and defining of KPIs, every laboratory could measure changes in daily workflow.

Selective testing of women based on age for genital Chlamydia trachomatis and Neisseria gonorrhoeae infection in a centralized regional microbiology laboratory.

PubMed

Church, Deirdre L; Amante, L; Semeniuk, H; Gregson, D B

2007-04-01

Calgary Laboratory Services, Alberta, Canada, provides microbiology services via a centralized laboratory to the Calgary Health Region. A selective genital Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) testing policy for women >35 years was implemented. The changes in physician ordering practice, the rate of detection of infections, and the test turnaround times were monitored. The volume of tests, the cost/test, and the total service costs accrued in the year before and after this policy change were compared. An immediate impact was a 30% decrease in tests performed due to the laboratory rejecting samples from older women. Subsequently, physicians' practice changed so that tests were ordered when test criteria were met. Detection rates did not change in any age group. A 27.9% decrease in the total service costs resulted in a labor reduction of 0.2 FTE. Selective testing of women >35 years with a low prevalence of CT/GC infection is clinically relevant and cost-effective.

Comparison of GLONASS and GPS Time Transfers Between Two West European Time Laboratories and VNIIFTRI

DTIC Science & Technology

1991-12-01

COMPARISON OF GLONASS AND GPS TIME TRANSFERS BETWEEN TWO WEST EUROPEAN TIME LABORATORIES AND VNIIFTRI P. Daly Department of Electronic and...Radiotechnical Measurements - VNIIFTRI Mendeleevo, Moscow region, 141570, USSR and W. Lewandowski, G. Petit, C. Thomas Bureau International des Poids et...00-1991 to 00-00-1991 4. TITLE AND SUBTITLE Comparison of GLONASS and GPS Time Transfers Between Two West European Time Laboratories and VNIIFTRI

Survey of Clinical Laboratory Practices for 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea.

PubMed

Lee, Mi-Kyung; Kim, Sinyoung; Kim, Mi-Na; Kweon, Oh Joo; Lim, Yong Kwan; Ki, Chang-Seok; Kim, Jae-Seok; Seong, Moon-Woo; Sung, Heungsup; Yong, Dongeun; Lee, Hyukmin; Choi, Jong-Rak; Kim, Jeong-Ho

2016-03-01

It is crucial to understand the current status of clinical laboratory practices for the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the Republic of Korea to be well prepared for future emerging infectious diseases. We conducted a survey of 49 clinical laboratories in medical institutions and referral medical laboratories. A short questionnaire to survey clinical laboratory practices relating to MERS-CoV diagnostic testing was sent by email to the directors and clinical pathologists in charge of the clinical laboratories performing MERS-CoV testing. The survey focused on testing volume, reporting of results, resources, and laboratory safety. A total of 40 clinical laboratories responded to the survey. A total of 27,009 MERS-CoV real-time reverse transcription PCR (rRT-PCR) tests were performed. Most of the specimens were sputum (73.5%). The median turnaround time (TAT) was 5.29 hr (first and third quartile, 4.11 and 7.48 hr) in 26 medical institutions. The median TAT of more than a half of the laboratories (57.7%) was less than 6 hr. Many laboratories were able to perform tests throughout the whole week. Laboratory biosafety preparedness included class II biosafety cabinets (100%); separated pre-PCR, PCR, and post-PCR rooms (88.6%); negative pressure pretreatment rooms (48.6%); and negative pressure sputum collection rooms (20.0%). Clinical laboratories were able to quickly expand their diagnostic capacity in response to the 2015 MERS-CoV outbreak. Our results show that clinical laboratories play an important role in the maintenance and enhancement of laboratory response in preparation for future emerging infections.

Survey of Clinical Laboratory Practices for 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea

PubMed Central

Lee, Mi-Kyung; Kim, Sinyoung; Kim, Mi-Na; Kweon, Oh Joo; Lim, Yong Kwan; Ki, Chang-Seok; Kim, Jae-Seok; Seong, Moon-Woo; Sung, Heungsup; Yong, Dongeun; Lee, Hyukmin; Choi, Jong-Rak

2016-01-01

Background It is crucial to understand the current status of clinical laboratory practices for the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the Republic of Korea to be well prepared for future emerging infectious diseases. Methods We conducted a survey of 49 clinical laboratories in medical institutions and referral medical laboratories. A short questionnaire to survey clinical laboratory practices relating to MERS-CoV diagnostic testing was sent by email to the directors and clinical pathologists in charge of the clinical laboratories performing MERS-CoV testing. The survey focused on testing volume, reporting of results, resources, and laboratory safety. Results A total of 40 clinical laboratories responded to the survey. A total of 27,009 MERS-CoV real-time reverse transcription PCR (rRT-PCR) tests were performed. Most of the specimens were sputum (73.5%). The median turnaround time (TAT) was 5.29 hr (first and third quartile, 4.11 and 7.48 hr) in 26 medical institutions. The median TAT of more than a half of the laboratories (57.7%) was less than 6 hr. Many laboratories were able to perform tests throughout the whole week. Laboratory biosafety preparedness included class II biosafety cabinets (100%); separated pre-PCR, PCR, and post-PCR rooms (88.6%); negative pressure pretreatment rooms (48.6%); and negative pressure sputum collection rooms (20.0%). Conclusions Clinical laboratories were able to quickly expand their diagnostic capacity in response to the 2015 MERS-CoV outbreak. Our results show that clinical laboratories play an important role in the maintenance and enhancement of laboratory response in preparation for future emerging infections. PMID:26709263

The Project L.I.F.T. Story: Early Lessons from a Public-Private Education Turnaround Initiative

ERIC Educational Resources Information Center

Kim, Juli; Ellison, Shonaka

2015-01-01

Leading Charlotte foundations formed a funding collaborative to support a five-year district turnaround initiative to dramatically improve educational outcomes for students in the West Charlotte High School corridor, one of the city's lowest-performing feeder zones. The "Project L.I.F.T." initiative involves four areas of education…

University of Wisconsin Ion Beam Laboratory: A facility for irradiated materials and ion beam analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Field, K. G.; Wetteland, C. J.; Cao, G.

2013-04-19

The University of Wisconsin Ion Beam Laboratory (UW-IBL) has recently undergone significant infrastructure upgrades to facilitate graduate level research in irradiated materials phenomena and ion beam analysis. A National Electrostatics Corp. (NEC) Torodial Volume Ion Source (TORVIS), the keystone upgrade for the facility, can produce currents of hydrogen ions and helium ions up to {approx}200 {mu}A and {approx}5 {mu}A, respectively. Recent upgrades also include RBS analysis packages, end station developments for irradiation of relevant material systems, and the development of an in-house touch screen based graphical user interface for ion beam monitoring. Key research facilitated by these upgrades includes irradiationmore » of nuclear fuels, studies of interfacial phenomena under irradiation, and clustering dynamics of irradiated oxide dispersion strengthened steels. The UW-IBL has also partnered with the Advanced Test Reactor National Scientific User Facility (ATR-NSUF) to provide access to the irradiation facilities housed at the UW-IBL as well as access to post irradiation facilities housed at the UW Characterization Laboratory for Irradiated Materials (CLIM) and other ATR-NSUF partner facilities. Partnering allows for rapid turnaround from proposed research to finalized results through the ATR-NSUF rapid turnaround proposal system. An overview of the UW-IBL including CLIM and relevant research is summarized.« less

The Reading Turn-Around: A Five Part Framework for Differentiated Instruction. Practitioners Bookshelf, Language & Literacy Series

ERIC Educational Resources Information Center

Jones, Stephanie; Clarke, Lane; Enriquez, Grace

2009-01-01

This book demonstrates a five-part framework for teachers, reading specialists, and literacy coaches who want to help their least engaged students become powerful readers. Merging theory and practice, the guide offers successful strategies to reach your "struggling" learners. The authors show how you can "turn-around" your instructional practice,…

A Rural School/Community: A Case Study of a Dramatic Turnaround & Its Implications for School Improvement.

ERIC Educational Resources Information Center

Carlson, Robert V.

This paper presents a case study of a rural community exhibiting a dramatic turnaround in community support for a new school bond issue. Demographic change was partly responsible for the change in community attitudes, with two waves of immigration altering the long-term conservative orientation of this community. After a series of failed…

The "City of Firsts" Charts a New Path on Turnaround. Linking State and Local School Improvement

ERIC Educational Resources Information Center

Jochim, Ashley; Opalka, Alice

2017-01-01

In 2014, the Springfield Public School district in Massachusetts had tried just about every strategy in the turnaround playbook to improve a set of struggling middle schools, but these efforts failed to generate the desired improvement. In 2015, drawing inspiration from national efforts to infuse schools with enhanced autonomy and accountability,…

Fiery Passion and Relentless Commitment: The Lived Experiences of African American Women Principals in Turnaround Model Schools

ERIC Educational Resources Information Center

Aldaco, Adrienne L. Gratten

2016-01-01

Chronically low performing schools in the United States have required targeted support and interventions to increase student achievement. In recent years, the school turnaround model has emerged as a swift, dramatic, comprehensive approach to implementing interventions in the lowest performing schools (Calkins, Guenther, Belfiore, & Lash,…

[Increasing Number of Road Traffic Fatalities in Germany - Turnaround or Snap-Shot].

PubMed

Brand, S; Schmucker, U; Lob, G; Haasper, C; Juhra, C; Hell, W; Rieth, P; Matthes, G

2017-04-01

Introduction: For the first time since 20 years, the number of road accident fatalities in 2011 increased on German roads compared to earlier periods. Methods and Results: The presented paper submitted by the expert group for accident prevention investigates and discusses possible reasons for the observed increase in road traffic fatalities. Results: Climate changes as well as changes in economic environment, and technological progress in car and passenger safety are identified as possible reasons for the observed increase. Discussion: Mentioning the "Decade of Action for Road Safety" initiated by the UNO and coordinated by the WHO, the overall goal is a worldwide reduction of accident related road fatalities. But prognostic calculations predict an asymptotic approximation to a limit of road fatalities. To achieve a reduction by half until 2020 intense collaboration and disproportional expenditure are necessary. Conclusion: From the authors' point of view the current increase of traffic fatalities in Germany is rated as a snapshot rather than a turnaround. Georg Thieme Verlag KG Stuttgart · New York.

Artificial Neural Network for Total Laboratory Automation to Improve the Management of Sample Dilution.

PubMed

Ialongo, Cristiano; Pieri, Massimo; Bernardini, Sergio

2017-02-01

Diluting a sample to obtain a measure within the analytical range is a common task in clinical laboratories. However, for urgent samples, it can cause delays in test reporting, which can put patients' safety at risk. The aim of this work is to show a simple artificial neural network that can be used to make it unnecessary to predilute a sample using the information available through the laboratory information system. Particularly, the Multilayer Perceptron neural network built on a data set of 16,106 cardiac troponin I test records produced a correct inference rate of 100% for samples not requiring predilution and 86.2% for those requiring predilution. With respect to the inference reliability, the most relevant inputs were the presence of a cardiac event or surgery and the result of the previous assay. Therefore, such an artificial neural network can be easily implemented into a total automation framework to sensibly reduce the turnaround time of critical orders delayed by the operation required to retrieve, dilute, and retest the sample.

Are Bad Schools Immortal? The Scarcity of Turnarounds and Shutdowns in Both Charter and District Sectors

ERIC Educational Resources Information Center

Stuit, David A.

2010-01-01

This study investigates the successes of the charter and district sectors in eliminating bad schools via dramatic turnarounds in performance and/or shutdowns. It identified 2,025 low-performing charter and district schools across ten states, each of which is home to a sizable number of charter schools. These particular schools were tracked from…

Turnaround Schools: Practices Used by Nationally Recognized Principals to Improve Student Achievement in High Poverty Schools

ERIC Educational Resources Information Center

Brown, Angela Antuanette

2012-01-01

The specific purpose of this study was to identify the practices used by leaders of National Blue Ribbon Awarded Schools to successfully turnaround a school or to maintain proficient achievement scores within the school. The school principals answered a four part questionnaire for this study. Part 1 of the questionnaire asked about the extent to…

Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study.

PubMed

Skodvin, Brita; Aase, Karina; Brekken, Anita Løvås; Charani, Esmita; Lindemann, Paul Christoffer; Smith, Ingrid

2017-09-01

Many countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view. Qualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions. The main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other's area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours. Communication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other's area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Portfolio District Reform Meets School Turnaround: Early Implementation Findings from the Los Angeles Public School Choice Initiative

ERIC Educational Resources Information Center

Marsh, Julie A.; Strunk, Katharine O.; Bush, Susan

2013-01-01

Purpose: Despite the popularity of school "turnaround" and "portfolio district" management as solutions to low performance, there has been limited research on these strategies. The purpose of this paper is to address this gap by exploring the strategic case of Los Angeles Unified School District's Public School Choice…

The Double Bind for Women: Exploring the Gendered Nature of Turnaround Leadership in a Principal Preparation Program

ERIC Educational Resources Information Center

Weiner, Jennie Miles; Burton, Laura J.

2016-01-01

In this study of nine participants in a turnaround principal preparation program, Jennie Miles Weiner and Laura J. Burton explore how gender role identity shaped participants' views of effective principal leadership and their place within it. The authors find that although female and male participants initially framed effective leadership…

Turnaround Policy and Practice: A Case Study of Turning around a Failing School with English-Language-Learners

ERIC Educational Resources Information Center

Reyes, Augustina; Garcia, Andres

2014-01-01

In an era of school reform and high stakes accountability, the major challenge in education is to turnaround the nation's lowest-performing schools. National policy provides abundant resources with often restrictive prerequisites. Research indicates that quality principals and teachers are the most important factors for turning around the lowest…

The SUCCESS model for laboratory performance and execution of rapid molecular diagnostics in patients with sepsis.

PubMed

Dekmezian, Mhair; Beal, Stacy G; Damashek, Mary Jane; Benavides, Raul; Dhiman, Neelam

2015-04-01

Successful performance and execution of rapid diagnostics in a clinical laboratory hinges heavily on careful validation, accurate and timely communication of results, and real-time quality monitoring. Laboratories must develop strategies to integrate diagnostics with stewardship and evidence-based clinical practice guidelines. We present a collaborative SUCCESS model for execution and monitoring of rapid sepsis diagnostics to facilitate timely treatment. Six months after execution of the Verigene Gram-Positive Blood Culture (BC-GP) and the AdvanDx PNA-FISH assays, data were collected on 579 and 28 episodes of bacteremia and fungemia, respectively. Clinical testing was executed using a SUCCESS model comprising the following components: stewardship, utilization of resources, core strategies, concierge services, education, support, and surveillance. Stewardship needs were identified by evaluating the specialty services benefiting from new testing. Utilization of resources was optimized by reviewing current treatment strategies and antibiogram and formulary options. Core strategies consisted of input from infectious disease leadership, pharmacy, and laboratory staff. Concierge services included automated Micro-eUpdate and physician-friendly actionable reports. Education modules were user-specific, and support was provided through a dedicated 24/7 microbiology hotline. Surveillance was performed by daily audit by the director. Using the SUCCESS model, the turnaround time for the detailed report with actionable guidelines to the physician was ∼3 hours from the time of culture positivity. The overall correlation between rapid methods and culture was 94% (546/579). Discrepant results were predominantly contaminants such as a coagulase-negative staphylococci or viridans streptococci in mixed cultures. SUCCESS is a cost-effective and easily adaptable model for clinical laboratories with limited stewardship resources.

Improving Emergency Department radiology transportation time: a successful implementation of lean methodology.

PubMed

Hitti, Eveline A; El-Eid, Ghada R; Tamim, Hani; Saleh, Rana; Saliba, Miriam; Naffaa, Lena

2017-09-05

Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography. We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period. Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value <0.0001). In addition, it was found that 71.6% of patients in the post-intervention had transportation TAT ≤ 10 min, as compared to 32.3% in the pre-intervention period, p-value <0.0001, with narrower interquartile ranges in the post-intervention period. Similarly, the "study processing to preliminary report time" and the length of stay were lower in the post-intervention as compared to the pre-intervention, (52.50 min ± 35.43 versus 54.04 min ± 34.72, p-value = 0.02 and 3.65 h ± 5.17 versus 4.57 h ± 10.43, p < 0.0001, respectively), in spite of an increase in the time it took to elease a preliminary report in the post-intervention period. Using Lean change management

Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town.

PubMed

Jacobsz, Lourens A; Zemlin, Annalise E; Roos, Mark J; Erasmus, Rajiv T

2011-10-14

Recent publications report that up to 70% of total laboratory errors occur in the pre-analytical phase. Identification of specific problems highlights pre-analytic processes susceptible to errors. The rejection of unsuitable samples can lead to delayed turnaround time and affect patient care. A retrospective audit was conducted investigating the rejection rate of routine blood specimens received at chemistry and haematology laboratories over a 2-week period. The reasons for rejection and potential clinical impact of these rejections were investigated. Thirty patient files were randomly selected and examined to assess the impact of these rejections on clinical care. A total of 32,910 specimens were received during the study period, of which 481 were rejected, giving a rejection rate of 1.46%. The main reasons for rejection were inappropriate clotting (30%) and inadequate sample volume (22%). Only 51.7% of rejected samples were repeated and the average time for a repeat sample to reach the laboratory was about 5 days (121 h). Of the repeated samples, 5.1% had results within critical values. Examination of patient folders showed that in 40% of cases the rejection of samples had an impact on patient care. The evaluation of pre-analytical processes in the laboratory, with regard to sample rejection, allowed one to identify problem areas where improvement is necessary. Rejected samples due to factors out of the laboratory's control had a definite impact on patient care and can thus affect customer satisfaction. Clinicians should be aware of these factors to prevent such rejections.

Real-time optical laboratory solution of parabolic differential equations

NASA Technical Reports Server (NTRS)

Casasent, David; Jackson, James

1988-01-01

An optical laboratory matrix-vector processor is used to solve parabolic differential equations (the transient diffusion equation with two space variables and time) by an explicit algorithm. This includes optical matrix-vector nonbase-2 encoded laboratory data, the combination of nonbase-2 and frequency-multiplexed data on such processors, a high-accuracy optical laboratory solution of a partial differential equation, new data partitioning techniques, and a discussion of a multiprocessor optical matrix-vector architecture.

Beyond Turnaround: A Synthesis of Relevant Frameworks for Leaders of Sustained Improvement in Previously Low-Performing Schools

ERIC Educational Resources Information Center

Hitt, Dallas Hambrick; Meyers, Coby V.

2018-01-01

We understand very little about what is special that leaders do to facilitate improvement that is both transformational and lasting in previously persistently failing schools in the United States. Relatively little is understood about change not just during the initial turnaround stage, but that "endures" on the larger journey as the…

Developing Arizona Turnaround Leaders to Build High-Capacity Schools in the Midst of Accountability Pressures and Changing Demographics

ERIC Educational Resources Information Center

Ylimaki, Rose M.; Brunderman, Lynnette; Bennett, Jeffrey V.; Dugan, Thad

2014-01-01

Today's accountability policies and changing demographics have created conditions in which leaders must rapidly build school capacity and improve outcomes in culturally diverse schools. This article presents findings from a mixed-methods evaluation of an Arizona Turnaround Leadership Development Project. The project drew on studies of turnaround…

Prospective evaluation of the VITEK MS for the routine identification of bacteria and yeast in the clinical microbiology laboratory: assessment of accuracy of identification and turnaround time.

PubMed

Charnot-Katsikas, Angella; Tesic, Vera; Boonlayangoor, Sue; Bethel, Cindy; Frank, Karen M

2014-02-01

This study assessed the accuracy of bacterial and yeast identification using the VITEK MS, and the time to reporting of isolates before and after its implementation in routine clinical practice. Three hundred and sixty-two isolates of bacteria and yeast, consisting of a variety of clinical isolates and American Type Culture Collection strains, were tested. Results were compared with reference identifications from the VITEK 2 system and with 16S rRNA sequence analysis. The VITEK MS provided an acceptable identification to species level for 283 (78 %) isolates. Considering organisms for which genus-level identification is acceptable for routine clinical care, 315 isolates (87 %) had an acceptable identification. Six isolates (2 %) were identified incorrectly, five of which were Shigella species. Finally, the time for reporting the identifications was decreased significantly after implementation of the VITEK MS for a total mean reduction in time of 10.52 h (P<0.0001). Overall, accuracy of the VITEK MS was comparable or superior to that from the VITEK 2. The findings were also comparable to other studies examining the accuracy of the VITEK MS, although differences exist, depending on the diversity of species represented as well as on the versions of the databases used. The VITEK MS can be incorporated effectively into routine use in a clinical microbiology laboratory and future expansion of the database should provide improved accuracy for the identification of micro-organisms.

Validation of the Six Sigma Z-score for the quality assessment of clinical laboratory timeliness.

PubMed

Ialongo, Cristiano; Bernardini, Sergio

2018-03-28

The International Federation of Clinical Chemistry and Laboratory Medicine has introduced in recent times the turnaround time (TAT) as mandatory quality indicator for the postanalytical phase. Classic TAT indicators, namely, average, median, 90th percentile and proportion of acceptable test (PAT), are in use since almost 40 years and to date represent the mainstay for gauging the laboratory timeliness. In this study, we investigated the performance of the Six Sigma Z-score, which was previously introduced as a device for the quantitative assessment of timeliness. A numerical simulation was obtained modeling the actual TAT data set using the log-logistic probability density function. Five thousand replicates for each size of the artificial TAT random sample (n=20, 50, 250 and 1000) were generated, and different laboratory conditions were simulated manipulating the PDF in order to generate more or less variable data. The Z-score and the classic TAT indicators were assessed for precision (%CV), robustness toward right-tailing (precision at different sample variability), sensitivity and specificity. Z-score showed sensitivity and specificity comparable to PAT (≈80% with n≥250), but superior precision that ranged within 20% by moderately small sized samples (n≥50); furthermore, Z-score was less affected by the value of the cutoff used for setting the acceptable TAT, as well as by the sample variability that reflected into the magnitude of right-tailing. The Z-score was a valid indicator of laboratory timeliness and a suitable device to improve as well as to maintain the achieved quality level.

