In-house Laboratory Research Articles

First year of in-house forensic neuropathology consultations in Helsinki, Finland.

In July 2023, an in-house forensic neuropathology consultation pilot was established at the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare. This offered an alternative to the previous practice of full outsourcing to a hospital neuropathology department. This paper aims to introduce the first year experiences of the pilot. The in-house consultant team comprised two forensic pathologists with special training in neuropathology. In-house consultations were offered for medico-legal autopsy cases with traumatic brain injury (TBI) and hypoxic-ischaemic encephalopathy. The in-house histology laboratory participated in the pilot, implementing beta-amyloid precursor protein (β-APP) stain at the end of the pilot year. An electronic database was also developed for data collection and reporting. The characteristics, costs, and duration of the first 25 consultation cases were reviewed. The cases involved mostly male decedents (84.0%) with TBI (84.0%). The median total cost of a pilot case was €624, which was substantially lower compared to the previous outsourced practice (€1013 per case + €38/84 for each microscope slide with special/immunohistochemical stain, respectively). After the implementation of β-APP stain into the in-house laboratory service, the median total cost of a pilot case was reduced further to €94. The median duration of an in-house consultation was 2.3 months. Thanks to a favourable in-house atmosphere, the first year experiences are encouraging. While the costs of the in-house consultation practice appear to be markedly lower than those of an external provider, both alternatives should be available for cases where sufficient expertise cannot be found in-house.

Operational Excellence by Implementation of 5S Concepts and Lean Management Practices in Vivarium

Modern vivarium operation requires collective efforts by cross-functional teams especially within the collaborative research organizations for the successful outcomes of comprehensive laboratory animal care program. The drug discovery with rapid screening turnovers and innovative approaches demands infrastructure expansion by increasing several other capabilities in vivarium. The strategic portfolio changes and therapeutic areas closure retained several high-end equipment’s left unused that eventually occupied space in the barrier system which intricate daily operations and space management became challenging over the period. The vivarium facility was under continuous improvement by the quality assurance program based on monthly independent audit reports and compiled the compliance including animal welfare standards of at least 5 years period. Corporate initiatives such as Kaizen events, 5S concepts, Gemba walk and green labs certifications were implemented systematically at various phases across the organization including vivarium. The leadership team was a driving force behind the lean management practices and its implementation. The quality assurance program was able to bring out several improved operational processes notably by creating an additional quarantine space; repurposing high-end equipment for other investigators to support their ongoing programs; effective space utilization by creating in-house diagnostic laboratory; donating low-density animal racks for academic institutions as part of educational outreach efforts; containment of solid radioactive waste disposal by compaction process for longer half-life radioisotopes. In conclusion, lean management practices collectively demonstrated a measurable outcome in terms of continuous process improvement, effective vivarium management by ensuring compliance based on periodical observations without compromising animal welfare, conservation of energy and resources, effective space utilization and systematic implementation of 5S concepts by repurposing of equipment to other laboratories. Overall, the system-driven process has improved the standards with better performance that eventually enhanced the quality and productivity at the laboratory animal facility

A Retrospective Review: Our Experience With an Adhesive-Based Pigmented Lesion Assay Used to Evaluate Cutaneous Lesions Suspicious for Melanoma.

Being one of the largest dermatology groups in the country with an in-house pathology laboratory, we have seen a significant increase in the number of adhesive-based pigmented lesion assays (ABPLAs) in addition to biopsies and excisions following a moderate-risk or high-risk result with this test. To report our clinical experience and independently confirm that our results with this ABPLA (Pigmented lesion assay, DermTech. San Diego, CA) are consistent with the results of the validation studies completed by the test manufacturer. A retrospective review of our electronic medical records for results of ABPLAs, corresponding histopathologic results and available clinical follow-up, along with their statistical analysis was completed. After reviewing our electronic medical records, we found that 893 ABPLAs for pigmented lesions concerning for melanoma were obtained in a period of 14 months. Of the 893 ABPLAs completed, 161 biopsies and excisions were performed after the initial results of these assays. Additional clinical follow-up data were recorded and used for the statistical analysis of the performance and accuracy of this test. The small number of lesions reported as low risk for melanoma with corresponding histopathologic results limits our evaluation of the performance of this test. In addition, there may have been some melanomas that were not identified because the duration of the clinical follow-up was insufficient or because some patients were lost to follow-up. In our experience this ABPLA has a sensitivity of 92.0%, a specificity of 79.5%, a positive predictive value of 16.9%, and a negative predictive value of 99.5% for the detection of melanoma.

