Trouble Shooting Research Articles

Driving value and impact through a community of practice: a case study from Australian and Aotearoa New Zealand University libraries

PurposeThis study addresses a recognised need in workforce development, a committee of the Council of Australian University Librarians (CAUL) facilitated the establishment of the Value and Impact community of practice (the community) between 2016 and 2017. The aim of this study is to create a structure that allows staff in Australian and Aotearoa New Zealand university libraries to promote best practice and build common capability in planning, performance, evaluation and measurement across a range of activities.Design/methodology/approachMembership is extended to those with roles focusing on quality, standards, analytics, communications or marketing and those with an interest in developing their understanding of these topics. A core group of members play a guardianship role to oversee the operations and liaise with CAUL. In walking the talk, an annual survey gathers performance measures that are reported to CAUL with examples of benefits and shared initiatives. Feedback is used to improve the operations of the community and determine meeting topics. The data and manaakitanga (support and care for each other) have driven these librarians to meet regularly as a community.FindingsMeetings offer a chance for a “round robin” to share practice and trouble shoot or cover a special topic with members or visiting experts presenting and facilitating discussion. At least 75% of the membership consistently report contact with other members outside of the meetings and that the community contributes to building their capability.Originality/valueThe community’s operating template and lessons learnt will be of value to those seeking to build community beyond a one-off professional development engagement.

Analisis Penyebab Kerusakan Mesin Diesel pada Generator Set untuk Tindakan Perawatan di Kapal Tanker MT. Sea Serenity

The generator set on the ship has the function of supplying electrical power needs. MT Tanker Ship. Sea Serenity is one of the ships that delivers goods between islands. In operation, the diesel generator engine on the MT. Sea Serenity sometimes experiences problems resulting in blackouts. This research aims to determine the factors that cause damage as well as appropriate maintenance actions and the method used is trouble shooting. Based on the research results, it is found that the causes of damage are: Engine knock, engine exhaust smoke, problems with the injection pump, worn plunger, damage to delivery valve seat, injection nozzle interference, valve opening pressure too low, engine output unstable, worn piston rings. Maintenance carried out: Injection timing must be adjusted according to ignition sequence, set injection timing, replace plunger and delivery valve seat, set valve opening pressure, replace spring, and clean injection orifice. On unstable engine output, the control rack stroke must be checked. Perform regular oil changes and regular tune ups

Management of obstructive sleep apnoea in primary care.

Obstructive sleep apnoea (OSA) is common in the community and is increasing in prevalence. Primary care plays a pivotal role in the diagnosis and management of OSA. This article focuses on the management options for a patient with an established diagnosis of OSA and provides a guide for driving licensing requirements. Indications for continuous positive airway pressure (CPAP) are discussed and tips provided toconsider when conducting a review appointment, including trouble shooting. There are several treatment options available for patients with an established diagnosis of OSA. Selecting the optimal therapy involves aligning the symptoms and severity of OSA with the presence of comorbidities. CPAP is a highly effective therapy for symptomatic adults with moderate-to-severe OSA and for some symptomatic patients with mild OSA. Early trouble shooting of side effects and using supportive interventions increases the probability of long-term adherence, which is key to symptomatic improvement.

Electrical Storm/Refractory Ventricular Tachycardia.

