Transit Time Effects Research Articles

The Impact of Facility Layout on Worker Behavior: An Empirical Study of Nurses in the Emergency Department

Problem Definition: We study the impact of service facility layout on how service workers organize their tasks. We focus on the hospital emergency department (ED) as a service setting where nurses (servers) have discretion over how they interact with their patients (customers) in a facility that introduces significant heterogeneity in necessary walking distance. Relevance: Prior studies on facility layout in operations have largely focused on the direct effect of transit times on reduced productivity. We extend this work to show how skilled service workers such as nurses make adaptations to their work behavior to enhance their productivity in light of facility layout constraints. Methodology: We utilize a unique dataset consisting of infrared nurse location tracking data, patient electronic medical record data, bedside patient call data, and the architectural floor plan, to study this empirically. Results: Nurses working in a busy ED reduce their walking distance by appearing to batch their tasks to distant patient rooms. While the patients in these rooms receive the same amount of care time, this behavior results in longer wait times between nurse visits, and more nurse call button activations. Nurse call button use is linked with poor patient satisfaction with care, and interrupts nurse work flow. Managerial Implications: These findings show that even in services, facility layout can lead to servers with discretion over task timing using that discretion in ways that help the server but that lead to reduced perceived customer quality. The negative effects of distance-based task batching can likely be addressed through proactive regular rounding by the service provider, or improved operational transparency for the patient.

Transit time corrected arterial spin labeling technique aids to overcome delayed transit time effect

This study aimed to evaluate the usefulness of transit time corrected cerebral blood flow (CBF) maps based on multi-phase arterial spin labeling MR perfusion imaging (ASL-MRP). The Institutional Review Board of our hospital approved this retrospective study. Written informed consent was waived. Conventional and multi-phase ASL-MRPs and dynamic susceptibility contrast MR perfusion imaging (DSC-MRP) were acquired for 108 consecutive patients. Vascular territory-based volumes of interest were applied to CBF and time to peak (TTP) maps obtained from DSC-MRP and CBF maps obtained from conventional and multi-phase ASL-MRPs. The concordances between normalized CBF (nCBF) from DSC-MRP and nCBF from conventional and transition time corrected CBF maps from multi-phase ASL-MRP were evaluated using Bland-Altman analysis. In addition, the dependence of difference between nCBF (ΔnCBF) values obtained from DSC-MRP and conventional ASL-MRP (or multi-phase ASL-MRP) on TTP obtained from DSC-MRP was also analyzed using regression analysis. The values of nCBFs from conventional and multi-phase ASL-MRPs had lower values than nCBF based on DSC-MRP (mean differences, 0.08 and 0.07, respectively). The values of ΔnCBF were dependent on TTP values from conventional ASL-MRP technique (F = 5.5679, P = 0.0384). No dependency of ΔnCBF on TTP values from multi-phase ASL-MRP technique was revealed (F = 0.1433, P > 0.05). The use of transit time corrected CBF maps based on multi-phase ASL-MRP technique can overcome the effect of delayed transit time on perfusion maps based on conventional ASL-MRP.

Transit Dose Measurement of a HDR Afterloading Brachytherapy Source by a Fluorescent Screen Based QA System

