Quality Control Guidelines Research Articles

Microbiological diagnosis of sexually transmitted infections (STI): Part 1. Non-viral STI

Non-viral sexually transmitted infections (STI) are an important cause of physical, psychological and social distress, have severe consequences for women's reproductive health and may be transmitted to the newborn child. These infections are also risk factors for the acquisition and transmission of HIV and other STI, and for premature labor. In the last years we have observed a gradual decrease in the national incidence of gonorrhea. The implementation of a screening program in our country for Chlamydia trachomatis is necessary, since up to 80% of infections in women are asymptomatic. Due to medical, psychosocial and legal reasons, laboratory diagnosis of STI has to be certain. This offers a great challenge to laboratories. Since etiological agents are susceptible to environmental conditions, present a high adaptation to their human host and have particular physiological characteristics, their laboratory diagnosis is more difficult than diagnosis of conventional microorganisms. Otherwise, the diagnostic techniques currently available for non-viral STI are characterized by their excellent sensitivity and specificity, which result of great interest given the curable nature of these infections. Clinical specimens obtained for diagnosis of STI and other genital infections, such as bacterial vaginosis or Candidiasis represent a large proportion of specimens processed by clinical laboratories. Thus, the creation of norms and quality control guidelines for laboratories which diagnose these infections, and also the epidemiologic and genetic surveillance of circulating sex transmitted microorganisms should be considered a priority in our country. The objective of this study is to review current literature on accurate diagnostic procedures especially for three non-viral STI agents: C. trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.

Diagnóstico microbiológico de las infecciones de transmisión sexual (ITS): Parte 1. ITS no virales

Non-viral sexually transmitted infections (STI) are an important cause of physical, psychological and social distress, have severe consequences for women's reproductive health and may be transmitted to the newborn child. These infections are also risk factors for the acquisition and transmission of HIV and other STI, and for premature labor. In the last years we have observed a gradual decrease in the national incidence of gonorrhea. The implementation of a screening program in our country for Chlamydia trachomatis is necessary, since up to 80% of infections in women are asymptomatic. Due to medical, psychosocial and legal reasons, laboratory diagnosis of STI has to be certain. This offers a great challenge to laboratories. Since etiological agents are susceptible to environmental conditions, present a high adaptation to their human host and have particular physiological characteristics, their laboratory diagnosis is more difficult than diagnosis of conventional microorganisms. Otherwise, the diagnostic techniques currently available for non-viral STI are characterized by their excellent sensitivity and specificity, which result of great interest given the curable nature of these infections. Clinical specimens obtained for diagnosis of STI and other genital infections, such as bacterial vaginosis or Candidiasis represent a large proportion of specimens processed by clinical laboratories. Thus, the creation of norms and quality control guidelines for laboratories which diagnose these infections, and also the epidemiologic and genetic surveillance of circulating sex transmitted microorganisms should be considered a priority in our country. The objective of this study is to review current literature on accurate diagnostic procedures especially for three non-viral STI agents: C. trachomatis, N. gonorrhoeae, and Trichomonas vaginalis.

Collection and Storage of Apheresis Platelets Results in a Significant Decline in the Percentage of Coated-Platelets.