Pathology economic model tool: a novel approach to workflow and budget cost analysis in an anatomic pathology laboratory.

PubMed

Muirhead, David; Aoun, Patricia; Powell, Michael; Juncker, Flemming; Mollerup, Jens

2010-08-01

The need for higher efficiency, maximum quality, and faster turnaround time is a continuous focus for anatomic pathology laboratories and drives changes in work scheduling, instrumentation, and management control systems. To determine the costs of generating routine, special, and immunohistochemical microscopic slides in a large, academic anatomic pathology laboratory using a top-down approach. The Pathology Economic Model Tool was used to analyze workflow processes at The Nebraska Medical Center's anatomic pathology laboratory. Data from the analysis were used to generate complete cost estimates, which included not only materials, consumables, and instrumentation but also specific labor and overhead components for each of the laboratory's subareas. The cost data generated by the Pathology Economic Model Tool were compared with the cost estimates generated using relative value units. Despite the use of automated systems for different processes, the workflow in the laboratory was found to be relatively labor intensive. The effect of labor and overhead on per-slide costs was significantly underestimated by traditional relative-value unit calculations when compared with the Pathology Economic Model Tool. Specific workflow defects with significant contributions to the cost per slide were identified. The cost of providing routine, special, and immunohistochemical slides may be significantly underestimated by traditional methods that rely on relative value units. Furthermore, a comprehensive analysis may identify specific workflow processes requiring improvement.

Does bacteriology laboratory automation reduce time to results and increase quality management?

PubMed

Dauwalder, O; Landrieve, L; Laurent, F; de Montclos, M; Vandenesch, F; Lina, G

2016-03-01

Due to reductions in financial and human resources, many microbiological laboratories have merged to build very large clinical microbiology laboratories, which allow the use of fully automated laboratory instruments. For clinical chemistry and haematology, automation has reduced the time to results and improved the management of laboratory quality. The aim of this review was to examine whether fully automated laboratory instruments for microbiology can reduce time to results and impact quality management. This study focused on solutions that are currently available, including the BD Kiestra™ Work Cell Automation and Total Lab Automation and the Copan WASPLab(®). Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Real-Time Internet Mediated Laboratory Experiments for Distance Education Students.

ERIC Educational Resources Information Center

Lemckert, Charles; Florance, John

2002-01-01

Discusses the demand for distance education opportunities in engineering and science and considers delivery methods for theoretical content and for laboratory work. Explains the Real-Time Internet Mediated Laboratory Experiments (RTIMLE) that use the World Wide Web, and suggests that RTIMLE may be most appropriate for students who already have…

A real-time dashboard for managing pathology processes.

PubMed

Halwani, Fawaz; Li, Wei Chen; Banerjee, Diponkar; Lessard, Lysanne; Amyot, Daniel; Michalowski, Wojtek; Giffen, Randy

2016-01-01

The Eastern Ontario Regional Laboratory Association (EORLA) is a newly established association of all the laboratory and pathology departments of Eastern Ontario that currently includes facilities from eight hospitals. All surgical specimens for EORLA are processed in one central location, the Department of Pathology and Laboratory Medicine (DPLM) at The Ottawa Hospital (TOH), where the rapid growth and influx of surgical and cytology specimens has created many challenges in ensuring the timely processing of cases and reports. Although the entire process is maintained and tracked in a clinical information system, this system lacks pre-emptive warnings that can help management address issues as they arise. Dashboard technology provides automated, real-time visual clues that could be used to alert management when a case or specimen is not being processed within predefined time frames. We describe the development of a dashboard helping pathology clinical management to make informed decisions on specimen allocation and tracking. The dashboard was designed and developed in two phases, following a prototyping approach. The first prototype of the dashboard helped monitor and manage pathology processes at the DPLM. The use of this dashboard helped to uncover operational inefficiencies and contributed to an improvement of turn-around time within The Ottawa Hospital's DPML. It also allowed the discovery of additional requirements, leading to a second prototype that provides finer-grained, real-time information about individual cases and specimens. We successfully developed a dashboard that enables managers to address delays and bottlenecks in specimen allocation and tracking. This support ensures that pathology reports are provided within time frame standards required for high-quality patient care. Given the importance of rapid diagnostics for a number of diseases, the use of real-time dashboards within pathology departments could contribute to improving the quality of

A real-time dashboard for managing pathology processes

PubMed Central

Halwani, Fawaz; Li, Wei Chen; Banerjee, Diponkar; Lessard, Lysanne; Amyot, Daniel; Michalowski, Wojtek; Giffen, Randy

2016-01-01

Context: The Eastern Ontario Regional Laboratory Association (EORLA) is a newly established association of all the laboratory and pathology departments of Eastern Ontario that currently includes facilities from eight hospitals. All surgical specimens for EORLA are processed in one central location, the Department of Pathology and Laboratory Medicine (DPLM) at The Ottawa Hospital (TOH), where the rapid growth and influx of surgical and cytology specimens has created many challenges in ensuring the timely processing of cases and reports. Although the entire process is maintained and tracked in a clinical information system, this system lacks pre-emptive warnings that can help management address issues as they arise. Aims: Dashboard technology provides automated, real-time visual clues that could be used to alert management when a case or specimen is not being processed within predefined time frames. We describe the development of a dashboard helping pathology clinical management to make informed decisions on specimen allocation and tracking. Methods: The dashboard was designed and developed in two phases, following a prototyping approach. The first prototype of the dashboard helped monitor and manage pathology processes at the DPLM. Results: The use of this dashboard helped to uncover operational inefficiencies and contributed to an improvement of turn-around time within The Ottawa Hospital's DPML. It also allowed the discovery of additional requirements, leading to a second prototype that provides finer-grained, real-time information about individual cases and specimens. Conclusion: We successfully developed a dashboard that enables managers to address delays and bottlenecks in specimen allocation and tracking. This support ensures that pathology reports are provided within time frame standards required for high-quality patient care. Given the importance of rapid diagnostics for a number of diseases, the use of real-time dashboards within pathology departments could

SpeedyTime_7-Minus_Eighty_Degrees_Laboratory_Freezer_for_ ISS

NASA Image and Video Library

2017-08-23

SpeedyTime 7 – Minus Eighty Degrees Laboratory Freezer for ISS Cutting-edge science is on the daily menu on board the International Space Station, but where do the astronauts store their lab results before they’re shipped back to Earth? In one of a dozen large freezers, of course: in this SpeedyTime segment, Expedition 52 flight engineer Jack Fischer shines a light on the MELFI, Minus Eighty Degrees Laboratory Freezer for ISS. _______________________________________ FOLLOW THE SPACE STATION! Twitter: https://twitter.com/Space_Station Facebook: https://www.facebook.com/ISS Instagram: https://instagram.com/iss/

Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia.

PubMed

Mesfin, Eyob Abera; Taye, Binyam; Belay, Getachew; Ashenafi, Aytenew; Girma, Veronica

2017-10-01

Quality laboratory service is an essential component of health care system but in Sub-Saharan Africa such as Ethiopia, laboratories quality system remains weak due to several factors and it needs more attention to strengthen its capacity and quality system. A cross sectional study was conducted using a questionnaire to assess factors affecting the quality of laboratory service at private and public health institutions in Addis Ababa. A total of 213 laboratory professionals participated in the study and 131 (61.5%) participants had bachelor degree. Majority, 133 (62.4%), of the professionals did not attend any work related training. Seventy five (35.2%) respondents believed that their laboratories did not provide quality laboratory services and the major reported factors affecting provision of quality services were shortage of resources (64.3%), poor management support (57.3%), poor equipment quality (53.4%), high workload (41.1%), lack of equipment calibration (38.3%) and lack of knowledge (23.3%). Moreover logistic regression analysis showed that provision of quality laboratory service was significantly associated with result verification (AOR=9.21, 95% CI=2.26, 37.48), internal quality control (AOR= 6.11, 95% CI=2.11, 17.70), turnaround time (AOR=5.11, 95% CI=1.94, 13.46), shortage of equipment (AOR=7.76, 95% CI=2.55, 23.66), communication with clinicians (AOR=3.24, 95% CI=1.25, 8.41) and lack of job description (AOR=3.67, 95% CI=1.319, 10.22). In conclusion, the major factors that affecting the quality of laboratory service were associated with poor human resource management, poor resources provision, poor management commitment, ineffective communication system and lack of well-established quality management system.

Real-Time, Sensor-Based Computing in the Laboratory.

ERIC Educational Resources Information Center

Badmus, O. O.; And Others

1996-01-01

Demonstrates the importance of Real-Time, Sensor-Based (RTSB) computing and how it can be easily and effectively integrated into university student laboratories. Describes the experimental processes, the process instrumentation and process-computer interface, the computer and communications systems, and typical software. Provides much technical…

A Case Study of a Turnaround High School: An Examination of the Maryland State Department of Education Breakthrough Center Intervention

ERIC Educational Resources Information Center

Galindo, Claudia; Stein, Kathleen; Schaffer, Eugene

2016-01-01

This study examined the Maryland State Department of Education Breakthrough Center (BTC) engagement in a Baltimore City turnaround high school. Utilizing a case-study design and mixed-methods research, data were collected through interviews, informal observations, and review of administrative and achievement documents. Beginning in the 2011-2012…

Do laboratories follow heart failure recommendations and guidelines and did we improve? The CARdiac MArker Guideline Uptake in Europe (CARMAGUE).

PubMed

Hammerer-Lercher, Angelika; Collinson, Paul; van Dieijen-Visser, Marja P; Pulkki, Kari; Suvisaari, Janne; Ravkilde, Jan; Stavljenic-Rukavina, Ana; Baum, Hannsjörg; Laitinen, Päivi

2013-06-01

Natriuretic peptides (NP) are well-established markers of heart failure (HF). During the past 5 years, analytical and clinical recommendations for measurement of these biomarkers have been published in guidelines. The aim of this follow-up survey was to investigate how well these guidelines for measurement of NP have been implemented in laboratory practice in Europe. Member societies of the European Federation of Clinical Chemistry and Laboratory Medicine were invited in 2009 to participate in a web-based audit questionnaire. The questionnaire requested information on type of tests performed, decision limits for HF, turn-around time and frequency of testing. There was a moderate increase (12%) of laboratories measuring NP compared to the initial survey in 2006. The most frequently used HF decision limits for B-type NP (BNP) and N-terminal BNP (NT-proBNP) were, respectively, 100 ng/L and 125 ng/L, derived from the package inserts in 55%. Fifty laboratories used a second decision limit. Age or gender dependent decision limits were applied in 10% (8.5% in 2006). The vast majority of laboratories (80%) did not have any criteria regarding frequency of testing, compared to 33% in 2006. The implementation of NP measurement for HF management was a slow process between 2006 and 2009 at a time when guidelines had just been established. The decision limits were derived from package insert information and literature. There was great uncertainty concerning frequency of testing which may reflect the debate about the biological variability which was not published for most of the assays in 2009.

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership

PubMed Central

Kebede, Yenew; Fonjungo, Peter N.; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N.; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-01-01

Background. Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)–US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). Methods. In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. Results. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2–14 days) to 2 days (range, 1–3 days) in Addis Ababa and from 10 days (range, 6–21 days) to 5 days (range, 2–6 days) in Amhara Region. Conclusions. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. PMID:27025700

External quality assessment of national public health laboratories in Africa, 2002–2009

PubMed Central

Perovic, Olga; Fensham, Vivian; McCarthy, Kerrigan; von Gottberg, Anne; de Gouveia, Linda; Poonsamy, Bhavani; Dini, Leigh; Rossouw, Jenny; Keddy, Karen; Alemu, Wondimagegnehu; Yahaya, Ali; Pierson, Antoine; Dolmazon, Virginie; Cognat, Sébastien; Ndihokubwayo, Jean Bosco

2012-01-01

Abstract Objective To describe findings from an external quality assessment programme involving laboratories in Africa that routinely investigate epidemic-prone diseases. Methods Beginning in 2002, the Regional Office for Africa of the World Health Organization (WHO) invited national public health laboratories and related facilities in Africa to participate in the programme. Three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria were sent annually to test participants’ diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. Materials were prepared, packaged and shipped in accordance with standard protocols. Findings and reports were due within 30 days. Key methodological decisions and test results were categorized as acceptable or unacceptable on the basis of consensus feedback from referees, using established grading schemes. Findings Between 2002 and 2009, participation increased from 30 to 48 Member States of the WHO and from 39 to 78 laboratories. Each survey was returned by 64–93% of participants. Mean turnaround time was 25.9 days. For bacterial enteric diseases and meningitis components, bacterial identification was acceptable in 65% and 69% of challenges, respectively, but serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73% of plague challenges. Tuberculosis microscopy was satisfactorily performed, with 87% of responses receiving acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable. Conclusion The external quality assessment programme consistently identified certain functional deficiencies requiring strengthening that were present in African public health microbiology laboratories. PMID:22461714

Surgical pathology extradepartmental consultation practices.

PubMed

Azam, Muhammad; Nakhleh, Raouf E

2002-04-01

To document the practice parameters and case characteristics associated with personal (expert) consultations. We also examine the value, level of participant (customer) satisfaction, turnaround time, and rate of personal consultations. We asked participants in the College of American Pathologists' Q-Probes program to document cases sent for consultation during 4 months or up to 20 cases. They documented patient and specimen characteristics, the turnaround times, and the participants' levels of satisfaction with the consultation experience. One hundred eighty laboratories/surgical pathology practices. One hundred seventy-two (95.6%) were from the United States; the remainder were located in Canada and Australia. Rate and turnaround time of consultations and participant level of satisfaction. A total of 2746 consultation cases were examined for an aggregate consultation rate of 0.5% (median, 0.7%). Institutions with a higher occupied bed size and a greater number of surgical pathology cases both had lower consultation rates (P < or =.05). The median turnaround time (defined as the interval from the date on which the case was sent to the date on which the diagnosis was received) was 6 days. Twenty-nine percent and 68% of cases had a turnaround time within 3 and 7 days, respectively. Fifty-two percent of cases were sent to nationally known experts, and 32% were sent to local experts. Skin (18.0%), hematolymphoid (11.6%), and breast (9.6%) specimens were most commonly sent for consultation. In 70.5% of cases, the consultant confirmed the referring pathologist's original diagnosis, but in 15.9% of cases, the consultant also added significant information. Satisfaction rates were higher with faster turnaround times and verbal reporting. Satisfaction rates were lower for cases in which the patient or the clinician requested the consultation and in which the consultant's diagnosis was ambiguous. This study establishes a multi-institutional consultation rate of 0.5%, defines

Designing an autoverification system in Zagazig University Hospitals Laboratories: preliminary evaluation on thyroid function profile.

PubMed

Sediq, Amany Mohy-Eldin; Abdel-Azeez, Ahmad GabAllahm Hala

2014-01-01

The current practice in Zagazig University Hospitals Laboratories (ZUHL) is manual verification of all results for the later release of reports. These processes are time consuming and tedious, with large inter-individual variation that slows the turnaround time (TAT). Autoverification is the process of comparing patient results, generated from interfaced instruments, against laboratory-defined acceptance parameters. This study describes an autoverification engine designed and implemented in ZUHL, Egypt. A descriptive study conducted at ZUHL, from January 2012-December 2013. A rule-based system was used in designing an autoverification engine. The engine was preliminarily evaluated on a thyroid function panel. A total of 563 rules were written and tested on 563 simulated cases and 1673 archived cases. The engine decisions were compared to that of 4 independent expert reviewers. The impact of engine implementation on TAT was evaluated. Agreement was achieved among the 4 reviewers in 55.5% of cases, and with the engine in 51.5% of cases. The autoverification rate for archived cases was 63.8%. Reported lab TAT was reduced by 34.9%, and TAT segment from the completion of analysis to verification was reduced by 61.8%. The developed rule-based autoverification system has a verification rate comparable to that of the commercially available software. However, the in-house development of this system had saved the hospital the cost of commercially available ones. The implementation of the system shortened the TAT and minimized the number of samples that needed staff revision, which enabled laboratory staff to devote more time and effort to handle problematic test results and to improve patient care quality.

Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making?

PubMed

Florkowski, Christopher; Don-Wauchope, Andrew; Gimenez, Nuria; Rodriguez-Capote, Karina; Wils, Julien; Zemlin, Annalise

Point-of-care testing (POCT) is the analysis of patient specimens outside the clinical laboratory, near or at the site of patient care, usually performed by clinical staff without laboratory training, although it also encompasses patient self-monitoring. It is able to provide a rapid result near the patient and which can be acted upon immediately. The key driver is the concept that clinical decision making may be delayed when samples are sent to the clinical laboratory. Balanced against this are considerations of increased costs for purchase and maintenance of equipment, staff training, connectivity to the laboratory information system (LIS), quality control (QC) and external quality assurance (EQA) procedures, all required for accreditation under ISO 22870. The justification for POCT depends upon being able to demonstrate that a more timely result (shorter turnaround times (TATs)) is able to leverage a clinically important advantage in decision making compared with the central laboratory (CL). In the four decades since POCT was adapted for the self-monitoring of blood glucose levels by subjects with diabetes, numerous new POCT methodologies have become available, enabling the clinician to receive results and initiate treatment more rapidly. However, these instruments are often operated by staff not trained in laboratory medicine and hence are prone to errors in the analytical phase (as opposed to laboratory testing where the analytical phase has the least errors). In some environments, particularly remote rural settings, the CL may be at a considerable distance and timely availability of cardiac troponins and other analytes can triage referrals to the main centers, thus avoiding expensive unnecessary patient transportation costs. However, in the Emergency Department, availability of more rapid results with POCT does not always translate into shorter stays due to other barriers to implementation of care. In this review, we apply the principles of evidence

School Improvement and Urban Renewal: The Impact of a Turnaround School's Performance on Real Property Values in Its Surrounding Community

ERIC Educational Resources Information Center

Jacobson, Stephen L.; Szczesek, Jill

2013-01-01

This study investigates the economic impact of a "turnaround" school on real property values in its surrounding community as related to the argument introduced by Tiebout in 1956 correlating local public goods, in this case school success, to housing-location decision making. Using single-family home sales found on the Multiple Listing System and…

Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia

PubMed Central

Taye, Binyam; Belay, Getachew; Ashenafi, Aytenew; Girma, Veronica

2017-01-01

Background Quality laboratory service is an essential component of health care system but in Sub-Saharan Africa such as Ethiopia, laboratories quality system remains weak due to several factors and it needs more attention to strengthen its capacity and quality system. Methodology A cross sectional study was conducted using a questionnaire to assess factors affecting the quality of laboratory service at private and public health institutions in Addis Ababa. Results A total of 213 laboratory professionals participated in the study and 131 (61.5%) participants had bachelor degree. Majority, 133 (62.4%), of the professionals did not attend any work related training. Seventy five (35.2%) respondents believed that their laboratories did not provide quality laboratory services and the major reported factors affecting provision of quality services were shortage of resources (64.3%), poor management support (57.3%), poor equipment quality (53.4%), high workload (41.1%), lack of equipment calibration (38.3%) and lack of knowledge (23.3%). Moreover logistic regression analysis showed that provision of quality laboratory service was significantly associated with result verification (AOR=9.21, 95% CI=2.26, 37.48), internal quality control (AOR= 6.11, 95% CI=2.11, 17.70), turnaround time (AOR=5.11, 95% CI=1.94, 13.46), shortage of equipment (AOR=7.76, 95% CI=2.55, 23.66), communication with clinicians (AOR=3.24, 95% CI=1.25, 8.41) and lack of job description (AOR=3.67, 95% CI=1.319, 10.22). Conclusion In conclusion, the major factors that affecting the quality of laboratory service were associated with poor human resource management, poor resources provision, poor management commitment, ineffective communication system and lack of well-established quality management system. PMID:29075171

The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments.

PubMed

Austin, Jodie A; Smith, Ian R; Tariq, Amina

2018-01-22

Closed-loop electronic medication management systems (EMMS) are recognised as an effective intervention to improve medication safety, yet evidence of their effectiveness in hospitals is limited. Few studies have compared medication turnaround time for a closed-loop electronic versus paper-based medication management environment. To compare medication turnaround times in a paper-based hospital environment with a digital hospital equipped with a closed-loop EMMS, consisting of computerised physician order entry, profiled automated dispensing cabinets packaged with unit dose medications and barcode medication administration. Data were collected during 2 weeks at three private hospital sites (one with closed-loop EMMS) within the same organisation network in Queensland, Australia. Time between scheduled and actual administration times was analysed for first dose of time-critical and non-critical medications located on the ward or sourced via pharmacy. Medication turnaround times at the EMMS site were less compared to the paper-based sites (median, IQR: 35 min, 8-57 min versus 120 min, 30-180 min, P < 0.001). For time-critical medications, 77% were administered within 60 min of scheduled time at the EMMS site versus 38% for the paper-based sites. Similar difference was observed for non-critical medications, 80% were administered within 60 min of their scheduled time at the EMMS site versus 41% at the paper-based facilities. The study indicates medication turnaround times utilising a closed-loop EMMS are less compared to paper-based systems. This improvement may be attributable to increased accessibility of medications using automated dispensing cabinets and electronic medication administration records flagging tasks to nurses in real time. © 2018 Royal Pharmaceutical Society.

The radiology digital dashboard: effects on report turnaround time.

PubMed

Morgan, Matthew B; Branstetter, Barton F; Lionetti, David M; Richardson, Jeremy S; Chang, Paul J

2008-03-01

As radiology departments transition to near-complete digital information management, work flows and their supporting informatics infrastructure are becoming increasingly complex. Digital dashboards can integrate separate computerized information systems and summarize key work flow metrics in real time to facilitate informed decision making. A PACS-integrated digital dashboard function designed to alert radiologists to their unsigned report queue status, coupled with an actionable link to the report signing application, resulted in a 24% reduction in the time between transcription and report finalization. The dashboard was well received by radiologists who reported high usage for signing reports. Further research is needed to identify and evaluate other potentially useful work flow metrics for inclusion in a radiology clinical dashboard.

Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011.