To assess the dosimetric discrepancy between treatment delivery and TPS in HDR brachytherapy due to effect of transit time and step size. The source positions during treatment were detected by a fluorescent screen system which converted the radiation signal to optical signal and utilized a high-speed camera with frame rate of 500 fps and pixel resolution of 1280X720 to capture the luminence. A catheter in which an Ir-192 source would be loaded was fixed on the fluorescent screen and the camera was placed about 30 cm away from the screen. When the source was in transit, the camera would capture images on the fluorescent screen sequentially. Source position was traced out by locating the centroid of the captured image. After capturing source positions, dose distribution of an Ir-192 source calculated by a brachytherapy TPS was assigned to each location and superpositioned to obtain a final dose distribution including transit dose. A series of treatment plans each with two source dwell positions of equal dwell times were created. Two different step sizes were tested, namely, 5 mm & 60 mm. Two different dwell times were assigned, namely, 0.5 s & 1 s. The measured dose distribution and TPS generated dose distribution were both normalized at the first dwell position while the second dwell position and the mid-point between dwell points were selected for dose comparison. From Table 1, at second dwell point, cases with 5 mm step size have a dose increase at treatment distance below 10 mm due to contribution from transit dose and this effect diminished when treatment distance increased. At 60 mm step size, second dwell position has a significant dose deficiency due to an decrease in dwell time. All step sizes have an increase in transit dose for treatment distance below 10 mm. Such an increase is larger when 60 mm step size was used. In case of shorter dwell time, transit dose has a greater change. For 60 mm step size, transit dose has a maximum discrepancy at around 10 mm distance. This was due to the higher normalization dose at 5 mm distance so that the transit dose effect is less significant. The dose discrepancy at different treatment distances was below 6% for 5 mm step size and can go up to 58% for 60 mm step size.Abstract 3547; Table 1Difference in percentage between measured and TPS calculated dose, both are normalized at the first dwell positionTreatment distances (mm)5101520Step size (mm) / Dwell time (s)% DifferenceSecond dwell point5 / 0.55.31.5-0.5-1.15 / 13.10.5-0.6-0.960 / 0.5-58.1-49.5-46.0-43.560 / 1-31.9-30.8-30.2-29.0Mid-point between dwell points5 / 0.52.90.4-0.5-0.85 / 12.60.2-0.4-0.560 / 0.511.914.611.55.660 / 17.19.07.44.0 Open table in a new tab Larger source step size and shorter dwell time would lead to a greater dose discrepancy. Transit dose could have a contribution up to 14.6% of prescribed dose which was not accounted for by brachytherapy TPS. This method may help to evaluate the transit dose contribution which could lead to dosimetric impact.

Optimizing packing of live seahorses for shipping

The packing and shipping of live marine organisms always poses a potential risk to their survival and well-being, with the costs associated with these practices being paramount for marine ornamental species value chains. The present study describes two experiments employing the longsnout seahorse Hippocampus reidi (~80mm) as a model seahorse species to optimize its packing methods for live shipping. The first experiment evaluated the combined effect of seahorse density (1 ind. per 300mL, 1 ind. per 450mL and 1 ind. per 600mL), transit time (24 vs. 48h), and use of an oxygen saturated atmosphere for packing (pure oxygen vs. compressed air). The second one evaluated the combined effect of water salinity (15, 25, and 35) and use of a substrate for packed specimens to hold onto it, at a density of 1 ind. per 300mL. Survival was 100% in all treatments in both experiments up to 48h after shipping, with ~90% of seahorses displaying a normal feeding behaviour immediately post-transportation. In the first experiment, no significant differences were found (P>0.05) in weight-specific total ammonia nitrogen (TAN) excreted in all treatments within the same transit time. At the end of the transit time, treatments with an oxygen saturated atmosphere displayed an oversaturation in dissolved oxygen (DO) concentrations, whereas those employing compressed air for 48h ended the experimental trial with a DO concentration above 80%. Water with a salinity of 15 promoted a significantly (P<0.05) lower decrease in pH, followed by water at a salinity of 25 and 35. The lower salinity employed may have reduced breathing frequency of seahorses during transport. The presence of a substrate significantly (P<0.05) decreased weight-specific TAN excreted, possibly due to stress reduction. Overall, H. reidi can be packed at a density as low as 1 ind. per 300mL for up to 48h, with the use of pure oxygen not being mandatory. Lower salinities and the use of substrate can enhance seahorse welfare when these are shipped over longer transit times without representing additional significant costs. Overall, the findings of the present study may allow traders to ship 3 times more live seahorses than they currently do without negatively impacting their welfare neither increasing associated shipping costs.