Abstract 23 Introduction:Platelets initiate hemostasis by adhering to the site of vascular injury and providing a negatively charged surface for thrombin generation. A subset of platelets, referred to as coated-platelets, has an enhanced ability to generate thrombin. Coated-platelets, observed in vitro upon dual agonist stimulation with collagen and thrombin, retain several serotonin-derivatized proteins on their surface and express phosphotidylserine, creating a highly active prothrombinase complex. Experimental studies have concluded that dogs deficient in coated-platelets manifest with excessive nasal, intraocular and post-operative bleeding, suggesting a key role for coated-platelets in hemostasis. The fraction of coated-platelets made by normal individuals is approximately 30% with a range of 15% – 55%. Platelet concentrates are stored at room temperature to preserve their viability and must be transfused within five days of collection secondary to a high risk of contamination. We conducted a pilot study in healthy platelet donors to evaluate how the process of apheresis and in vitro storage affect the ability to generate coated-platelets. Secondarily, we aimed to evaluate the coated-platelet potential of apheresis platelet units transfused in clinical practice. Methods: Healthy voluntary platelet donors presenting at the Oklahoma Blood Institute were enrolled and demographic data such as age, sex, smoking status, donation history, past medical history and medications were noted. A Pre-donation blood sample was obtained. Thereafter, donors underwent apheresis using the Caridian BCT Trima system via continuous centrifugation in a closed system per guidelines outlined by the American Association of Blood Banks (AABB). A Post-donation sample was drawn from the platelet concentrate bag 30 minutes after apheresis. Units were packaged, processed and stored per routine procedures. A third platelet sample was obtained when the unit was released for transfusion. Platelet rich plasma was prepared and coated-platelets were assayed as previously described (J. Thromb. Haemostasis 6:609, 2008). Statistical analysis was performed using paired t-test to compare the change in percentage of coated-platelets between the three samples. Results: Nine donors were enrolled. The mean percentage of coated-platelets in the Pre-donation samples was 40.4% (20.7%–59.7%). Thirty minutes after the apheresis collection procedure, the mean percentage of coated-platelets in the concentrate was 34.3% (17.3%–49.0%) suggesting a 15% decline in percentage of coated-platelets with the process of apheresis (p<0.01). Eight units were transfused within one to four days of collection. The mean percentage of coated-platelets in the transfused product was 17.1 % (10.1%–28.4%); a 52% decline in the percentage of coated-platelets during the process of storage was noted (p<0.001). [Figure A and B]. [Display omitted] Conclusion:Coated-platelets are a recently recognized component of hemostasis, and the ability of stored platelets to retain coated-platelet potential is unknown. Our preliminary results indicate that the process of platelet apheresis and storage significantly decreases the ability to generate coated-platelets. Current quality control guidelines for platelet storage measure platelet viability with factors such as pH, pCO2, pO2, lactate and platelet morphology; however, there is no evaluation of the hemostatic function of stored platelets relative to coated-platelets. Our results reveal that during storage following current transfusion guidelines, the percentage of coated-platelets decreases. Part of this decline appears to be associated with the apheresis process itself and further progresses with storage. Our study provides the first evidence that retention of coated platelet levels during preparation and storage is problematic and may be an important factor in evaluating the hemostatic potential of infused platelets. Disclosures:No relevant conflicts of interest to declare.

Cell line cross‐contamination initiative: An interactive reference database of STR profiles covering common cancer cell lines

Dear Sir, Recent reports 1–4 demonstrate the growing perception in the scientific community that cross contamination (CC) of mammalian cell lines represents a major risk for generating false scientific data. The level to which research has been compromised by the use of contaminated or misidentified cell lines has become a major concern for scientists, granting agencies, and, increasingly, scientific journals. In 2007, a group of cell biologists led by Roland M. Nardone petitioned the United States Secretary of Health and Human Services to develop an active program for cell line authentication. 5 They stressed that research and teaching tools in diverse fields of science and industry would be unimaginable without cell cultures. Despite the key importance of cell cultures, only little consensus exists regarding the technical means by which cell line identity can be controlled and how to follow through the results of any such testing. The key problems of CC are known and chronic in nature: neglecting guidelines for quality control and disregarding adequate cell culture techniques are the main reasons why cell lines have been misidentified or cross contaminated. The incidence of CC in directly and indirectly provenanced cell lines alike 1,3 implies that the majority of false cell lines are perpetrated in originators’ own laboratories, presumably by failures during the establishment of new cell lines. A plethora of reports unmasking bogus cancer cell lines, including members of the NCI-60 panel used to generate reference baseline transcriptional drug responses has triggered calls for remedial action. 5,6 Nevertheless, standard authentication procedures for testing cell line identity have yet to be defined. Short tandem repeat (STR) microsatellite sequences are highly polymorphic in human populations, and their stability throughout the lifespan of individuals renders STR profiling (typing) ideal for forensic use. STR typing has served as a reference technique for identity control of human cell lines at Biological Resource Centers (BRCs) since the turn of the millennium. 7 Ideally, authentication involves coincident STR

