Prospective evaluation of a nonradiographic device for determination of endotracheal tube position in children.

A new noninvasive, nonradiographic endotracheal tube (ETT) position detection system (ETT-PDS) for guidance of ETT positioning was evaluated in pediatric ICU patients. The system includes an ETT with a metallic element embedded at a defined distance from the ETT tip, and a portable locator instrument which detects transcutaneously the position of the metallic element. The contribution of ETT-PDS to accuracy of ETT positioning after intubation and before chest radiographs was evaluated in 92 critically ill children. The ETT malposition rates observed on the postintubation chest radiographs were 39.1% after positioning guided by clinical assessment alone, and 19.6% after positioning guided by clinical assessment plus the ETT-PDS (p less than 0.5). This reduction in malnutrition rate could not be demonstrated when the ETT-PDS was used to guide routine ETT positioning performed before morning chest radiographs.

Alienation and the game dungeons and dragons.

The media has speculated about negative effects of the role-playing game Dungeons and Dragons on players of the game. This study examined differences in feelings of alienation between 35 active players and 35 nonplayers. Fewer players expressed feelings of meaninglessness and more players expressed feelings of cultural estrangement than nonplayers. Other feelings of alienation between players and non-players were not different. Also, more committed players--those who spent more money on the game and played the game more frequently--expressed greater feelings of alienation.

Computerized threshold determination for automated ABO/Rh tests.

Automated microplate blood-grouping systems rely on a pair of thresholds to determine whether reactions are positive or negative. The determination of these thresholds is a critical step in the quality control process for automated microplate blood grouping. A simple method has been developed for automatically setting these thresholds. A more sophisticated method, which required substantial computational complexity, was also tried. The more complex method did not perform better than the simple method described here.

A one-step Du test in microplates.

A one-step Du test, developed for use in automated microplate systems, uses anti-D with 0.6 percent dextran to potentiate the reaction. Because the washing and reagent-adding steps of the antiglobulin test are not required, the Du test can be performed in the same microplate as the ABO/Rh test. A set of reactions prepared with this technique was visually interpreted and also classified by an automated microplate ABO/Rh system. Visual interpretation of reactions resulted in a sensitivity and specificity close to those of the antiglobulin test, although the sensitivity of the test was reagent-dependent. When the automated microplate blood grouping system was used, the test was not as sensitive or as specific as the antiglobulin test, although it may be sufficient for many applications.

Considerations in the use of laboratory robots: aspects of safety and accuracy.

A general-purpose laboratory robot was configured to prepare blood samples for the HBsAg and anti-HIV tests. Several issues were studied in order to eliminate problems and optimize the system. These included pipetting accuracy, intersample carryover, reagent interference, splashing and aerosol generation and user-related issues. A number of general guidelines were developed to assist others in developing and implementing systems for this and similar applications.

Stability of serum alanine aminotransferase activity.

In this study the authors examine the effects of common storage and handling procedures on serum alanine aminotransferase (ALT) levels. Clotted blood samples from 14 subjects were centrifuged at 280 X g for 10 minutes. Serum was tested immediately for baseline ALT levels and aliquots were stored at 22, 4, -20, and -80 degrees C. Additional serums were stored on the clot at 22 and 4 degrees C. ALT quantitation was performed at intervals of 3, 6, 9, and 24 hours and on Days 2, 4, 6, and 8. Unseparated tubes were sampled both proximal and distal to the red cells to determine ALT leakage from red cells lysis. For all storage conditions, gradual loss of activity occurred over time. Mean activity loss in separated serum at 2 days was 6 percent at 4 degrees C and 20 percent at 22 degrees C. Mean loss in unseparated serum was 3 percent at 4 degrees C and 12 percent at 22 degrees C. Marked ALT loss averaging 46 percent by day 6 occurred with storage at -20 degrees C, whereas storage at -80 degrees C resulted in an 8 percent decrease for the same period. For storage of up to 1 week, it is recommended that serum be separated early and retained at 4 degrees C. Frozen samples should be kept at -80 degrees C. Storage of separated or unseparated blood for up to 24 hours at 22 or 4 degrees C, as commonly found in blood centers, will marginally adversely affect the accuracy of ALT determination.

Cost analysis of routine laboratory testing in blood centers.

The direct costs of ABO, Rh, Du, syphilis, and antibody screening tests were investigated. Questionnaires from 58 blood centers were analyzed to compare cost-effectiveness among methods of testing and annual collection volume as well as differences in cost of the various methods of testing within the same-size center. We found that "expensive" automated equipment cannot be justified on the basis of direct costs in centers processing less than 100,000 units of blood per year and that there is a wide variation in costs among centers using the same equipment.

A robotic system to prepare samples for HTLV-III testing.

A robotic handling system was adapted to perform the sampling and dilution steps needed in an assay to detect antibodies to the HTLV-III virus, the causative agent of AIDS. The system reduced the labor required to prepare the samples and provided standardization and accuracy in the preparation of the samples.