Validation of borehole heat exchanger models against multi-flow rate thermal response tests

A recently developed vertical borehole ground heat exchanger model that accounts for transit time effects and time-varying short-circuiting heat transfer has been validated against two multi-flow-rate thermal response tests (MFR-TRT). The MFR-TRT, when performed with a wide range of flow rates, results in significant changes in the borehole thermal resistance, the borehole internal thermal resistance, and the short-circuiting heat transfer between the two legs of a single U-tube. The model accounts for short-circuiting by an analytically computed weighting factor that is used to determine the mean fluid temperature. The weighting factor portion of the model can be readily utilized in other ground heat exchanger models that currently rely on a simple mean fluid temperature. Use of the weighting factor is shown to give significantly better estimations of entering and exiting fluid temperature than using the simple mean fluid temperature. The new model is also compared to an alternative approach − using an effective borehole thermal resistance. While both the effective borehole thermal resistance model and the weighting factor give quite good results a few hours after a step change in flow rate, the weighting factor model gives much better results in the first few hours after a step change in flow rate.

The Acute Effect of Loperamide on Ileostomy Output: A Randomized, Double-Blinded, Placebo-Controlled, Crossover Study.

High stoma output is a common problem in patients with ileostomy and can lead to dehydration and electrolyte disturbances. The first drug of choice to reduce stoma output is often loperamide. The aim was to assess the acute effect of loperamide on (a) ileostomy output in g/day, (b) gastrointestinal transit time and (c) patient-reported effects. A total of 12 patients completed this double-blinded, randomized, placebo-controlled, crossover study, consisting of a 3-day treatment period with loperamide 12mg/day or placebo followed by the reverse after a washout period of 5-7days. Patients collected stoma output and noted food and fluid intake over 48hr and swallowed a capsule with radiopaque markers for the determination of gastrointestinal transit time over 24hr. At the end of the study, patients were asked to report their treatment sequence. Ileostomy output was significantly reduced during loperamide treatment (p<0.02) with a median of 16.5% (range -5% to 46%). Transit time was reduced significantly for the passage of 10% of the markers (p=0.02), but not for 50% and 100% of the markers. Fifty-eight per cent (N=7) of the patients reported the correct treatment sequence (p=0.41). Loperamide 12mg/day reduced ileostomy output statistically significantly, but with varying effects among patients and without reaching the clinical significance of 20% set-up by this study. Dose-response studies should be performed, and standard treatment doses of loperamide should be reassessed. The study was registered at ClinicalTrials.gov - NCT02266849.

Ground-state atomic polarization relaxation-time measurement of Rb filled hypocycloidal core-shaped Kagome HC-PCF

We report on the measurement of ground-state atomic polarization relaxation time of Rb vapor confined in five different hypocycloidal core-shape Kagome hollow-core photonic crystal fibers made with uncoated silica glass. We are able to distinguish between wall-collision and transit-time effects in an optical waveguide and deduce the contribution of the atom’s dwell time at the core wall surface. In contrast with conventional macroscopic atomic cell configuration, and in agreement with Monte Carlo simulations, the measured relaxation times were found to be at least one order of magnitude longer than the limit set by atom-wall collisional from thermal atoms. This extended relaxation time is explained by the combination of a stronger contribution of the slow atoms in the atomic polarization build-up, and of the relatively significant contribution of dwell time to the relaxation process of the ground state polarization.