목초액의 안정성 및 모발 성장 촉진 효과

Generally, it takes a long time to purify wood vinegar, and it contains toxic compounds such as tar, methanol, phenol and benzopyrene. To reduce the toxicity of wood vinegar itself, we have developed a new purification method of wood vinegar using an oxidation-cohesion reaction and distillation with an active carbon. We have investigated the physico-chemical change (pH, specific gravity, refractive index and dissolved tar), the change of amount of toxic compounds (carbonyl group, phenol, benzopyrene and residual solvents) and organic acids (formic acid (FA), acetic acid (AA), propionic acid (PA)) of the purified wood vinegar under the long term and accelerated storage conditions. Also, we have evaluated the effect of the purified wood vinegar on hair growth using an alopecia model of C57BL/6 mice. As a result, we could find out that the purified wood vinegar was stable and remained without decay under the storage conditions and benzopyrene, a carcinogenic agent, was not detected in the purified wood vinegar. After topical treatment of the purified wood vinegar solution or minoxidil (MXD) for 2 weeks to dorsal skin, the hair regrowth of the mice accelerated faster than that of the control, with no clinical signs. In conclusion, we could suggest a guideline for quality control of process to reduce the toxic compounds in wood vinegar and it might be a useful hair growth promoter in the treatment of baldness or alopecia.

An assessment of municipal solid waste compost quality produced in different cities of India in the perspective of developing quality control indices

A study was conducted to investigate physico-chemical properties, fertilizing potential and heavy metal polluting potentials of municipal solid waste composts produced in 29 cities of the country. Results indicated that except a very few samples, all other samples have normal pH and EC. Organic matter as well as major nutrients N and P contents in MSW composts are generally low as compared to the composts prepared from rural wastes. Heavy metal contents in composts from bigger cities (>1 million population) were higher by about 86% for Zn, 155% for Cu, 194% for Cd, 105% for Pb, 43% for Ni and 132% for Cr as compared to those from smaller cities (<1 million population). Composts prepared from source separated biogenos wastes contained, on average, higher organic matter (by 57%), total N (by 77%) and total P (by 78%), but lower concentrations of heavy metals Zn (by 63%), Cu (by 78%), Cd (by 64%), Pb (by 84%), Ni (by 50%), and Cr (by 63%) as compared to those prepared from mixed wastes. Partial segregation at the site of composting did not improve quality of compost significantly in terms of fertilizing parameters and heavy metal contents. Majority of MSW composts did not conform to the quality control guideline of ‘The Fertilizer (Control) Order 1985’ in respect of total organic C, total P, total K as well as heavy metals Cu, Pb and Cr. In order to enable the relevant stakeholders to judge overall quality, a scheme has been proposed for the categorization of composts into different marketable classes (A, B, C, and D) and restricted use classes (RU-1, RU-2, and RU-3) on the basis their fertilizing potential and as well as potential for contaminating soil and food chain. Under the scheme, ‘Fertilizing index’ was calculated from the values of total organic C, N, P, K, C/N ratio and stability parameter, and ‘Clean index’ was calculated from the contents of heavy metals, taking the relative importance of each of the parameters into consideration. As per the scheme, majority of the compost samples did not belong to any classes and hence, have been found unsuitable for any kind of use. As per the regulatory limits of different countries, very few compost samples (prepared from source separated biogenos wastes) were found in marketable classes (A, B, C and D) and some samples (11–14) were found suitable only for some restricted use.

Contrast sensitivity of digital imaging display systems: Contrast threshold dependency on object type and implications for monitor quality assurance and quality control in PACS

The American Association of Physicists in Medicine Task Group 18 has published standards and quality control (QC) guidelines to ensure consistency and optimal quality for digital image display systems (DIDSs). In many of these recommended QC tests, static test patterns that contain low-contrast objects are often used to assess and validate the quality of a DIDS. These low-contrast objects often have the shape of circular disks or squares with sharp edges, neither of which resemble most of the diagnostic findings in medical images. On the other hand, circular objects with fuzzy boundaries bear a closer resemblance to lung nodules in chest radiography and masses in mammography; thus, they may be more clinically relevant in assessing display system quality. In this article human observers' contrast sensitivities of circular objects with sharp edges and those with fuzzy ones were investigated. The contrast thresholds of human viewers using a consumer-grade color LCD monitor and a medical-grade monochrome LCD monitor were measured for objects of various sizes displayed against uniform backgrounds with various luminance levels. Contrast-detail curves for circular objects with sharp edges and those with fuzzy boundaries were measured and compared. It was found that contrast thresholds for objects with fuzzy boundaries were higher (i.e., the objects were more difficult to detect) than those with sharp edges. Objects with fuzzy boundaries were potentially more sensitive in distinguishing quality differences among image display devices and thus may be a better QC measurement in detecting subtle deterioration in image display devices.

The PET and the Pendulum

Use of PET and CT for noninvasive detection of distant metastatic disease in lung cancer has been validated by many detailed studies, including Maziak and colleagues' study in this issue. Given acc...