PubMed

Meier, Frederick A; Souers, Rhona J; Howanitz, Peter J; Tworek, Joseph A; Perrotta, Peter L; Nakhleh, Raouf E; Karcher, Donald S; Bashleben, Christine; Darcy, Teresa P; Schifman, Ron B; Jones, Bruce A

2015-06-01

Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring. To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors. Subscribers measured monthly rates of outpatient order-entry errors, identification band defects, and specimen rejections; median troponin order-to-report cycle times and rates of STAT test receipt-to-report turnaround time outliers; and critical values reporting event defects, and corrected reports. From these submissions Q-Tracks program staff produced quarterly and annual reports. These charted each subscriber's performance relative to other participating laboratories and aggregate and subgroup performance over time, dividing participants into best and median performers and performers with the most room to improve. Each monitor's patterns of change present percentile distributions of subscribers' performance in relation to monitoring durations and numbers of participating subscribers. Changes over time in defect frequencies and the cycle duration quantify effects on performance of monitor participation. All monitors showed significant decreases in defect rates as the 7 monitors ran variously for 6, 6, 7, 11, 12, 13, and 13 years. The most striking decreases occurred among performers who initially had the most room to improve and among subscribers who participated the longest. All 7 monitors registered significant improvement. Participation effects improved between 0.85% and 5.1% per quarter of participation. Using statistical quality measures, collecting data monthly, and receiving reports quarterly and yearly, subscribers to a comparative monitoring program documented significant decreases in defect rates and shortening of a cycle time for 6 to 13 years in all 7 ongoing

The Fiftieth Anniversary of Brookhaven National Laboratory: A Turbulent Time

NASA Astrophysics Data System (ADS)

Bond, Peter D.

2018-03-01

The fiftieth anniversary year of Brookhaven National Laboratory was momentous, but for reasons other than celebrating its scientific accomplishments. Legacy environmental contamination, community unrest, politics, and internal Department of Energy issues dominated the year. It was the early days of perhaps the most turbulent time in the lab's history. The consequences resulted in significant changes at the lab, but in addition they brought a change to contracts to manage the Department of Energy laboratories.

The Fiftieth Anniversary of Brookhaven National Laboratory: A Turbulent Time

NASA Astrophysics Data System (ADS)

Bond, Peter D.

2018-06-01

The fiftieth anniversary year of Brookhaven National Laboratory was momentous, but for reasons other than celebrating its scientific accomplishments. Legacy environmental contamination, community unrest, politics, and internal Department of Energy issues dominated the year. It was the early days of perhaps the most turbulent time in the lab's history. The consequences resulted in significant changes at the lab, but in addition they brought a change to contracts to manage the Department of Energy laboratories.

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership.

PubMed

Kebede, Yenew; Fonjungo, Peter N; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-04-15

Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)-US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2-14 days) to 2 days (range, 1-3 days) in Addis Ababa and from 10 days (range, 6-21 days) to 5 days (range, 2-6 days) in Amhara Region. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The Fulton County Medical Examiner's experience with the Federal Bureau of Investigation National Missing Person DNA Database Program, 2004-2007.

PubMed

Heninger, Michael; Hanzlick, Randy

2011-03-01

Medical examiners and coroners occasionally encounter unidentified human bodies, which remain unidentified for extended periods. In such cases, when traditional methods of identification have failed or cannot be used, DNA profiling may be used. The Federal Bureau of Investigation has a National Missing Person DNA database (NMPDD) laboratory to which samples may be submitted on such cases and from possible relatives or environments of unidentified decedents. This article describes the experience of the Fulton County Medical Examiner (FCME) in submitting samples to the NMPDD laboratory. A database was established at the FCME to track the submission of samples from unidentified decedents to the NMPDD laboratory for DNA testing along with the results and turnaround times. In December 2004, the FCME inventoried all cases for which samples were available and began to submit them to the NMPDD laboratory for testing. DNA testing and isolation rates, sample type, and turnaround times were tabulated in October 2006 for samples submitted between December 16, 2004 and December 16, 2005. An overall summary of data was also prepared concerning the status of all samples submitted as of April 17, 2007. During the 1-year study period, samples from 77 unidentified decedents were submitted to the laboratory. As of October 2006 (22 months after submission of the first samples and 10 months after submission of the last samples), testing had been completed on 53% of the samples submitted, and 68% of those tested resulted in a mitochondrial DNA profile. Turnaround times ranged from 66 to 557 days, improved with time, and had a mean of 107 days for specimens submitted during the latter part of the study period. As of April 17, 2007, we had submitted samples involving 84 unidentified decedents. Seventy-five percent of the samples have now been tested. Data from the NMPDD laboratory have resulted in 4 identifications by comparison with putative relatives, 4 exclusions, and no cold hits

Novel molecular diagnostic tools for malaria elimination: a review of options from the point of view of high-throughput and applicability in resource limited settings.

PubMed

Britton, Sumudu; Cheng, Qin; McCarthy, James S

2016-02-16

As malaria transmission continues to decrease, an increasing number of countries will enter pre-elimination and elimination. To interrupt transmission, changes in control strategies are likely to require more accurate identification of all carriers of Plasmodium parasites, both symptomatic and asymptomatic, using diagnostic tools that are highly sensitive, high throughput and with fast turnaround times preferably performed in local health service settings. Currently available immunochromatographic lateral flow rapid diagnostic tests and field microscopy are unlikely to consistently detect infections at parasite densities less than 100 parasites/µL making them insufficiently sensitive for detecting all carriers. Molecular diagnostic platforms, such as PCR and LAMP, are currently available in reference laboratories, but at a cost both financially and in turnaround time. This review describes the recent progress in developing molecular diagnostic tools in terms of their capacity for high throughput and potential for performance in non-reference laboratories for malaria elimination.

Evaluation of Massachusetts Office of District and School Turnaround Assistance to Commissioner's Districts and Schools: Impact of School Redesign Grants

ERIC Educational Resources Information Center

LiCalsi, Christina; Citkowicz, Martyna; Friedman, Lawrence B.; Brown, Megan

2015-01-01

The Massachusetts Office of District and School Turnaround (ODST) assists the Commissioner's Districts (the 10 largest districts in the state) and schools within those districts. The assistance focuses on turning around the lowest performing schools in the district while building district capacity to support improvement in other district schools.…

Real-time laboratory exercises to test contingency plans for classical swine fever: experiences from two national laboratories.

PubMed

Koenen, F; Uttenthal, A; Meindl-Böhmer, A

2007-12-01

In order to adequately and efficiently handle outbreaks of contagious diseases such as classical swine fever (CSF), foot and mouth disease or highly pathogenic avian influenza, competent authorities and the laboratories involved have to be well prepared and must be in possession of functioning contingency plans. These plans should ensure that in the event of an outbreak access to facilities, equipment, resources, trained personnel, and all other facilities needed for the rapid and efficient eradication of the outbreak is guaranteed, and that the procedures to follow are well rehearsed. It is essential that these plans are established during 'peace-time' and are reviewed regularly. This paper provides suggestions on how to perform laboratory exercises to test preparedness and describes the experiences of two national reference laboratories for CSF. The major lesson learnt was the importance of a well-documented laboratory contingency plan. The major pitfalls encountered were shortage of space, difficulties in guaranteeing biosecurity and sufficient supplies of sterile equipment and consumables. The need for a standardised laboratory information management system, that is used by all those involved in order to reduce the administrative load, is also discussed.

Real-Time PCR in Clinical Microbiology: Applications for Routine Laboratory Testing

PubMed Central

Espy, M. J.; Uhl, J. R.; Sloan, L. M.; Buckwalter, S. P.; Jones, M. F.; Vetter, E. A.; Yao, J. D. C.; Wengenack, N. L.; Rosenblatt, J. E.; Cockerill, F. R.; Smith, T. F.

2006-01-01

Real-time PCR has revolutionized the way clinical microbiology laboratories diagnose many human microbial infections. This testing method combines PCR chemistry with fluorescent probe detection of amplified product in the same reaction vessel. In general, both PCR and amplified product detection are completed in an hour or less, which is considerably faster than conventional PCR detection methods. Real-time PCR assays provide sensitivity and specificity equivalent to that of conventional PCR combined with Southern blot analysis, and since amplification and detection steps are performed in the same closed vessel, the risk of releasing amplified nucleic acids into the environment is negligible. The combination of excellent sensitivity and specificity, low contamination risk, and speed has made real-time PCR technology an appealing alternative to culture- or immunoassay-based testing methods for diagnosing many infectious diseases. This review focuses on the application of real-time PCR in the clinical microbiology laboratory. PMID:16418529

Use of a United States-based laboratory as a hematopathology reference center for a developing country: logistics and results.

PubMed

Deetz, C O; Scott, M G; Ladenson, J H; Seyoum, M; Hassan, A; Kreisel, F H; Nguyen, T T; Frater, J L

2013-02-01

With proper logistical support and sponsorship, a laboratory in an industrialized nation might be able to act as a reference laboratory for clinicians based in a developing country. We built on previous experience in the clinical laboratory to see whether a specialized histopathology service (hematopathology) could be provided to a developing country without the expertise or experience to do it in country. Over an 13-year period, 582 cases from 579 individuals were analyzed. Principal pathologic findings included acute leukemia in 84 cases (14%), dyspoiesis in one or more of the hematopoietic lineages in 65 cases (11%, including three cases with high-grade myelodysplasia), 23 cases (4%) with findings suspicious for a chronic myeloproliferative disorder, 35 cases (6%) with findings suspicious for a lymphoproliferative disorder, and infectious organisms (presumably Leishmania in most instances) in 9 (1%) of cases. Specimens from 45 cases (8%) were unsatisfactory owing to extreme hemodilution and/or specimen degeneration. With proper support, a medical laboratory in an industrialized nation may serve as a reference facility for a developing nation. The use of existing infrastructure may be remarkably effective to achieve optimal turnaround time. Although the lack of ancillary studies and follow-up biopsies limit the ability to achieve a definitive diagnosis in many cases, this must be viewed in the context of the limited ability to diagnose or manage hematopoietic neoplasia in developing nations. © 2012 Blackwell Publishing Ltd.

On the turnaround of stratospheric ozone trends deduced from the reevaluated Umkehr record of Arosa, Switzerland

NASA Astrophysics Data System (ADS)

Zanis, P.; Maillard, E.; Staehelin, J.; Zerefos, C.; Kosmidis, E.; Tourpali, K.; Wohltmann, I.

2006-11-01

In this work, we investigate the issue of the turnaround in ozone trends of the recently homogenized Umkehr ozone record of Arosa, Switzerland, which is the longest Umkehr data set, extending from 1956 to date, using different statistical methods. All methods show statistically significant negative ozone trends from 1970 to 1995 in the upper stratosphere (above 32.6 km) throughout the course of the year as well as in the lower stratosphere (below 23.5 km) mainly during winter to spring, which can be partially attributed to dynamical changes. Over the recent period (1996-2004) the year-round trends in the lower stratosphere become positive and are more positive during the winter to spring period. The results also show changes in upper stratospheric ozone trends after 1996, which are, however, not statistically significant at 95% if aerosol correction is applied on the retrieved data. This lack of significant trend changes during the recent period in the upper stratosphere is regionally coherent with recent results derived from upper stratospheric ozone data recorded by lidars, microwave radiometers, and satellite instruments at an adjacent location. Although the positive change in trends after 1996 both for upper and lower stratospheric ozone is in line with the reduction of the emissions of ozone-depleting substances from the successful implementation of the Montreal Protocol and its amendments, we recommend, because of lack of significance for the upper stratospheric trends, repeating this analysis in a few years in order to overcome ambiguous results for documentation of the turnaround of upper stratospheric ozone.

Errors in laboratory medicine: practical lessons to improve patient safety.

PubMed

Howanitz, Peter J

2005-10-01

Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

Under soggy skies on a Sunday morning, the Space Shuttle Endeavour is encased in the Mate-DeMate gantry during turnaround processing at NASA DFRC

NASA Image and Video Library

2008-12-07

Under soggy skies on a Sunday morning, the Space Shuttle Endeavour is encased in the Mate-DeMate gantry during turnaround processing at NASA's Dryden Flight Research Center following its STS-126 landing at Edwards Air Force Base a week earlier.

Inter-laboratory agreement on embryo classification and clinical decision: Conventional morphological assessment vs. time lapse.

PubMed

Martínez-Granados, Luis; Serrano, María; González-Utor, Antonio; Ortíz, Nereyda; Badajoz, Vicente; Olaya, Enrique; Prados, Nicolás; Boada, Montse; Castilla, Jose A

2017-01-01

The aim of this study is to determine inter-laboratory variability on embryo assessment using time-lapse platform and conventional morphological assessment. This study compares the data obtained from a pilot study of external quality control (EQC) of time lapse, performed in 2014, with the classical EQC of the Spanish Society for the Study of Reproductive Biology (ASEBIR) performed in 2013 and 2014. In total, 24 laboratories (8 using EmbryoScope™, 15 using Primo Vision™ and one with both platforms) took part in the pilot study. The clinics that used EmbryoScope™ analysed 31 embryos and those using Primo Vision™ analysed 35. The classical EQC was implemented by 39 clinics, based on an analysis of 25 embryos per year. Both groups were required to evaluate various qualitative morphological variables (cell fragmentation, the presence of vacuoles, blastomere asymmetry and multinucleation), to classify the embryos in accordance with ASEBIR criteria and to stipulate the clinical decision taken. In the EQC time-lapse pilot study, the groups were asked to determine, as well as the above characteristics, the embryo development times, the number, opposition and size of pronuclei, the direct division of 1 into 3 cells and/or of 3 into 5 cells and false divisions. The degree of agreement was determined by calculating the intra-class correlation coefficients and the coefficient of variation for the quantitative variables and the Gwet index for the qualitative variables. For both EmbryoScope™ and Primo Vision™, two periods of greater inter-laboratory variability were observed in the times of embryo development events. One peak of variability was recorded among the laboratories addressing the first embryo events (extrusion of the second polar body and the appearance of pronuclei); the second peak took place between the times corresponding to the 8-cell and morula stages. In most of the qualitative variables analysed regarding embryo development, there was almost

Inter-laboratory agreement on embryo classification and clinical decision: Conventional morphological assessment vs. time lapse

PubMed Central

Serrano, María; González-Utor, Antonio; Ortíz, Nereyda; Badajoz, Vicente; Olaya, Enrique; Prados, Nicolás; Boada, Montse; Castilla, Jose A.

2017-01-01

The aim of this study is to determine inter-laboratory variability on embryo assessment using time-lapse platform and conventional morphological assessment. This study compares the data obtained from a pilot study of external quality control (EQC) of time lapse, performed in 2014, with the classical EQC of the Spanish Society for the Study of Reproductive Biology (ASEBIR) performed in 2013 and 2014. In total, 24 laboratories (8 using EmbryoScope™, 15 using Primo Vision™ and one with both platforms) took part in the pilot study. The clinics that used EmbryoScope™ analysed 31 embryos and those using Primo Vision™ analysed 35. The classical EQC was implemented by 39 clinics, based on an analysis of 25 embryos per year. Both groups were required to evaluate various qualitative morphological variables (cell fragmentation, the presence of vacuoles, blastomere asymmetry and multinucleation), to classify the embryos in accordance with ASEBIR criteria and to stipulate the clinical decision taken. In the EQC time-lapse pilot study, the groups were asked to determine, as well as the above characteristics, the embryo development times, the number, opposition and size of pronuclei, the direct division of 1 into 3 cells and/or of 3 into 5 cells and false divisions. The degree of agreement was determined by calculating the intra-class correlation coefficients and the coefficient of variation for the quantitative variables and the Gwet index for the qualitative variables. For both EmbryoScope™ and Primo Vision™, two periods of greater inter-laboratory variability were observed in the times of embryo development events. One peak of variability was recorded among the laboratories addressing the first embryo events (extrusion of the second polar body and the appearance of pronuclei); the second peak took place between the times corresponding to the 8-cell and morula stages. In most of the qualitative variables analysed regarding embryo development, there was almost

BetaScint{trademark} fiber-optic sensor for detecting strontium-90 and uranium-238 in soil. Innovative technology summary report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-12-01

Accurate measurements of radioactivity in soils contaminated with Strontium-90 (Sr-90) or Uranium-238 (U-238) are essential for many DOE site remediation programs. These crucial measurements determine if excavation and soil removal is necessary, where remediation efforts should be focused, and/or if a site has reached closure. Measuring soil contamination by standard EPA laboratory methods typically takes a week (accelerated analytical test turnaround) or a month (standard analytical test turnaround). The time delay extends to operations involving heavy excavation equipment and associated personnel which are the main costs of remediation. This report describes an application of the BetaScint{trademark} fiber-optic sensor that measuresmore » Sr-90 or U-238 contamination in soil samples on site in about 20 minutes, at a much lower cost than time-consuming laboratory methods, to greatly facilitate remediation. This report describes the technology, its performance, its uses, cost, regulatory and policy issues, and lessons learned.« less

District Support Systems for the Alignment of Curriculum, Instruction, and Assessment: Can We Predict Student Achievement in Reading and Writing for School Turnaround?

ERIC Educational Resources Information Center

Abbott, Laura Lynn Tanner

2014-01-01

The purpose of this quantitative non-experimental predictive study was to determine if CIA alignment factors and related district support systems are associated with student achievement to enable the turnaround of schools in crisis. This study aimed to utilize the District Snapshot Tool to determine if the district systems that support CIA…

Kuss Middle School: Expanding Time to Accelerate School Improvement

ERIC Educational Resources Information Center

Massachusetts 2020, 2012

2012-01-01

In 2004, Kuss Middle School became the first school declared "Chronically Underperforming" by the state of Massachusetts. But by 2010, Kuss had transformed itself into a model for schools around the country seeking a comprehensive turnaround strategy. Kuss is using increased learning time as the primary catalyst to accelerate learning,…

Measuring trade-offs that matter: assessing the impact of a new electronic cross-match policy on the turnaround time and the cross-match workload efficiency.

PubMed

Lin, David M; Goldfinger, Dennis; Lu, Qun; Wallace, Bridget; Kosaka-Nguyen, Dawn; Wood, Alisa; Porter, Bethany; Bumerts, Pamela; Jeffery, Rebecca; Fang, Amy; Stalcup, Irene; Penaflorida, Tracy; Ziman, Alyssa

2014-12-01

Our traditional cross-match (XM) policy generated a significant number of XM units that were never issued. To minimize the unnecessary XM workload, we proposed a new policy where orders eligible for the electronic XM (EXM) are pended until orders to issue red blood cells (RBCs) are received. To address concerns that this new policy might unduly delay blood availability, we conducted a study to assess whether the new policy was noninferior to the traditional policy with regard to the turnaround time (TAT). We monitored the TAT and XM workload efficiency (XM-to-issue [C : I] ratio) for a total of 8 weeks split between the two policies' periods. The primary outcome was the proportion of RBC issue requests that was turned around in less than 12 minutes. Fifty percent (1133 of 2265) of issue requests were turned around in 12 minutes or less under the traditional policy compared to 43.9% (975 of 2223) under the new policy (absolute difference of 6.1%; 95% confidence interval [CI], 3.2%-9.1%; p < 0.001). The adjusted overall median TAT was slower by 1 minute (13 min vs. 14 min, p < 0.001) but the adjusted C : I ratio was better (1.00 vs. 1.15; p < 0.001) under the new policy. Our study showed that the impact of the new policy on the TAT was not inferior to the traditional policy. Since the median TAT of 14 minutes under the new policy met the published benchmarks, the trade-off between delays in the TAT and efficiency gains in the XM workload remained acceptable for patient care. © 2014 AABB.

Assessment of laboratory test utilization for HIV/AIDS care in urban ART clinics of Lilongwe, Malawi.

PubMed

Palchaudhuri, Sonali; Tweya, Hannock; Hosseinipour, Mina

2014-06-01

The 2011 Malawi HIV guidelines promote CD4 monitoring for pre-ART assessment and considering HIVRNA monitoring for ART response assessment, while some clinics used CD4 for both. We assessed clinical ordering practices as compared to guidelines, and determined whether the samples were successfully and promptly processed. We conducted a retrospective review of all patients seen in from August 2010 through July 2011,, in two urban HIV-care clinics that utilized 6-monthly CD4 monitoring regardless of ART status. We calculated the percentage of patients on whom clinicians ordered CD4 or HIVRNA analysis. For all samples sent, we determined rates of successful lab-processing, and mean time to returned results. Of 20581 patients seen, 8029 (39%) had at least one blood draw for CD4 count. Among pre-ART patients, 2668/2844 (93.8%) had CD4 counts performed for eligibility. Of all CD4 samples sent, 8082/9207 (89%) samples were successfully processed. Of those, mean time to processing was 1.6 days (s.d 1.5) but mean time to results being available to clinician was 9.3 days (s.d. 3.7). Regarding HIVRNA, 172 patients of 17737 on ART had a blood draw and only 118/213 (55%) samples were successfully processed. Mean processing time was 39.5 days (s.d. 21.7); mean time to results being available to clinician was 43.1 days (s.d. 25.1). During the one-year evaluated, there were multiple lapses in processing HIVRNA samples for up to 2 months. Clinicians underutilize CD4 and HIVRNA as monitoring tools in HIV care. Laboratory processing failures and turnaround times are unacceptably high for viral load analysis. Alternative strategies need to be considered in order to meet laboratory monitoring needs.

Using Adaptive Turnaround Documents to Electronically Acquire Structured Data in Clinical Settings

PubMed Central

Biondich, Paul G.; Anand, Vibha; Downs, Stephen M.; McDonald, Clement J.