The efficacy of integrated vermifiltration technology for treatment of food analysis laboratory wastewater

The macrophyte-assisted vermifiltration (MAVF) technology was applied for treatment of food analysis laboratory wastewater at Industrial Technology Institute (ITI), Sri Lanka for the first time. Three laboratory-scale sub-surface vertical flow units were established:1) without earthworms and plants (Control unit), 2) with earthworms (Eisenia fetida) (vermi-filtration unit (VF unit), 3) with both earthworms and macrophytes (Canna indica) (MAVF unit). Wastewater was fed batch-wise with a feeding rate of 10 mL/min and seven days hydraulic retention time (HRT) for eight consecutive batches. Physiochemical parameters, Chemical Oxygen Demand (COD), Total Phosphorus (TP), Total Nitrogen (TN), pH, of the influent and effluent of all three units were analyzed to investigate the treatment efficiencies. One-Way ANOVA was performed to evaluate the significant differences in treatment efficiencies. The mean COD removal efficiencies of the control unit, VF unit, and MAVF unit were 60.2 % ± 10.7, 71.6± 8.07 %, and 72.0 % ± 8.86, respectively. Average TN removal efficiencies of the control unit, VF unit, and MAVF unit were 8.05 % ± 5.75, 10.9±6.4 %, and 24.9 % ±12.84, respectively. Average TP removal efficiencies were 35.84 % ± 17.5, 35.84 % ± 17.5 %, and 40.0 % ±16.76, respectively. The COD removal displayed promising results, whereas the means for enhancing TP and TN removal should be further studied. The findings of this study sensitizes the testing laboratories to go green by adopting in-house cost effective laboratory wastewater treatment systems.

Retrospective analysis on the occurrence of kidney cysts in mice in a central animal facility in the years 2009-2019.

Kidney cysts in humans are mainly caused by inheritable polycystic kidney disease. Although they are a regular finding in laboratory mice, their occurrence upon dissection has not been systematically investigated, yet. Therefore, the aim of this report was to investigate on prevalence, phenotype and aetiology of spontaneously occurring kidney cysts in mice by retrospectively analysing the laboratory-receipt tables of the in-house laboratory of a central animal facility in North Rhine-Westphalia, Germany, years 2009-2019. A percentage of 0.4% of dissected mice displayed kidney cysts, with more male than female animals affected and average age equal to that of all dissected animals. Preliminary report in half of the cases was distended abdomen, and a few individuals displayed additional pathologic alterations of kidneys, most commonly dilated renal pelvis, or extrarenal comorbidities. Kidney cysts occurred independently of a renal phenotype of the transgenic strain or presence of infectious agents in health monitoring. To conclude, kidney cysts were characterized as harmless for affected mice but, as inheritability is suggested according with the literature, affected animals should be excluded from breeding.

A 3-D interactive microbiology laboratory via virtual reality for enhancing practical skills

Virtual Reality (VR) laboratories are a new pedagogical approach to support psychomotor skills development in undergraduate programmes to achieve practical competency. VR laboratories are successfully used to carry out virtual experiments in science courses and for clinical skills training in professional courses. This paper describes the development and evaluation of a VR-based microbiology laboratory on Head-Mounted Display (HMD) for undergraduate students. Student and faculty perceptions and expectations were collected to incorporate into the laboratory design. An interactive 3-dimensional VR laboratory with a 360° view was developed simulating our physical laboratory setup. The laboratory environment was created using Unity with the (created) necessary assets and 3D models. The virtual laboratory was designed to replicate the physical laboratory environment as suggested by the students and faculty. In this VR laboratory, six microbiology experiments on Gram staining, bacterial streaking, bacterial motility, catalase test, oxidase test and biochemical tests were placed on the virtual platform. First-year biomedical science students were recruited to evaluate the VR laboratory. Students’ perception of the virtual laboratory was positive and encouraging. About 70% of the students expressed they felt safe using the VR laboratory and that it was engaging. They felt that the VR laboratory provided an immersive learning experience. They appreciated that they could repeat each experiment multiple times without worrying about mistakes or mishaps. They could personalise their learning by concentrating on the specific experiments. Our in-house VR-based microbiology laboratory was later extended to other health professions programmes teaching microbiology.

