Comparison of Field and Laboratory Result of Fiber Reinforced Shotcrete Application

Synthetic fibers, which have become one of the main components of shotcrete, have been studied by many researchers in the laboratory environment. Unfortunately, the results obtained as a result of these researches are not suitable for underground chimneys due to the differences in ambient conditions and application differences. In this study, it is aimed to compare the results of the experiment samples prepared and kept in the laboratory with the mechanical properties of the shotcrete applied in underground conditions. For this purpose, keeping the slump and cement proportions constant, 35 cubic samples were prepared using 2 and 6 kg synthetic fiber for 1 m3 in the laboratory, and 30 cylinder samples and 6 plate samples were prepared for underground. While mechanical experiments were carried out on prepared cube and cylinder samples, the EFNARC plate test and freeze-thaw test were carried out on plate samples. It was observed that the set accelerator made a significant increase in resistance at the end of the 28 days and that the resistance of the samples prepared with polyester fibers in the laboratory environment were very high. As a result of the EFNARC panel tests performed, it was determined that the energy absorption of synthetic fibers increased with fiber amount. Thanks to this study, the energy absorption of the synthetic fiber used has been measured, and the reliability and practicality of the experiments carried out in the laboratory have been increased by evaluating the field conditions and laboratory conditions.

A case of gastric ulcers and intussusception due to Ascariasis in a 4-months old American Hampshire boar in Sabon Gari Local Government Area, Kaduna State, Nigeria

A Four months old American Hampshire boar weighing about 35kg from a back-yard piggery in Sabon Gari Local Government Area, Kaduna State was presented with the chief complains of restlessness, shivering and pasty perineum. There was no medical history. Physical examination revealed, pale ocular mucus membrane, restlessness, shivering and pasty perineum. The vital parameters were above normal ranges. Faecal sample from the rectum was taken to the helminthology laboratory of the Veterinary Teaching Hospital, Ahmadu Bello University, Zaria, for helminth egg detection and identification. Based on the tentative diagnosis of Ascariasis and enteritis, 35mg of a 17% piperazine adipate solution and 700mg of a 20% oxytetracyline long acting were administered orally and deep intramuscularly, respectively as single doses. The boar died 2 hours after therapy. Post-mortem examination revealed; distended ingesta-filled stomach, ulceration of the stomach mucosal wall with tarry (blackish) haemorrhages, Ascaris suum in the stomach and small intestine, intussusception of the small intestine and empty distal portion of the intussuscepted small intest ne. The helminthology laboratory result indicated eggs of Ascaris suum. Based on the helminthology laboratory result and the post mortem examination findings, it was concluded that the b ar died of gastric ulcer and small intestine intussusception due to Ascariasis. Routine deworming and deworming record keeping in order to know when the next deworming is due were advocated to the farmer.

The diagnostic certainty levels of junior clinicians: A retrospective cohort study

ABSTRACT Purpose of the Study To characterise the documentation of working diagnoses and their associated level of certainty by clinicians assessing patients referred to the medical team from the emergency department. Design This was a single centre retrospective cohort study of non-consultant grade clinicians at the Royal London Hospital, Barts Health NHS Trust between 01/03/19 to 31/03/19. De-identified electronic health record data was collected to include the type of diagnosis documented (clinical, laboratory result or symptom/sign defined) and the certainty adjective used for single diagnoses. Presence or absence of diagnostic uncertainty was collected for multiple diagnoses. Results 865 medical assessments were recorded during the study period. 850 were available for further analysis. 420 presented a single diagnosis while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign, and 16 (4%) were laboratory-result defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. Conclusion The documentation of working diagnoses is highly variable amongst non-consultant grade clinicians assessing patients admitted via the emergency department. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses however documentation style was heterogenous. These data have implications for prospective studies examining the quantification of diagnostic certainty and its association with important process or outcome measures.