투수콘크리트 현장품질관리 지침서 개발에 관한 연구

General criteria for the quality of porous concrete have not been established yet in Korea. And yet, pavement and construction have been performed. In this paper, guidelines on the construction site quality control of porous concrete were developed in order to establish criteria for resolving the issues and problems of porous concrete, to establish methods for improving poor performance, and to manage porous concrete more systematically. In addition, a guide for the construction site quality control of porous concrete, which was appropriate for reality, was developed by researching several quality control guides and maintenance at construction sites. The guide consists of a total of nine chapters such as Application Range, Overview, the Structure of Porous Concrete, the Design of Package Thickness, Package Materials for Porous Concrete, Construction Methods, Quality Assurance and Inspections, Construction Site Quality Control, and Maintenance. It describes quality control guidelines in all steps such as methods for transporting porous concrete from the factory to the construction site, cautions for construction work at construction sites, maintenance, and management. The Guide for the Construction Site Quality Control of Porous Concrete is expected to ensure the quality of porous concrete, to reduce national costs for quality assurance, and to help ensure the health and safety of Korean people.

SU-FF-I-79: Development of The Practical Guidelines of PET-CT Quality Control

Introduction:Positron emission tomography combined with computed tomography (PET‐CT) provides both functional and anatomical images of high quality noninvasively. Recently, increase in the use of PET‐CT for diagnosis of the cancer and the planning of radiation therapy accrues the demands for accurate evaluation of system performance and well designed programs of quality assurance. We analyzed the quality assurance practice in the PET‐CT laboratories and developed the practical guidelines of PET‐CT quality assurance.Methods: The survey questionnaire were send to 60 PET‐CT laboratories and the data of quality assurance practice were collected. We reviewed the surveyed data and the quality assurance systems of foreign counties and made the practical guidelines of PET‐CT quality assurance.Results: The developed practical guidelines of PET‐CT quality assurance consists of practical items of performance evaluation and protocols for quality assurance. For 30 PET‐CT laboratories, we are investigating the usefulness of the new guidelines. Conclusions: We developed the new practical guidelines of PET‐CT quality assurance. These guidelines could be used to guarantee the confidence of PET‐CT imaging as a quality assurance keeper.

Trends in antifungal susceptibility testing using CLSI reference and commercial methods

Antifungal susceptibility testing should identify in vitro resistance among a normally susceptible population or should detect the development of resistance during therapy. The Clinical and Laboratory Standards Institute (CLSI; formerly the National Committee for Clinical Laboratory Standards [NCCLS]) has developed reproducible methods for testing the activity of antifungal agents against yeasts (the M27-A3, M27-S3, M44-A and M44-S2 documents) and filamentous fungi (molds; the M38-A2 document). The yeast documents describe both quality control (QC) and interpretative breakpoint parameters for several antifungal agents versus Candida spp. In vitro breakpoints, as well as a QC and reference strain, has been recently described for mold testing. Standard guidelines for testing echinocandins against molds, guidelines for testing dermatophytes, as well as a disk-diffusion method for molds, have been developed recently. However, standard parameters for minimum fungicidal concentration determinations and selection of QC strains and guidelines for testing Malassezia spp. are under development. Breakpoints for Cryptococcus neoformans, dermatophytes and Malassezia spp. versus any antifungal agent and for posaconazole and amphotericin B versus yeasts are not available.

Validation and uncertainty study of a comprehensive list of 160 pesticide residues in multi-class vegetables by liquid chromatography–tandem mass spectrometry

A rapid and sensitive liquid chromatography–tandem mass spectrometry method, in electrospray ionization positive mode, has been developed for the determination of 160 selected multi-class pesticides over a 33-min run time. Extracts were obtained using the acetonitrile-based QuEChERS (quick, easy, cheap, effective, rugged and safe) sample preparation technique. The validation study was carried out on tomato, pear and orange matrices following DG SANCO/2007/3131 of the European Quality Control Guidelines. These matrices represent high water, high sugar and high acidic content commodities, respectively. Matrix influence on recoveries and its effects on ionization were evaluated for the three matrices. Ten out of the 160 pesticides showed very low intensity, linearity and/or sensitivity problems. Linearity was studied in the 5–500 μg kg −1 concentration range. Soft (<20%), medium (20–50%), and strong (>50%) matrix effects were obtained for 69%, 20%, and 11% of the studied compounds, respectively. Recoveries were investigated at the 10 and 100 μg kg −1 levels, and depending on the commodity, 97%, 98% and 97% of the compounds in tomato, pear and orange, respectively, were in the 70–120% range. More than 90% of the investigated compounds had less or equal to a 5 μg kg −1 limit of detection in the studied matrices. The relative standard deviations obtained exceeded 20% in only very few cases. The overall standard deviation obtained in the survey study (0.1551) was used for the method's uncertainty estimation. The expanded uncertainty resulted as being 0.3002 (coverage factor K = 2, confidence level 95%). The method was applied on 59 real samples from 14 different kinds of fruits and vegetables. Thirty-three compounds were detected in 50 positive samples.