2003-01-01

We developed adaptive turnaround documents (ATDs) to address longstanding challenges inherent in acquiring structured data at the point of care. These computer-generated paper forms both request and receive patient tailored information specifically for electronic storage. In our pilot, we evaluated the usability, accuracy, and user acceptance of an ATD designed to enrich a pediatric preventative care decision support system. The system had an overall digit recognition rate of 98.6% (95% CI: 98.3 to 98.9) and a marksense accuracy of 99.2% (95% CI: 99.1 to 99.3). More importantly, the system reliably extracted all data from 56.6% (95% CI: 53.3 to 59.9) of our pilot forms without the need for a verification step. These results translate to a minimal workflow burden to end users. This suggests that ATDs can serve as an inexpensive, workflow-sensitive means of structured data acquisition in the clinical setting. PMID:14728139

Comparison of GLONASS and GPS time transfers between two west European time laboratories and VNIIFTRI

NASA Technical Reports Server (NTRS)

Daly, P.; Koshelyaevsky, N. B.; Lewandowski, Wlodzimierz; Petit, Gerard; Thomas, Claudine

1992-01-01

The University of Leeds built a Global Positioning System/Global Orbiting Navigation Satellite System (GPS/GLONASS) receiver about five years ago and since then has provided continuous information about GLONASS time and its comparison with GPS time. For the last two years, VNIIFTRI (All Union Institute for Physical, Technical and Radiotechnical Measurements) and some other Soviet time laboratories have used Soviet built GLONASS navigation receivers for time comparisons. Since June 1991, VNIIFTIR has been operating a GPS time receiver on loan from the BIPM (Bureau International des Poids et Mesures). This offered, for the first time, an opportunity for direct comparison of time transfers using GPS and GLONASS. This experiment shows that even with relatively imprecise data recording and processing, in terms of time metrology, GLONASS can provide continental time transfer at a level of several tens of nanoseconds.

Process improvement for regulatory analyses of custom-blend fertilizers.

PubMed

Wegner, Keith A

2014-01-01

Chemical testing of custom-blend fertilizers is essential to ensure that the products meet the formulation requirements. For purposes of proper crop nutrition and consumer protection, regulatory oversight promotes compliance and particular attention to blending and formulation specifications. Analyses of custom-blend fertilizer products must be performed and reported within a very narrow window in order to be effective. The Colorado Department of Agriculture's Biochemistry Laboratory is an ISO 17025 accredited facility and conducts analyses of custom-blend fertilizer products primarily during the spring planting season. Using the Lean Six Sigma (LSS) process, the Biochemistry Laboratory has reduced turnaround times from as much as 45 days to as little as 3 days. The LSS methodology focuses on waste reduction through identifying: non-value-added steps, unneeded process reviews, optimization of screening and confirmatory analyses, equipment utilization, nonessential reporting requirements, and inefficient personnel deployment. Eliminating these non-value-added activities helped the laboratory significantly shorten turnaround time and reduce costs. Key improvement elements discovered during the LSS process included: focused sample tracking, equipment redundancy, strategic supply stocking, batch size optimization, critical sample paths, elimination of nonessential QC reviews, and more efficient personnel deployment.

Personal exposure to benzene and 1,3-butadiene during petroleum refinery turnarounds and work in the oil harbour.

PubMed

Akerstrom, M; Almerud, P; Andersson, E M; Strandberg, B; Sallsten, G

2016-11-01

Petroleum refinery workers' exposure to the carcinogens benzene and 1,3-butadiene has decreased during normal operations. However, certain occupational groups or events at the refineries still involve a risk of higher exposures. The aim of this study was to examine the personal exposure to benzene and 1,3-butadiene at refinery turnarounds and during work in the oil harbour. Personal exposure measurements of benzene and 1,3-butadiene were taken during work shifts, with a priori assumed higher benzene exposure, using PerkinElmer diffusive samplers filled with Carbopack X. Mean exposure levels were calculated, and repeated exposure measurements, when available, were assessed using mixed effect models. Group and individual compliance with the Swedish occupational exposure limit (OEL) was tested for the different exposure groups. Mean benzene exposure levels for refinery workers during the three measured turnarounds were 150, 610 and 960 µg/m 3 , and mean exposures for oil harbour workers and sewage tanker drivers were 310 and 360 µg/m 3 , respectively. Higher exposures were associated with handling benzene-rich products. Most occupational groups did not comply with the Swedish OEL for benzene nor did the individuals within the groups. The exposure to 1,3-butadiene was very low, between <1 and 3 % of the Swedish OEL. Work within the petroleum refinery industry, with potential exposure to open product streams containing higher fractions of benzene, pose a risk of personal benzene exposures exceeding the OEL. Refinery workers performing these work tasks frequently, such as contractors, sewage tanker drivers and oil harbour workers, need to be identified and protected.

Outbreak Investigation Using High-Throughput Genome Sequencing within a Diagnostic Microbiology Laboratory

PubMed Central

Sherry, Norelle L.; Porter, Jessica L.; Seemann, Torsten; Watkins, Andrew; Stinear, Timothy P.

2013-01-01

Next-generation sequencing (NGS) of bacterial genomes has recently become more accessible and is now available to the routine diagnostic microbiology laboratory. However, questions remain regarding its feasibility, particularly with respect to data analysis in nonspecialist centers. To test the applicability of NGS to outbreak investigations, Ion Torrent sequencing was used to investigate a putative multidrug-resistant Escherichia coli outbreak in the neonatal unit of the Mercy Hospital for Women, Melbourne, Australia. Four suspected outbreak strains and a comparator strain were sequenced. Genome-wide single nucleotide polymorphism (SNP) analysis demonstrated that the four neonatal intensive care unit (NICU) strains were identical and easily differentiated from the comparator strain. Genome sequence data also determined that the NICU strains belonged to multilocus sequence type 131 and carried the blaCTX-M-15 extended-spectrum beta-lactamase. Comparison of the outbreak strains to all publicly available complete E. coli genome sequences showed that they clustered with neonatal meningitis and uropathogenic isolates. The turnaround time from a positive culture to the completion of sequencing (prior to data analysis) was 5 days, and the cost was approximately $300 per strain (for the reagents only). The main obstacles to a mainstream adoption of NGS technologies in diagnostic microbiology laboratories are currently cost (although this is decreasing), a paucity of user-friendly and clinically focused bioinformatics platforms, and a lack of genomics expertise outside the research environment. Despite these hurdles, NGS technologies provide unparalleled high-resolution genotyping in a short time frame and are likely to be widely implemented in the field of diagnostic microbiology in the next few years, particularly for epidemiological investigations (replacing current typing methods) and the characterization of resistance determinants. Clinical microbiologists need to

Laboratory testing in primary care: A systematic review of health IT impacts.

PubMed

Maillet, Éric; Paré, Guy; Currie, Leanne M; Raymond, Louis; Ortiz de Guinea, Ana; Trudel, Marie-Claude; Marsan, Josianne

2018-08-01

Laboratory testing in primary care is a fundamental process that supports patient management and care. Any breakdown in the process may alter clinical information gathering and decision-making activities and can lead to medical errors and potential adverse outcomes for patients. Various information technologies are being used in primary care with the goal to support the process, maximize patient benefits and reduce medical errors. However, the overall impact of health information technologies on laboratory testing processes has not been evaluated. To synthesize the positive and negative impacts resulting from the use of health information technology in each phase of the laboratory 'total testing process' in primary care. We conducted a systematic review. Databases including Medline, PubMed, CINAHL, Web of Science and Google Scholar were searched. Studies eligible for inclusion reported empirical data on: 1) the use of a specific IT system, 2) the impacts of the systems to support the laboratory testing process, and were conducted in 3) primary care settings (including ambulatory care and primary care offices). Our final sample consisted of 22 empirical studies which were mapped to a framework that outlines the phases of the laboratory total testing process, focusing on phases where medical errors may occur. Health information technology systems support several phases of the laboratory testing process, from ordering the test to following-up with patients. This is a growing field of research with most studies focusing on the use of information technology during the final phases of the laboratory total testing process. The findings were largely positive. Positive impacts included easier access to test results by primary care providers, reduced turnaround times, and increased prescribed tests based on best practice guidelines. Negative impacts were reported in several studies: paper-based processes employed in parallel to the electronic process increased the potential

Big data, miniregistries: a rapid-turnaround solution to get quality improvement data into the hands of medical specialists.

PubMed

Herrinton, Lisa J; Liu, Liyan; Altschuler, Andrea; Dell, Richard; Rabrenovich, Violeta; Compton-Phillips, Amy L

2015-01-01

The cost to build and to maintain traditional registries for many dire, complex, low-frequency conditions is prohibitive. The authors used accessible technology to develop a platform that would generate miniregistries (small, routinely updated datasets) for surveillance, to identify patients who were missing elected utilization and to influence clinicians to change practices to improve care. The platform, tested in 5 medical specialty departments, enabled the specialists to rapidly and effectively communicate clinical questions, knowledge of disease, clinical workflows, and improve opportunities. Each miniregistry required 1 to 2 hours of collaboration by a specialist. Turnaround was 1 to 14 days.

Workflow and maintenance characteristics of five automated laboratory instruments for the diagnosis of sexually transmitted infections.

PubMed

Ratnam, Sam; Jang, Dan; Gilchrist, Jodi; Smieja, Marek; Poirier, Andre; Hatchette, Todd; Flandin, Jean-Frederic; Chernesky, Max

2014-07-01

The choice of a suitable automated system for a diagnostic laboratory depends on various factors. Comparative workflow studies provide quantifiable and objective metrics to determine hands-on time during specimen handling and processing, reagent preparation, return visits and maintenance, and test turnaround time and throughput. Using objective time study techniques, workflow characteristics for processing 96 and 192 tests were determined on m2000 RealTime (Abbott Molecular), Viper XTR (Becton Dickinson), cobas 4800 (Roche Molecular Diagnostics), Tigris (Hologic Gen-Probe), and Panther (Hologic Gen-Probe) platforms using second-generation assays for Chlamydia trachomatis and Neisseria gonorrhoeae. A combination of operational and maintenance steps requiring manual labor showed that Panther had the shortest overall hands-on times and Viper XTR the longest. Both Panther and Tigris showed greater efficiency whether 96 or 192 tests were processed. Viper XTR and Panther had the shortest times to results and m2000 RealTime the longest. Sample preparation and loading time was the shortest for Panther and longest for cobas 4800. Mandatory return visits were required only for m2000 RealTime and cobas 4800 when 96 tests were processed, and both required substantially more hands-on time than the other systems due to increased numbers of return visits when 192 tests were processed. These results show that there are substantial differences in the amount of labor required to operate each system. Assay performance, instrumentation, testing capacity, workflow, maintenance, and reagent costs should be considered in choosing a system. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Comparison of direct selective versus nonselective agar media plus LIM broth enrichment for determination of group B streptococcus colonization status in pregnant women.

PubMed

Elsayed, Sameer; Gregson, Daniel B; Church, Deirdre L

2003-06-01

Group B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in developed countries, and determination of the GBS colonization status in pregnant patients near term is essential for the provision of prophylactic measures to prevent early-onset disease. To determine if GBS recovery rates and/or result turnaround times for vaginal or combined vaginal/rectal swab specimens from pregnant patients near term are enhanced if swabs are inoculated initially onto selective versus nonselective agar media, in addition to the standard Centers for Disease Control and Prevention method. Prospective laboratory analysis. Urban health region/centralized diagnostic microbiology laboratory. Pregnant women presenting for routine obstetrical care and collection of vaginal or combined vaginal/rectal swab specimens for GBS testing at 35 to 37 weeks' gestation. Culture of specimens directly onto selective (5% sheep blood with colistin and nalidixic acid) or nonselective (5% sheep blood) agar media, in addition to LIM broth enrichment and terminal subculture. Group B streptococcus recovery rate and culture result turnaround time. A total of 639 specimens were tested, with 128 (20%) positive for GBS. Sixty-three isolates were recovered on direct agar media at 24 hours, of which 16 (12.5%) were isolated on selective plates only. An additional 38 isolates were recovered at 48 hours from direct plates. Twenty-seven (21.1%) isolates that failed to grow on direct plates were recovered from the LIM broth subculture only. Three (2.3%) isolates not recovered from LIM broths were detected at 48 hours on the direct selective (2 isolates) and nonselective (1 isolate) agar plates. A 24-hour result turnaround time was achieved for 63 (49.2%) and 47 (36.7%) of the 128 culture-positive specimens for direct selective and nonselective plates, respectively (chi2 = 76.63, P <.001). Use of direct selective agar media, in addition to LIM broth enrichment, for the determination of the GBS

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

PubMed Central

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

PubMed

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Alchemy: A Web 2.0 Real-time Quality Assurance Platform for Human Immunodeficiency Virus, Hepatitis C Virus, and BK Virus Quantitation Assays.

PubMed

Agosto-Arroyo, Emmanuel; Coshatt, Gina M; Winokur, Thomas S; Harada, Shuko; Park, Seung L

2017-01-01

The molecular diagnostics laboratory faces the challenge of improving test turnaround time (TAT). Low and consistent TATs are of great clinical and regulatory importance, especially for molecular virology tests. Laboratory information systems (LISs) contain all the data elements necessary to do accurate quality assurance (QA) reporting of TAT and other measures, but these reports are in most cases still performed manually: a time-consuming and error-prone task. The aim of this study was to develop a web-based real-time QA platform that would automate QA reporting in the molecular diagnostics laboratory at our institution, and minimize the time expended in preparing these reports. Using a standard Linux, Nginx, MariaDB, PHP stack virtual machine running atop a Dell Precision 5810, we designed and built a web-based QA platform, code-named Alchemy. Data files pulled periodically from the LIS in comma-separated value format were used to autogenerate QA reports for the human immunodeficiency virus (HIV) quantitation, hepatitis C virus (HCV) quantitation, and BK virus (BKV) quantitation. Alchemy allowed the user to select a specific timeframe to be analyzed and calculated key QA statistics in real-time, including the average TAT in days, tests falling outside the expected TAT ranges, and test result ranges. Before implementing Alchemy, reporting QA for the HIV, HCV, and BKV quantitation assays took 45-60 min of personnel time per test every month. With Alchemy, that time has decreased to 15 min total per month. Alchemy allowed the user to select specific periods of time and analyzed the TAT data in-depth without the need of extensive manual calculations. Alchemy has significantly decreased the time and the human error associated with QA report generation in our molecular diagnostics laboratory. Other tests will be added to this web-based platform in future updates. This effort shows the utility of informatician-supervised resident/fellow programming projects as learning

Alchemy: A Web 2.0 Real-time Quality Assurance Platform for Human Immunodeficiency Virus, Hepatitis C Virus, and BK Virus Quantitation Assays

PubMed Central

Agosto-Arroyo, Emmanuel; Coshatt, Gina M.; Winokur, Thomas S.; Harada, Shuko; Park, Seung L.

2017-01-01

Background: The molecular diagnostics laboratory faces the challenge of improving test turnaround time (TAT). Low and consistent TATs are of great clinical and regulatory importance, especially for molecular virology tests. Laboratory information systems (LISs) contain all the data elements necessary to do accurate quality assurance (QA) reporting of TAT and other measures, but these reports are in most cases still performed manually: a time-consuming and error-prone task. The aim of this study was to develop a web-based real-time QA platform that would automate QA reporting in the molecular diagnostics laboratory at our institution, and minimize the time expended in preparing these reports. Methods: Using a standard Linux, Nginx, MariaDB, PHP stack virtual machine running atop a Dell Precision 5810, we designed and built a web-based QA platform, code-named Alchemy. Data files pulled periodically from the LIS in comma-separated value format were used to autogenerate QA reports for the human immunodeficiency virus (HIV) quantitation, hepatitis C virus (HCV) quantitation, and BK virus (BKV) quantitation. Alchemy allowed the user to select a specific timeframe to be analyzed and calculated key QA statistics in real-time, including the average TAT in days, tests falling outside the expected TAT ranges, and test result ranges. Results: Before implementing Alchemy, reporting QA for the HIV, HCV, and BKV quantitation assays took 45–60 min of personnel time per test every month. With Alchemy, that time has decreased to 15 min total per month. Alchemy allowed the user to select specific periods of time and analyzed the TAT data in-depth without the need of extensive manual calculations. Conclusions: Alchemy has significantly decreased the time and the human error associated with QA report generation in our molecular diagnostics laboratory. Other tests will be added to this web-based platform in future updates. This effort shows the utility of informatician

Impact of Time Lapse on ASCP Board of Certification Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) Examination Scores.

PubMed

Brown, Karen A; Fenn, JoAnn P; Freeman, Vicki S; Fisher, Patrick B; Genzen, Jonathan R; Goodyear, Nancy; Houston, Mary Lunz; O'Brien, Mary Elizabeth; Tanabe, Patricia A

2015-01-01

Research in several professional fields has demonstrated that delays (time lapse) in taking certification examinations may result in poorer performance by examinees. Thirteen states and/or territories require licensure for laboratory personnel. A core component of licensure is passing a certification exam. Also, many facilities in states that do not require licensure require certification for employment or preferentially hire certified individuals. To analyze examinee performance on the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) certification examinations to determine whether delays in taking the examination from the time of program completion are associated with poorer performance. We obtained examination data from April 2013 through December 2014 to look for changes in mean (SD) exam scaled scores and overall pass/fail rates. First-time examinees (MLS: n = 6037; MLT, n = 3920) were divided into 3-month categories based on the interval of time between date of program completion and taking the certification exam. We observed significant decreases in mean (SD) scaled scores and pass rates after the first quarter in MLS and MLT examinations for applicants who delayed taking their examination until the second, third, and fourth quarter after completing their training programs. Those who take the ASCP BOC MLS and MLT examinations are encouraged to do so shortly after completion of their educational training programs. Delays in taking an exam are generally not beneficial to the examinee and result in poorer performance on the exam. Copyright© by the American Society for Clinical Pathology (ASCP).

Automation, consolidation, and integration in autoimmune diagnostics.

PubMed

Tozzoli, Renato; D'Aurizio, Federica; Villalta, Danilo; Bizzaro, Nicola

2015-08-01

Over the past two decades, we have witnessed an extraordinary change in autoimmune diagnostics, characterized by the progressive evolution of analytical technologies, the availability of new tests, and the explosive growth of molecular biology and proteomics. Aside from these huge improvements, organizational changes have also occurred which brought about a more modern vision of the autoimmune laboratory. The introduction of automation (for harmonization of testing, reduction of human error, reduction of handling steps, increase of productivity, decrease of turnaround time, improvement of safety), consolidation (combining different analytical technologies or strategies on one instrument or on one group of connected instruments) and integration (linking analytical instruments or group of instruments with pre- and post-analytical devices) opened a new era in immunodiagnostics. In this article, we review the most important changes that have occurred in autoimmune diagnostics and present some models related to the introduction of automation in the autoimmunology laboratory, such as automated indirect immunofluorescence and changes in the two-step strategy for detection of autoantibodies; automated monoplex immunoassays and reduction of turnaround time; and automated multiplex immunoassays for autoantibody profiling.

Evaluation of MALDI-TOF MS (Matrix-Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry) for routine identification of anaerobic bacteria.

PubMed

Rodríguez-Sánchez, Belén; Alcalá, Luis; Marín, Mercedes; Ruiz, Adrián; Alonso, Elena; Bouza, Emilio

2016-12-01

Information regarding the use of MALDI-TOF MS as an alternative to conventional laboratory methods for the rapid and reliable identification of bacterial isolates is still limited. In this study, MALDI-TOF MS was evaluated on 295 anaerobic isolates previously identified by 16S rRNA gene sequencing and with biochemical tests (Rapid ID 32A system, BioMérieux). In total, 85.8% of the isolates were identified by MALDI-TOF MS at the species level vs 49.8% using the Rapid ID 32A system (p < 0.0001). None of the isolates was discordantly identified at the genus level using MALDI-TOF MS and only 9 of them could not be identified using the method. Thus, our results show that MALDI-TOF MS is a robust and reliable tool for the identification of anaerobic isolates in the microbiology laboratory. Its implementation will reduce the turnaround time for a final identification and the number of isolates that require 16S rRNA sequencing. Copyright © 2016 Elsevier Ltd. All rights reserved.

A model for the statistical description of analytical errors occurring in clinical chemical laboratories with time.

PubMed

Hyvärinen, A

1985-01-01

The main purpose of the present study was to describe the statistical behaviour of daily analytical errors in the dimensions of place and time, providing a statistical basis for realistic estimates of the analytical error, and hence allowing the importance of the error and the relative contributions of its different sources to be re-evaluated. The observation material consists of creatinine and glucose results for control sera measured in daily routine quality control in five laboratories for a period of one year. The observation data were processed and computed by means of an automated data processing system. Graphic representations of time series of daily observations, as well as their means and dispersion limits when grouped over various time intervals, were investigated. For partition of the total variation several two-way analyses of variance were done with laboratory and various time classifications as factors. Pooled sets of observations were tested for normality of distribution and for consistency of variances, and the distribution characteristics of error variation in different categories of place and time were compared. Errors were found from the time series to vary typically between days. Due to irregular fluctuations in general and particular seasonal effects in creatinine, stable estimates of means or of dispersions for errors in individual laboratories could not be easily obtained over short periods of time but only from data sets pooled over long intervals (preferably at least one year). Pooled estimates of proportions of intralaboratory variation were relatively low (less than 33%) when the variation was pooled within days. However, when the variation was pooled over longer intervals this proportion increased considerably, even to a maximum of 89-98% (95-98% in each method category) when an outlying laboratory in glucose was omitted, with a concomitant decrease in the interaction component (representing laboratory-dependent variation with time

Comparable Educational Benefits in Half the Time: An Alternating Organic Chemistry Laboratory Sequence Targeting Prehealth Students

ERIC Educational Resources Information Center

Young, Sherri C.; Colabroy, Keri L.; Baar, Marsha R.

2016-01-01

The laboratory is a mainstay in STEM education, promoting the development of critical thinking skills, dexterity, and scientific curiosity. The goals in the laboratory for nonchemistry, prehealth majors, though, could be distinguished from those for chemistry majors. In service courses such as organic chemistry, much laboratory time is often spent…

Evaluation of Wet Chemical ICP-AES Elemental Analysis Methods usingSimulated Hanford Waste Samples-Phase I Interim Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coleman, Charles J.; Edwards, Thomas B.