Interactions between magnetosonic waves and ring current protons: Gyroaveraged test particle simulations

AbstractGyroaveraged test particle simulations are implemented to quantitatively investigate interactions between linearly polarized magnetosonic waves (i.e., equatorial noises) and ring current protons inside and outside the plasmasphere at L = 4.5. For magnetosonic waves at the frequency of 33.3 Hz (fw/fcp = 6.4 at the magnetic equator, for L = 4.5), it is found that wave‐particle interactions at the resonance order corresponding to the lowest resonant proton energy (i.e., N = 6) are dominant. The interactions at other resonance orders make much less contribution. Near the equatorial loss cone at L = 4.5, magnetosonic waves produce strongest proton pitch angle diffusion at ~ 20 keV inside the plasmasphere and at ~ 100 keV outside the plasmasphere, respectively, reaching a rate above 10−6 s−1. The corresponding energy diffusion dominates over pitch angle diffusion at high pitch angles; therefore, magnetosonic waves are likely to accelerate protons at a few keV inside the plasmasphere and at ~ 10 keV outside the plasmasphere. Due to the emission equatorial confinement, the effect of transit time scattering also occurs for interactions of magnetosonic waves with ring current protons and tends to be increasingly important outside the plasmasphere, which is consistent with previous studies on interactions of magnetosonic waves with radiation belt electrons.

Modeling of the current-dependent 3-dB bandwidth in modified uni-traveling-carrier photodiodes

A physics-based model is proposed for the current-dependent 3-dB bandwidth in Modified Un-Traveling-Carrier Photodiodes. In the effective circuit model of the photodiodes, the junction resistance and capacitance are extracted from the real and imaginary parts of the near-DC complex junction impedance; the effect of carrier transit time across the absorber and electron transition layer is evaluated by the frequency-dependent AC conduction current output to the electron transition layer and the average induced AC electron current across the electron transition layer, respectively. The simulation results by this model agree well with the measurements.

Sometimes Treatment Is Hard To Swallow

Sometimes Treatment Is Hard To Swallow

Effect of Transit Time and Gas Density on the Conservation of Agitated Saline Contrast in an in vitro Model of the Pulmonary Circulation

Agitated saline contrast echocardiography is often used as a tool to subjectively measure blood flow through intrapulmonary arteriovenous anastomoses (Q̇IPAVA). This method assumes that an intravenous injection of agitated saline contrast will not survive the pulmonary circulation or reach the left heart unless it travels through a shunt. However, agitated saline contrast is unstable, and contrast lost to microbubble dissolution likely impacts its utility for measuring Q̇IPAVA. We applied indicator dilution theory to acoustic intensity‐time curves obtained from a bolus injection of hand‐agitated saline contrast to acquire a quantitative index of contrast mass. Using this methodology and an in vitro model of the pulmonary circulation, the purpose of this study was to determine the effect of transit time on the conservation of contrast mass between two detection sites separated by a convoluted network of vessels with a variable volume (300–600 ml). In addition, we wished to determine if agitating saline with a high density, low solubility gas (sulfur hexafluoride, SF6) could improve contrast mass conservation by minimizing microbubble dissolution. We hypothesized that the contrast lost between the in‐ and out‐flow detection sites would increase with increasing transit times and would be reduced by using microbubbles composed of SF6 instead of air. The experimental apparatus consisted of a reservoir of 0.9% saline connected to a centrifugal pump and a network of latex surgical tubing mimicking the pulmonary circulation. An in‐ and out‐flow detection site passed under a 3.5 MHz ultrasound transducer to record acoustic intensity‐time curves. A 6 ml bolus of agitated saline contrast (10:1 ratio of saline and gas) was injected into the circuit proximal to the in‐flow detection site and distal to a calibrated flow probe. Transit time was manipulated in two ways: (1) setting flow rate to 1.5 or 2.0 l min−1; and, (2) reducing the volume of the circulatory network (no reduction, 25%, 50%, 75%). Five trials were conducted for each combination. Contrast conservation was measured as the ratio of outflow contrast mass to inflow contrast mass, where contrast mass is the respective area under the acoustic intensity‐time curve. Inflow contrast mass did not differ amongst all conditions (P&gt;0.05). Transit time ranged from 9.12 ± 0.03 to 24.47 ± 0.03s as the cross sectional area and flow of the system changed. For air, 53.2 ± 3.4% of contrast was conserved at a transit time of 9.25 ± 0.02s but dropped to 16.0 ± 1.0% at a transit time of 10.17 ± 0.06s. Compared to air, SF6 contrast conservation was significantly greater (P&lt;0.01) with 98.3 ± 11.5 % and 94.8 ± 5.8% of contrast conserved at a transit time of 10.40 ± 0.21s and 13.46 ± 0.04s respectively. In summary, acoustic‐intensity‐time curves can be used to quantify agitated saline contrast mass but loss of contrast due to microbubble dissolution makes measuring Q̇IPAVA across varying transit time difficult. Agitated saline mixed with SF6 is stabilized and may be a suitable alternative for Q̇IPAVA measurement.Support or Funding InformationFunding: NSERC, CFI