Challenges in Routine Implementation and Quality Control of Rapid Diagnostic Tests for Malaria–Rufiji District, Tanzania

Rapid diagnostic tests (RDTs) represent an alternative to microscopy for malaria diagnosis and have shown high sensitivity and specificity in a variety of study settings. Current World Health Organization (WHO) guidelines for quality control of RDTs provide detailed instructions on pre-field testing, but offer little guidance for quality assurance once RDTs are deployed in health facilities. From September 2006 to April 2007, we introduced a histidine-rich protein II (HRP2)-based RDT (Paracheck) for suspected malaria cases five years of age and older in nine health facilities in Rufiji District, Tanzania, to assess sensitivity and specificity of RDTs in routine use at rural health facilities. Thick blood smears were collected for all patients tested with RDTs and stained and read by laboratory personnel in each facility. Thick smears were subsequently reviewed by a reference microscopist to determine RDT sensitivity and specificity. In all nine health facilities, there were significant problems with the quality of staining and microscopy. Sensitivity and specificity of RDTs were difficult to assess given the poor quality of routine blood smear staining. Mean operational sensitivity of RDTs based on reference microscopy was 64.8%, but varied greatly by health facility, range 18.8-85.9%. Sensitivity of RDTs increased with increasing parasite density. Specificity remained high at 87.8% despite relatively poor slide quality. Institution of quality control of RDTs based on poor quality blood smear staining may impede reliable measurement of sensitivity and specificity and undermine confidence in the new diagnostic. There is an urgent need for the development of alternative quality control procedures for rapid diagnostic tests that can be performed at the facility level.

SU‐GG‐I‐74: New IAEA Document On Acceptance Testing, Quality Assurance and Quality Control for PET and PET/CT Systems

Purpose: The increased role played by PET and PET combined with computed tomography (PET/CT) in oncology as well as cardiology and neurology associated with increasing reimbursement of multiple PET indications has prompted the need for updated guidelines specific to PET and PET/CT in terms of acceptance testing as well as quality assurance and quality control. These new IAEA guidelines are intended to provide standard testing procedures for use by end users and manufacturers. Method and Materials: The document address more recent developments in PET technology, such as the addition of the CT component, the need to ensure proper registration of the PET and CT data, mobile PET/CT units, time‐of‐flight systems, and the significant natural radioactivity present in some detector materials. Results and Conclusion: The new IAEA document is a reference technical document that provides guidance about the specifications and prerequisites required for acceptance testing of PET and PET/CT scanners, including professionals to be involved, definition of applications, minimal required configurations and corresponding performances parameters as well as ancillary equipment. The document also provides guidelines for routine quality control of PET and PET/CT scanners and a framework for setting reference values, tolerances and action levels. Following these guidelines would ensure operation of the scanner under optimal conditions that yield the best performance in routine clinical tasks that involve lesion detection as well as quantification of radioactivity concentration.

EUCAST Definitive Document EDef 7.1: method for the determination of broth dilution MICs of antifungal agents for fermentative yeasts: Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST)∗