Mesoscopic simulations of a fracture process in reinforced concrete beam in bending using a 2D coupled DEM/micro-CT approach

In this study, a complex fracture process in a short rectangular concrete (RC) beam reinforced by one longitudinal bar (without vertical reinforcement) and subjected to quasi-static three-point bending was numerically explored in 2D conditions. A critical diagonal shear crack in the beam caused it to fail during the experiment. The numerical simulations were conducted with a classical particle discrete element method (DEM). A three-phase concrete description (aggregate, mortar, and interfacial transitional zones (ITZs) around aggregates) accounted for the concrete heterogeneity. In mesoscopic DEM calculations based on a 2D X-ray CT scan, the actual shape and placement of aggregate particles in concrete were taken for granted. In the study, the steel bar with ribs was replicated. ITZ was also assumed between the bar and mortar. Without imposing any bond-slip law, a geometrical bar/concrete interface condition was explicitly considered. The focus was on the force–deflection diagram, fracture process, contact forces, and stresses along the bar. A good level of agreement about the evolution of the vertical force versus the deflection and failure mechanism was attained between DEM analyses and in-house laboratory tests despite simplified 2D conditions. A strong effect of concrete mesostructure on the crack pattern was found.

Development and field evaluation in African and Asian countries of an hepatitis B virus PCR on open polyvalent platforms to determine treatment eligibility: results from the “Agence Nationale de Recherche sur le Sida et les hépatites” 12327 study

ObjectivesWidespread testing and treatment are essential to eliminate hepatitis B virus (HBV) infection as a public health concern. However, in resource-limited countries, access to HBV PCR is limited. In this study, we developed a quantitative HBV PCR assay on open molecular platforms and evaluate its performance in diagnosing clinically significant HBV DNA thresholds as defined by the WHO (2000 IU/mL, 20 000 IU/mL, and 200 000 IU/mL). MethodsWe implemented our HBV PCR test in seven African and Asian countries and France, using either an in-house laboratory method or a European conformity for in vitro diagnostic (CE-IVD) marked version of the PCR (Generic HBV Charge Virale, Biocentric). Results were compared with reference tests (Roche Cobas AmpliPrep/Cobas TaqMan and Abbott RealTime on Abbott m2000). ResultsThere was a good agreement between the HBV DNA results of 1015 samples tested by the PCR on open polyvalent platforms and the results from reference tests (mean difference (bias ± standard deviation [SD]): −0.3 ± 0.7 log10 IU/mL and −0.2 ± 0.9 log10 IU/mL when compared with Roche and Abbott tests, respectively). Kappa-Cohen agreements between the HBV PCR on open polyvalent platforms and the Roche/Abbott assays appeared almost perfect for HBV DNA levels ranged from >20 000 to 200 000 IU/mL and >200 000 IU/mL, substantial and moderate for HBV DNA levels ranged from 2000 to 20 000 IU/mL when compared with Abbott and Roche, respectively. The assay's performance was consistent across genotypes A, B, C, D, and E. DiscussionThis field evaluation showed that our HBV PCR test is a valuable alternative to proprietary PCR systems. PCR assays on open platforms contribute to expanding clinical laboratory solutions for diagnosing individuals who meet the viral load criteria for antiviral therapy (>20 000 IU/mL) and mother-to-child prophylaxis (>200 000 IU/mL).