Effect of live food transition time on survival, growth and metamorphosis of yellowtail clownfish, Amphiprion clarkii, larvae

Amphiprion clarkii, a popular marine ornamental fish, despite having an already established reproduction technology, still presents divergences regarding the feeding protocol used for its larviculture in what concerns the ideal day of transition from rotifers to Artemia. This study aimed to determine the optimum time to start supplying Artemia to larvae. Survival, growth, weight gain and metamorphosis of treatments: (T2) start of Artemia supply at the 2nd day after hatching (DAH); (T4) start at the 4th DAH; and (T6) start at the 6th DAH were evaluated. Survival rates ranged from 60 to 66 %. Fish in T2 had a number of metamorphosed fish statistically higher than T6 and began to metamorphose 1 day sooner than other treatments. The positive results obtained for T2 can be related to the premature ability of this species to capture large live food, which can provide many benefits to the larvae. It is concluded that it is possible to offer Artemia nauplii to yellowtail clownfish at 2 DAH.

Effect of Intestinal Permeability and Gastrointestinal Segmental Transit Time Determined by Wireless Motility Capsule (SmartPill®)

Peroxisome proliferator-activated receptor gamma (PPAR gamma), a nuclear transcription factor, plays a critical role in the regulation of gene expression associated with inflammation and cancer. PPAR gamma is expressed in human gastric cancer as well as in colon cancer. Activation of PPAR gamma by ligand produces pro-apoptotic effect and ameliorate growing of cancer cells. Helicobacter pylori (H. pylori) is a main etiologic agent for gastric inflammation, and raises cell turnover in gastric epithelium. Longstanding infection with this organism is related with the development of non-cardiac gastric cancer. The aim of this study was to investigate the effect of H. pylori on the expression of PPAR gamma protein and mRNA in chronic gastritis.Gastric biopsy samples were taken from H. pylori infected (n=18) and non-infected (n=21) patients during endoscopic examination. PPAR gamma expressions were assessed by real time polymerase chain reaction and immunohistochemistry.PPAR gamma was localized to the nuclei of the foveolar epithelial cells in both infected and non-infected mucosa. PPAR gamma protein expression was higher in H. pylori infected patients than in non-infected patients (3.8+/-0.4 vs. 2.6+/-1.0, H. pylori infected and non-infected, respectively; p<0.05). However, PPAR gamma mRNA levels were not significantly different between the two groups (24+/-18 vs. 29+/-25, H. pylori infected and noninfected, respectively).PPAR gamma expression is increased in the gastric mucosa of H. pylori infected chronic gastritis, which suggests a certain role of PPAR gamma in the mucosal inflammatory reaction to H. pylori infection.

