Charles D. Hawker

Parathyroid Hormone in Chronic Renal Failure: Studies with Two Different Parathyroid Hormone Radioimmunoassays

Two assays for immunoreactive parathyroid hormone (iPTH) with different specificities were used to evaluate the role of iPTH measurement in patients with chronic renal failure (CRF). One measured largely C-terminal iPTH fragments, the other largely intact iPTH. In untreated CRF, the log iPRH for each assay was significantly correlated with the reciprocal of the creatinine clearance (CCr). C-terminal iPTH was elevated at relatively high CCr values, but intact iPTH was not elevated until later in the progression of CRF. In hemodialysis patients treated with 25-hydroxyvitamin D3, intct iPTH correlated better than C-terminal iPTH with clinical improvement. These two assays used together were more helpful in evaluation of CRF patients than either assay alone.

Nonanalytic Laboratory Automation: A Quarter Century of Progress

Clinical laboratory automation has blossomed since the 1989 AACC meeting, at which Dr. Masahide Sasaki first showed a western audience what his laboratory had implemented. Many diagnostics and other vendors are now offering a variety of automated options for laboratories of all sizes. Replacing manual processing and handling procedures with automation was embraced by the laboratory community because of the obvious benefits of labor savings and improvement in turnaround time and quality. Automation was also embraced by the diagnostics vendors who saw automation as a means of incorporating the analyzers purchased by their customers into larger systems in which the benefits of automation were integrated to the analyzers.This report reviews the options that are available to laboratory customers. These options include so called task-targeted automation-modules that range from single function devices that automate single tasks (e.g., decapping or aliquoting) to multifunction workstations that incorporate several of the functions of a laboratory sample processing department. The options also include total laboratory automation systems that use conveyors to link sample processing functions to analyzers and often include postanalytical features such as refrigerated storage and sample retrieval.Most importantly, this report reviews a recommended process for evaluating the need for new automation and for identifying the specific requirements of a laboratory and developing solutions that can meet those requirements. The report also discusses some of the practical considerations facing a laboratory in a new implementation and reviews the concept of machine vision to replace human inspections.

Bar Codes May Have Poorer Error Rates Than Commonly Believed

By most accounts (1), the development of bar code technology is credited to 2 graduate students at Drexel University. In 1948, Bernard Silver had overheard the president of a local grocery chain asking a dean at the University whether they could develop a system to read product information at checkout. Silver told his colleague Norman Woodland of this request. After one failed idea involving ultraviolet light, Woodland, convinced that he could solve this problem, quit his part-time teaching position at Drexel and moved to Florida to live with his grandfather. While walking on the beach one day and with the inspiration of the Morse code, he used sand to extend the dots and dashes of the codes downward in thin and thick lines. Silver and Woodland filed a US patent application on October 20, 1949, entitled “Classifying Apparatus and Method.” The patent, 2 612 994, was issued on October 7, 1952. It described both a bulls-eye printing pattern of codes as well as a linear pattern similar to that of the bar codes we know today. The initial adoption of bar code technology was slow. Attempts to track railroad cars, vehicles with monthly passes crossing a toll bridge, and US Post Office trucks all had limited success. A trial in which Kal Kan used bar codes to track cases of pet food for inventory control sparked the interest of the grocery industry, and a meeting of the National Association of Food Chains in 1966 discussed the use of automated checkout systems. Progress continued to be slow, but in 1974 the first successful scan of a Universal Product Code (UPC) code on a package of chewing gum at a grocery store in Troy, Ohio, ushered in the bar code era (1). Today, more than 2 dozen different linear bar code …

An Automated System for Transporting and Sorting Laboratory Specimens: The ARUP Plan

Shipping Container Specimen Bag Requisition or Manual Worklist Specimen Aliquot Tube Empty Aliquot Tube Not Empty Pre-Labeling Bin (E2+E8) Post-Labeling Bin (ESF+ElO+Ell) ARUP Laboratories is a commercial esoteric reference laboratory performing more than 1800 different procedures with a daily volume of more than 10,000 accessions. The clinical reference volume (excluding cytopathology, veterinary pathology, and employee drug testing) exceeds 8000 accessions per day. As a reference lab ARUP serves hospital clinical labs and other reference labs in all 50 states across all six time zones and as well as serving large clients in Brazil and Japan. Our rapid growth rate (25% per year for the past three years) and the competitive cost pressures inherent in the laboratory environment have made automation of our processes a key strategy. However, automating in an environment that specifically has no routine clinicallaboratory testing (our clients do those tests themselves) and in which 85% of all incoming specimens are either refrigerated or frozen presented a major challenge. In the summer of 1998, ARUP Laboratories expects to implement our automation plan, some 3 1/z years after initiating the first feasibility evaluations.

