Use of Radio Frequency Identification (RFID) Tags in Bedside Monitoring of Endotracheal Tube Position

Improper positioning of the endotracheal tube during intubation poses a serious health risk to patients. In one prospective study of 219 critically ill patients, 14% required endotracheal tube repositioning after intubation [Brunel et al. Chest 1989; 96: 1043–1045] While a variety of techniques are used to confirm proper tube placement, a chest X-ray is usually employed for definitive verification. Radio frequency identification (RFID) technology, in which an RFID reader emits and receives a signal from an RFID tag, may be useful in evaluating endotracheal tube position. RFID technology has already been approved for use in humans as a safe and effective tool in a variety of applications. The use of handheld RFID detectors and RFID tag-labeled endotracheal tubes could allow for easy and accurate bedside monitoring of endotracheal tube position, once initial proper placement is confirmed. Reicher D, Reicher J,Reicher M. Use of Radio Frequency Identification (RFID) tags in bedside monitoring of endotracheal tube position.     

A System for Implanting Laboratory Mice with Light-Activated Microtransponders

The mouse is the most commonly used laboratory animal, accounting for up to 80% of all mammals used in research studies. Because rodents generally are group-housed, an efficient system of uniquely identifying individual animals for use in research studies, breeding, and proper colony management is required. Several temporary and permanent methods (for example, ear punching and toe clipping) are available for labeling research mice and other small animals, each with advantages and disadvantages. This report describes a new radiofrequency identification tagging method that uses 500-µm, light-activated microtransponders implanted subcutaneously into the ear or tail of mice. The preferred location for implanting is in the side of the tail, because implantation at this site was simple to perform and was associated with shorter implantation times (average, 53 versus 325 s) and a higher success rate (98% versus 50%) compared with the ear. The main benefits of using light-activated microtransponders over other identification methods, including other radiofrequency identification tags, is their small size, which minimizes stress to the animals during implantation and low cost due to their one-piece (monolithic) design. In addition, the implantation procedure uses a custom-designed 21-gauge needle injector and does not require anesthetization of the mice. We conclude that this method allows improved identification and management of laboratory mice.Abbreviation: RFID, radiofrequency identification; ID, serial numberLaboratory mice play an important role in basic, biomedical, and mammalian research. Inbred and mutant mice are accepted universally as the primary model for analyzing and understanding inherited human disorders.¹⁷ Over 75 million laboratory mice are used worldwide annually, including 25 million in the United States. Much of this use is in biomedical research and pharmaceutical drug development; therefore mice play a key part in improving healthcare for people around the world. Mice are social animals, and group-housing, at recommended densities, generally is considered to reduce stress in rodents.^6,9,16 However, this housing method requires an efficient system of uniquely identifying individual animals. Despite this need, our ability to identify and keep track of laboratory mice is limited. The most widely used methods for permanently identifying rodents—ear punching, ear tagging, and toe clipping—are relatively primitive. The number of possible identification numbers is limited with ear and toe clipping, thereby complicating breeding programs. In addition, these methods are potentially stressful for animals and do not foster ‘cradle-to-grave’ tracking. Compared with clipping methods, ear tags offer a greater number of identification codes and are simple to apply; however, they can cause irritation and are often subject to self-removal.^2,19 Each of these methods may lead to errors associated with misreading by technicians, and, in some cases, lead to repetition of partial or full experiments, a situation that is both costly and labor-intensive.Recently, radiofrequency identification transponders (RFID tags), which are implanted subcutaneously, have been used to label mice, given that these tags address several of the problems associated with nonelectronic methods. An RFID tag typically consists of electronic circuitry and a solenoid antenna enclosed in a glass capsule. The transponders transmit unique alphanumeric codes that are easily distinguished from each other by a dedicated reading device. The typical size of an RFID transponder capsule is 13 × 2 mm, although somewhat smaller RFID tags (6 × 1 mm) are available also. RFID tags are manufactured and distributed by several vendors.^1,7,13 However, the current tags have not been cost-effective for routine identification of laboratory mice and, therefore, their use has primarily been limited to high-value animals used in specialized studies.The purpose of the present report is to describe the use of a new type of RFID tag for identifying laboratory mice. It is based on a very small microtransponder that transmits a numerical serial code when activated by laser light. Microtransponders have been used previously in cell-based¹² and multiplex DNA¹¹ assays and as a means of tracking ants in behavioral studies.¹⁵ The main benefits of these devices over other RFID transponders is their small size, which minimizes stress to the animals during implantation, and low cost, due to their monolithic design. The microtransponder surface is silicon dioxide, similar to capsule-type implantable tags, a feature that is important for biocompatibility. The RFID tag is part of a system with a dedicated reader, software, and specialized injection device for implanting mice. These components combine to provide a system that simplifies identification individual mouse and tracking and, if widely adopted, can lead to improvements in animal welfare.     