Development of timely controlled-release systems for chronotherapy of propranolol with minimization of the pH effect in the simulated gastrointestinal medium

A timely controlled release dosage form with minimization of transit time and pH effects of gastrointestinal tract for chronotherapy of propranolol was developed. Ethylcellulose (EC) and Eudragit RS selected as the controlling membrane for drug-layering non-pareil seeds (NP) or extrusion-spheronized pellets incorporated with matrix materials or osmogents were characterized in the simulated gastric fluid (SGF) and pH change medium. Results demonstrated that when propranolol was layered on NP, Eudragit RS plasticized with 30% triethylcitrate (TEC) coated at 15% level could adjust a lag time close to the reference but with a slower release rate after then, while EC plasticized with HPMC could not delay drug release at a lag time close to the reference. Furthermore, EC incorporated with lactose coated on the extrusion-spheronized pellets could adjust the lag time, but a release rate correspondingly decreased with increasing lag time. Nevertheless, coating Eudragit RS on matrix pellets as controlling membrane at different levels could adjust a desired lag time with a pulsatile release pattern. However, the lag time adjusted was only within a 5 h range. Finally, coating Eudragit RS at different level on matrix pellets containing various ratio of osmogent, NaCl or lactose, could effectively adjust a desired lag time as long as 15 h with a pulsatile release pattern to accomplish the timely controlled release with minimization of the pH effects of gastrointestinal tract that could meet the clinical need for chronotherapy of propranolol.

Resonant plasmonic terahertz detection in vertical graphene-base hot-electron transistors

We analyze dynamic properties of vertical graphene-base hot-electron transistors (GB-HETs) and consider their operation as detectors of terahertz (THz) radiation using the developed device model. The GB-HET model accounts for the tunneling electron injection from the emitter, electron propagation across the barrier layers with the partial capture into the GB, and the self-consistent oscillations of the electric potential and the hole density in the GB (plasma oscillations), as well as the quantum capacitance and the electron transit-time effects. Using the proposed device model, we calculate the responsivity of GB-HETs operating as THz detectors as a function of the signal frequency, applied bias voltages, and the structural parameters. The inclusion of the plasmonic effect leads to the possibility of the GB-HET operation at the frequencies significantly exceeding those limited by the characteristic RC-time. It is found that the responsivity of GB-HETs with a sufficiently perfect GB exhibits sharp resonant maxima in the THz range of frequencies associated with the excitation of plasma oscillations. The positions of these maxima are controlled by the applied bias voltages. The GB-HETs can compete with and even surpass other plasmonic THz detectors.

Analytical approximation of transit time scattering due to magnetosonic waves

AbstractRecent test particle simulations have shown that energetic electrons traveling through fast magnetosonic (MS) wave packets can experience an effect which is specifically associated with the tight equatorial confinement of these waves, known as transit time scattering. However, such test particle simulations can be computationally cumbersome and offer limited insight into the dominant physical processes controlling the wave‐particle interactions, that is, in determining the effects of the various wave parameters and equatorial confinement on the particle scattering. In this paper, we show that such nonresonant effects can be effectively captured with a straightforward analytical treatment that is made possible with a set of reasonable, simplifying assumptions. It is shown that the effect of the wave confinement, which is not captured by the standard quasi‐linear theory approach, acts in such a way as to broaden the range of particle energies and pitch angles that can effectively resonate with the wave. The resulting diffusion coefficients can be readily incorporated into global diffusion models in order to test the effects of transit time scattering on the dynamical evolution of radiation belt fluxes.

A radio frequency helical deflector for keV electrons

This paper describes a helical deflector to perform circular sweeps of keV electrons by means of radio frequency fields in a frequency range of 500–1000MHz. By converting the time dependence of incident electrons to a hit position dependence on a circle, this device can potentially achieve extremely precise timing. The system can be adjusted to the velocity of the electrons to exclude the reduction of deflection sensitivity due to finite transit time effects. The deflection electrodes form a resonant circuit, with quality factor Q in excess of 100, and at resonance the sensitivity of the deflection system is around 1mm per V of applied RF input.