This simulation case was created for emergency medicine (EM) residents at all levels of training. Cardiac electrical storm (ES) is commonly defined as three or more episodes of sustained ventricular tachycardia, ventricular fibrillation, or three shocks from an implantable defibrillator within a 24 hour period.1 This can occur in up to 30-40% of patients with implantable defibrillators; however, it may also present in a wide variety of patients, including those with structural heart disease, myocardial infarction, electrolyte disturbances, and channelopathies.2,3 With each subsequent episode of ventricular arrhythmia, the arrhythmogenic potential of the heart may increase secondary to increased intracellular calcium dysregulation, myocardial injury, and increased endogenous release of catecholamines. The increased pain and catecholamine release from cardioversion/defibrillation and exogenous epinephrine during cardiac arrest further exacerbates ES.2 This carries a significant mortality risk of up to 12% in the first 48 hours.3This case involves a basic knowledge of the Advanced Cardiac Life Support (ACLS) for ventricular tachycardia, both with and without a pulse, and the application of Sgarbossa criteria in a patient with an ST elevation myocardial infarction (STEMI) which makes it ideal for the PGY-1. However, the case quickly becomes refractory to the basic management prescribed in ACLS, requiring trouble shooting and quick thinking about deeper pathophysiology, a skill that is crucial for all emergency medicine physicians. There are multiple ways to troubleshoot this case, making for a good variety of discussion and recent literature review on the complexities of a relatively common arrhythmia, ventricular tachycardia. By the end of this simulation, learners should be able to: 1) recognize unstable ventricular tachycardia and initiate ACLS protocol, 2) practice dynamic decision making by switching between various ACLS algorithms, 3) create a thoughtful approach for further management of refractory ventricular tachycardia, 4) interpret electrocardiogram (ECG) with ST-segment elevation (STE) and left bundle branch block (LBBB), 5) appropriately disposition the patient and provide care after return of spontaneous circulation (ROSC), 6) navigate a difficult conversation with the patient's husband when she reveals that the patient's wishes were to not be resuscitated. This simulation was performed using high-fidelity simulation followed by an immediate debriefing with nine learners who directly participated in the SIM and twenty-three residents, who were online observers via Zoom. This case was done during our conference day, and there were a total of approximately forty total learners comprised of medical students, PGY-1, PGY-2 and PGY-3 residents. There were several medical students who also observed via Zoom but were not surveyed, and the survey was sent to 32 learners. The case was run three separate times with each session consisting of three-four learners at the same level of training, with other learners in the same level of training observing via Zoom™ video platform. Since we can only have a team of three-four learners participate per group during simulation, the rest of the learners were observing the case and the debrief. There was one simulation instructor and one technician. We sent an online survey to all the participants and the observers after the debrief via surveymonkey.com. The survey collected responses to the following statements: (1) the case was believable, (2) the case had right amount of complexity, (3) the case helped in improving medical knowledge and patient care, (4) the simulation environment gave me a real-life experience and, (5) the debriefing session after simulation helped improve my knowledge. Likert scale was used to collect the responses. A total of thirteen participants responded to the survey. One hundred percent of them either strongly agreed or agreed that the case was believable and that it helped in improving medical knowledge and patient care. Fifty-four percent strongly agreed, 38 percent agreed, and eight percent were neutral about the case having the right amount of complexity. Thirty one percent strongly agreed, 61 percent agreed, and eight percent were neutral about the case giving them real-life experience. All of them agreed that the debriefing session helped them improve their knowledge. The high-fidelity simulation case was helpful with educating learners with ventricular tachycardia and fibrillation. Learners learned how to switch between various ACLS algorithms and how to manage a patient with refractory ventricular fibrillation. Learners enforced their knowledge in how to communicate with patient's family members when the patient does not want resuscitation. Stable ventricular tachycardia, unstable ventricular tachycardia, refractory ventricular tachycardia, electrical storm, STEMI equivalents, medical simulation.

Impact of Business Intelligence on Company Performance: A System Dynamics Approach

Abstract Research background Businesses struggle with operational optimisation and seek a solution by implementing Business Intelligence (BI) to boost sales. But, due to the lack of research that use actual data from real-world situations; the impetus of this research is to exploit BI parameters to enhance company performance. Purpose This research aims to develop a System Dynamics (SD) based model to assess whether a Japanese company which manufactures Printed Circuit Boards (PCB) should invest in BI to improve its operations based on the rate of information processing, thereby leading to increased financial performance. Research methodology The authors requested financial statements for three years (2019 to 2021) from the management of the PCB company, followed by validation based on subject experts’ assessments. The model was developed and simulated step-by-step with consideration of the SD approach involving problem identification, model prototyping, trouble shooting and error analysis. Results If BI was used to process data at a rate of 40%, the endogenous factors considered in this study would increase the company’s net profit and accumulated earnings by 25.77% and 48.28%, respectively. Novelty The research is unique in the sense that the model was developed based on inter-relationships between the variables, and the data is based on a real-life situation. Furthermore, the methodology could be applied with the necessary modifications to industries such as service, media, and education.