Disaster triage tags: Is one better than another?

Objective: To determine which of the disaster triage tag systems in use in Australia and New Zealand is better in terms of the time taken to complete the triage and the ease of use. Methods: A disaster scenario was created. Mock patients were provided with clinical information to allow them to be triaged in a disaster sieve. Six different triage tag systems available in Australia and New Zealand were trialled. Participants triaged 10 patients with each triage tag system. The 10 patients used were different for each of the tag systems and were standardized for acuity and triage category. The time to complete the triage of the 10 patients with each different tag system was measured. The participants then completed a questionnaire with regards to the ease of use of the different tags and were asked to nominate their most preferred tag. Results: The Victorian cruciate fold up tag was the quickest to complete, with an average of 6.6 min to triage 10 patients, compared with an average time for all systems of 7.8 min. New Zealand tags were found to be the easiest to use, easiest to fill in and were considered the most preferred tag. Conclusion: The Victorian style of tag was found to be the most efficient in terms of the time to complete a triage. The New Zealand tags were the easiest to use, easiest to fill in and the most preferred tag by the participants. We recommend that one of these tags be adapted for use as a nationwide system.     

Impact of 13.56-MHz radiofrequency identification systems on the quality of stored red blood cells

BACKGROUND: Radiofrequency identification (RFID) technology is emerging as one of the most pervasive computing technologies due to its broad applicability. Storage of red blood cells (RBCs) is a routine procedure worldwide. Depending on the additive solution, RBCs can be stored at 4 ± 2°C up to 49 days. To support the decision of discarding or further using a blood product, temperature measurement of each unit could be provided by RFID application. The safety evaluation of RFID devices was demonstrated in a regulatory agency required study. It has been concluded in limit tests that high frequency–based RFID technology performed safely for blood products; therefore, a longer exposure of radiofrequency (RF) energy on blood units was performed in this study to detect any biologic effects in RBC samples. STUDY DESIGN AND METHODS: Buffy coat–depleted, in line–filtered RBCs were used as standard products in all tests. Various variables like pH, potassium, glucose, lactate, hemoglobin (Hb), hematocrit, free Hb, and hemolysis rate were measured in a test group with RFID tags placed on their surface and continuously radiated with 13.56‐MHz RFID reader radiation for 42 days while stored at 4 ± 2°C and compared to a control group by two‐sample t test. RESULTS: In both groups glucose and pH levels decreased while lactate, free Hb, and potassium increased within the expected levels. The hemolysis rate showed increase after the 25th day but remained below the maximum acceptable threshold of 0.8%. CONCLUSION: It is feasible to implement RFID‐enabled processes, without detecting any known biologic effects of longer exposure of RF energy on the quality of RBCs.     

Teak plantation smallholders in Lao PDR: what influences compliance with plantation regulations?

ABSTRACT

Past policies to promote the planting of trees by smallholders have been effective in Lao PDR. In Luang Prabang Province over 15 000 ha of teak (Tectona grandis) have been established. New policies to stop illegal logging, promote timber legality of wood exports and encourage domestic wood processing aim to mobilise this teak resource as an alternative to timber from natural forests. Several factors are thought to inhibit smallholder participation in the timber value chain and this risks their exclusion from international markets. These factors include the hidden nature of their teak plantation resource, inability to comply with complex regulations and limited capacity to engage with markets. This paper explores the policy and regulatory environment for smallholder plantation teak to understand how instrumental and normative factors may influence compliance with plantation regulations and affect participation in new governance structures such as grower groups. The results emphasise the need for policies, regulations and governance to take into account the human factor if value chains that depend on smallholder plantations are to be effective.     

FISH landmarks for Aedes aegypti chromosomes

Aedes aegypti metaphase chromosome landmarks have been developed so that each chromosome of the haploid genome can be unambiguously identified and oriented by fluorescence In situ hybridization (FISH) and digital imaging microscopy. The FISH tags were derived from three cosmids that contain repetitive Ae. aegypti sequences and their unique FISH tagging characteristics are demonstrated. The sequence of the three chromosomal tags revealed that the chromosome 1 tag is an 18S fragment from the ribosomal cistron, and the other two chromosomal tags are repeats found in Ae, aegypti with no apparent similarity to known sequences. A single plasmid that contains the three chromosome tag sequences has been constructed to simplify future FISH physical mapping.     