Analysis and design of a Ka-band sheet beam relativistic extended interaction klystron amplifier

The sheet beam klystron is a kind of novel powerful microwave and millimeter-wave vacuum electron device, in which used is a thin rectangular sheet beam with high aspect ratio in order to improve beam-wave interaction efficiency by improving space-charge-limiting current of electron beam and obtaining big electric current, and it has many actual and potential applications. Based on the motion of the single electron under the small signal condition, the transit-time effect of electron beam in 2π-mode standing wave electric field in a multiple-cavity resonator is investigated, the expression of electron load conductance in a multiple-cavity resonator is presented, and the influence of the cavity number N on transit-time effect in a multiple-cavity resonator is discussed. The high frequency characteristics of the three-gap extended cavity are studied. The abilities for the single-gap cavity and three-gap cavity to modulate the sheet beam are compared by 3D PIC simulation. The simulation result shows that the three-gap extended interaction cavity operating at 2πmode is better than the single-gap cavity. The electron load conductance is derived and corrected based on the theory of relativity, by which a more accurate relation of electron load conductance to transmit angle can be obtained. In order to improve the output power and electron efficiency, the three-gap extended output cavity is used in the relativistic klystron to replace the single gap output cavity. By using the electromagnetic simulation software and 3D PIC code, a Ka-band sheet beam relativistic extended interaction klystron amplifie is designed. A sheet electron beam with a width-to-height ratio of 30 is adopted to reduce the space charge effect. In the PIC simulation, when the beam voltage is 500 kV and current is 1 kA, the device can generate a 190 MW output power at 40 GHz with an efficiency of 38% and a gain of 69 dB. The 3 dB bandwidth of the EISBK is about 150 MHz. Meanwhile, the output microwave is without the clutter jamming, which makes the contribution avoid the shrinkage of output microwave impulse. This study is of great importance for the physical design and process in engineering of the Ka-band sheet beam extended interaction relativistic klystron amplifier.

Voltage measurements at the vacuum post-hole convolute of theZpulsed-power accelerator

Presented are voltage measurements taken near the load region on the $Z$ pulsed-power accelerator using an inductive voltage monitor (IVM). Specifically, the IVM was connected to, and thus monitored the voltage at, the bottom level of the accelerator's vacuum double post-hole convolute. Additional voltage and current measurements were taken at the accelerator's vacuum-insulator stack (at a radius of 1.6 m) by using standard $D$-dot and $B$-dot probes, respectively. During postprocessing, the measurements taken at the stack were translated to the location of the IVM measurements by using a lossless propagation model of the $Z$ accelerator's magnetically insulated transmission lines (MITLs) and a lumped inductor model of the vacuum post-hole convolute. Across a wide variety of experiments conducted on the $Z$ accelerator, the voltage histories obtained from the IVM and the lossless propagation technique agree well in overall shape and magnitude. However, large-amplitude, high-frequency oscillations are more pronounced in the IVM records. It is unclear whether these larger oscillations represent true voltage oscillations at the convolute or if they are due to noise pickup and/or transit-time effects and other resonant modes in the IVM. Results using a transit-time-correction technique and Fourier analysis support the latter. Regardless of which interpretation is correct, both true voltage oscillations and the excitement of resonant modes could be the result of transient electrical breakdowns in the post-hole convolute, though more information is required to determine definitively if such breakdowns occurred. Despite the larger oscillations in the IVM records, the general agreement found between the lossless propagation results and the results of the IVM shows that large voltages are transmitted efficiently through the MITLs on $Z$. These results are complementary to previous studies [R. D. McBride et al., Phys. Rev. ST Accel. Beams 13, 120401 (2010)] that showed efficient transmission of large currents through the MITLs on $Z$. Taken together, the two studies demonstrate the overall efficient delivery of very large electrical powers through the MITLs on $Z$.