2005-04-30

The wet chemistry digestion method development for providing process control elemental analyses of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) Melter Feed Preparation Vessel (MFPV) samples is divided into two phases: Phase I consists of: (1) optimizing digestion methods as a precursor to elemental analyses by ICP-AES techniques; (2) selecting methods with the desired analytical reliability and speed to support the nine-hour or less turnaround time requirement of the WTP; and (3) providing baseline comparison to the laser ablation (LA) sample introduction technique for ICP-AES elemental analyses that is being developed at the Savannah River National Laboratory (SRNL).more » Phase II consists of: (1) Time-and-Motion study of the selected methods from Phase I with actual Hanford waste or waste simulants in shielded cell facilities to ensure that the methods can be performed remotely and maintain the desired characteristics; and (2) digestion of glass samples prepared from actual Hanford Waste tank sludge for providing comparative results to the LA Phase II study. Based on the Phase I testing discussed in this report, a tandem digestion approach consisting of sodium peroxide fusion digestions carried out in nickel crucibles and warm mixed-acid digestions carried out in plastic bottles has been selected for Time-and-Motion study in Phase II. SRNL experience with performing this analytical approach in laboratory hoods indicates that well-trained cell operator teams will be able to perform the tandem digestions in five hours or less. The selected approach will produce two sets of solutions for analysis by ICP-AES techniques. Four hours would then be allocated for performing the ICP-AES analyses and reporting results to meet the nine-hour or less turnaround time requirement. The tandem digestion approach will need to be performed in two separate shielded analytical cells by two separate cell operator teams in order to achieve the nine-hour or less

Impact of Glucose Measurement Processing Delays on Clinical Accuracy and Relevance

PubMed Central

Jangam, Sujit R.; Hayter, Gary; Dunn, Timothy C.

2013-01-01

Background In a hospital setting, glucose is often measured from venous blood in the clinical laboratory. However, laboratory glucose measurements are typically not available in real time. In practice, turn-around times for laboratory measurements can be minutes to hours. This analysis assesses the impact of turn-around time on the effective clinical accuracy of laboratory measurements. Methods Data obtained from an earlier study with 58 subjects with type 1 diabetes mellitus (T1DM) were used for this analysis. In the study, glucose measurements using a YSI glucose analyzer were obtained from venous blood samples every 15 min while the subjects were at the health care facility. To simulate delayed laboratory results, each YSI glucose value from a subject was paired with one from a later time point (from the same subject) separated by 15, 30, 45, and 60 min. To assess the clinical accuracy of a delayed YSI result relative to a real-time result, the percentage of YSI pairs that meet the International Organization for Standardization (ISO) 15197:2003(E) standard for glucose measurement accuracy (±15 mg/dl for blood glucose < 75 mg/dl, ±20% for blood glucose ≥ 75 mg/dl) was calculated. Results It was observed that delays of 15 min or more reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95%. The accuracy was less than 65% for delays of 60 min. Conclusion This analysis suggests that processing delays in glucose measurements reduce the clinical relevance of results in patients with T1DM and may similarly degrade the clinical value of measurements in other patient populations. PMID:23759399

Impact of glucose measurement processing delays on clinical accuracy and relevance.

PubMed

Jangam, Sujit R; Hayter, Gary; Dunn, Timothy C

2013-05-01

In a hospital setting, glucose is often measured from venous blood in the clinical laboratory. However, laboratory glucose measurements are typically not available in real time. In practice, turn-around times for laboratory measurements can be minutes to hours. This analysis assesses the impact of turn-around time on the effective clinical accuracy of laboratory measurements. Data obtained from an earlier study with 58 subjects with type 1 diabetes mellitus (T1DM) were used for this analysis. In the study, glucose measurements using a YSI glucose analyzer were obtained from venous blood samples every 15 min while the subjects were at the health care facility. To simulate delayed laboratory results, each YSI glucose value from a subject was paired with one from a later time point (from the same subject) separated by 15, 30, 45, and 60 min. To assess the clinical accuracy of a delayed YSI result relative to a real-time result, the percentage of YSI pairs that meet the International Organization for Standardization (ISO) 15197:2003(E) standard for glucose measurement accuracy (±15 mg/dl for blood glucose < 75 mg/dl, ±20% for blood glucose ≥ 75 mg/dl) was calculated. It was observed that delays of 15 min or more reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95%. The accuracy was less than 65% for delays of 60 min. This analysis suggests that processing delays in glucose measurements reduce the clinical relevance of results in patients with T1DM and may similarly degrade the clinical value of measurements in other patient populations. © 2013 Diabetes Technology Society.

Evaluating the benefits of digital pathology implementation: Time savings in laboratory logistics.

PubMed

Baidoshvili, Alexi; Bucur, Anca; van Leeuwen, Jasper; van der Laak, Jeroen; Kluin, Philip; van Diest, Paul J

2018-06-20

The benefits of digital pathology for workflow improvement and thereby cost savings in pathology, at least partly outweighing investment costs, are increasingly recognized. Successful implementations in a variety of scenarios start to demonstrate cost benefits of digital pathology for both research and routine diagnostics, contributing to a sound business case encouraging further adoption. To further support new adopters, there is still a need for detailed assessment of the impact this technology has on the relevant pathology workflows with emphasis on time saving. To assess the impact of digital pathology adoption on logistic laboratory tasks (i.e. not including pathologists' time for diagnosis making) in LabPON, a large regional pathology laboratory in The Netherlands. To quantify the benefits of digitization we analyzed the differences between the traditional analog and new digital workflows, carried out detailed measurements of all relevant steps in key analog and digital processes, and compared time spent. We modeled and assessed the logistic savings in five workflows: (1) Routine diagnosis, (2) Multi-disciplinary meeting, (3) External revision requests, (4) Extra stainings and (5) External consultation. On average over 19 working hours were saved on a typical day by working digitally, with the highest savings in routine diagnosis and multi-disciplinary meeting workflows. By working digitally, a significant amount of time could be saved in a large regional pathology lab with a typical case mix. We also present the data in each workflow per task and concrete logistic steps to allow extrapolation to the context and case mix of other laboratories. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Performance of Mycobacterium Growth Indicator Tube BACTEC 960 with Lowenstein-Jensen method for diagnosis of Mycobacterium tuberculosis at Ethiopian National Tuberculosis Reference Laboratory, Addis Ababa, Ethiopia.

PubMed

Diriba, Getu; Kebede, Abebaw; Yaregal, Zelalem; Getahun, Muluwork; Tadesse, Mengistu; Meaza, Abyot; Dagne, Zekarias; Moga, Shewki; Dilebo, Jibril; Gudena, Kebebe; Hassen, Mulu; Desta, Kassu

2017-05-10

Bacteriological confirmed active case detection remains the corner stone for diagnosing tuberculosis. Non-radiometric liquid culture system Mycobacterium Growth Indicator Tube with automated interface had been recommended by expert groups in addition to conventional solid culture media such as Lowenstein-Jensen. However in high burden resource limited countries advanced non-radiometric based tuberculosis diagnostic methods such as MGIT 960 is limited. Therefore we have evaluated the performance of MGIT 960 system compared to LJ for recovery of Mycobacterium complex (MTBC) from clinical specimens. A cross sectional study was conducted from a total of 908 samples between January 1st, 2013 to December 31st, 2014. Clinical specimens were processed following standard procedures and the final suspension was inoculated to MGIT tubes and LJ slant. Identification and confirmation of MTBC was done by ZN staining and SD Bioline test. Data was analyzed by SPSS version 20. The sensitivity, specificity, recovery rate and the average turnaround time to recover the organism was computed. From a total of 908 clinical specimens processed using both LJ and BACTEC MGIT liquid culture methods the recovery rate for LJ and MGIT, for smear positive samples was 66.7% (74/111) and 87.4% (97/ 111) respectively while for smear negative samples was 13.4% (108/797) and 17.4% (139/797) for LJ and MGIT methods respectively. The overall recovery rate for MGIT is significantly higher than LJ methods [26% (236/908; vs. 20%, 182/908, P = 0.002)]. The average turnaround time for smear positive samples was 16 and 31 days for MGIT and LJ respectively. Turnaround time for smear negative samples was 20 and 36 days for MGIT and LJ respectively. The overall agreement between MGIT and LJ was fairly good with Kappa value of 0.59 (P < 0.001). In the present study the contamination rate for MGIT is higher than the LJ methods, 15 and 9.3% respectively. The BACTEC MGIT liquid culture system has better MTBC

Characteristics of Occupational Exposure to Benzene during Turnaround in the Petrochemical Industries

PubMed Central

Shin, Jung-Ah; Lee, Byung-Kyu; Kwon, Jiwoon; Lee, Naroo; Chung, Kwang-Jae; Lee, Jong-Han; Lee, In-Seop; Kang, Seong-Kyu; Jang, Jae-Kil

2010-01-01

Objectives The level of benzene exposure in the petrochemical industry during regular operation has been well established, but not in turnaround (TA), where high exposure may occur. In this study, the characteristics of occupational exposure to benzene during TA in the petrochemical companies were investigated in order to determine the best management strategies and improve the working environment. This was accomplished by evaluating the exposure level for the workers working in environments where benzene was being produced or used as an ingredient during the unit process. Methods From 2003 to 2008, a total of 705 workers in three petrochemical companies in Korea were studied. Long- and short-term (< 1 hr) samples were taken during TAs. TA was classified into three stages: shut-down, maintenance and start-up. All works were classified into 12 occupation categories. Results The long-term geometric mean (GM) benzene exposure level was 0.025 (5.82) ppm (0.005-42.120 ppm) and the short-term exposure concentration during TA was 0.020 (17.42) ppm (0.005-61.855 ppm). The proportions of TA samples exceeding the time-weighted average, occupational exposure level (TWA-OEL in Korea, 1 ppm) and the short-term exposure limit (STEL-OEL, 5 ppm) were 4.1% (20 samples of 488) and 6.0% (13 samples of 217), respectively. The results for the benzene exposure levels and the rates of exceeding the OEL were both statistically significant (p < 0.05). Among the 12 job categories of petrochemical workers, mechanical engineers, plumbers, welders, fieldman and scaffolding workers exhibited long-term samples that exceeded the OEL of benzene, and the rate of exceeding the OEL was statistically significant for the first two occupations (p < 0.05). Conclusion These findings suggest that the periodic work environment must be assessed during non-routine works such as TA. PMID:22953163

Characteristics of Occupational Exposure to Benzene during Turnaround in the Petrochemical Industries.

PubMed

Chung, Eun-Kyo; Shin, Jung-Ah; Lee, Byung-Kyu; Kwon, Jiwoon; Lee, Naroo; Chung, Kwang-Jae; Lee, Jong-Han; Lee, In-Seop; Kang, Seong-Kyu; Jang, Jae-Kil

2010-09-01

The level of benzene exposure in the petrochemical industry during regular operation has been well established, but not in turnaround (TA), where high exposure may occur. In this study, the characteristics of occupational exposure to benzene during TA in the petrochemical companies were investigated in order to determine the best management strategies and improve the working environment. This was accomplished by evaluating the exposure level for the workers working in environments where benzene was being produced or used as an ingredient during the unit process. From 2003 to 2008, a total of 705 workers in three petrochemical companies in Korea were studied. Long- and short-term (< 1 hr) samples were taken during TAs. TA was classified into three stages: shut-down, maintenance and start-up. All works were classified into 12 occupation categories. The long-term geometric mean (GM) benzene exposure level was 0.025 (5.82) ppm (0.005-42.120 ppm) and the short-term exposure concentration during TA was 0.020 (17.42) ppm (0.005-61.855 ppm). The proportions of TA samples exceeding the time-weighted average, occupational exposure level (TWA-OEL in Korea, 1 ppm) and the short-term exposure limit (STEL-OEL, 5 ppm) were 4.1% (20 samples of 488) and 6.0% (13 samples of 217), respectively. The results for the benzene exposure levels and the rates of exceeding the OEL were both statistically significant (p < 0.05). Among the 12 job categories of petrochemical workers, mechanical engineers, plumbers, welders, fieldman and scaffolding workers exhibited long-term samples that exceeded the OEL of benzene, and the rate of exceeding the OEL was statistically significant for the first two occupations (p < 0.05). These findings suggest that the periodic work environment must be assessed during non-routine works such as TA.

Lack of concordance between a rapid bedside and conventional laboratory method of cardiac troponin testing: impact on risk stratification of patients suspected of acute coronary syndrome.

PubMed

Cramer, G Etienne; Kievit, Peter C; Brouwer, Marc A; de Keijzer, Marinus H; Luijten, Hans E; Verheugt, Freek W A

2007-06-01

This study was designed to test the usefulness of a bedside assay as compared to a laboratory method of troponin testing to predict adverse cardiac outcome of chest pain patients. We studied 358 ER visits of patients suspected of a non ST-elevation acute coronary syndrome. cTnI (Immulite, DPC) on a lab analyser and cTnT (Cardiac Reader, Roche) at bedside were measured at baseline. The between-assay level of concordance, reporting turnaround times and clinical outcomes during 180 days of follow-up were assessed. Death and myocardial infarction were then evaluated according to troponin result, either concordant negative, discordant or concordant positive. Discordance occurred in 11.4% (41/358) of cases. The proportion of patients with a positive cTnI and negative cTnT result (8.9%) versus the reverse (2.5%) differed significantly (p<0.001). The median time gained using the rapid test was 72 min. The rate of death and/or MI was 25% (10/40) among patients with discordant results as compared to 7.5% (17/228) with a concordant negative result (p<0.001). All patients from the discordant group with an event had a positive cTnI result, while cTnT was negative. Patients with a discordant reading were at high risk of adverse cardiac outcome, which was only identified by the laboratory cTnI assay. Markedly, the use of the rapid assay saved time at the expense of clinical sensitivity.

Laboratory diagnosis of tuberculosis: Advances in technology and drug susceptibility testing.

PubMed

Oommen, Seema; Banaji, Nandita

2017-01-01

There have been rapid technological advances in the detection of Mycobacterium tuberculosis and its drug susceptibility in clinical samples. These include advances in microscopic examination, in vitro culture and application of molecular techniques. The World Health Organization (WHO) has played a large role in evaluating these technologies for their efficacy and feasibility, especially in the developing countries. Amongst these, the Revised National Tuberculosis Control Programme (RNTCP), through its national network of designated microscopy centres and intermediate reference laboratories, has adopted certain technologies that are currently implemented in India. Advances in microscopy technology include fluorescent microscopy using light-emitting diode source, sodium hypochlorite microscopy and vital fluorescent staining of sputum smears. Automation of in vitro culture has markedly reduced the turnaround time (TAT), even in smear-negative samples, and permits simultaneous detection of resistant mutants. Molecular detection of drug resistance has further reduced the TAT, and the cartridge-based nucleic acid amplification test with its performance convenience and rapid results, appears poised to become the future of tuberculosis (TB) diagnosis in all settings, provided the cost of testing is reduced especially for use in private diagnostic settings. This article reviews technologies currently available for the diagnosis of TB, keeping in mind the WHO recommendations and the RNTCP practices. This is a thematic synthesis of data available on diagnosis in literature, preserving the conclusions of the primary studies.

Student Understanding of Time in an Introductory Astronomy Laboratory

NASA Astrophysics Data System (ADS)

Traxler, A. L.; Batuski, D. J.; Comins, N. F.; Thompson, J. R.

2005-09-01

The astronomy lab at the University of Maine consists of discrete weekly lessons in which students work in small groups. Individual pretests and post-tests accompany each lesson. The lesson studied here covers the topic of time, including sidereal time, Apparent Solar Time, and time zones. The pretest consists of four multiple-choice questions, which are also administered after instruction as a post-test. In the fall 2004 semester, the pretest was rewritten to focus on some major conceptual components of the lab, while the lesson materials were not modified from previous years. Examination of class performance (n = 96) revealed no significant improvements in score from pre- to post-lesson. In the spring 2005 semester, the lesson was altered to incorporate the Starry Night software for simulating the sky instead of the celestial sphere models previously used. The goal of the change was to give students a more interactive environment for completing the laboratory exercise, which was otherwise altered as little as possible. Data from the spring semester show some gains on the pre/post-test questions covering sidereal time and Daylight Savings Time. Results to date have informed planned modifications to the lesson. A. L. T. was supported during this research by the University of Maine through a Provost Fellowship.

A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a).

PubMed

Baron, Ellen Jo; Miller, J Michael; Weinstein, Melvin P; Richter, Sandra S; Gilligan, Peter H; Thomson, Richard B; Bourbeau, Paul; Carroll, Karen C; Kehl, Sue C; Dunne, W Michael; Robinson-Dunn, Barbara; Schwartzman, Joseph D; Chapin, Kimberle C; Snyder, James W; Forbes, Betty A; Patel, Robin; Rosenblatt, Jon E; Pritt, Bobbi S

2013-08-01

The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

Performance evaluation of a particle-enhanced turbidimetric cystatin C assay on the Abbott ci8200 analyzer.

PubMed

Flodin, Mats; Larsson, Anders

2009-06-01

Glomerular filtration rate (GFR) is widely accepted as the best overall measure of kidney function. Cystatin C is a novel endogenous GFR marker that has been shown to be superior to creatinine for estimation of GFR in several studies. There is a need for cystatin C assays adapted to routine chemistry instrument to minimize turnaround times and allowing 24 h/day availability. We have evaluated a new cystatin C assay developed for Architect cSystem (Abbott Laboratories, Abbott Park, IL, USA). The cystatin C assay showed good agreement with the corresponding assay from Dade Behring (Deerfield, IL, USA). The assay has a very low total imprecision and a good linearity. The new cystatin C assay is an interesting alternative to current cystatin C assays. On an Architect cSystem the assay can be performed with the same turnaround times and availability as creatinine.

Transforming Schools through Expanded Learning Time: Orchard Gardens K-8 Pilot School. Update 2013

ERIC Educational Resources Information Center

Chan, Roy

2013-01-01

For years, Orchard Gardens K-8 Pilot School was plagued by low student achievement and high staff turnover. Then, in 2010, with an expanded school schedule made possible through federal funding, Orchard Gardens began a remarkable turnaround. Today, the school is demonstrating how increased learning time, combined with other key turnaround…

LABORATORY AND NUMERICAL INVESTIGATIONS OF RESIDENCE TIME DISTRIBUTION OF FLUIDS IN LAMINAR FLOW STIRRED ANNULAR PHOTOREACTOR

EPA Science Inventory

Laboratory and Numerical Investigations of Residence Time Distribution of Fluids in Laminar Flow Stirred Annular Photoreactor

E. Sahle-Demessie1, Siefu Bekele2, U. R. Pillai1

1U.S. EPA, National Risk Management Research Laboratory
Sustainable Technology Division,...

Wildlife specimen collection, preservation, and shipment

USGS Publications Warehouse

White, C. LeAnn; Dusek, Robert J.; Franson, J. Christian; Friend, Milton; Gibbs, Samantha E.J.; Wild, Margaret A.

2015-01-01

Prior to collecting samples, it is important to determine the capabilities and submission criteria of the laboratory receiving the samples. Some laboratories may specialize in a limited number of tests, be equipped to accept only certain types of tissues (instead of entire carcasses), or specialize in particular species or group of animals (e.g., reptiles, birds, mammals). Diagnostic laboratories have specific requirements regarding preparation, labeling, and shipping of samples. Adherence to these requirements helps ensure the usefulness of any submitted specimens. Although laboratories may vary in the cost and turnaround times for diagnostic tests, some laboratories may be able to prioritize samples and accommodate accelerated time frames if communicated at the time of submission. Keeping a prepacked kit with basic carcass-collection supplies, including a paper copy of the specimen history form (available for download from the Web sites of most diagnostic laboratories), in the office or vehicle will decrease the chances of forgetting an essential item and decrease response time for arriving at an event.

[Application of mass spectrometry in mycology].

PubMed

Quiles Melero, Inmaculada; Peláez, Teresa; Rezusta López, Antonio; Garcia-Rodríguez, Julio

2016-06-01

MALDI-TOF (matrix-assisted laser desorption ionization time-of-flight) mass spectrometry (MS) is becoming an essential tool in most microbiology laboratories. At present, by using a characteristic fungal profile obtained from whole cells or through simple extraction protocols, MALDI-TOF MS allows the identification of pathogenic fungi with a high performance potential. This methodology decreases the laboratory turnaround time, optimizing the detection of mycoses. This article describes the state-of-the-art of the use of MALDI-TOF MS for the detection of human clinical fungal pathogens in the laboratory and discusses the future applications of this technology, which will further improve routine mycological diagnosis. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Executive summary: a guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a).

PubMed

Baron, Ellen Jo; Miller, J Michael; Weinstein, Melvin P; Richter, Sandra S; Gilligan, Peter H; Thomson, Richard B; Bourbeau, Paul; Carroll, Karen C; Kehl, Sue C; Dunne, W Michael; Robinson-Dunn, Barbara; Schwartzman, Joseph D; Chapin, Kimberle C; Snyder, James W; Forbes, Betty A; Patel, Robin; Rosenblatt, Jon E; Pritt, Bobbi S

2013-08-01

The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

Comparison of two matrix-assisted laser desorption ionization-time of flight mass spectrometry methods with conventional phenotypic identification for routine identification of bacteria to the species level.

PubMed

Cherkaoui, Abdessalam; Hibbs, Jonathan; Emonet, Stéphane; Tangomo, Manuela; Girard, Myriam; Francois, Patrice; Schrenzel, Jacques

2010-04-01

Bacterial identification relies primarily on culture-based methodologies requiring 24 h for isolation and an additional 24 to 48 h for species identification. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is an emerging technology newly applied to the problem of bacterial species identification. We evaluated two MALDI-TOF MS systems with 720 consecutively isolated bacterial colonies under routine clinical laboratory conditions. Isolates were analyzed in parallel on both devices, using the manufacturers' default recommendations. We compared MS with conventional biochemical test system identifications. Discordant results were resolved with "gold standard" 16S rRNA gene sequencing. The first MS system (Bruker) gave high-confidence identifications for 680 isolates, of which 674 (99.1%) were correct; the second MS system (Shimadzu) gave high-confidence identifications for 639 isolates, of which 635 (99.4%) were correct. Had MS been used for initial testing and biochemical identification used only in the absence of high-confidence MS identifications, the laboratory would have saved approximately US$5 per isolate in marginal costs and reduced average turnaround time by more than an 8-h shift, with no loss in accuracy. Our data suggest that implementation of MS as a first test strategy for one-step species identification would improve timeliness and reduce isolate identification costs in clinical bacteriology laboratories now.