Human decision-substitutable chemometric identification of pixel shrinkage in OLEDs using secondary ion mass spectrometry

Secondary ion mass spectrometry (SIMS)-based depth profiling of organic light-emitting diode (OLED) samples composed of multiple layers is a useful analytical tool for identification of pixel shrinkage, which is a frequent defect occurring in OLED production. As an alternative to engineer-based defect identification, which is time-consuming and occasionally suffers from person-to-person discrepancies, a chemometric analysis scheme utilizing the whole SIMS dataset of the OLED sample has been explored in this study. Initially, all the depth-profiled spectra of each sample were assigned (classified) into the corresponding layers (groups) using a Gaussian mixture model (GMM), and the subsequent average spectra of each layer were used for layer-by-layer comparisons. Then, a one-class support vector machine (OC-SVM) was adopted for defect identification, and principal component (PC) scores of the spectra in each layer were used as the inputs for OC-SVM. The occurrence of defects in the 3rd layer was clear in the PC score domain, and the accuracy obtained by predicting the external test samples was 97.4%. Moving forward, the identification of potential peaks significantly contributing to the defect could be valuable clues to track the causes of defects (trouble shooting) during production. Kernel density estimation (KDE) was adopted for this purpose, and the top nine peaks with the lowest p-values (most significant contributions) were finally provided.

Deep Adversarial Tensor Completion for Accurate Network Traffic Measurement

Network trouble shooting, failure location, and anomaly detection rely heavily on network traffic measurement data. Due to the lack of measurement infrastructure, the high measurement cost, and the unavoidable transmission loss, network monitoring systems suffer from the problem that the network traffic data are incomplete. This article models the traffic data as a tensor to exploit its strong ability of feature extraction to recover the missing data. Different from traditional tensor completion which relies on tensor factorization, we design a novel Deep Adversarial Tensor Completion (DATC) scheme based on Deep Learning (DL) techniques. DATC is the first scheme that exploits the data reconstruction ability of autoencoder and the power of adversarial training from Generative Adversarial Networks to infer the missing data. Despite that DL techniques achieve great success in the image field, designing an algorithm based on DL techniques to recover the traffic data with missing entries faces additional challenges due to the skewed distribution and the sparsity of traffic data. To conquer these challenges, we propose the use of two techniques, adversarial training and missing data aware convolution. These techniques help DATC to learn the complex features of the traffic data and infer the missing data following the data distribution of traffic data. Our extensive experimental results using two public real-world network traffic datasets and running both offline and online demonstrate that DATC can achieve significantly better recovery accuracy while capturing the data distribution of the traffic data even when the sampling ratio is very low.

Systematic investigation of centrifugal slurry pump under different operating condition by DDPM method

The process characteristics of centrifugal slurry pump can be significantly affected by the operation strategy. However, their systematic quantifications and understandings are still lacking. This work studied the effects by applying the DDPM method, with confirmed validity. Via this model, the effects of distinct variables, including slurry flowrate (Q), impeller speed (N), particle size (ds) are quantified. Moreover, the interplays between solid concentration (Cs) to variables listed above are discussed, respectively. The results reveal that the flowrate plays significant influence on volute erosion distribution in circumference. The impeller speed increment greatly enforced the volute erosion severity, other than the distribution pattern. Fine particles intensify erosion in side-liner clearance and impeller passage, while greater particles are erosive in volute. This study offers a systematic operation evaluation with centrifugal slurry pump in fixed size, which herein provides guidance for pump selection and process trouble shooting in practice.

Robot-assisted radical prostatectomy using hugo RAS system: The pioneer experience in Taiwan and Northeast Asia.

Among the novel robotic platforms, the Hugo RAS system is the second most studied platform, next to the da Vinci system, and we aim to address our experiences in radical prostatectomy (RP) with the Hugo RAS system. We recorded our first 12 cases of prostate cancer undergoing RP with the Hugo RAS system. The median console time was 145min and median hospital stay was 7days. Hedge' g was applied to search for the cut-off case in four parameters in surgeries. Pre-console preparation was significantly improved after the first seven cases, and the console time was remarkably shortened after the first two cases. The intraoperative pause for trouble shooting was remarkably shortened after the first three cases. We found that RP with the Hugo RAS system was feasible, and the learning curve was short as surgeons may benefit from the previous experience with the da Vinci system.