Paper or Plastic: RT-PCR of BCR-ABL from Blood Spots Stored and Shipped on Paper

▪In many parts of the world, diagnosis and monitoring of CML patients is limited by the availability and cost of molecular testing. In countries without molecular diagnostic capabilities, blood samples can be shipped to central labs, but this is both hampered by sample degradation, and the high costs of shipping. This study explores the method of directly spotting peripheral blood onto a paper template (dried blood spots), with subsequent shipping, RNA extraction, and BCR-ABL testing.Methods:Blood Spots and Shipment. We received dried blood spots from Australia and African countries by mail or courier, and blood from CML patients from our institution were also used for these experiments. 200μL of blood (PB) was pipetted onto Whatman 503 Protein Saver Cards (PSC; Sigma-Aldrich), where each card contains four 50μL spots. Cards were allowed to dry for at least 24 hours at room temperature. For mailing, PSCs were sealed into glassine envelopes with a packet of desiccant, and then placed inside a mailing envelope following DOT and IATA regulation for shipping non-regulated, exempt human specimens.RNA Extraction from Cards and %BCR-ABL determination. Blood spots were incubated with proteinase K followed by RNA isolation using RNeasy Mini Kits (Qiagen). Extracted RNA was quantified using a NanoDrop spectrometer (Thermo Scientific). %BCR-ABL was determined using the automated Cepheid GeneXpert platform or manual two-step quantitative RT-PCR on the 7900HT Fast Real-Time PCR System (Applied Biosystems).Results:Bench top time course: To test for effects of long transit times on RNA quality, we performed a time course study of cards at room temperature (RT) with 5 samples. For each sample, multiple cards were spotted with PB. The cards were then allowed to sit at RT for predetermined amounts of time, up to 42 days, before extracting RNA. We measured RNA integrity for one of the specimens (CML # 5) and found rapid degradation with the RIN number going from 8.7 for the fresh blood to 2.8 after 28 days on the card. However the amplification for both BCR-ABL and ABL differed less than one cycle between the fresh blood and the last time point by manual qRT-PCR (BCR-ABL Ct = 23.63 for fresh blood and 24.06 for day 28 PSC; ABL Ct = 26.69 for fresh blood and 27.64 for day 28 PSC). Figure 1 shows the results of the time course experiment for the 5 samples as a plot of ΔCt versus time in days.BCR-ABL qRT-PCR concordance studies: We compared the %BCR-ABL results obtained in fresh specimen at the institution sending the sample with the %BCR-ABL results we obtained from RNA extracted from PSC using the Cepheid GeneXpert. Paired evaluable results were available for 9 samples with a median WBC = 9.8 x 109/L (range: 3.37x109/L – 85.5x109/L). Samples were 8 to 49 days old at the time of extraction. The amount of RNA input into the GeneXpert reaction ranged from 38.75ng to 1μg. The %BCR-ABL detected ranged from 0.37% to 27% (see Table). The mean absolute difference between fresh blood and PSC BCR-ABL% is 2%; the relative mean percent change for BCR-ABL, using fresh blood as the reference is 13.1% (S.D., 31.2), P = 0.24.Conclusions and future directions:Dried blood spots are relatively inexpensive method to transport blood that preserves enough RNA stability to allow highly accurate BCR-ABL detection, when compared to results performed on an identical platform using fresh peripheral blood samples.Further studies are undergoing to accurately determine the sensitivity of this method and the feasibility of using regular mail for inexpensive transport of specimens. Table 1IDWBC (1000/μL)Sample Age at Spotting (Days)Sample Age at RNA extraction (Days)RNA ng/μlVolume GeneXPert (μL)Paper %BCR-ABL (IS)GeneXpertFresh Blood % BCR-ABL (IS) GeneXpertI1na010426349naI224.101311092745I38009181544naI47.4285102.4*3.1I55.50495241.92I63.61307.4225912I785.5130102102439I812.212912.415128.8I9na1281.5250.37*0.71I103.370273257.85.7I1115.912731102325I126.612714.415na2.3*%BCR-ABL was manually calculated due to late ABL Cts because of low starting material. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.