INTRODUCTIONAntifungal susceptibility tests are performed onfungi that cause disease, especially if they belongto a species exhibiting resistance to commonlyused antifungal agents. Antifungal susceptibilitytesting is also important for resistance surveil-lance, for epidemiological studies and forcomparing the in-vitro activity of new and exist-ing agents.Dilution methods are used to establish theMICs of antimicrobial agents. These are thereference methods for antimicrobial susceptibilitytesting, and are used mainly to establish theactivity of a new antifungal agent, to confirm thesusceptibility of organisms that give equivocalresults in routine tests, and to determine thesusceptibility of fungi where routine dilution testsmay be unreliable. Fungi are tested for theirability to produce visible growth in microdilutionplate wells containing broth culture media andserial dilutions of the antifungal agents (brothmicrodilution). The MIC is defined as the lowestconcentration (in mg⁄L) of an antifungal agentthat inhibits the growth of a fungus. The MICprovides information concerning the susceptibil-ity or resistance of an organism to the antifungalagent and can help in making correct treatmentdecisions.The method described in this document isintended for testing the susceptibility ofyeasts that cause clinically significant infections(primarily Candida spp.). The method encom-passes only those yeasts that are able to fermentglucose. Thus, the susceptibility of non-fermenta-tive yeasts, e.g., Cryptococcus neoformans, cannotbe determined by the current procedure, and themethod is not suitable for testing the yeast formsof dimorphic fungi.SCOPEThe standard method described in this documentprovides a valid method for testing the suscepti-bility of glucose-fermenting yeasts to antifungalagents by determination of the MIC. MICs indi-cate the activity of a given antifungal drug underthe described test conditions, and can be used inmaking decisions concerning patient manage-ment after taking into account other factors, e.g.,pharmacokinetics, pharmacodynamics and resis-tance mechanisms. The MIC also allows fungi tobe categorised as ‘susceptible’ (S), ‘intermediate’(I) or ‘resistant’ (R) to a drug. In addition, MICdistributions can be used to define wild-type ornon-wild-type fungal populations.This method is intended primarily to facilitatean acceptable degree of conformity, i.e., agree-ment within specified ranges among laboratories,in measuring the susceptibility of yeasts to anti-fungal agents. The method is designed to be easyto perform, rapid, economical, and suitable forreading by microdilution plate readers in order toallow direct transfer, storage and manipulation ofthe data by computer. The method is alsointended to yield results that are concordantwith those obtained using the procedure

Acceptance testing and routine quality control in general radiography: mobile units and film/screen fixed systems

This study presents the findings from acceptance testing and routine quality control (QC) of general radiographic X-ray equipment in Ireland during 2006 and early 2007, including mobile X-ray units and film/screen fixed systems. Acceptance testing and routine QC of the diagnostic X-ray imaging equipment are requirements of European and Irish legislation. One hundred general radiographic X-ray systems were tested within Ireland, 73% of them failed to meet the required QC guidelines, whereby one or more faults were identified. The majority of these failures were minor ones, requiring attention by the suppliers at the next routine service. Significant faults were only identified in seven systems. The suppliers were requested to investigate these issues as soon as possible and take the necessary corrective action. A review of the QC results highlights the need to perform comprehensive acceptance and routine testing of the systems.

Operations Research Advances Cancer Therapeutics

Memorial Sloan-Kettering Cancer Center (MSKCC), the world's oldest private cancer center, seeks next-generation cancer treatment advances to enhance its ability to treat patients effectively by improving care and reducing costs. Using operations research approaches, our team has devised sophisticated optimization modeling and computational techniques for real-time (intraoperative) treatment of prostate cancer using brachytherapy (the placement of radioactive “seeds” inside a tumor). The resulting system offers significantly safer and more reliable treatment outcomes. In addition, it eliminates the need for preoperative simulation and postimplant dosimetric analysis, resulting in savings of hundreds of millions of dollars per year in the United States alone. Posttreatment quality of life is improved through drastic reduction (up to 45–60 percent) of complications. The reason for this is twofold: (a) treatment plans thus devised deliver less radiation to adjacent healthy structures, and (b) the ability to perform midimplant replanning eliminates the unavoidable discrepancies between planned and actual seed placement in the target. This has a profound impact on the cost of managing treatment-associated morbidity. The procedure uses approximately 20–30 percent fewer seeds and 15 percent fewer needles (used to place seeds inside the prostate gland). As a result, the operating-room time is shortened, and the entire procedure is less invasive. The system has the potential to establish standards and guidelines for cancer treatment quality control and quality assurance of the implantable plan. Wide distribution of our system should allow consistent treatment planning across different clinics and significantly reduce variability in treatment plan quality. The next phase of this effort will expand the applicability of our system to other forms of brachytherapy, such as treatment of breast, cervix, esophagus, biliary tract, pancreas, head and neck, and eye.