Impact of the COVID-19 pandemic on audiology services in South Africa: A preliminary study.

Hygiene-, work practices, travel, personal interactions and access to healthcare services changed for the majority of the world during the pandemic. This study aimed to discover the knowledge, impact and attitudes towards COVID-19 on the professional practices of public and private sector audiologists in South Africa. The study included 76 audiologists registered with the Health Professions Council of South Africa (HPCSA) and employed in the public, educational, tertiary or private practice and private sector in South Africa. A cross-sectional self-administered electronic survey study design was implemented. Audiologists had appropriate knowledge regarding COVID-19. During hard lockdown, 69% of respondents saw less than 40% of their usual patient load, only 31% saw 60% - 100% of their usual patient load. During lower lockdown levels, majority of respondents (73.7%) saw 60% - 100% of their patient load while 26.3% still saw less than 40% of their usual patient load. Only hearing aid reprogramming, hearing aid trouble shooting, cochlear implant pre-counselling and adult hearing screening could be offered via tele-audiology. The main challenges faced were fear of infection, infection control measures in the workplace, accessibility and limited services provided during the various lockdown levels. The pandemic and lockdown levels had a definite impact on audiological service provision and many adaptations regarding service delivery and infection control in the workplace were required. The relevance of this work for health services is the identification of the challenges experienced by audiologists during the pandemic and the opportunities to prepare for the future.

Quantitative study of biofilm yield and biomass distribution of a multi-stage moving-bed biofilm system

Abstract A multi-stage anoxic/oxic (A/O) moving-bed biofilm reactor (MBBR) system with multiple chambers was established for municipal wastewater treatment. The active biomass quantity, bioactivity, and biomass yield of a pilot-scale multi-stage MBBR were investigated in this study. The microbial activity and heterotrophic yield coefficients (YH) were measured using respirometric techniques in each chamber at different temperature conditions. Meanwhile, the growth, nitrification, and denitrification rates of functional biomass were also quantified as specific respiration rate (SOUR). The total active biomass in the multi-stage A/O-MBBR system was 0.71–1.68 g COD/m2 for the aerobic reactor and 0.39–1.44 g COD/m2 for the anoxic reactor at 10–19 °C. The YH values for the anoxic reactors were 0.61–0.69, which were comparable to the recommended value of the activated sludge model (ASM1). The correlation coefficient between Nitrospira and the autotrophic specific respiration rate (SOURA) was 0.82. Meanwhile, denitrifying genera showed a significant correlation with the heterotrophic specific respiration rate (SOURH) and the active heterotrophic biomass (XH). This study provided insights into biomass distribution and the corresponding kinetic parameters for the multi-stage MBBR systems, which may serve as a reference for process design and trouble shooting.

Organizational Factors Associated with The Implementation of a Health Management Information System at Kenyatta National Hospital