A Variable Speed Induction Motor Drive With 24-Stepped Voltage Waveform Throughout Modulation Range

Multi-level inverters produce low order harmonics in over-modulation region, which can be eliminated by generating polygonal space vector structure. A variable speed induction motor drive to generate 24-stepped voltage waveform throughout modulation range is proposed in this article. An open-end winding configuration induction motor (OEIM) is fed with primary and secondary inverter from both the ends of OEIM and generates a 24-stepped phase voltage. The proposed scheme also produces 96-stepped phase voltage waveform at extreme modulation index with highly suppressed higher order harmonics and excellent quality phase voltage. The motor terminal sees a 24-stepped waveform at all speeds, devoid of low order harmonics up to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$19^{th}$</tex-math></inline-formula> order. The scheme does not require vector timing calculation due to availability of highly dense 24-sided polygonal structure. Primary and secondary inverters are derived by cascading flying capacitor and CHB cells. Experimental verifications are performed on in-house developed laboratory prototype. Motor phase voltage and phase current waveforms during steady state and transient conditions justifies performance of the proposed scheme. Dynamic performance and floating capacitors voltage balancing method are verified by experimental results.

Efficacy of an impression disinfectant solution after repeated use: An in vitro study

Statement of problemThere are very few studies using Benzalkonium Chloride (BAC) as an active disinfection agent for immersion techniques and there are no studies investigating the efficacy of repeated use of a disinfectant solution. PurposeThis study evaluated an impression disinfectant by testing bacterial contamination of disinfectant batches used in a clinical setting after repeated use. Materials and methodsLiquid samples were collected from impression disinfectant solutions used to disinfect dental impressions taken at a university dental clinic. The experimental samples (500 ml from 1 L of solution) were collected from teaching and professional clinics and the in-house commercial processing laboratory and stored at room temperature each day of clinic operation over five weeks. To determine to what extent the disinfectant efficacy of the active product decreased over time, the following tests were carried out: a. Inoculation b. Gram staining technique c. Matrix Assisted Laser Desorption/Ionization Mass spectrometry (MALDI- MS). Microbial growth was monitored and photographed. A culture revival was made from colonies grown on sheep blood agar, to isolate pure colonies incubated for 24 h at 37 °C. Each morphologically distinct type of colony was gram stained and MALDI spectrometry analysis was performed using the VITEK MS (BioMerieux Inc.) ResultsEvidence of growth of bacteria was detected in teaching clinics’ samples, and no growth from the professional clinic or the commercial laboratory. ConclusionsThe study demonstrated that the impression disinfectant solution tested is effective against common oral bacteria, despite some rare species such as Bacillus circulans, Bacillus horneckiae, Bacillus altitudinis/pumilus and Bacillus cereus showing evidence of survival in solutions used for disinfection of impressions. However, in a high use teaching clinic environment its efficacy deteriorated. Though a second level disinfection protocol in the commercial laboratory-maintained impression disinfection.

A cascaded deep learning approach for detecting pipeline defects via pretrained YOLOv5 and ViT models based on MFL data

Long-distance oil and gas pipeline has become the main mode of transporting oil and gas resources as the demand for fossil energy increases. The complex environment of long-distance pipeline makes the pipeline susceptible to surface defects, which pose a major safety threat. Magnetic flux leakage (MFL) detection is a non-destructive testing (NDT) method that can be used to map and monitor pipeline defects. However, the accuracy and reliability of MFL detection can be severely compromised by the data processing and analytics methods used. This paper presents a novel hybrid method for detecting pipeline defects by combining well-established computer vision algorithms, i.e., YOLOv5 and Vision Transformer (ViT), enabling accurate detection and classification of pipeline defects simultaneously. An in-house laboratory dataset generated by Pull Through Testing (PTT) was used for model training and verification, which contains the manipulated pipeline defects, e.g., metal corrosion, geometrical defect, metal material loss, and geometrical structures etc. The effect of different model architectures on “the defect identification performance was investigated. Comparisons show that the proposed cascaded approach surpasses the YOLOv5 algorithm alone in pipeline defect classification accuracy, while still preserving the versatile ability of defect detection with high precision.