Open-circuit respirometry: real-time, laboratory-based systems.

PubMed

Ward, Susan A

2018-05-04

This review explores the conceptual and technological factors integral to the development of laboratory-based, automated real-time open-circuit mixing-chamber and breath-by-breath (B × B) gas-exchange systems, together with considerations of assumptions and limitations. Advances in sensor technology, signal analysis, and digital computation led to the emergence of these technologies in the mid-20th century, at a time when investigators were beginning to recognise the interpretational advantages of nonsteady-state physiological-system interrogation in understanding the aetiology of exercise (in)tolerance in health, sport, and disease. Key milestones include the 'Auchincloss' description of an off-line system to estimate alveolar O 2 uptake B × B during exercise. This was followed by the first descriptions of real-time automated O 2 uptake and CO 2 output B × B measurement by Beaver and colleagues and by Linnarsson and Lindborg, and mixing-chamber measurement by Wilmore and colleagues. Challenges to both approaches soon emerged: e.g., the influence of mixing-chamber washout kinetics on mixed-expired gas concentration determination, and B × B alignment of gas-concentration signals with respired flow. The challenging algorithmic and technical refinements required for gas-exchange estimation at the alveolar level have also been extensively explored. In conclusion, while the technology (both hardware and software) underpinning real-time automated gas-exchange measurement has progressively advanced, there are still concerns regarding accuracy especially under the challenging conditions of changing metabolic rate.

Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories.

PubMed

Howanitz, Peter J; Darcy, Theresa P; Meier, Frederick A; Bashleben, Christine P

2015-09-01

The anticoagulant warfarin has been identified as the second most frequent drug responsible for serious, disabling, and fatal adverse drug events in the United States, and its effect on blood coagulation is monitored by the laboratory test called international normalized ratio (INR). To determine the presence of INR policies and procedures, INR practices, and completeness and timeliness of reporting critical INR results in participants' clinical laboratories. Participants reviewed their INR policies and procedure requirements, identified their practices by using a questionnaire, and studied completeness of documentation and timeliness of reporting critical value INR results for outpatients and emergency department patients. In 98 participating institutions, the 5 required policies and procedures were in place in 93% to 99% of clinical laboratories. Fifteen options for the allowable variations among duplicate results from different analyzers, 12 different timeliness goals for reporting critical values, and 18 unique critical value limits were used by participants. All required documentation elements were present in 94.8% of 192 reviewed INR validation reports. Critical value INR results were reported within the time frame established by the laboratory for 93.4% of 2604 results, but 1.0% of results were not reported. Although the median laboratories successfully communicated all critical results within their established time frames and had all the required validation elements based in their 2 most recent INR calculations, those participants at the lowest 10th percentile were successful in 80.0% and 85.7% of these requirements, respectively. Significant opportunities exist for adherence to INR procedural requirements and for practice patterns and timeliness goals for INR critical results' reporting.

Conditions of High Resolution Melting Analysis on the Cobas z480 Instrument for the Genotyping of VKORC1 in the Clinical Routine Laboratory.

PubMed

Paar, Christian; Hammerl, Verena; Blessberger, Hermann; Stekel, Herbert; Steinwender, Clemens; Berg, Jörg

2016-12-01

High resolution melting (HRM) of amplicons is a simple method for genotyping of single nucleotide polymorphisms (SNPs). Albeit many applications reported, HRM seems to be rarely used in clinical laboratories. The suitability of HRM-PCR for the clinical laboratory was investigated for genotyping of SNPs of the vitamin K epoxide reductase complex unit 1 gene. About 100 DNA samples were analyzed by two different HRM-PCRs on the Cobas z480 instrument and compared with a PCR with fluorescently labeled probes (HybProbe-PCR) on the LightCycler 2.0 instrument as reference. Reliable genotyping with 100% matching results was obtained, when the amplicon size was small (63 bp) and DNA input was limited by e.g., sample dilution with salt-free water. DNA extracted by differing methods may be used for genotyping by HRM-PCR. Compared with HybProbe-PCR, HRM-PCR on the Cobas z480 instrument allows for higher through-put, however, at the cost of a higher degree of laboratory standardization and a slower turnaround.

Open-source Software for Demand Forecasting of Clinical Laboratory Test Volumes Using Time-series Analysis.

PubMed

Mohammed, Emad A; Naugler, Christopher

2017-01-01

Demand forecasting is the area of predictive analytics devoted to predicting future volumes of services or consumables. Fair understanding and estimation of how demand will vary facilitates the optimal utilization of resources. In a medical laboratory, accurate forecasting of future demand, that is, test volumes, can increase efficiency and facilitate long-term laboratory planning. Importantly, in an era of utilization management initiatives, accurately predicted volumes compared to the realized test volumes can form a precise way to evaluate utilization management initiatives. Laboratory test volumes are often highly amenable to forecasting by time-series models; however, the statistical software needed to do this is generally either expensive or highly technical. In this paper, we describe an open-source web-based software tool for time-series forecasting and explain how to use it as a demand forecasting tool in clinical laboratories to estimate test volumes. This tool has three different models, that is, Holt-Winters multiplicative, Holt-Winters additive, and simple linear regression. Moreover, these models are ranked and the best one is highlighted. This tool will allow anyone with historic test volume data to model future demand.

Open-source Software for Demand Forecasting of Clinical Laboratory Test Volumes Using Time-series Analysis

PubMed Central

Mohammed, Emad A.; Naugler, Christopher

2017-01-01

Background: Demand forecasting is the area of predictive analytics devoted to predicting future volumes of services or consumables. Fair understanding and estimation of how demand will vary facilitates the optimal utilization of resources. In a medical laboratory, accurate forecasting of future demand, that is, test volumes, can increase efficiency and facilitate long-term laboratory planning. Importantly, in an era of utilization management initiatives, accurately predicted volumes compared to the realized test volumes can form a precise way to evaluate utilization management initiatives. Laboratory test volumes are often highly amenable to forecasting by time-series models; however, the statistical software needed to do this is generally either expensive or highly technical. Method: In this paper, we describe an open-source web-based software tool for time-series forecasting and explain how to use it as a demand forecasting tool in clinical laboratories to estimate test volumes. Results: This tool has three different models, that is, Holt-Winters multiplicative, Holt-Winters additive, and simple linear regression. Moreover, these models are ranked and the best one is highlighted. Conclusion: This tool will allow anyone with historic test volume data to model future demand. PMID:28400996

Learning motion concepts using real-time microcomputer-based laboratory tools

NASA Astrophysics Data System (ADS)

Thornton, Ronald K.; Sokoloff, David R.

1990-09-01

Microcomputer-based laboratory (MBL) tools have been developed which interface to Apple II and Macintosh computers. Students use these tools to collect physical data that are graphed in real time and then can be manipulated and analyzed. The MBL tools have made possible discovery-based laboratory curricula that embody results from educational research. These curricula allow students to take an active role in their learning and encourage them to construct physical knowledge from observation of the physical world. The curricula encourage collaborative learning by taking advantage of the fact that MBL tools present data in an immediately understandable graphical form. This article describes one of the tools—the motion detector (hardware and software)—and the kinematics curriculum. The effectiveness of this curriculum compared to traditional college and university methods for helping students learn basic kinematics concepts has been evaluated by pre- and post-testing and by observation. There is strong evidence for significantly improved learning and retention by students who used the MBL materials, compared to those taught in lecture.

Laboratory preparation questionnaires as a tool for the implementation of the Just in Time Teaching in the Physics I laboratories: Research training

NASA Astrophysics Data System (ADS)

Miranda, David A.; Sanchez, Melba J.; Forero, Oscar M.

2017-06-01

The implementation of the JiTT (Just in Time Teaching) strategy is presented to increase the previous preparation of students enrolled in the subject Physics Laboratory I offered at the Industrial University of Santander (UIS), Colombia. In this study, a laboratory preparation questionnaire (CPL) was applied as a tool for the implementation of JiTT combined with elements of mediated learning. It was found that the CPL allows to improve the students’ experience regarding the preparation of the laboratory and the development of the experimental session. These questionnaires were implemented in an academic manager (Moodle) and a web application (lab.ciencias.uis.edu.co) was used to publish the contents essential for the preparation of the student before each practical session. The most significant result was that the students performed the experimental session with the basic knowledge to improve their learning experience.

Multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.

PubMed

Halligan, E; Edgeworth, J; Bisnauthsing, K; Bible, J; Cliff, P; Aarons, E; Klein, J; Patel, A; Goldenberg, S

2014-08-01

Laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. Tests are often requested sequentially and undertaken in different laboratories. This causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. A molecular multiplex test (Luminex(®) Gastrointestinal Pathogen Panel (GPP)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use of isolation facilities and user acceptability. A total of 262 (12%) patients had a pathogen detected by conventional methods compared with 483 (22.1%) by GPP. Most additional cases were detected in patients developing symptoms in the first 4 days of admission. Additional cases were detected because of presumed improved diagnostic sensitivity but also because clinicians had not requested the correct pathogen. Turnaround time (41.8 h) was faster than bacterial culture (66.5 h) and parasite investigation (66.5 h) but slower than conventional testing for Clostridium difficile (17.3 h) and viruses (27 h). The test could allow simplified requesting by clinicians and a consolidated laboratory workflow, reducing the overall number of specimens received by the laboratory. A total of 154 isolation days were saved at an estimated cost of £30 800. Consumables and labour were estimated at £150 641 compared with £63 431 for conventional testing. Multiplex molecular testing using a panel of targets allowed enhanced detection and a consolidated laboratory workflow. This is likely to be of greater benefit to cases that present within the first 4 days of hospital admission. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

PubMed

Baig, Ayaz; Siddiqui, Imran; Jabbar, Abdul; Azam, Syed Iqbal; Sabir, Salman; Alam, Shahryar; Ghani, Farooq

2007-01-01

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

Turnaround Insights from the Organizational Sciences: A Review of the Empirical Evidence and the Development of a Staged Model of Recovery with Potential Implications for the PK-12 Education Sector

ERIC Educational Resources Information Center

Murphy, Joseph

2008-01-01

In this article, we review research from the organizational sciences to develop lessons for educators and policy makers. The approach is an integrative review of the literature. We employ a comprehensive process to unpack and make sense of the turnaround literature from the organizational sciences. We rely on strategies appropriate for document…

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)a

PubMed Central

Baron, Ellen Jo; Miller, J. Michael; Weinstein, Melvin P.; Richter, Sandra S.; Gilligan, Peter H.; Thomson, Richard B.; Bourbeau, Paul; Carroll, Karen C.; Kehl, Sue C.; Dunne, W. Michael; Robinson-Dunn, Barbara; Schwartzman, Joseph D.; Chapin, Kimberle C.; Snyder, James W.; Forbes, Betty A.; Patel, Robin; Rosenblatt, Jon E.; Pritt, Bobbi S.

2013-01-01

The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients. PMID:23845951

Causes and impact of specimen rejection in a clinical chemistry laboratory.

PubMed

Cao, Liyun; Chen, Meng; Phipps, Ron A; Del Guidice, Robert E; Handy, Beverly C; Wagar, Elizabeth A; Meng, Qing H

2016-07-01

Pre-analytical errors necessitate specimen rejection and negatively affect patient safety. Our purpose was to investigate the factors leading to specimen rejection and its impact. Specimen rejections in a clinical chemistry laboratory during a 1-year period were reviewed retrospectively and analyzed for frequency, cause, circumstances, and impact. Of the 837,862 specimens received, 2178 (0.26%) were rejected. The most common reasons for specimen rejection were contamination (n=764, 35.1%), inappropriate collection container/tube (n=330, 15.2%), quantity not sufficient (QNS) (n=329, 15.1%), labeling errors (n=321, 14.7%), hemolyzed specimen (n=205, 9.4%), and clotted specimen (n=203, 9.3%). The analytes most often affected were glucose (n=192, 8.8%); calcium (n=152, 7.0%), magnesium (n=148, 6.8%), potassium (n=137, 6.3%), creatinine (n=100, 4.6%), and blood urea nitrogen (n=97, 4.4%). Outpatient service and blood draw by phlebotomists were associated with low rejection rates (536/493,501 or 0.11% and 368/586,503 or 0.06%, respectively). Recollection due to specimen rejection increased the turnaround time by an average of 108min. The total cost for the recollection was around $43,210 USD with an average cost around $21.9 USD. The factors associated with rejection are remediable by improved training and quality assurance measures. Policies and procedures specific to specimen collection, transportation, and preparation should be strictly followed. Copyright © 2016 Elsevier B.V. All rights reserved.

Clinical laboratory urine analysis: comparison of the UriSed automated microscopic analyzer and the manual microscopy.

PubMed

Ma, Junlong; Wang, Chengbin; Yue, Jiaxin; Li, Mianyang; Zhang, Hongrui; Ma, Xiaojing; Li, Xincui; Xue, Dandan; Qing, Xiaoyan; Wang, Shengjiang; Xiang, Daijun; Cong, Yulong

2013-01-01

Several automated urine sediment analyzers have been introduced to clinical laboratories. Automated microscopic pattern recognition is a new technique for urine particle analysis. We evaluated the analytical and diagnostic performance of the UriSed automated microscopic analyzer and compared with manual microscopy for urine sediment analysis. Precision, linearity, carry-over, and method comparison were carried out. A total of 600 urine samples sent for urinalysis were assessed using the UriSed automated microscopic analyzer and manual microscopy. Within-run and between-run precision of the UriSed for red blood cells (RBC) and white blood cells (WBC) were acceptable at all levels (CV < 20%). Within-run and between-run imprecision of the UriSed testing for cast, squamous epithelial cells (EPI), and bacteria (BAC) were good at middle level and high level (CV < 20%). The linearity analysis revealed substantial agreement between the measured value and the theoretical value of the UriSed for RBC, WBC, cast, EPI, and BAC (r > 0.95). There was no carry-over. RBC, WBC, and squamous epithelial cells with sensitivities and specificities were more than 80% in this study. There is substantial agreement between the UriSed automated microscopic analyzer and the manual microscopy methods. The UriSed provides for a rapid turnaround time.

Residual life assessment of the SSME/ATD HPOTP turnaround duct (TAD)

NASA Technical Reports Server (NTRS)

Gross, R. Steven

1996-01-01

This paper is concerned with the prediction of the low cycle thermal fatigue behavior of a component in a developmental (ATD) high pressure liquid oxygen turbopump (HPOTP) for the Space Shuttle Main Engine (SSME). This component is called the Turnaround Duct (TAD). The TAD is a complex single piece casting of MAR-M-247 material. Its function is to turn the hot turbine exhaust gas (1200 F hydrogen rich gas steam) such that it can exhaust radially out of the turbopump. In very simple terms, the TAD consists of two rings connected axially by 22 hollow airfoil shaped struts with the turning vanes placed at the top, middle, and bottom of each strut. The TAD is attached to the other components of the pump via bolts passing through 14 of the 22 struts. Of the remaining 8 struts, four are equally spaced (90 deg interval) and containing a cooling tube through which liquid hydrogen passes on its way to cool the shaft bearing assemblies. The remaining 4 struts are empty. One of the pump units in the certification test series was destructively examined after 22 test firings. Substantial axial cracking was found in two of the struts which contain cooling tubes. None of the other 20 struts showed any sign of internal cracking. This unusual low cycle thermal fatigue behavior within the two cooling tube struts is the focus of this study.

Using data to make decisions and drive results: a LEAN implementation strategy.

PubMed

Panning, Rick

2005-03-28

During the process of facility planning, Fairview Laboratory Services utilized LEAN manufacturing to maximize efficiency, simplify processes, and improve laboratory support of patient care services. By incorporating the LEAN program's concepts in our pilot program, we were able to reduce turnaround time by 50%, improve productivity by greater than 40%, reduce costs by 31%, save more than 440 square feet of space, standardize work practices, reduce errors and error potential, continuously measure performance, eliminate excess unused inventory and visual noise, and cross-train 100% of staff in the core laboratory. In addition, we trained a core team of people that is available to coordinate future LEAN projects in the laboratory and other areas of the organization.

A formative evaluation of problem-based learning as an instructional strategy in a medical laboratory technician course

NASA Astrophysics Data System (ADS)

Nelson, Diane Patricia

2002-09-01

This study is a formative evaluation of problem-based learning as an effective course delivery strategy in a second year introductory Medical Laboratory Technician discipline-specific hematology course. This strategy can serve two purposes in this type of course: discipline specific content knowledge and process skills learning. A needs study identified that students required additional workplace skills as they entered the clinical internship. Students tested well on the national registry examinations, discipline-specific content knowledge, but group process skills needed improvement in the areas of collaboration, communication, and critical reasoning. Problem-based learning was identified as an change intervention to help provide these skills. A search of the literature revealed that the Baker College cultural and physical environment would support this intervention. Twelve cases were written, situated in a clinical laboratory environment, addressing learning issues identified in a modified Delphi survey of laboratory personnel e.g. fiscal responsibility, turn-around time, invasiveness of laboratory techniques, and holistic view of healthcare environment. A hematology class of 13 students received the intervention. The cases were structured to proceed from instructor-centered (guided) learning issues to learner-centered learning issues. Observations of the in-group collaboration processes were documented, as well as oral presentations and critical reasoning, with students given periodic feedback on these skills. Student surveys provided data about satisfaction, attitude to PBL process, and self-efficacy. Multiple choice discipline-specific content examinations were given and compared with classes from the previous four years. The study found that students receiving the PBL treatment scored as well as or better than students from previous years on traditional multiple choice exams. Recall questions showed positive significance and application/analysis questions

A comparison of time-shared vs. batch development of space software

NASA Technical Reports Server (NTRS)

Forthofer, M.

1977-01-01

In connection with a study regarding the ground support software development for the Space Shuttle, an investigation was conducted concerning the most suitable software development techniques to be employed. A time-sharing 'trial period' was used to determine whether or not time-sharing would be a cost-effective software development technique for the Ground Based Shuttle system. It was found that time-sharing substantially improved job turnaround and programmer access to the computer for the representative group of ground support programmers. Moreover, this improvement resulted in an estimated saving of over fifty programmer days during the trial period.

Voice recognition technology implementation in surgical pathology: advantages and limitations.

PubMed

Singh, Meenakshi; Pal, Timothy R

2011-11-01

Voice recognition technology (VRT) has been in use for medical transcription outside of laboratories for many years, and in recent years it has evolved to a level where it merits consideration by surgical pathologists. To determine the feasibility and impact of making a transition from a transcriptionist-based service to VRT in surgical pathology. We have evaluated VRT in a phased manner for sign out of general and subspecialty surgical pathology cases after conducting a pilot study. We evaluated the effect on turnaround time, workflow, staffing, typographical error rates, and the overall ability of VRT to be adapted for use in surgical pathology. The stepwise implementation of VRT has resulted in real-time sign out of cases and improvement in average turnaround time from 4 to 3 days. The percentage of cases signed out in 1 day improved from 22% to 37%. Amendment rates for typographical errors have decreased. Use of templates and synoptic reports has been facilitated. The transcription staff has been reassigned to other duties and is successfully assisting in other areas. Resident involvement and exposure to complete case sign out has been achieved resulting in a positive impact on resident education. Voice recognition technology allows for a seamless workflow in surgical pathology, with improvements in turnaround time and a positive impact on competency-based resident education. Individual practices may assess the value of VRT and decide to implement it, potentially with gains in many aspects of their practice.

Development and Implementation of a Coagulation Factor Testing Method Utilizing Autoverification in a High-volume Clinical Reference Laboratory Environment

PubMed Central

Riley, Paul W.; Gallea, Benoit; Valcour, Andre

2017-01-01

Background: Testing coagulation factor activities requires that multiple dilutions be assayed and analyzed to produce a single result. The slope of the line created by plotting measured factor concentration against sample dilution is evaluated to discern the presence of inhibitors giving rise to nonparallelism. Moreover, samples producing results on initial dilution falling outside the analytic measurement range of the assay must be tested at additional dilutions to produce reportable results. Methods: The complexity of this process has motivated a large clinical reference laboratory to develop advanced computer algorithms with automated reflex testing rules to complete coagulation factor analysis. A method was developed for autoverification of coagulation factor activity using expert rules developed with on an off the shelf commercially available data manager system integrated into an automated coagulation platform. Results: Here, we present an approach allowing for the autoverification and reporting of factor activity results with greatly diminished technologist effort. Conclusions: To the best of our knowledge, this is the first report of its kind providing a detailed procedure for implementation of autoverification expert rules as applied to coagulation factor activity testing. Advantages of this system include ease of training for new operators, minimization of technologist time spent, reduction of staff fatigue, minimization of unnecessary reflex tests, optimization of turnaround time, and assurance of the consistency of the testing and reporting process. PMID:28706751

Development and Implementation of a Coagulation Factor Testing Method Utilizing Autoverification in a High-volume Clinical Reference Laboratory Environment.

PubMed

Riley, Paul W; Gallea, Benoit; Valcour, Andre

2017-01-01

Testing coagulation factor activities requires that multiple dilutions be assayed and analyzed to produce a single result. The slope of the line created by plotting measured factor concentration against sample dilution is evaluated to discern the presence of inhibitors giving rise to nonparallelism. Moreover, samples producing results on initial dilution falling outside the analytic measurement range of the assay must be tested at additional dilutions to produce reportable results. The complexity of this process has motivated a large clinical reference laboratory to develop advanced computer algorithms with automated reflex testing rules to complete coagulation factor analysis. A method was developed for autoverification of coagulation factor activity using expert rules developed with on an off the shelf commercially available data manager system integrated into an automated coagulation platform. Here, we present an approach allowing for the autoverification and reporting of factor activity results with greatly diminished technologist effort. To the best of our knowledge, this is the first report of its kind providing a detailed procedure for implementation of autoverification expert rules as applied to coagulation factor activity testing. Advantages of this system include ease of training for new operators, minimization of technologist time spent, reduction of staff fatigue, minimization of unnecessary reflex tests, optimization of turnaround time, and assurance of the consistency of the testing and reporting process.