Contribution of integrated forest-farm system on household food security in the mid-hills of Nepal: assessment with EnLiFT model

ABSTRACT

About half of the households in the mid-hills of Nepal are severely food insecure, and the development of agriculture and forestry sectors could hold keys to reduce food insecurity and achieve other sustainable development goals. This paper presents results from a bio-economic model, Enhancing Livelihood from Improved Forest Management in Nepal (EnLiFT), that estimates a Food Security Index (FSI) across six household types in rural Nepal simulating selected agroforestry livelihood interventions. The FSI is calculated as the ratio between household expenditure capacity and household poverty threshold based on the national per capita poverty threshold. Market-oriented timber production shows strong potential to increase food security across all household types with greater benefits accruing to land-rich households. For land-poor households, remittances from household members working abroad remains the strongest route to their food security despite the underutilisation of agricultural land due to adult male labour outmigration. A drawback of market-oriented timber production is the long-term nature of timber production. As EnLiFT assumes that timber can only be harvested from Year 9, complimentary livelihood strategies are required to address food insecurity in the short term. Complimentary agroforestry interventions with the strongest potential to improve food security include combined high-yielding fodder production and commercial goat production, and production of non-timber forest products. Commercial vegetable production does not improve food security because of the high input costs. Currently, farmers in Nepal cannot yet fully obtain the financial benefits of agroforestry due to the complex and unsupportive forestry regulations surrounding harvesting and marketing of planted trees. While land-poor households are seen to rely on foreign remittances for food security, it is argued that policies encouraging use of remittances to promote agroforestry businesses is needed.     

NOTES OF FACTORS INFLUENCING THE STRAIGHTNESS OF THE INTERNODES OF PINUS RADIATA

Two prerequisites for multiple-use management of Australian forests are an increased knowledge of the biology of the forest fauna and of the effects of various forestry practices on their populations. Road construction, stand improvement operations and selective logging, clear-felling for woodchips or establishment of indigenous or exotic plantations, and prescribed (control) burning all affect wildlife according to the degree that each species depends on the forest as habitat and the degree to which the forest is changed, particularly in plant species diversity and structure. Their general effect, however, is to initiate or reset a succession of different plant communities and associated wildlife populations in which the types and numbers of animals present depend upon the age and size of the forest and the diversity of vegetation (especially the type and density of understorey) present.

Because each species varies in its dependence on the forest as habitat it is clearly impossible to satisfy all their requirements by a single management plan. The setting aside of a representative series of large reserves and National Parks, establishment of individual or groups of species as the objectives of management programmes in some areas and modification of existing forestry practices, however, should allow both commercial timber production and conservation of wildlife in Australian forests.     

Enhancing the knowledge and skills of smallholders to adopt market-oriented tree management practices: lessons from Master TreeGrower training courses in Indonesia

ABSTRACT

Growing trees on farmland continues to be a promising land-use option for smallholders in Indonesia as they look to diversify their enterprises beyond the main agricultural sector. While most smallholders integrate trees into their farming systems, selling timber and other tree products has usually been infrequent and opportunistic. Because of this infrequent trade, most smallholders rarely adopt silvicultural practices that would increase the commercial value of their trees. A research project trialled an alternative approach to forestry extension in Indonesia, known as the Master TreeGrower (MTG) training course. The MTG training courses used a farmer-centred approach to teach smallholders about forest science and took participants to market hubs so they could better understand how different forest products were valued by traders. The MTG training approach was trialled in 2014 in five districts in Indonesia and involved 118 smallholders and 27 non-farmers as course participants. This article reports on a recent evaluation of the MTG training courses held about three years earlier to explore the enduring impacts of the training approach and whether it can be scaled-out to other areas of Indonesia. The evaluation data were collected via focus group discussions (FGDs), in-depth interviews, household surveys and observations at three project sites: Pati (Central Java), Gunungkidul (Yogyakarta) and Bulukumba (South Sulawesi). A questionnaire was distributed among the participants of the FGDs to assess the extent different knowledge and skills of tree management that had been adopted by them following the MTG courses. The evaluation of the MTG approach revealed that the courses were effective in increasing smallholders’ knowledge of commercial forestry and their silvicultural skills. Many participants were more active with silviculture and planned to invest further in commercial forestry following the MTG training. In effect, the MTG training appeared to change the hearts and minds of the farmers about how commercial forestry could enhance their livelihoods.     