Rates of Laboratory Adverse Events By Chemotherapy Course for Pediatric Acute Leukemia Patients within the Leukemia Electronic Abstraction of Records Network (LEARN)

Introduction: Adverse events (AEs) are often under- or misreported on clinical trials, leading to an incomplete understanding of therapy-associated toxicities. We previously demonstrated that laboratory result data can be extracted from the electronic health record (EHR), cleaned, and processed to ascertain laboratory AEs with high accuracy compared to gold standard chart abstraction at a single institution. We sought to employ this methodology at three large children's hospitals to demonstrate scalability and describe laboratory AE rates during therapy for pediatric acute myeloid and acute lymphoblastic leukemia (AML, ALL). Methods: The Leukemia Electronic Abstraction of Records Network (LEARN) comprises data from patients with AML and ALL treated at the Children's Hospital of Philadelphia (CHOP) from 2006 to 2014, Children's Healthcare of Atlanta from 2010 to 2018, and Texas Children's Hospital from 2008 to 2014. Risk classification, clinical trial enrollment status, and chemotherapy course start and end dates for all patients were collected via manual chart abstraction. After manual input of medical record numbers and course dates, a package we developed in the R programming language (ExtractEHR) was employed to extract laboratory results from the Epic EHR at each site. De-identified laboratory result data were cleaned centrally at CHOP to remove falsely abnormal results, including hemolyzed specimens and results that normalized within 1 hour for electrolytes and hematology tests and within 12 hours for liver function tests (LFTs). Laboratory results were processed and graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5 definitions for 22 AEs. The highest grade of each AE in each course was calculated and results were tabulated by chemotherapy course for ALL and AML separately. Only chemotherapy courses with complete start and end dates were included; courses that were ongoing at time of abstraction were excluded. Highest grades for each AE over all chemotherapy courses combined were stratified by leukemia risk classification and trial enrollment status and were compared using chi square tests. CTCAE grade 5 definitions are not numerically based, so were excluded. Results: Laboratory result data on 1687 patients (AML: 282, ALL: 1405) who experienced 6652 courses (AML: 909, ALL: 5743) were extracted, processed and graded. For the purposes of these results, AEs indicate grades 3-4. More than 95% of AML courses had anemia, neutropenia and thrombocytopenia (Table). AML patients experienced the most laboratory AEs during Induction I and Intensification III (prevalence of grade 3-4 AEs was ≥10% for 10 AEs evaluated). Apart from hematologic AEs, hypokalemia (17.9-44.9% of courses) and increased LFTs (7.7-18.6% of courses) were the most common AEs in AML courses. While AML patients experienced higher rates of hematologic AEs, ALL patients had higher rates of electrolyte and LFT AEs over all courses. These AEs were distributed across all courses; in each course there were 7-9 AEs with a prevalence of ≥10%. Increased alanine aminotransferase was common in every ALL course (17.4-66.2%). For both for AML and ALL, AE rates were similar among patients enrolled on trials and those who were not. AE rates were similar for all AML risk classifications. In contrast, for ALL there were significantly higher rates (p<0.05) among intermediate/high risk compared to standard risk patients for 17 AEs, including AEs in all laboratory categories. Conclusions: The ExtractEHR tool is scalable for extracting laboratory result data from the EHR at multiple hospitals. These data can be processed centrally using a series of electronic code to describe comprehensive laboratory AE rates during chemotherapy, which does not otherwise exist in the literature. The lack of difference by trial enrollment status indicates that these results apply to all patients with AML and ALL. These data therefore describe expected AE rates for patients during each chemotherapy phase that can be used to provide clinical guidance and serve as a baseline comparison for experimental agents in clinical trials. These data and LEARN provide a granular resource for clinical epidemiology research focused on evaluating factors associated with incidence and resolution of laboratory AEs. Efforts are ongoing to incorporate medication and outcome data to investigate the impact of these AEs on clinical experience and outcomes. Disclosures Fisher: Pfizer: Research Funding; Astellas: Other: Data Safety Monitoring Board Chair for an antifungal study; Merck: Research Funding.

Prevention of Clinical Laboratory Test Error: Pre-analytical Error

Laboratory test errors are classified into 3 categories: 1) pre-analytical error, 2) analytical error, and 3) post-analytical error. Most errors occur during pre-analytical step, usually caused by human error. The errors make laboratory result unreliable, following with the improper patient care by increasing cost, misdiagnosis, inappropriate treatment, and unexpected complication (even death). Therefore, the implementation of regulation to improve the sample handling process by accurate identification, contamination control, appropriate collection and transportation, is necessary to reduce the errors. In addition, awareness of test’s limitation and communication with laboratory service, when the result is not consistent with clinical manifestation, are also the important factors. The above measures should lead to the appropriate interpretation of laboratory result, following with the effective patient care. Apart from the laboratory test errors, the test itself could give falsely positive or falsely negative results. Therefore, the appropriate laboratory use based on indication is the vital part to minimize unnecessary consequences.