Healthcare organizations are increasingly spending and allocating huge budgets in embracing modern technology innovations and ways of dealing with healthcare related issues. While modern technology benefits cannot be disputed they however come at an expense and require a rigorous process before adopting the innovation. Studies done indicated Health care organizations find the process a rigmarole and opt for easier ways to incorporate or adopt the innovations, these usually results to a collapse or bottlenecks in the outputs of the innovations, in fact, majority of organizations have abandoned their ultra-modern system only to go back to their old manual system. The main objective of the study was to determine Organizational factors associated with implementation of a Health Management information Systems among healthcare workers at Kenyatta National Hospital. The research was conducted at KNH and adopted a cross-sectional study design. The target population of the study were 4,900 healthcare workers at KNH who were involved in implementing HMIS. The sample techniques used were mixed method sampling of stratified sampling, snowball sampling and convenience sampling. A sample total of 263 respondents was calculated for the quantitative study. The study utilized a questionnaire and a key informant interview schedule. Before processing the quantitative data, the data collected from the field was cleaned, coded, entered into a computer software and analyzed using SPSS version 21 while qualitative data was manually analyzed based on themes that were developed from responses (thematic analysis). Data presentation from the quantitative data was in form of quantitative statistics such as frequency distribution, percentages, tables, use of chi square for analysis, p values and odds ratios. Qualitative findings were presented in verbatim form. This study was submitted to KNH/UON Ethical Review Committee for ethical approval. Consenting was sought from individuals. Results indicated that majority of those interviewed were of the opinion that HMIS had improved services delivery by effecting efficiency especially in accident and emergency department, the wards and reception areas, generally there was improved efficiency in information handling in that, it had helped to identify patients in and through the system and there was reduction in costs. However, a few respondents were of the view that, HMIS had not improved efficiency to a larger extent since a lot of things were still done manually, no proper training and the system not fully implemented. Main challenges included, lack of technical assistance which led to loss of data which had never been recovered to date and scarce resources. In relation to the cadre of the hospital, the systems were quite complex, inadequate healthcare staff experience, scarcity of infrastructure and shortage of ICT technicians to assist in trouble shooting. There were very many refunds to patients by finance, resistance by users due to the perception that, it was a business-oriented system rather than goal oriented. Results show that the ratio of males to females was 1:1, 133(50.6%) and females 129(49.4%) thus gender balanced. A greater number of the respondents were aged between 26-35, 91 (34.6%), followed closely by the age bracket 36-45, 74(28.1%), the minority were aged 55 and above, 12(4.6%). In Kenyatta more than half of the respondent’s education level was college, 160(60.8%) with very few at secondary, 5(1.9%). population age, level of education and duration worked at KNH, (p value 0.008, 0.050 and 0.004). KNH might not be where they want or need to be as far as HMIS is concerned but they have made strides towards the right direction. Technologically, HIMS have already taken a vital role in the healthcare industry and are obliged to be organizational tools meant to create a better healthcare environment. It is essential for the KNH management to ensure that there is a systems thinking where each and every individual staff is not only motivated but also feels part and parcel of the HIMS process. KNH needs to devise a HIMS specifically for their clientele

Teaching undergraduate students to think like real‐world systems engineers: A technology‐based hybrid learning approach

AbstractA hybrid teaching approach that relied on combining Project Based Learning with Team Based Learning was developed in an engineering module during the past 5 years. Our motivation was to expose students to real‐world authentic engineering problems and to steer them away from the classical banking approach, with a view to developing their systems engineering skills via collaborative learning. Our third year module was called Team Design and Project Skills and was concerned with 320 students dividing themselves in teams to develop a smart electronics system. We reveal module design details and discuss the effectiveness of our teaching approach via analysis of student grades during the past 5 years, as well as data from surveys that were completed by 68 students. 64% of surveyed students agreed that the module helped broaden their perspective in electronic systems design. Moreover, 84% recognized that this module was a valuable component in their degree programme. Adopting this approach in an engineering curriculum enabled students to integrate knowledge in areas that included control systems, image processing, embedded systems, sensors, as well as team working, decision making, trouble shooting and project planning.

Transformation of Pharma Curriculum as Per the Anticipation of Pharma Industries-Need to Empower Fresh Breeds with Globally Accepted Pharma Syllabus, Soft Skills, AI and Hands-on Training

Abstract: In this domain of specialty and globalization the pharmacy teaching and learning in India is suffering from serious backdrops and flaws. In India, in present-day need of pharmacy is to physique and shape strategies for a renovated innovative future for affordable and effective healthcare system. There is a crucial necessity to begin an academic exercise aimed at renewing of prospectus, focusing recent and evolving learnings in the field of pharmacy. The current youth of pharmacy graduate sought to have technical expertise of sophisticated instrument functioning, trouble shooting, product and process development, IPR, innovative rational based thinking, quality by design, regulatory aspects of global level to match the anticipation of industrial revolution of pharma 4.0. Certainly, they are short age of expertise in new generation instruments, latest development in Pharma Industry, Intellectual Property Rights and Regulatory needs of Industries and profound exposure of Process Analytical Technology (PAT). The numerous factors which should be well-known are Environmental Health and Safety (EHS), Investigation like 6 sigma’s, Ishikawa Fish bone skills and CAPA, Parameters Efficiency including OEE, SMED, 5S, OPE, Lean production, Latest Development of Pharma Industries, Regulatory knowledge about Internal and External Audits, Self-Inspections, technology Transfer, Change Management emphasizing on Control on changes and Risk management: FMECA, Risk Evaluation and Mitigation. Artificial intelligence (AI) has the potential to bring about a paradigm shift in the way drug are researched, developed and marketed. AI is changing the pharmaceutical industry by looking at 5 key areas of AI in pharma: data science, drug discovery, clinical trials, marketing and R&D. The article emphasizes on raising the current standards of knowledge, skills and domain of scholars of Diploma, Bachelors, Masters and Doctorate of Pharmacy course. The necessity of an hour is to work on enhancing the concept of innovation and quality management. Solicitation of technical expertise to the educational system improves the present situation. The admission procedures should be brought underneath the scanner as these are the opening of the students for entrance in the profession. Gaining expertise at bachelor’s level will lead to proficiency and brilliance. Keywords: Pharmacy Education, Pharma Industries, Latest Development, Pharma 4.0, Artificial Intelligence.