Nylon ear tags for individual identification of guinea pigs.

Although customarily used for individual identification of guinea pigs, metal ear tags are suboptimal because frequent detachment often results in wounds with inflammation and secondary bacterial infections. Using 60 6-week-old individually housed male Dunkin-Hartley guinea pigs (Cavia porcellus), we conducted an 8-week study to determine the stability of a new nylon tag attached to the center of the pinna. The subsequent tissue reaction was compared with those due to metal tags attached either at the center or near the edge of the pinna. Physical changes in the tagged ear and tag loss were noted during the study period, at the end of which 10 animals per group were selected randomly for euthanasia and necropsy. The tagged ears were collected for histopathologic examination. Loss of the nylon ear tags (10%) over the 8-week study period was significantly less compared with that of metal tags at the center (45%, P < 0.05) or near the edge (100%, P < 0.01) of the pinna. Histopathologically, complete regeneration of epidermis was observed in pinnae tagged with nylon, whereas pinnae with metal tags showed occasional formation of new cartilaginous nodules with no evidence of epithelial regeneration or healing. The nylon ear tag is considered highly reliable and is recommended as a better alternative to the traditional metal ear tag for the identification of individually housed guinea pigs.     

High-throughput SNP genotyping with the Masscode system.

QIAGEN Genomics, Inc, has developed the Masscode tagging system for DNA labeling and detection. In this application, the Masscode system is described as applied to high-throughput single-nucleotide polymorphism (SNP) genotyping. The labeling system is based on a small-molecular-weight tag that is covalently attached through a photocleavable linker to a DNA oligonucleotide. The tagged oligonucleotide is used as a primer in an allele-specific PCR SNP discrimination assay. The allele-specific amplicons are differentiated through their Masscode tag assignments. After a photolysis step to cleave the tags from the amplicon, the samples are introduced into a single quadrupole mass spectrometry detection system for analysis. Genotyping determinations are based on the relative proportions of the paired allele tags. The system has a lower limit of detection in the femtomolar range (10(-15) M). At present, 30 different Masscode tags may be used simultaneously in a multiplex fashion to routinely provide more than 40,000 SNP genotyping measurements daily. Further developments will allow for the simultaneous detection of several hundred tags.     

Applications for Radio-frequency Identification Technology in the Perioperative Setting

We implemented a two-year project to develop a security-gated management system for the perioperative setting using radio-frequency identification (RFID) technology to enhance the management efficiency of the OR. We installed RFID readers beside the entrances to the OR and changing areas to receive and process signals from the RFID tags that we sewed into surgical scrub attire and shoes. The system also required integrating automatic access control panels, computerized lockers, light-emitting diode (LED) information screens, wireless networks, and an information system. By doing this, we are able to control the flow of personnel and materials more effectively, reduce OR costs, optimize the registration and attire-changing process for personnel, and improve management efficiency. We also anticipate this system will improve patient safety by reducing the risk of surgical site infection. Application of security-gated management systems is an important and effective way to help ensure a clean, convenient, and safe management process to manage costs in the perioperative area and promote patient safety.     

The future of molecular genetic testing

The potential applications for genetic testing are immense, with most diseases having some aspect influenced by, if not directly caused by, changes in the genome of the patient. The translation of genetic information into medical applications will be influenced by our understanding of the human genome, technological advances, and social, ethical, and legal issues surrounding genetic testing. With time, new genetic information will be translated into clinical tests for the diagnosis of current illness and prediction of future disease risk, and will be used for the development of genetically directed therapies and preventive interventions. Most genetic testing will be highly automated, with only rare genetic disease tests performed manually. The challenge for the clinical genetic laboratory is to keep pace with this information explosion to provide state-of-the-art genetic testing and to ensure that the genetic test results are used in a morally, ethically, and socially responsible way.     

Demystifying Analytical Approaches for Urine Drug Testing to Evaluate Medication Adherence in Chronic Pain Management

ABSTRACT

This comprehensive review of analytical methods used for urine drug testing for the support of pain management describes the methods, their strengths and limitations, and types of analyses used in clinical laboratories today. Specific applications to analysis of opioid levels are addressed. Qualitative versus quantitative testing, immunoassays, chromatographic methods, and spectrometry are discussed. The importance of proper urine sample collection and processing is addressed. Analytical explanations for unexpected results are described. This article describes the scientific basis for urine drug testing providing information which will allow clinicians to differentiate between valid and questionable claims for urine drug testing to monitor medication adherence among chronic pain patients.     