Evaluation of a u.s. Public health laboratory service for the molecular detection of drug resistant tuberculosis.

PubMed

Yakrus, Mitchell A; Metchock, Beverly; Starks, Angela M

2015-01-01

Crucial to interrupting the spread of tuberculosis (TB) is prompt implementation of effective treatment regimens. We evaluated satisfaction, comfort with interpretation, and use of molecular results from a public health service provided by the Centers for Disease Control and Prevention (CDC) for the molecular detection of drug resistant Mycobacterium tuberculosis complex (MTBC). An electronic survey instrument was used to collect information anonymously from U.S. Public Health Laboratories (PHL) that submitted at least one isolate of MTBC to CDC from September 2009 through February 2011. Over 97% of those responding expressed satisfaction with the turnaround time for receiving results. Twenty-six PHL (74%) reported molecular results to healthcare providers in less than two business days. When comparing the molecular results from CDC with their own phenotypic drug susceptibility testing, 50% of PHL observed discordance. No respondents found the molecular results difficult to interpret and 82% were comfortably discussing them with TB program officials and healthcare providers. Survey results indicate PHL were satisfied with CDC's ability to rapidly provide interpretable molecular results for isolates of MTBC submitted for determination of drug resistance. To develop educational materials and strategies for service improvement, reasons for discordant results and areas of confusion need to be identified.

Estimating implementation and operational costs of an integrated tiered CD4 service including laboratory and point of care testing in a remote health district in South Africa.

PubMed

Cassim, Naseem; Coetzee, Lindi M; Schnippel, Kathryn; Glencross, Deborah K

2014-01-01

An integrated tiered service delivery model (ITSDM) has been proposed to provide 'full-coverage' of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing < 30-40 samples from 8-10 health-clinics; Tier-3/Community laboratories servicing ∼ 50 health-clinics, processing < 150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing < 300 or > 600 samples/day and serving > 100 or > 200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of > 24-48 hours. Full service coverage with TAT < 6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured 'full service coverage' and < 24 hour LTR-TAT for the district at $7.42 per-test. Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an

Accurate Detection of Streptococcus pyogenes at the Point of Care Using the cobas Liat Strep A Nucleic Acid Test.

PubMed

Wang, Fangnian; Tian, Yu; Chen, Lingjun; Luo, Robert; Sickler, Joanna; Liesenfeld, Oliver; Chen, Shuqi

2017-10-01

The performance of a polymerase chain reaction-based point-of-care assay, the cobas Strep A Nucleic Acid Test for use on the cobas Liat System (cobas Liat Strep A assay), for the detection of group A Streptococcus bacteria was evaluated in primary care settings. Throat swab specimens from 427 patients were tested with the cobas Liat Strep A assay and a rapid antigen detection test (RADT) by existing medical staff at 5 primary care clinics, and results were compared with bacterial culture. The cobas Liat Strep A assay demonstrated equivalent sensitivity (97.7%) and specificity (93.3%) to reference culture with a 15-minute turnaround time. In comparison to RADTs, the cobas Liat Strep A assay showed improved sensitivity (97.7% Liat vs 84.5% RADT). The Clinical Laboratory Improvement Amendments-waived cobas Liat Strep A assay demonstrated the ease of use and improved turnaround time of RADTs along with the sensitivity of culture.

Sharing the skies: the Gemini Observatory international time allocation process

NASA Astrophysics Data System (ADS)

Margheim, Steven J.

2016-07-01

Gemini Observatory serves a diverse community of four partner countries (United States, Canada, Brazil, and Argentina), two hosts (Chile and University of Hawaii), and limited-term partnerships (currently Australia and the Republic of Korea). Observing time is available via multiple opportunities including Large and Long Pro- grams, Fast-turnaround programs, and regular semester queue programs. The slate of programs for observation each semester must be created by merging programs from these multiple, conflicting sources. This paper de- scribes the time allocation process used to schedule the overall science program for the semester, with emphasis on the International Time Allocation Committee and the software applications used.

Comprehensive GMO detection using real-time PCR array: single-laboratory validation.

PubMed

Mano, Junichi; Harada, Mioko; Takabatake, Reona; Furui, Satoshi; Kitta, Kazumi; Nakamura, Kosuke; Akiyama, Hiroshi; Teshima, Reiko; Noritake, Hiromichi; Hatano, Shuko; Futo, Satoshi; Minegishi, Yasutaka; Iizuka, Tayoshi

2012-01-01

We have developed a real-time PCR array method to comprehensively detect genetically modified (GM) organisms. In the method, genomic DNA extracted from an agricultural product is analyzed using various qualitative real-time PCR assays on a 96-well PCR plate, targeting for individual GM events, recombinant DNA (r-DNA) segments, taxon-specific DNAs, and donor organisms of the respective r-DNAs. In this article, we report the single-laboratory validation of both DNA extraction methods and component PCR assays constituting the real-time PCR array. We selected some DNA extraction methods for specified plant matrixes, i.e., maize flour, soybean flour, and ground canola seeds, then evaluated the DNA quantity, DNA fragmentation, and PCR inhibition of the resultant DNA extracts. For the component PCR assays, we evaluated the specificity and LOD. All DNA extraction methods and component PCR assays satisfied the criteria set on the basis of previous reports.

Impact of a voice recognition system on report cycle time and radiologist reading time

NASA Astrophysics Data System (ADS)

Melson, David L.; Brophy, Robert; Blaine, G. James; Jost, R. Gilbert; Brink, Gary S.

1998-07-01

Because of its exciting potential to improve clinical service, as well as reduce costs, a voice recognition system for radiological dictation was recently installed at our institution. This system will be clinically successful if it dramatically reduces radiology report turnaround time without substantially affecting radiologist dictation and editing time. This report summarizes an observer study currently under way in which radiologist reporting times using the traditional transcription system and the voice recognition system are compared. Four radiologists are observed interpreting portable intensive care unit (ICU) chest examinations at a workstation in the chest reading area. Data are recorded with the radiologists using the transcription system and using the voice recognition system. The measurements distinguish between time spent performing clerical tasks and time spent actually dictating the report. Editing time and the number of corrections made are recorded. Additionally, statistics are gathered to assess the voice recognition system's impact on the report cycle time -- the time from report dictation to availability of an edited and finalized report -- and the length of reports.

Prepopulated radiology report templates: a prospective analysis of error rate and turnaround time.

PubMed

Hawkins, C M; Hall, S; Hardin, J; Salisbury, S; Towbin, A J

2012-08-01

Current speech recognition software allows exam-specific standard reports to be prepopulated into the dictation field based on the radiology information system procedure code. While it is thought that prepopulating reports can decrease the time required to dictate a study and the overall number of errors in the final report, this hypothesis has not been studied in a clinical setting. A prospective study was performed. During the first week, radiologists dictated all studies using prepopulated standard reports. During the second week, all studies were dictated after prepopulated reports had been disabled. Final radiology reports were evaluated for 11 different types of errors. Each error within a report was classified individually. The median time required to dictate an exam was compared between the 2 weeks. There were 12,387 reports dictated during the study, of which, 1,173 randomly distributed reports were analyzed for errors. There was no difference in the number of errors per report between the 2 weeks; however, radiologists overwhelmingly preferred using a standard report both weeks. Grammatical errors were by far the most common error type, followed by missense errors and errors of omission. There was no significant difference in the median dictation time when comparing studies performed each week. The use of prepopulated reports does not alone affect the error rate or dictation time of radiology reports. While it is a useful feature for radiologists, it must be coupled with other strategies in order to decrease errors.

Evaluation of second-generation sequencing of 19 dilated cardiomyopathy genes for clinical applications.

PubMed

Gowrisankar, Sivakumar; Lerner-Ellis, Jordan P; Cox, Stephanie; White, Emily T; Manion, Megan; LeVan, Kevin; Liu, Jonathan; Farwell, Lisa M; Iartchouk, Oleg; Rehm, Heidi L; Funke, Birgit H

2010-11-01

Medical sequencing for diseases with locus and allelic heterogeneities has been limited by the high cost and low throughput of traditional sequencing technologies. "Second-generation" sequencing (SGS) technologies allow the parallel processing of a large number of genes and, therefore, offer great promise for medical sequencing; however, their use in clinical laboratories is still in its infancy. Our laboratory offers clinical resequencing for dilated cardiomyopathy (DCM) using an array-based platform that interrogates 19 of more than 30 genes known to cause DCM. We explored both the feasibility and cost effectiveness of using PCR amplification followed by SGS technology for sequencing these 19 genes in a set of five samples enriched for known sequence alterations (109 unique substitutions and 27 insertions and deletions). While the analytical sensitivity for substitutions was comparable to that of the DCM array (98%), SGS technology performed better than the DCM array for insertions and deletions (90.6% versus 58%). Overall, SGS performed substantially better than did the current array-based testing platform; however, the operational cost and projected turnaround time do not meet our current standards. Therefore, efficient capture methods and/or sample pooling strategies that shorten the turnaround time and decrease reagent and labor costs are needed before implementing this platform into routine clinical applications.

Single-Pair Fret Analysis of mRNA Transcripts for Highly Sensitive Gene Expression Profiling in Near Real Time

PubMed Central

Peng, Zhiyong; Young, Brandon; Baird, Alison E.; Soper, Steven A.

2013-01-01

Expression analysis of mRNAs transcribed from certain genes can be used as important sources of biomarkers for in vitro diagnostics. While the use of reverse transcription quantitative PCR (RT-qPCR) can provide excellent analytical sensitivity for monitoring transcript numbers, more sensitive approaches for expression analysis that can report results in near real-time are needed for many critical applications. We report a novel assay that can provide exquisite limits-of-quantitation and consists of reverse transcription (RT) followed by a ligase detection reaction (LDR) with single-pair fluorescence resonance energy transfer (spFRET) to provide digital readout through molecular counting. For this assay, no PCR was employed, which enabled short assay turnaround times. To facilitate implementation of the assay, a cyclic olefin copolymer (COC) microchip, which was fabricated using hot embossing, was employed to carry out the LDR in a continuous flow format with on-line single-molecule detection following the LDR. As demonstrators of the assay's utility, MMP-7 mRNA was expression profiled from several colorectal cancer cell lines. It was found that the RT-LDR/spFRET assay produced highly linear calibration plots even in the low copy number regime. Comparison to RT-qPCR indicated a better linearity over the low copy number range investigated (10 − 10,000 copies) with an R2 = 0.9995 for RT-LDR/spFRET and R2 = 0.98 for RT-qPCR. In addition, differentiating between copy numbers of 10 and 50 could be performed with higher confidence using RT-LDR/spFRET. To demonstrate the short assay turnaround times obtainable using the RT-LDR/spFRET assay, a 2 thermal cycle LDR was carried out on amphiphysin gene transcripts that can serve as important diagnostic markers for ischemic stroke. The ability to supply diagnostic information on possible stroke events in short turnaround times using RT-LDR/spFRET will enable clinicians to treat patients effectively with appropriate time

Nonpreemptive run-time scheduling issues on a multitasked, multiprogrammed multiprocessor with dependencies, bidimensional tasks, folding and dynamic graphs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, Allan Ray

1987-05-01

Increases in high speed hardware have mandated studies in software techniques to exploit the parallel capabilities. This thesis examines the effects a run-time scheduler has on a multiprocessor. The model consists of directed, acyclic graphs, generated from serial FORTRAN benchmark programs by the parallel compiler Parafrase. A multitasked, multiprogrammed environment is created. Dependencies are generated by the compiler. Tasks are bidimensional, i.e., they may specify both time and processor requests. Processor requests may be folded into execution time by the scheduler. The graphs may arrive at arbitrary time intervals. The general case is NP-hard, thus, a variety of heuristics aremore » examined by a simulator. Multiprogramming demonstrates a greater need for a run-time scheduler than does monoprogramming for a variety of reasons, e.g., greater stress on the processors, a larger number of independent control paths, more variety in the task parameters, etc. The dynamic critical path series of algorithms perform well. Dynamic critical volume did not add much. Unfortunately, dynamic critical path maximizes turnaround time as well as throughput. Two schedulers are presented which balance throughput and turnaround time. The first requires classification of jobs by type; the second requires selection of a ratio value which is dependent upon system parameters. 45 refs., 19 figs., 20 tabs.« less

An open-source, extensible system for laboratory timing and control

NASA Astrophysics Data System (ADS)

Gaskell, Peter E.; Thorn, Jeremy J.; Alba, Sequoia; Steck, Daniel A.

2009-11-01

We describe a simple system for timing and control, which provides control of analog, digital, and radio-frequency signals. Our system differs from most common laboratory setups in that it is open source, built from off-the-shelf components, synchronized to a common and accurate clock, and connected over an Ethernet network. A simple bus architecture facilitates creating new and specialized devices with only moderate experience in circuit design. Each device operates independently, requiring only an Ethernet network connection to the controlling computer, a clock signal, and a trigger signal. This makes the system highly robust and scalable. The devices can all be connected to a single external clock, allowing synchronous operation of a large number of devices for situations requiring precise timing of many parallel control and acquisition channels. Provided an accurate enough clock, these devices are capable of triggering events separated by one day with near-microsecond precision. We have achieved precisions of ˜0.1 ppb (parts per 109) over 16 s.

Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction.

PubMed

Khot, Umesh N; Johnson, Michele L; Ramsey, Curtis; Khot, Monica B; Todd, Randall; Shaikh, Saeed R; Berg, William J

2007-07-03

Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of < or = 90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time. We prospectively determined the impact on median door-to-balloon time of a protocol mandating (1) emergency department physician activation of the catheterization laboratory and (2) immediate transfer of the patient to an immediately available catheterization laboratory by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected door-to-balloon time for 60 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention within 24 hours of presentation from October 1, 2004, through August 31, 2005, and compared this group with 86 consecutive ST-elevation myocardial infarction patients from September 1, 2005, through June 26, 2006, after protocol implementation. Median door-to-balloon time decreased overall (113.5 versus 75.5 minutes; P<0.0001), during regular hours (83.5 versus 64.5 minutes; P=0.005), during off-hours (123.5 versus 77.5 minutes; P<0.0001), and with transfer from an outside affiliated emergency department (147 versus 85 minutes; P=0.0006). Treatment within 90 minutes increased from 28% to 71% (P<0.0001). Mean infarct size decreased (peak creatinine kinase, 2623+/-3329 versus 1517+/-1556 IU/L; P=0.0089), as did hospital length of stay (5+/-7 versus 3+/-2 days; P=0.0097) and total hospital costs per admission ($26,826+/-29,497 versus $18,280+/-8943; P=0.0125). Emergency department physician activation of the catheterization laboratory and immediate transfer of the patient to an immediately available catheterization laboratory reduce door-to-balloon time, leading to a reduction in myocardial infarct size, hospital length of stay, and total hospital costs.

Evaluation of a reduced centrifugation time and higher centrifugal force on various general chemistry and immunochemistry analytes in plasma and serum.

PubMed

Møller, Mette F; Søndergaard, Tove R; Kristensen, Helle T; Münster, Anna-Marie B

2017-09-01

Background Centrifugation of blood samples is an essential preanalytical step in the clinical biochemistry laboratory. Centrifugation settings are often altered to optimize sample flow and turnaround time. Few studies have addressed the effect of altering centrifugation settings on analytical quality, and almost all studies have been done using collection tubes with gel separator. Methods In this study, we compared a centrifugation time of 5 min at 3000 ×  g to a standard protocol of 10 min at 2200 ×  g. Nine selected general chemistry and immunochemistry analytes and interference indices were studied in lithium heparin plasma tubes and serum tubes without gel separator. Results were evaluated using mean bias, difference plots and coefficient of variation, compared with maximum allowable bias and coefficient of variation used in laboratory routine quality control. Results For all analytes except lactate dehydrogenase, the results were within the predefined acceptance criteria, indicating that the analytical quality was not compromised. Lactate dehydrogenase showed higher values after centrifugation for 5 min at 3000 ×  g, mean bias was 6.3 ± 2.2% and the coefficient of variation was 5%. Conclusions We found that a centrifugation protocol of 5 min at 3000 ×  g can be used for the general chemistry and immunochemistry analytes studied, with the possible exception of lactate dehydrogenase, which requires further assessment.

An intra-laboratory cultural and real-time PCR method comparison and evaluation for the detection of subclinical paratuberculosis in dairy herds.

PubMed

Heuvelink, Annet; Hassan, Abdulwahed Ahmed; van Weering, Hilmar; van Engelen, Erik; Bülte, Michael; Akineden, Ömer

2017-05-01

Mycobacterium avium subsp. paratuberculosis (MAP) is a vigorous microorganism which causes incurable chronic enteritis, Johne's disease (JD) in cattle. A target of control programmes for JD is to accurately detect MAP-infected cattle early to reduce disease transmission. The present study evaluated the efficacy of two different cultural procedures and a TaqMan real-time PCR assay for detection of subclinical paratuberculosis in dairy herds. Therefore, sixty-one faecal samples were collected from two Dutch dairy herds (n = 40 and n = 21, respectively) which were known to be MAP-ELISA positive. All individual samples were assessed using two different cultural protocols in two different laboratories. The first cultural protocol (first laboratory) included a decontamination step with 0.75% hexadecylpyridinium chloride (HPC) followed by inoculation on Herrold's egg yolk media (HEYM). The second protocol (second laboratory) comprised of a decontamination step using 4% NaOH and malachite green-oxalic acid followed by inoculation on two media, HEYM and in parallel on modified Löwenstein-Jensen media (mLJ). For the TaqMan real-time PCR assay, all faecal samples were tested in two different laboratories using TaqMan® MAP (Johne's) reagents (Life Technologies). The cultural procedures revealed positive reactions in 1.64% of the samples for cultivation protocol 1 and 6.56 and 8.20% of the samples for cultivation protocol 2, respectively. The results of the TaqMan real-time PCR performed in two different laboratories yielded 13.11 and 19.76% positive reaction. The kappa test showed proportional agreement 0.54 between the mLJ media (second laboratory) and TaqMan® real-time PCR method (second laboratory). In conclusion, the TaqMan real-time PCR could be a strongly useful and efficient assay for the detection of subclinical paratuberculosis in dairy cattle leading to an improvement in the efficiency of MAP control strategies.

Transfer of patients with ST-elevation myocardial infarction for primary percutaneous coronary intervention: a province-wide evaluation of "door-in to door-out" delays at the first hospital.

PubMed

Lambert, Laurie J; Brown, Kevin A; Boothroyd, Lucy J; Segal, Eli; Maire, Sébastien; Kouz, Simon; Ross, Dave; Harvey, Richard; Rinfret, Stéphane; Xiao, Yongling; Nasmith, James; Bogaty, Peter

2014-06-24

Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround ("door in" to "door out," or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases. Two core laboratory cardiologists reviewed presenting ECGs to identify left bundle-branch block and, in the absence of left bundle-branch block, definite STEMI (according to both cardiologists) or an ambiguous reading. Median DIDO time was 51 minutes (25th to 75th percentile: 35-82 minutes); 14.1% of the 988 patients had a timely DIDO interval (≤30 minutes as recommended by guidelines). The data-to-decision delay was the major contributor to DIDO time. Female sex, more comorbidities, longer symptom duration, arrival by means other than ambulance, arrival at a hospital not exclusively transferring for PPCI, arrival at a center with a low STEMI volume, and an ambiguous ECG were independently associated with longer DIDO time. When turnaround was timely, 70% of patients received timely PPCI (door-to-device time ≤90 minutes) versus 14% if turnaround was not timely (P<0.0001). Benchmark DIDO times for STEMI patients transferred for PPCI were rarely achieved. Interventions aimed at facilitating the transfer decision, particularly in cases of ECGs that are difficult to interpret, are likely to have the best impact on reducing delay to reperfusion. © 2014 American Heart Association, Inc.

Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department.

PubMed

Burke, John A; Greenslade, Jaimi; Chabrowska, Jadwiga; Greenslade, Katherine; Jones, Sally; Montana, Jacqueline; Bell, Anthony; O'Connor, Alan

2017-06-01

The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Profile of Instrumentation Laboratory's HemosIL® AcuStar HIT-Ab(PF4-H) assay for diagnosis of heparin-induced thrombocytopenia.

PubMed

Nagler, Michael; Cuker, Adam

2017-05-01

Immunoassays play an essential role in the diagnosis of heparin-induced thrombocytopenia (HIT). The objective of this article is to review HemosIL® AcuStar HIT-Ab(PF4-H) (Instrumentation Laboratory, Bedford, MA, USA), a new chemiluminescent immunoassay for HIT. Areas covered: The authors searched the published literature for evaluation studies of HemosIL® AcuStar HIT-Ab(PF4-H) and sought information from the manufacturer. In this paper, the authors discuss the analytical principle and technical aspects of the assay; describe its diagnostic performance in validation studies; report on its reproducibility, cost-effectiveness, and regulatory status; and discuss the implications of the assay on clinical practice and means of integrating it in diagnostic pathways. HemosIL® AcuStar HIT-Ab(PF4-H) is compared with other rapid assays and widely used enzyme-linked immunoassays for the diagnosis of HIT. Expert commentary: HemosIL® AcuStar HIT-Ab(PF4-H) is automatable, can be performed 24 h per day, offers a rapid turnaround time, and appears to have favorable diagnostic accuracy, particularly at thresholds above that listed in the label. These advantages could lead to improved patient outcomes through rapid provision of results at the point of care, enhancing the accuracy of initial diagnosis.

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2013 CFR

2013-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2012 CFR

2012-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

Materials and processes laboratory composite materials characterization task, part 1. Damage tolerance

NASA Technical Reports Server (NTRS)

Nettles, A. T.; Tucker, D. S.; Patterson, W. J.; Franklin, S. W.; Gordon, G. H.; Hart, L.; Hodge, A. J.; Lance, D. G.; Russel, S. S.