Applications of comet and MTT assays in studying Dunaliella algae species

Chloroplasts and unicellular algae genomes, are the most important and vital intracellular organelles which determine the cells physiological performance. Using Comet and MTT assay technics in algal studies, will provide researchers prominent features about both their photosynthesis and genomes. Using two unicellular algal groups, Dunaliella salina (orange) and Dunaliella viridis (green), collected from a hypersaline lake (Maharloo lake) located east of Shiraz, Iran, MTT and Comet assays along with their trouble shootings were used to study these two algae. Results showed that, MTT was reduced due to the presence of oxidoreductive enzymes both in photosynthetic reaction centers and in electron transport chains. It was concluded that, MTT reduction in unicellular algal cells, mostly reflects the chloroplasts activity. The rates of light absorbance at λ = 570 nm due to MTT reduction for 100 000 D. salina cells/well (R2 = 0.9457) as well as for 160 000 D. viridis cells/well (R2=9838) were the same as equal to 1. Due to the presence of beta-carotene in D. salina cells, lower number of cell was required to give the same absorbance as compared to D. viridis. In continuation of this study, non-physiological apoptosis cells death caused by Cis‑platinum drug was investigated in these two algal species. Using Comet assay, the DNA damage was determined in both positive and negative control groups. The tail averages in positive control group and in negative control group, were 14.9 % and 0.73 % respectively. Unicellular aquatic algae that lack cell wall, are suitable models to be used in such studies. We would like to recommend the application of MTT and Comet assays technics due to their high sensitivities for revealing damages done to both photosynthetic system and to DNA which will be effective tools for monitoring the biological and non-biological environmental hazards.

Intravesical Infusion of Oncolytic Virus CG0070 in the Treatment of Bladder Cancer.

CG0070 is a conditionally replicating oncolytic adenovirus that preferentially replicates within and kills Rb-defective cancer cells. It has been used successfully in an intravesical formulation to treat Bacillus Calmette-Guerin (BCG) unresponsive carcinoma in situ (CIS) containing non-muscle-invasive bladder cancer. As a self-replicating biologic, it shares many characteristics with intravesical BCG but has other unique features. Herein, we detail recommended standardized protocols for bladder infusion of CG0070 for the treatment of bladder cancer and provide many useful tips for trouble shooting.

E-Office Computer Application Competencies Required of Office Technology Education Graduates by Employers in Public Organizations in Edo and Delta States, Nigeria

Employers in public sector companies in Edo and Delta states in Nigeria requested this research to determine the e-office computer application competencies needed by graduates of office technology education programs. To find out what e-office computer applications are needed by public sector employers in Edo and Delta states, we conducted a survey. The study was led by a single research topic and a single null hypothesis that was evaluated at the 0.05 level of significance. This study was conducted using a survey methodology. In Edo and Delta States, the sample size was 262 employers in public organizations. The population was small enough that no sampling was necessary. A 16-item structured questionnaire was utilized to gather the data. Several specialists in business education and a test-and-measurement expert evaluated the instrument's validity. Test re-test approach was used to confirm the instrument's dependability, and Pearson Product Moment Correlation Coefficient was used to get the coefficient of reliability. It is safe to say that the coefficient of trustworthiness is at least 0.78. For data analysis, the mean and the t-test statistics were utilized, respectively, to test the null hypothesis. The findings of the study showed that the identified competencies such as understand computer and its related components, trouble shoot the computer where necessary, use the Microsoft office packages, connect the computer to printer, scanner etc. were deemed required by employers. As a result of the findings, it was suggested that the identified competencies be used to enhance the office technology education curriculum and that sufficient computer systems with internet facilities be made available for the teaching and learning of office technology education students in order for them to successfully transition from school into the workplace. Keywords: competencies, office technology education, employers, office automation. DOI: 10.7176/EJBM/14-18-02 Publication date: September 30 th 2022