Oblique 3D MRI tags for the estimation of true 3D cardiac motion parameters

Aim of this study is to demonstrate the advantages of oblique 3D tags in cardiac magnetic resonance imaging (MRI) and the potential to accurately describe the complex motion of the myocardial wall. 3D cardiac Cine data were densely tagged with 3D oblique tags. The latter were tracked using Gabor analysis and active geometries. From the tag intersections, common 2D parameters such as long axis shortening, radial shortening and rotation were evaluated on a global as well as detailed local level. Finally, the same data were used to estimate left ventricular volume change and myocardial stress/strain. We have successfully tracked dense 3D tags and evaluated common parameters on a detailed local level. In addition, inherently 3D parameters could be estimated. Global motion data are in accordance with previously published data. Oblique tags allow for unambiguous localization of the tag plane in all MRI slices and in any time frame. In contrast to HARP, our tag tracking methodology allows for tracking of the tags even when they are dense. Motion parameters can be extracted in greater detail. Moreover, the intersections of dense oblique 3D tags provide a natural basis for a finite element model of the heart. Straight forward access to the 3D characteristics of the cardiac motion is provided.     

The Australian Farm Forestry Financial Model

The Australian Farm Forestry Financial Model (AFFFM) has been developed as a tool for the financial appraisal of farm forestry investments. It is a whole-farm financial model developed in modules using Visual Basic as the programming language, and provides estimates of key financial criteria including net present value, land expectation value and internal rate of return. It also provides details of the effects of forestry options on cash flows and the business cash position. Included in the AFFFM are data sets for plantation establishment and maintenance costs, growth rates and potential timber products of a number of tree species, for three regions. This paper outlines the scope of the AFFFM including its structure, assumptions, input parameters and key variables. The paper also reports the process by which the model was validated through replication of previous studies, the development of case studies and testing by undergraduate students.     

Model tags: direct three-dimensional tracking of heart wall motion from tagged magnetic resonance images

Although magnetic resonance tissue tagging is a useful tool for the non-invasive measurement of three-dimensional (3-D) heart wall motion, the clinical utility of current analysis techniques is limited by the prohibitively long time required for image analysis. A method was therefore developed for the reconstruction of 3-D heart wall motion directly from tagged magnetic resonance images, without prior identification of ventricular boundaries or tag stripe locations. The method utilized a finite-element model to describe the shape and motion of the heart. Initially, the model geometry was determined at the time of tag creation by fitting a small number of guide points which were placed interactively on the images. Model tags were then created within the model as material surfaces which defined the location of the magnetic tags. An objective function was derived to measure the degree of match between the model tags and the image stripes. The objective was minimized by allowing the model to deform directly under the influence of the images, utilizing an efficient method for calculating image-derived motion constraints. The model deformation could also be manipulated interactively by guide points. Experiments were performed using clinical images of a normal volunteer, as well as simulated images in which the true motion was specified. The root-mean-squared errors between the known and calculated displacement and strain for the simulated images were similar to those obtained using previous stripe-tracking and model-fitting methods. A significant improvement in analysis time was obtained for the normal volunteer and further improvements may allow the method to be applied in a 'real-time' clinical environment.     

Reflex and reflective testing strategies for early detection of pituitary dysfunction

ObjectiveThe clinical presentation of pituitary dysfunction is typically variable and may often be insidious, resulting in delayed diagnosis by up to decades. The complexity of presentation and difficulty in pattern recognition of first line hormone tests result in challenges in early diagnosis of this condition. The aim of this study was to determine the impact of reflective testing and interpretive commenting on the early detection and management of such cases from primary care.MethodsProspective audit over 12 months in which first line pituitary target organ hormones were identified via a reflex algorithm in the laboratory information system. Selected tests were reviewed by a laboratory clinician and decision made on reflective testing and interpretive commenting based on available clinical information and previous result trends. Patients who had a laboratory intervention were followed up to determine the clinical outcome.ResultsOut of 1099 patients identified, additional testing was made for 214. Interpretative comments were subsequently added to reports of 196 patients, 48 (25%) of whom were referred to endocrinology and 35 (73%) of these were directly related to the laboratory intervention. Eleven other patients had outcomes related to the intervention. Pituitary related conditions (insufficiency and/or adenoma) were found in 29 patients, 24 of which were identified as a result of laboratory intervention.ConclusionsThis study highlights the clinical value of laboratory intervention in aiding early detection of pituitary dysfunction and may avoid the disease burden of delayed management.