Standard Operating Procedure

Genetic testing in a clinical diagnostic environment must be subject to rigorous quality control procedures, in order to ensure consistency and accuracy of results. Denaturing high performance liquid chromatography (DHPLC) has become a standard prescreening tool for mutation detection, offering very high efficiency and sensitivity of detection. Despite the relatively simple software-assisted assay setup, DHPLC is a complex assay, and quality control is reliant on ensuring optimal instrument performance, excellent assay design and validation, and sufficient user training and proficiency to interpret results. We describe here a unique collaborative effort by a group of diagnostic clinical genetics laboratories with DHPLC expertise who, together with the manufacturer of one of the most widely used DHPLC platforms, have generated standard operating procedures (SOPs) for instrument operation and maintenance, and for mutation detection by DHPLC. We also describe the validation of a disease-specific SOP for DHPLC assisted mutation screening of the MECP2 gene associated with Rett syndrome. The proposed SOP was validated, and used independently in two laboratories to introduce MECP2 testing. In addition, we provide empirically derived normal ranges for the WAVE s System Mutation Standards, which are essential for optimal instrument performance. This effort was initiated to try to standardize DHPLCbased mutation screening procedures across laboratories, and so increase the overall quality of this testing method. This endeavor will thus save each laboratory from having to generate SOPs on their own, which is a lengthy and laborious task. In this respect, we define ''generic'' SOPs as procedures that are easily adaptable to the individual laboratories' quality systems. Hum Mutat 25:583-592, 2005. r r 2005 Wiley-Liss, Inc.

Purpose  To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic. Methods  Based on a literature review and expert opinion, a Delphi process was used to define the essential topics. Results  Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals

The After Action Review (AAR) process provides a powerful methodology that in the context of training maximizes the benefits of exercises by enabling a unit to learn from experience by systematically reflecting on their strengths and weaknesses. We have developed a tool that supports the AAR process, essentially extending an Observer Controller's (O/C) reach automatically. This tool was developed with two training contexts in mind: live STX lane convoy training at the National Training Center (NTC) and simulated convoy training using DARWARS Ambush! at the Mission Support Training Facility at Fort Lewis. At NTC, live radio communication is captured during training, while with Ambush! communication using voice over IP (VOIP) is recorded. The tool automatically converts recorded speech to text and then analyzes the text, using advanced statistical machine learning technologies, to determine a unit's performance and identify critical incidents, leading indicators, and other training events that could be included in an AAR.

Since Etrurian age, the Viterbo Province (Central Italy) is famous for its ancient towns carved out of local ignimbrite deposits which geologically represent the sedimentation of pumice-rich, volcano-related pyroclastic flows. Almost the entire study area is geologically characterized by a thick succession of ignimbrites, tephra fallouts and lava flow deposits locally subjected to zeolitization. Among zeolites, fibrous erionite represents a well-known health hazard and so this work aims at locating and quantifying the presence of fibrous zeolites in volcanic deposits of the Viterbo area, suggesting at the same time a standard operational procedure useful in other areas showing the same possible hazard. 41 samples collected in the Viterbo area were analyzed by X-ray powder diffraction, optical and electron microscopy. Fibrous zeolites were detected in five samples and quantified in amounts ranging from 0.35 to 1.66% vol. They generally occur in tetragonal or orthorhombic prismatic habit and showed chemical composition mainly consistent with K-phillipsite. Fibrous zeolites occurred with aspect ratios (mean = 6.3), comparable or lower than those of erionite fibers reported in previous studies and mean diameters [3 lm.