How to Improve Audiology Services: The Patient Perspective

How to Improve Audiology Services: The Patient Perspective

Imaging Flow Cytometry for Sizing and Counting of Subvisible Particles in Biotherapeutics

Imaging flow cytometry (IFC), a technique originally designed for cellular imaging, is featured by the parallel acquisition in brightfield (BF), fluorescence (FL), and side scattering channels. Introduced to the field of subvisible particle analysis in biopharmaceuticals roughly ten years ago, it has the potential to yield additional information, e.g., on particle origin. Here, we present an extensive, systematic development of masks for IFC image analysis to optimize the accuracy of size determination of polystyrene beads and pharmaceutically relevant particles (protein, silicone oil) in BF and FL channels. Based on the developed masks, particle sizing and counting by IFC are compared to flow imaging microscopy (FIM). Mask verification based on fluorescent polystyrene particles revealed good agreement between sizes obtained from IFC and FIM. In the evaluation of counting accuracy, IFC reported lower concentrations for polystyrene particle standards than FIM. For the analysis of fluorescently stained silicone oil and protein particles however, IFC FL imaging reported higher particle concentrations in the low micrometer size range. Overall, we identified IFC as suitable tool to generate supportive data for particle characterization purposes or trouble shooting activities, but not as routine quantitative technique, e.g., for subvisible particle analysis during drug product development or quality control.

510-P: DKA Prevention on Insulin Pumps: Lessons Learned from a Large Pediatric Pump Practice

While the Type 1 Diabetes Exchange data noted that diabetic ketoacidosis (DKA) is more common in those utilizing injection regimens than insulin pumps, DKA remains a risk for pump users, as it can precipitously develop if insulin infusion is interrupted. We sought to obtain more recent DKA admission data in T1D youth using insulin pumps and the impact of CGM on DKA rates. Methods: We characterized DKA data in insulin pump users from episodes between 12/20 and 6/2021 in an academic pediatric endocrine practice in which 68% were pump users. Results: Among 591 pump patients aged <25 years (y) , 28 events occurred (3.16 events per 100 patient-y. Mean age was 13.6±3.4y; 85.7% were 12-19y old. More events were in males (60.7%) , 53.6% were white, 71.4% non-Hispanic. Mean HbA1c was 10.22.3%, diabetes duration 6.1±4.0y, and 57.1% used CGM; 28.6% of patients were new to pump therapy (<1y) .Admission pH levels ranged between 7.0-7.31, with 28.6% of events classified as “moderate” and 46.4% as “severe.” Average length of stay was 2.0±0.7 days. While there was no significant difference in pH levels, CGM wearers had higher admission bicarbonate values (11.8 vs. 9.3, p=0.04) . Clinicians assessed the cause of DKA to be related to concurrent illness (10.7%) , insulin omission (14.3%) , pump infusion site failure (57.1%) or other pump malfunctions (14.3%) . For most (60.7%) , this was the first documented DKA event. Alcohol consumption was a contributing factor in only one event. Conclusions: DKA events were relatively uncommon; most episodes occurred in adolescents in poor diabetes control. Notably, most events could have been avoided if users followed standard trouble shooting guidelines. Thus, education on DKA prevention should be reinforced at each visit, particularly for teens on pumps with higher A1c levels. Moreover, while CGM wearers had higher admission bicarbonate values, over 50% of those hospitalized for DKA wore a CGM, suggesting even pump users using CGM require frequent reinforcement of DKA prevention education. Disclosure E.Doyle: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. W.V.Tamborlane: Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Medtronic, Novo Nordisk, Sanofi, Takeda Pharmaceutical Company Limited.