Latest American Export: Pay for Performance

Back to table of contents Previous article Next article Professional NewsFull AccessLatest American Export: Pay for PerformanceJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:1 Feb 2008https://doi.org/10.1176/pn.43.3.0014Although many physicians are less than enchanted with pay for performance—the concept of paying hospitals and physicians for adhering to practice guidelines and meeting standards of quality improvement—the concept has received the endorsement of many members of Congress.As a result, the federal Centers for Medicare and Medicaid Services (CMS) has received money to launch various pay-for-performance (P4P) demonstration projects.For example, CMS and Premier Inc. of San Diego joined forces in 2003 to launch a P4P demonstration project in some 250 American hospitals. The goal was to determine whether economic incentives could improve the quality of patient care in them. In 2006 CMS launched a three-year P4P program to encourage physicians who treat chronically ill patients to adhere to specific quality-control guidelines (Psychiatric News, November 17, 2006). The Tax Relief and Healthcare Act of 2006 authorizes CMS's Physician Quality Reporting Initiative, which is getting under way this year (Psychiatric News, December 21, 2007).P4P is getting a foothold in England as well. In 2004 England's National Health Service implemented a P4P contract with family practitioners (Psychiatric News, December 15, 2006). And now the North West Strategic Health Authority, which is part of England's National Health Service, has commissioned Premier Inc. of San Diego to implement a P4P demonstration project in hospitals and other health-care sites in northwest England.According to Mike Farrar, chief executive of the North West Strategic Health Authority, “We have carried out an extensive search to identify the most effective health services offered around the globe, and we have teamed up with a world leader that has already delivered dramatic results in the United States.”The P4P demonstration project in northwest England, called “Advancing Quality,” will first focus on improving the quality of care in the five areas targeted by the American project—heart attacks, heart bypass, heart failure, hip and knee replacements, and pneumonia. If those efforts prove successful, the project might then be expanded to other areas of hospital care.Premier will work with hospitals and the ambulance service in northwest England to set up data collection and processing systems. The structure of the financial-incentive scheme is currently being developed. There are no plans to penalize hospitals that do not meet quality-care standards.The northwest region of England includes some 7 million people, both in cities and in rural areas, and with a wide range of incomes. Some of the major health challenges in the region are cancer, excessive alcohol use, obesity, and teenage pregnancies.More information about the “Advancing Quality” demonstration project is posted at<www.northwest.nhs.uk/about_us/> and<www.premierinc.com>.▪ ISSUES NewArchived

Rapid Assessment of Cement and Fiber-Stabilized Soil Using Roller-Integrated Compaction Monitoring

Test sections of high-early strength (Type III) portland cement and polypropylene monofilament fibers were constructed at the Bradshaw Field Training Area in the Northern Territory (NT), Australia as part of a Joint Rapid Airfield Construction (JRAC) project. Aprons, taxi-ways, and a helipad were stabilized using these materials in combination with screened native soil. The purpose of the test sections was to (a) evaluate the resulting properties for different stabilization dosage rates; (b) develop construction methods, criteria (including limits), and quality control guidelines; and (c) provide a hands-on training opportunity for the joint United States and Australia military construction team. Testing and monitoring consisted of roller-integrated compaction monitoring (global position systems monitoring pass coverages and compaction machine values) and in situ testing, which included dynamic cone penetration tests, Clegg impact tests, and light-weight deflectometer tests. After the test sections, construction of the helipad helped refine the construction methods and quality control testing for the selected stabilization dosage rates and machine speed. Lessons learned on the helipad were applied to the subsequent aircraft parking aprons and taxiways. Recommendations were developed for rapid stabilization construction procedures and quality control testing using Clegg impact values and light-weight deflectometer for cement-fiber stabilized soils, and the application of roller-integrated compaction technology was demonstrated to document compaction effort and uniformity.

An update on using protein microarrays in drug discovery

Protein microarrays are evolving as useful tools for biopharmaceutical research. The differences in characteristics of individual proteins has made development challenging compared with DNA arrays. Nonetheless, significant advances have nontheless been made in developing protein microarray technology. Retention of function has been demonstrated for proteins belonging to various structural and functional classes after arraying. Focused arrays with small groups of proteins have been developed for a variety of applications, from biomarker validation to small molecule screening. Issues of protein stability as well as assay specificity and sensitivity, are being worked out for panels of arrayed proteins. The development of robust manufacturing methods has resulted in an increase in the number of commercially available protein array products. Quality control guidelines, which will also aid in accelerating development of the technology, are being established.