ARUP Laboratories' Automated Transport and Sorting System: A Report of the First 10 Months Experience

INTRODUCTION ARUP Laboratories, Inc., is a commercial esoteric reference laboratory performing more than 2000 different procedures with a daily volume of more than 12,000 accessions. The clinical reference volume (excluding cytopathology, veterinary pathology, and our hospital stat laboratory) approaches 10,000 accessions per day. As a reference lab ARUP serves hospital clinical labs and other reference labs in all 50 of the United States and other countries. Our rapid rate of specimen growth (averaging 20% per year) and competitive cost pressures inherent in the laboratory environment made automation and re-engineering of our processes a key strategy. However, automation in a setting that specifically has no routine clinical laboratory testing and in which 85% of all incoming specimens are either frozen or refrigerated presented major challenges. Prior to our “go live” date, we had previously reported on the design and plan for an automated transport and sorting system that was developed to address the unique needs of our operations. This report describes the impacts of our automation initiative on productivity, turn-around time, and quality of our service during the first approximately 10 months since we went live (November 17, 1998), some 3.8 years after we began to consider the feasibility of automation in our environment. ARUP’s esoteric testing creates a different volume profile from that of most laboratories. In most hospital clinical labs and reference labs that serve physician offices, about 50-55 different tests typically comprise 80% of the actual test volume of the laboratory. At ARUP only 1-2 tests even have 1% of our total volume, and to reach 80% of our volume requires more than 1000 different tests. However, at this level (1000 tests deep into our menu arranged by volume), we may receive an average of only 2-3 specimens per week for each different test. Thus, for an automation system to handle 80% of our volume, it would first have to address the sorting of many different tests each of which is relatively low volume. In addition, with more than 100 employees in our Specimen Processing section, for the 1000 or more different tests that arrive twice a week or less, it means that each employee, on average, may see that test once per year or less, and yet is still expected to know exactly what to do. Therefore, part of our overall design was to reengineer our Specimen Processing section to reduce training time and ensure better quality and efficiency of processing for these entry-level positions that typically have a high turnover rate.

Countercurrent Chromatography and Countercurrent Distribution

I read with great interest the report of Napolitano et al. in the February, 2009 issue of JALA concerning countercurrent chromatography (CCC), because I had the privilege more than 40 years ago of briefly working in the laboratory at the Rockefeller Institute (now Rockefeller University) of Dr. Lyman C. Craig, the inventor of countercurrent distribution (CCD), the predecessor technology to CCC. These two technologies are virtually identical except for the mechanical sophistication. Each system provides for sequential partitions of a solute between a stationary solvent phase and a mobile solvent phase. It is understandable that the authors would not have known of Dr. Craig’s work because it would not appear in current searchable databases. Dr. Craig was world renowned for his developments in extraction, dialysis, partition chromatography, microdistillation, fractional distillation, thin film countercurrent dialysis, and for the invention of CCD. A brief perusal of his more than 70 publications in American Chemical Society journals revealed that CCD had been used in the purification of albumin, lysozyme, ribonuclease, insulin, Bacitracin A, parathyroid hormone, Bence-Jones protein, hemoglobin, and many more substances. Many scientists at that time believed that he should have been awarded a Nobel Prize. However, in his day, it was hard to compete with Watson & Crick, Ochoa & Kornberg, and many others for the prize in medicine, or with Linus Pauling, Melvin Calvin, Frederick Sanger, or Willard Libby for the prize in chemistry. Dr. Craig’s CCD techniques and machines were clearly the predecessor to CCC. My own visit to Dr. Craig’s laboratory was with my graduate school advisor, Howard Rasmussen, who was the first to purify bovine parathyroid hormone as a graduate student under Dr. Craig. On our visit to the Rockefeller Institute in 1967, we attempted to purify porcine thyrocalcitonin (now calcitonin) using Dr. Craig’s 1000-tube CCD machine, a marvel to just look at. Building such a machine kept a glassblower busy for months. Performing 1000 transfers with this machine required nearly three full days.