B-338 A Clinical Research LC-MS/MS Method for the Analysis of Immunosuppressant Drugs in Whole Blood Using Capitainer B Devices

Abstract Background Traditional laboratory analysis of the immunosuppressant drugs cyclosporine, everolimus, sirolimus and tacrolimus is well-established in clinical research. However there remains a need for individuals to undergo an invasive, time-consuming and disruptive process under the supervision of trained staff in order to collect a sufficient volume of whole blood for laboratory analysis. A reliable, remote sampling method may find utility in a clinical research setting. Here we describe the use of Capitainer® B qDBS devices to obtain analytically sensitive, precise and accurate data for cyclosporine, everolimus, sirolimus and tacrolimus analysis using small sample volumes. The Waters ACQUITY™ UPLC I-Class with Xevo™ TQ Absolute mass spectrometer was used to analyze these samples. Methods An in-house laboratory developed LC-MS/MS method to analyze all four immunosuppressants in a single ruin was developed. Waters MassTrak Immunosuppressant Calibrator and Control Sets (IVD) and whole blood External Quality Assurance samples (LGC, Bury, UK) were used in conjunction with Capitainer® B qDBS devices to assess the performance of the method. Samples were collected using Capitainer® B qDBS devices, and the sample (10 µL) extracted using solvent containing internal standards. A water/methanol/ammonium acetate gradient was used with a Waters C18 HSS SB column on a Waters ACQUITY™ UPLC™ I-Class and Xevo TQ Absolute Mass Spectrometer operating in positive electrospray ionization mode with run time of less than 2 min. Results Analytical sensitivity of the lowest calibrator at 1 ng/mL for everolimus, sirolimus and tacrolimus and 25 ng/mL for cyclosporine was demonstrated with S/N (PtP) &amp;gt; 10 across five analytical runs. We successfully demonstrated linearity of cyclosporine from 25–1500 ng/mL and everolimus, sirolimus and tacrolimus from 1–30 ng/mL, with r2 &amp;gt; 0.995 over five analytical runs. Total precision and repeatability across the four immunosuppressants (2, 8 and 22 ng/mL for everolimus, tacrolimus and tacrolimus; 150, 400 and 900 ng/mL for cyclosporine) with five replicates over five analytical runs (n = 25) was ≤15% CV. External quality assurance samples for all drugs met the scheme acceptance criteria, with mean bias ≤15% CV. Conclusion Using Capitainer® B qDBS devices and sample small volumes (10 µL) of whole blood, an in-house laboratory method was used to meet validation goals for analytical sensitivity, linearity, precision and accuracy for cyclosporine, everolimus, sirolimus and tacrolimus. Furthermore, the advantages conferred by volumetric absorptive microsampling, notably removing the requirement for travel and a venous blood draw and facilitating home sampling, render this technique applicable to clinical research. For Research Use Only. Not for Use in Diagnostic Procedures.

A Drug Safety Concept (I) to Avoid Polypharmacy Risks in Transplantation by Individual Pharmacotherapy Management in Therapeutic Drug Monitoring of Immunosuppressants.

For several, also vital medications, such as immunosuppressants in solid organ and hematopoietic stem cell transplantation, therapeutic drug monitoring (TDM) remains the only strategy for fine-tuning the dosage to the individual patient. Especially in severe clinical complications, the intraindividual condition of the patient changes abruptly, and in addition, drug-drug interactions (DDIs) can significantly impact exposure, due to concomitant medication alterations. Therefore, a single TDM value can hardly be the sole basis for optimal timely dose adjustment. Moreover, every intraindividually varying situation that affects the drug exposure needs synoptic consideration for the earliest adjustment. To place the TDM value in the context of the patient's most detailed current condition and concomitant medications, the Individual Pharmacotherapy Management (IPM) was implemented in the posttransplant TDM of calcineurin inhibitors assessed by the in-house laboratory. The first strategic pillar are the defined patient scores from the electronic patient record. In this synopsis, the Summaries of Product Characteristics (SmPCs) of each drug from the updated medication list are reconciled for contraindication, dosing, adverse drug reactions (ADRs), and DDIs, accounting for defined medication scores as a second pillar. In parallel, IPM documents the resulting review of each TDM value chronologically in a separate electronic Excel file throughout each patient's transplant course. This longitudinal overview provides a further source of information at a glance. Thus, the applied two-arm concept of TDM and IPM ensures an individually tailored immunosuppression in the severely susceptible early phase of transplantation through digital interdisciplinary networking, with instructive and educative recommendations to the attending physicians in real-time. This concept of contextualizing a TDM value to the precise patient's condition and comedication was established at Halle University Hospital to ensure patient, graft, and drug safety.