1991-01-01

A test run was performed on IM6/3501-6 carbon-epoxy in which the material was processed, machined into specimens, and tested for damage tolerance capabilities. Nondestructive test data played a major role in this element of composite characterization. A time chart was produced showing the time the composite material spent within each Branch or Division in order to identify those areas which produce a long turnaround time. Instrumented drop weight testing was performed on the specimens with nondestructive evaluation being performed before and after the impacts. Destructive testing in the form of cross-sectional photomicrography and compression-after-impact testing were used. Results show that the processing and machining steps needed to be performed more rapidly if data on composite material is to be collected within a reasonable timeframe. The results of the damage tolerance testing showed that IM6/3501-6 is a brittle material that is very susceptible to impact damage.

Single-pair fluorescence resonance energy transfer analysis of mRNA transcripts for highly sensitive gene expression profiling in near real time.

PubMed

Peng, Zhiyong; Young, Brandon; Baird, Alison E; Soper, Steven A

2013-08-20

Expression analysis of mRNAs transcribed from certain genes can be used as important sources of biomarkers for in vitro diagnostics. While the use of reverse transcription quantitative PCR (RT-qPCR) can provide excellent analytical sensitivity for monitoring transcript numbers, more sensitive approaches for expression analysis that can report results in near real-time are needed for many critical applications. We report a novel assay that can provide exquisite limits-of-quantitation and consists of reverse transcription (RT) followed by a ligase detection reaction (LDR) with single-pair fluorescence resonance energy transfer (spFRET) to provide digital readout through molecular counting. For this assay, no PCR was employed, which enabled short assay turnaround times. To facilitate implementation of the assay, a cyclic olefin copolymer (COC) microchip, which was fabricated using hot embossing, was employed to carry out the LDR in a continuous flow format with online single-molecule detection following the LDR. As demonstrators of the assay's utility, MMP-7 mRNA was expression profiled from several colorectal cancer cell lines. It was found that the RT-LDR/spFRET assay produced highly linear calibration plots even in the low copy number regime. Comparison to RT-qPCR indicated a better linearity over the low copy number range investigated (10-10,000 copies) with an R(2) = 0.9995 for RT-LDR/spFRET and R(2) = 0.98 for RT-qPCR. In addition, differentiating between copy numbers of 10 and 50 could be performed with higher confidence using RT-LDR/spFRET. To demonstrate the short assay turnaround times obtainable using the RT-LDR/spFRET assay, a two thermal cycle LDR was carried out on amphiphysin gene transcripts that can serve as important diagnostic markers for ischemic stroke. The ability to supply diagnostic information on possible stroke events in short turnaround times using RT-LDR/spFRET will enable clinicians to treat patients effectively with appropriate time

Variability in Laboratory vs. Field Testing of Peak Power, Torque, and Time of Peak Power Production Among Elite Bicycle Motocross Cyclists.

PubMed

Rylands, Lee P; Roberts, Simon J; Hurst, Howard T

2015-09-01

The aim of this study was to ascertain the variation in elite male bicycle motocross (BMX) cyclists' peak power, torque, and time of power production during laboratory and field-based testing. Eight elite male BMX riders volunteered for the study, and each rider completed 3 maximal sprints using both a Schoberer Rad Messtechnik (SRM) ergometer in the laboratory and a portable SRM power meter on an Olympic standard indoor BMX track. The results revealed a significantly higher peak power (p ≤ 0.001, 34 ± 9%) and reduced time of power production (p ≤ 0.001, 105 ± 24%) in the field tests when compared with laboratory-derived values. Torque was also reported to be lower in the laboratory tests but not to an accepted level of significance (p = 0.182, 6 ± 8%). These results suggest that field-based testing may be a more effective and accurate measure of a BMX rider's peak power, torque, and time of power production.

Cycling performance is superior for time-to-exhaustion versus time-trial in endurance laboratory tests.

PubMed

Coakley, Sarah L; Passfield, Louis

2018-06-01

Time-to-exhaustion (TTE) trials are used in a laboratory setting to measure endurance performance. However, there is some concern with their ecological validity compared with time-trials (TT). Consequently, we aimed to compare cycling performance in TTE and TT where the duration of the trials was matched. Seventeen trained male cyclists completed three TTE trials at 80, 100 and 105% of maximal aerobic power (MAP). On a subsequent visit they performed three TT over the same duration as the TTE. Participants were blinded to elapsed time, power output, cadence and heart rate (HR). Average TTE was 865 ± 345 s, 165 ± 98 s and 117 ± 45 s for the 80, 100 and 105% trials respectively. Average power output was higher for TTE (294 ± 44 W) compared to TT (282 ± 43 W) at 80% MAP (P < 0.01), but not at 100 and 105% MAP (P > 0.05). There was no difference in cadence, HR, or RPE for any trial (P > 0.05). Critical power (CP) was also higher when derived from TTE compared to TT (P < 0.01). It is concluded that TTE results in a higher average power output compared to TT at 80% MAP. When determining CP, TTE rather than TT protocols appear superior.

Practical issues in implementing whole-genome-sequencing in routine diagnostic microbiology.

PubMed

Rossen, J W A; Friedrich, A W; Moran-Gilad, J

2018-04-01

Next generation sequencing (NGS) is increasingly being used in clinical microbiology. Like every new technology adopted in microbiology, the integration of NGS into clinical and routine workflows must be carefully managed. To review the practical aspects of implementing bacterial whole genome sequencing (WGS) in routine diagnostic laboratories. Review of the literature and expert opinion. In this review, we discuss when and how to integrate whole genome sequencing (WGS) in the routine workflow of the clinical laboratory. In addition, as the microbiology laboratories have to adhere to various national and international regulations and criteria for their accreditation, we deliberate on quality control issues for using WGS in microbiology, including the importance of proficiency testing. Furthermore, the current and future place of this technology in the diagnostic hierarchy of microbiology is described as well as the necessity of maintaining backwards compatibility with already established methods. Finally, we speculate on the question of whether WGS can entirely replace routine microbiology in the future and the tension between the fact that most sequencers are designed to process multiple samples in parallel whereas for optimal diagnosis a one-by-one processing of the samples is preferred. Special reference is made to the cost and turnaround time of WGS in diagnostic laboratories. Further development is required to improve the workflow for WGS, in particular to shorten the turnaround time, reduce costs, and streamline downstream data analyses. Only when these processes reach maturity will reliance on WGS for routine patient management and infection control management become feasible, enabling the transformation of clinical microbiology into a genome-based and personalized diagnostic field. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa

PubMed Central

Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.

2014-01-01

Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing <30–40 samples from 8–10 health-clinics; Tier-3/Community laboratories servicing ∼50 health-clinics, processing <150 samples/day; high-volume centralized laboratories (Tier-4 and Tier-5) processing <300 or >600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT <6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and <24 hour LTR-TAT for the district at $7.42 per-test. Conclusion Implementing a single Tier-3/community laboratory to extend and improve delivery

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2010 CFR

2010-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction... lp gene. (c) MGLP ReTi. Primers and probe should be utilized in a 25 µl reaction containing 12.5 µl...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2011 CFR

2011-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction... lp gene. (c) MGLP ReTi. Primers and probe should be utilized in a 25 µl reaction containing 12.5 µl...

Real-time loop-mediated isothermal amplification (RealAmp) for the species-specific identification of Plasmodium vivax.

PubMed

Patel, Jaymin C; Oberstaller, Jenna; Xayavong, Maniphet; Narayanan, Jothikumar; DeBarry, Jeremy D; Srinivasamoorthy, Ganesh; Villegas, Leopoldo; Escalante, Ananias A; DaSilva, Alexandre; Peterson, David S; Barnwell, John W; Kissinger, Jessica C; Udhayakumar, Venkatachalam; Lucchi, Naomi W

2013-01-01

Plasmodium vivax infections remain a major source of malaria-related morbidity and mortality. Early and accurate diagnosis is an integral component of effective malaria control programs. Conventional molecular diagnostic methods provide accurate results but are often resource-intensive, expensive, have a long turnaround time and are beyond the capacity of most malaria-endemic countries. Our laboratory has recently developed a new platform called RealAmp, which combines loop-mediated isothermal amplification (LAMP) with a portable tube scanner real-time isothermal instrument for the rapid detection of malaria parasites. Here we describe new primers for the detection of P. vivax using the RealAmp method. Three pairs of amplification primers required for this method were derived from a conserved DNA sequence unique to the P. vivax genome. The amplification was carried out at 64°C using SYBR Green or SYTO-9 intercalating dyes for 90 minutes with the tube scanner set to collect fluorescence signals at 1-minute intervals. Clinical samples of P. vivax and other human-infecting malaria parasite species were used to determine the sensitivity and specificity of the primers by comparing with an 18S ribosomal RNA-based nested PCR as the gold standard. The new set of primers consistently detected laboratory-maintained isolates of P. vivax from different parts of the world. The primers detected P. vivax in the clinical samples with 94.59% sensitivity (95% CI: 87.48-98.26%) and 100% specificity (95% CI: 90.40-100%) compared to the gold standard nested-PCR method. The new primers also proved to be more sensitive than the published species-specific primers specifically developed for the LAMP method in detecting P. vivax.

MOBLAB: a mobile laboratory for testing real-time vision-based systems in path monitoring

NASA Astrophysics Data System (ADS)

Cumani, Aldo; Denasi, Sandra; Grattoni, Paolo; Guiducci, Antonio; Pettiti, Giuseppe; Quaglia, Giorgio

1995-01-01

In the framework of the EUREKA PROMETHEUS European Project, a Mobile Laboratory (MOBLAB) has been equipped for studying, implementing and testing real-time algorithms which monitor the path of a vehicle moving on roads. Its goal is the evaluation of systems suitable to map the position of the vehicle within the environment where it moves, to detect obstacles, to estimate motion, to plan the path and to warn the driver about unsafe conditions. MOBLAB has been built with the financial support of the National Research Council and will be shared with teams working in the PROMETHEUS Project. It consists of a van equipped with an autonomous power supply, a real-time image processing system, workstations and PCs, B/W and color TV cameras, and TV equipment. This paper describes the laboratory outline and presents the computer vision system and the strategies that have been studied and are being developed at I.E.N. `Galileo Ferraris'. The system is based on several tasks that cooperate to integrate information gathered from different processes and sources of knowledge. Some preliminary results are presented showing the performances of the system.

Rapid Genotyping of Single Nucleotide Polymorphisms Influencing Warfarin Drug Response by Surface-Enhanced Laser Desorption and Ionization Time-of-Flight (SELDI-TOF) Mass Spectrometry

PubMed Central

Yang, Shangbin; Xu, LiHui; Wu, Haifeng M.

2010-01-01

Warfarin exhibits significant interindividual variability in dosing requirements. Different drug responses are partly attributed to the single nucleotide polymorphisms (SNPs) that influence either drug action or drug metabolism. Rapid genotyping of these SNPs helps clinicians to choose appropriate initial doses to quickly achieve anticoagulation effects and to prevent complications. We report a novel application of surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF MS) in the rapid genotyping of SNPs that impact warfarin efficacy. The SNPs were first amplified by PCR and then underwent single base extension to generate the specific SNP product. Next, genetic variants displaying different masses were bound to Q10 anionic proteinChips and then genotyped by using SELDI-TOF MS in a multiplex fashion. SELDI-TOF MS offered unique properties of on-chip sample enrichment and clean-ups, which streamlined the testing procedures and eliminated many tedious experimental steps required by the conventional MS-based method. The turn-around time for genotyping three known warfarin-related SNPs, CYP2C9*2, CYP2C9*3, and VKORC1 3673G>A by SELDI-TOF MS was less than 5 hours. The analytical accuracy of this method was confirmed both by bidirectional DNA sequencing and by comparing the genotype results (n = 189) obtained by SELDI-TOF MS to reports from a clinical reference laboratory. This new multiplex genotyping method provides an excellent clinical laboratory platform to promote personalized medicine in warfarin therapy. PMID:20075209

Rapid genotyping of single nucleotide polymorphisms influencing warfarin drug response by surface-enhanced laser desorption and ionization time-of-flight (SELDI-TOF) mass spectrometry.

PubMed

Yang, Shangbin; Xu, LiHui; Wu, Haifeng M

2010-03-01

Warfarin exhibits significant interindividual variability in dosing requirements. Different drug responses are partly attributed to the single nucleotide polymorphisms (SNPs) that influence either drug action or drug metabolism. Rapid genotyping of these SNPs helps clinicians to choose appropriate initial doses to quickly achieve anticoagulation effects and to prevent complications. We report a novel application of surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF MS) in the rapid genotyping of SNPs that impact warfarin efficacy. The SNPs were first amplified by PCR and then underwent single base extension to generate the specific SNP product. Next, genetic variants displaying different masses were bound to Q10 anionic proteinChips and then genotyped by using SELDI-TOF MS in a multiplex fashion. SELDI-TOF MS offered unique properties of on-chip sample enrichment and clean-ups, which streamlined the testing procedures and eliminated many tedious experimental steps required by the conventional MS-based method. The turn-around time for genotyping three known warfarin-related SNPs, CYP2C9*2, CYP2C9*3, and VKORC1 3673G>A by SELDI-TOF MS was less than 5 hours. The analytical accuracy of this method was confirmed both by bidirectional DNA sequencing and by comparing the genotype results (n = 189) obtained by SELDI-TOF MS to reports from a clinical reference laboratory. This new multiplex genotyping method provides an excellent clinical laboratory platform to promote personalized medicine in warfarin therapy.

[Introduction and some problems of the rapid time series laboratory reporting system].

PubMed

Kanao, M; Yamashita, K; Kuwajima, M

1999-09-01

We introduced an on-line system of biochemical, hematological, serological, urinary, bacteriological, and emergency examinations and associated office work using a client server system NEC PC-LACS based on a system consisting of concentration of outpatient blood collection, concentration of outpatient reception, and outpatient examination by reservation. Using this on-line system, results of 71 items in chemical serological, hematological, and urinary examinations are rapidly reported within 1 hour. Since the ordering system at our hospital has not been completed yet, we constructed a rapid time series reporting system in which time series data obtained on 5 serial occasions are printed on 2 sheets of A4 paper at the time of the final report. In each consultation room of the medical outpatient clinic, at the neuromedical outpatient clinic, and at the kidney center where examinations are frequently performed, terminal equipment and a printer for inquiry were established for real-time output of time series reports. Results are reported by FAX to the other outpatient clinics and wards, and subsequently, time series reports are output at the clinical laboratory department. This system allowed rapid examination, especially preconsultation examination. This system was also useful for reducing office work and effectively utilize examination data.

Simulation of robotic courier deliveries in hospital distribution services.

PubMed

Rossetti, M D; Felder, R A; Kumar, A

2000-06-01

Flexible automation in the form of robotic couriers holds the potential for decreasing operating costs while improving delivery performance in hospital delivery systems. This paper discusses the use of simulation modeling to analyze the costs, benefits, and performance tradeoffs related to the installation and use of a fleet of robotic couriers within hospital facilities. The results of this study enable a better understanding of the delivery and transportation requirements of hospitals. Specifically, we examine how a fleet of robotic couriers can meet the performance requirements of the system while maintaining cost efficiency. We show that for clinical laboratory and pharmaceutical deliveries a fleet of six robotic couriers can achieve significant performance gains in terms of turn-around time and delivery variability over the current system of three human couriers per shift or 13 FTEs. Specifically, the simulation results indicate that using robotic couriers to perform both clinical laboratory and pharmaceutical deliveries would result in a 34% decrease in turn-around time, and a 38% decrease in delivery variability. In addition, a break-even analysis indicated that a positive net present value occurs if nine or more FTEs are eliminated with a resulting ROI of 12%. This analysis demonstrates that simulation can be a valuable tool for examining health care distribution services and indicates that a robotic courier system may yield significant benefits over a traditional courier system in this application.

Improvised double-embedding technique of minute biopsies: a mega boon to histopathology laboratory.

PubMed

Yadav, Lokendra; Thomas, Sarega; Kini, Usha

2015-01-01

Optimal orientation of minute mucosal biopsies is essential for a definite diagnosis in gastrointestinal pathology or to visualize neural plexuses in Hirschsprung disease. The problem of minute size of the biopsy and its orientation gets compounded when they are from neonates and mandates exhaustive strip cuts, thus delaying reporting. A modified agar-paraffin technique is aimed to make tissue embedding efficient and user-friendly by inking mapping biopsies (one or more) either fresh or fixed with surgical coloring inks followed by embedding first in agar after orientation and followed thereafter by processing, re-embedding in paraffin wax, sectioning and staining. The tissues in agar paraffin block were found to be well processed, firm, held secure and well preserved. The blocks were easy to cut, with serial sections of thickness 2-3 μ and easy to spread. The colored inks remained permanently on the tissues both in the block as well as on the sections which helped in easy identification of tissues. Agar did not interfere with any stain such as Hematoxylin and Eosin or with histochemical stains, enzyme histochemistry or immunohistochemistry. Inking biopsies and pooling them in a block when obtained from the same patient reduced the number of tissue blocks. The modified agar-paraffin embedding technique is a simple reliable user friendly method that can greatly improve the quality of diagnostic information from minute biopsies by optimal orientation, better quality of sections, faster turnaround time and cost-effectiveness by economizing on the number of paraffin blocks, manpower, chemical reagents and laboratory infrastructure.

Real-Time Rocket/Vehicle System Integrated Health Management Laboratory For Development and Testing of Health Monitoring/Management Systems

NASA Technical Reports Server (NTRS)

Aguilar, R.

2006-01-01

Pratt & Whitney Rocketdyne has developed a real-time engine/vehicle system integrated health management laboratory, or testbed, for developing and testing health management system concepts. This laboratory simulates components of an integrated system such as the rocket engine, rocket engine controller, vehicle or test controller, as well as a health management computer on separate general purpose computers. These general purpose computers can be replaced with more realistic components such as actual electronic controllers and valve actuators for hardware-in-the-loop simulation. Various engine configurations and propellant combinations are available. Fault or failure insertion capability on-the-fly using direct memory insertion from a user console is used to test system detection and response. The laboratory is currently capable of simulating the flow-path of a single rocket engine but work is underway to include structural and multiengine simulation capability as well as a dedicated data acquisition system. The ultimate goal is to simulate as accurately and realistically as possible the environment in which the health management system will operate including noise, dynamic response of the engine/engine controller, sensor time delays, and asynchronous operation of the various components. The rationale for the laboratory is also discussed including limited alternatives for demonstrating the effectiveness and safety of a flight system.

[Study of quality of a branch laboratory--an opinion of a laboratory manager].

PubMed

Yazawa, Naoyuki

2006-11-01

At the stage of establishing a branch laboratory, quality evaluation is extremely difficult. Even the results of a control survey by the headquarters of the branch laboratory are unhelpful. For a clinical laboratory, the most important function is to provide reliable data all the time, and to maintain the reliability of clinical doctors with informed responses. We mostly refer to control surveys and daily quality control data to evaluate a clinical laboratory, but we rarely check its fundamental abilities, such as planning events, preserving statistical data about the standard range, using the right method for quality control and others. This is generally disregarded and it is taken for granted that they will be correct the first time. From my six years of experience working with X's branch laboratory, I realized that there might be some relation between the quality of a branch laboratory and the fundamental abilities of the company itself. I would never argue that all branch laboratories are ineffective, but they should be conscious of fundamental activities. The referring laboratory, not the referral laboratory, should be responsible for ensuring that the referral laboratory's examination results and findings are correct.

Time-resolved acoustic emission tomography in the laboratory: tracking localised damage in rocks

NASA Astrophysics Data System (ADS)

Brantut, N.

2017-12-01

Over the past three decades, there has been tremendous technological developments of laboratory equipment and studies using acoustic emission and ultrasonic monitoring of rock samples during deformation. Using relatively standard seismological techniques, acoustic emissions can be detected, located in space and time, and source mechanisms can be obtained. In parallel, ultrasonic velocities can be measured routinely using standard pulse-receiver techniques.Despite these major developments, current acoustic emission and ultrasonic monitoring systems are typically used separately, and the poor spatial coverage of acoustic transducers precludes performing active 3D tomography in typical laboratory settings.Here, I present an algorithm and software package that uses both passive acoustic emission data and active ultrasonic measurements to determine acoustic emission locations together with the 3D, anisotropic P-wave structure of rock samples during deformation. The technique is analogous to local earthquake tomography, but tailored to the specificities of small scale laboratory tests. The fast marching method is employed to compute the forward problem. The acoustic emission locations and the anisotropic P-wave field are jointly inverted using the Quasi-Newton method.The method is used to track the propagation of compaction bands in a porous sandstone deformed in the ductile, cataclastic flow regime under triaxial stress conditions. Near the yield point, a compaction front forms at one end of the sample, and slowly progresses towards the other end. The front is illuminated by clusters of Acoustic Emissions, and leaves behind a heavily damaged material where the P-wave speed has dropped by up to 20%.The technique opens new possibilities to track in-situ strain localisation and damage around laboratory faults, and preliminary results on quasi-static rupture in granite will be presented.

Tough Questions for Tough Times

ERIC Educational Resources Information Center

Parrett, William; Budge, Kathleen

2009-01-01

Six high-performing/high-poverty schools provide insights into what it takes to make a dramatic turnaround. School leaders had to make tough calls--and many of those decisions were about how to use resources. The budget in a high-performing, high-poverty school is a moral document, reflective of the school's beliefs about the conditions necessary…

From Corporation to Community: Culturally Relevant Pedagogy in an Urban Laboratory for School Reform

ERIC Educational Resources Information Center

Anderson, Celia Rousseau; Bullock, Erika C.; Cross, Beverly; Powell, Angiline

2017-01-01

Background/Context: Memphis has, in many ways, become "ground zero" for neoliberal--or corporate--reform efforts, including a statewide turnaround school district, proliferation of charter schools, and value-added teacher evaluation measures. Along with these reforms come models of schooling that undermine the concept of the…

Clinical Practice as Natural Laboratory for Psychotherapy Research: A Guide to Case-Based Time-Series Analysis

ERIC Educational Resources Information Center

Borckardt, Jeffrey J.; Nash, Michael R.; Murphy, Martin D.; Moore, Mark; Shaw, Darlene; O'Neil, Patrick

2008-01-01

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice…