Computerized screening devices and performance assessment: development of a policy towards automation. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The extension of automation to the diagnostic assessment of clinical materials raises issues of professional responsibility, on the part of both the medical professional and designer of the device. The International Academy of Cytology (IAC) and other professional cytology societies should develop a policy towards automation in the diagnostic assessment of clinical cytologic materials. CONSENSUS POSITION: The following summarizes the discussion of the initial position statement at the International Expert Conference on Diagnostic Cytology Towards the 21st Century, Hawaii, June 1997. 1. The professional in charge of a clinical cytopathology laboratory continues to bear the ultimate medical responsibility for diagnostic decisions made at the facility, whether automated devices are involved or not. 2. The introduction of automated procedures into clinical cytology should under no circumstances lead to a lowering of standards of performance. A prime objective of any guidelines should be to ensure that an automated procedure, in principle, does not expose any patient to new risks, nor should it increase already-existing, inherent risks. 3. Automated devices should provide capabilities for the medical professional to conduct periodic tests of the appropriate performance of the device. 4. Supervisory personnel should continue visual quality control screening of a certain percentage of slides dismissed at primary screening as within normal limits (WNL), even when automated procedures are employed in the laboratory. 5. Specifications for the design of primary screening devices for the detection of cervical cancer issued by the IAC in 1984 were reaffirmed. 6. The setting of numeric performance criteria is the proper charge of regulatory agencies, which also have the power of enforcement. 7. Human expert verification of results represents the "gold standard" at this time. Performance characteristics of computerized cytology devices should be determined by adherence to defined and well-considered protocols. Manufacturers should not claim a new standard of care; this is the responsibility of the medical community and professional groups. 8. Cytology professionals should support the development of procedures that bring about an improvement in diagnostic decision making. Advances in technology should be adopted if they can help solve problems in clinical cytology. The introduction of automated procedures into diagnostic decision making should take place strictly under the supervision and with the active participation and critical evaluation by the professional cytology community. ONGOING ISSUES: Guidelines should be developed for the communication of technical information about the performance of automated screening devices by the IAC to governmental agencies and national societies. Also, guidelines are necessary for the official communication of IAC concerns to industry, medicolegal entities and the media. Procedures and guidelines for the evaluation of studies pertaining to the performance of automated devices, performance metrics and definitions for evaluation criteria should be established.

Suppression of antibody response by excess dietary zinc exposure during certain stages of ontogeny.

A study was made of the effects of excess dietary zinc on the antibody response to sheep red blood cells (SRBC) in mice. C57BL/6J mice were divided into 10 different dietary groups and exposed to diets containing zinc in normal (50 ppm) or excess (2000 ppm) concentrations during gestation/lactation/postweaning development in the sequences (1) 50/50/50; (2) 50/50/2000; (3) 2000/50/50; (4) 2000/2000/50; (5) 2000/50/2000; (6) 50/2000/50; (7) 50/2000/2000; (8) 2000/2000/2000; (9) 50/50/50 (pair-fed); and (10) chow/chow/chow. Mice in group 8 had severe signs of copper deficiency at 8 weeks of age, such as reduced plasma copper, lowered plasma hematocrit, and achromotrichia. Mice receiving 2000 ppm zinc during gestation had fewer offspring per litter (measured at 2 weeks of age) and more nonviable births than mice given 50 ppm zinc during gestation. The growth curve of mice exposed to excess zinc in the 50/50/2000 group was identical to that of the control (50/50/50) group. Growth curves for all other groups were reduced by varying amounts. The plaque-forming cell response to SRBC was reduced only in the groups receiving 50/2000/2000 and 2000/2000/2000 ppm zinc (P less than 0.05); this reduced response was not associated with atrophy of the lymphoid organs. Splenic cell surface markers and mitogenic responsiveness were similar in the 50/50/50 and 2000/2000/2000 groups. These results suggest that the immune response is more susceptible to dietary manipulation during development than after the immune response has been developed.