The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period.

Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer. We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis. Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001). Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.

PERBEDAAN KADAR HEMOGLOBIN MENGGUNAKAN METODE HB METER DAN HEMATOLOGY ANALYZER

Examination of hemoglobin levels before blood donation is an important check to certify that potential donors can donate blood. Hemoglobin levels can be measured using the hematology analyzer method where this method checks more quickly and the results issued usually have gone through quality control carried out by an in-house laboratory, it's just that this method has limitations including treatment, room temperature, must be controlled periodically. Checking hemoglobin levels can also be measured using the Hb meter method. Checking hemoglobin levels can also be done using Hb meters which are widely used by health services, such as clinical laboratories, health centers and hospitals. The advantages of the Hb meter include the results obtained faster and cheaper. This study aims to determine differences in the results of examination of hemoglobin levels using the Hb meter method with a hematology analyzer. The research method used is True Experiment with the type of research The Posttest Only Design. The sample in this study were 16 prospective blood donors at PMI Yogyakarta City. Respondents who had been given an explanation and signed an informed consent were then taken a sample of their venous blood and examined the hemoglobin level using the Hb meter and hematology analyzer methods. results are recorded and then data processing is carried out using univariate analysis and bivariate analysis. Based on the results of the study it was concluded that there was no significant difference between the results of examining hemoglobin levels using the Hb meter method and the Hematology Analyzer (p = 0.321 : p &gt; 0.05). The average value of hemoglobin levels in the Hb meter method is 14.631 g/dl while the average value of hemoglobin levels in the Hematology Analyzer method is 14.294 g/dl.

Amyloid goiter secondary to familial Mediterranean fever with E148Q mutation: A unique case.

Amyloid goiter secondary to familial Mediterranean fever with E148Q mutation: A unique case.

Candida auris screening practices at healthcare facilities in the United States: A survey of the Emerging Infections Network

Background:Candida auris, an emerging fungal pathogen, is frequently drug resistant and spreads rapidly in healthcare facilities. Screening to identify patients colonized with C. auris can prevent further spread by prompting aggressive infection prevention and control measures. The CDC recommends C. auris screening based on local epidemiological conditions, patient characteristics, and facility-level risk factors; such screening might help facilities in higher burden areas to mitigate transmission and those in lower-burden areas to detect new introductions before spread begins. To describe US screening practices and challenges, we surveyed a network of infection disease practitioners, comparing responses by local C. auris case burdens. Methods: In August 2022, we emailed a survey about C. auris screening practices to ~3,000 members of the IDSA Emerging Infection Network. We describe survey results, stratifying findings by whether the healthcare facility was in a region where C. auris is frequently identified (tier 3 facility) or not frequently identified (tier 2 facility), based on CDC assessment using existing multidrug-resistant organism containment guidance (https://www.cdc.gov/hai/containment/guidelines.html). Results: We received 253 responses (tier 3 facilities: 119, tier 2 facilities: 134); overall, 37% performed screening. Tier 3 facilities more frequently performed screening than tier 2 facilities (59% vs 17%). Among facilities that performed screening, tier 3 facilities, compared with tier 2 facilities, more frequently screened patients on admission (84% vs 55%) and used an in-house laboratory for testing (68% vs 29%), most often with culture-based methods. Tier 2 facilities more frequently screened patients already admitted in the facility (eg, in response to cases or as part of point-prevalence surveys) compared with tier 3 facilities (59% vs 49%). Among facilities performing screening, 72% had identified ≥1 case in the previous year (tier 3 facilities, 85%; tier 2 facilities, 33%). Barriers to screening included limited laboratory capacity, long testing turnaround times, and the perception that screening was not useful. Conclusions: Most facilities surveyed did not perform C. auris screening. However, most facilities that performed screening, including those in regions of higher and lower C. auris burden, detected cases during the previous year. Admission screening, which might help detect new introductions before spread begins, was uncommon in facilities in lower-burden areas. Improving ease of C. auris screening through access to in-house laboratory testing with rapid turnaround times might increase the adoption of C. auris screening by facilities, thereby increasing detection and preventing spread.Disclosures: None

How to…

Abstract Anita Patel discusses how to interpret in-house cytology and laboratory culture and sensitivity results, using pictures, examples, and case studies of canine otitis externa to illustrate the theme.

Multiannuli Solution Uses Intelligent Pipe for Real-Time Monitoring

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 211546, “Intelligent Pipe: A Multiannuli Monitoring Solution,” by Francois-Xavier Bulard, Vallourec; Emmanuel Tavernier, OpenField Technology; and Lucas Kling, Vallourec. The paper has not been peer reviewed. _ The authors describe a multiannular monitoring solution that measures pressure and temperature for each well annulus. These key parameters are captured by sensors based on microelectromechanical-system technology. A transmission methodology is used that allows power supply and data retrieval even for annuli beyond the B annulus. All electronic elements of the solution will be qualified through an international recommendation protocol [Advanced Well Equipment Standards (AWES)] that consists of a series of mechanical and long-term tests to ensure that the system will survive for 20 years at 125°C. The solution could be used in all storage applications, especially those related to the energy transition. Introduction The initial goal of the intelligent-pipe solution was to add functionality to tubulars by embedding miniaturized sensors into the pipe body. The secondary objective was to monitor the pipe’s environment to properly characterize well loads and compare them to its strength resistance. The main application of the solution was then to monitor annulus conditions in real time during the whole life of the well and to anticipate any leakage or annular-pressure-buildup issue that could not be monitored currently on subsea wells. A tubular design was developed to incorporate pressure and temperature sensors without affecting the integrity of the pipe. The design was verified by a testing protocol performed by an in-house testing laboratory. This protocol consisted, first, of finite-element analysis (FEA) performed on different tubular designs with the objective of optimizing the different shapes of the grooves created to incorporate the sensors. The second steps included physical tests performed on a specimen inside test frames that confirmed that the tubular integrity was not affected after several pressure and axial load cycles, even when applying maximum pipe-resistance loads. This mechanical test qualification demonstrated that the monitoring mandrel was able to withstand the constraints observed in a well. The qualification level achieved was the same as that achieved on the premium pipe connection. Much of the complete paper is dedicated to the development of the permanent solution; this synopsis focuses on the system’s pilot deployment and its global system qualification. First Deployment in a Deepwater Subsea Well The operator’s objective was to monitor several annuli of a subsea well to determine the effect of completion operations. This characterization was completed before the well-production phase. The main outputs of the pilot were annuli trapped pressure and temperature. The pilot was defined initially in two stages. The first was to monitor the B and C annuli conditions (pressure and temperature) immediately after casing deployment. The second was to do so again after running completions and various stimulation operations. A secondary objective was to retrieve historical sensor data, pressure, and temperature records from the time of sensor deployment to data-retrieval operation.

Finite Element Modeling of the Soil-Nailing Process in Nailed-Soil Slopes

The finite element technique has been accepted as a tool for modeling geotechnical complex processes. In this study, finite element (FE) modeling of various stages of the soil-nailing process, i.e., construction stages and overburden pressure stages, is carried out considering different soil parameters, simulating with in-house developed laboratory models. The soil-nailing process built in laboratory models is idealized as a plain strain problem and modeled in PLAXIS software. The laboratory models of the soil-nailing process consist of a Perspex sheet box containing a sandy soil slope, a Perspex sheet facing, steel bars as reinforcement and a steel plate as foundation. The stress–strain relationship of the sand is represented by a Hardening-Soil model. The interface at the soil and nail is described by the Coulomb friction model. The behavior of the soil-nailing process, during the construction stage and under varying overburden pressure and varying soil density, are investigated in terms of displacements of slope and stress conditions in slope soil mass. The slope displacements and stress conditions in slope soil mass are all well presented by the FE modeling and compared with laboratory model test data. The sensitivity analysis of the laboratory models’ dimensions is carried out by three-dimensional modeling of the nailed-soil slope. It can be concluded that the developed finite element model has the potential to simulate the performance of a field nailed-soil slope during construction and working stages and could provide guidance for the construction/maintenance of soil-nailed cut slopes in granular soils/weathered rocks.