Laboratory Diagnosis of Bacterial Gastroenteritis
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Book Details Author : Xaiver R. Description Most clinical laboratory assistants, complete a post-secondary training of one to two years, obtaining a certificate or associate degree. Others complete on-the-job training instead of formal education. Certification remains voluntary as of , but may result in a higher salary, according to the U.
Bureau of Labor Statistics. Clinical laboratory certification offers potential employers a means of identifying highly trained, committed and professional assistants.
Abstracts of 14th FELASA congress ,
It can also differentiate between experienced assistants and entry-level ones with little or no work background in the field, this guide was created to facilitate this transition. The larger the black hole, the brighter it will be as it accretes material. Because the brighter ones are easier to find, that means that most of the known accreting black holes are quite massive. This allows us to measure the mass of black holes directly, not the brightness of material that falls into them. Because it is a more direct measurement, it allows us to have a better idea of what the average mass of a black hole is.
Notice of Non Discrimination. Skip to main content. By charting galaxies, the map will also document areas holding large amounts of dark matter. Researcher Helps Find Smallest Known Black Hole A star survey conducted by another Pitt astronomer has led to the discovery of the smallest known black hole in the universe. Recently several authors have demonstrated that harmonization  of laboratory activities is a critical step in developing health systems.
Specifically, it allows more accurate understanding and planning of facility needs, which in turn would avoid, for example, the expiry of medicines and consumables and the consequent wastage of resources. CUAMM needed a ground plan to manage the health laboratories they would help, by structuring their activities, procedures and resources and prioritizing investments. To fulfil this requirement, a new, up-to-date, harmonized model for African health laboratories has been developed.
To address the major health problems, this work proposes lists of procedures for each level of the pyramidal network of health laboratories. An evaluation was made to select and suggests the most appropriate equipment. The suitability of appliances was assessed in accordance with recognized international recommendations, reported experiences in the field, and the availability of innovative solutions that can be implemented on site in rural areas, while requiring minimal sample preparation and little technical expertise.
The effectiveness of the developed standard was tested by evaluating the performance of four different healthcare facilities managed by CUAMM and by submitting it to clinicians with experience in the field. Comparison between actual and theoretical conditions allowed gaps to be identified in the service offered and to programme future interventions, taking into account the major health problems of local communities. The reported analysis began with the assessment of previous attempts at harmonization of laboratory medicine [8, 11—14].
The WHO archive was the major source of data and one of its documents represents the cornerstone of the proposed standard .
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- Abstracts of 14th FELASA congress , .
It was established that each new publication about laboratory medicine must consider all the most recent discoveries in the field and each innovative procedure or technology. More recent publications on health laboratory services have also been taken into account: the most relevant concerns the work of the Maputo Conference 22—24 July , where international attention focused on the diagnostic tests required at each level of the tiered health laboratory network.
Attention was specifically directed at four case studies, which were compared with the developed standard to assess performance. Finally, a market survey was conducted to include the most recent scientific and technological innovations that allow CUAMM to perform all envisaged laboratory procedures, avoiding wastage of resources and taking advantage of available, but relatively unqualified staff.
A review of previous works on laboratory harmonization showed that the health laboratory system could only be strengthened through harmonization of laboratory activities and equipment [3, 10]. In the present model, laboratory procedures have been proposed for four theoretical levels of the tiered health laboratory network, in accordance with the Maputo Meeting Report . The lowest level is defined as the primary laboratory level and consists of all laboratory units serving health centres and rural hospitals. This level also includes mobile units and microscopy centers. Above the first level are the district laboratories connected to hospitals of the same name.
The third level of the network is represented by provincial or regional facilities while the national laboratories stand at the top of the network. The present work did not establish or propose a standard model for the uppermost level of the network because facilities at this level are strictly governed at the national level, with their own national programmes, guidelines and ad hoc standards — or are connected with academic institutions interested in specific research fields.
The first step was to propose a list of health problems that each of the above-reported levels must be able to treat. It is also deemed necessary for primary facilities to implement diagnostic techniques for clinical chemistry and hematology. According to the present standard, district laboratories should treat the same pathological and physiological conditions managed at the primary level in addition to handling hepatitis B and C and inpatient monitoring.
Provincial laboratories have to manage all the previous states in the same way as Western facilities. A brief summary of the activities envisaged for primary and district health laboratories in Africa is reported in Table 1. It has been suggested to implement rapid diagnostic tests RDTs because they are generally less expensive than traditional methods, and are readily usable and understandable, even by less qualified personnel.
This equipment is also recommended in part because of its price: following WHO negotiation, laboratories in endemic countries can procure it at a fair rate . Table 1 clarifies a few points. Analysis of thin film samples for malaria diagnosis in primary laboratories can only be performed if adequate safety devices are available for workers. The same applies to samples of cerebrospinal fluid CSF , which can only be tested if a lumbar puncture is performed and personnel able to perform one are available.
The present model takes into account that some facilities are seriously underdeveloped. Accordingly, dry clinical chemistry techniques can also be considered acceptable in district laboratories, although wet chemistry remains the best solution Figure 3. Concerning standardized technologies and equipment, the present model suggests that primary laboratories must have at least a scale for weighing products and reagents; a hot plate or equivalent; a mixer; a Bunsen burner; a pH meter; a bench centrifuge; a microscope; a colorimeter; a hemoglobinometer; a glucometer or dry chemistry analyser; a laboratory refrigerator; a water purification system; and a ventilated workstation.
The latest technology was introduced to protect health workers from the use of dangerous substances, such as ethanol or HCl, and particularly during the Ziehl-Neelsen procedure, which requires adequate aeration. A feasible option is the model developed by the Global Laboratory Initiative  which provides instructions on how to produce a cheap, effective ventilated workstation with the option of mounting a HEPA high efficiency particulate air filter.
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The SolarChill battery-free unit represents an interesting alternative to traditional refrigerators . Only devices for vaccines have been developed to date, but they can also be appropriately used for the present standard, while waiting for a specific one. Relevant initiatives have also been taken for traditional instruments as the microscope. District laboratories must have the same equipment as primary ones; in addition they should have cell counters; CD4 counters, in accordance with Westerman et al.
Lastly, provincial laboratories should also have a CO 2 incubator and biosafety cabinet for cell cultures. The facilities at Aber, Lui, Pujehun and Yirol are all district laboratories. First, panels of laboratory activities were compared with the standard; the results are shown in Table 2.
Comparing the standardized model with actual performance in selected case studies permitted gaps to be identified in the expected health service. In particular it was observed that it is frequently difficult to perform thin film analysis for malaria diagnosis. This prevents the Plasmodium causing the disease from being clearly identified, so treatments are often not focused. Another relevant question concerns clinical chemistry, which is fundamental in addressing the expected increase in noncommunicable diseases in the African region over the coming years.
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Number of case studies complying with requirements of standard for district laboratory activities. Comparison of the inventory of theoretically and actually available technology has highlighted several shortages, strictly connected to the items missing from the panel of procedures.
Using the standardized model as a guideline has also highlighted the scarcity of data about basic laboratory instrumentation, as mixers, thermostatic baths, weighing scales and other similar devices. This should prompt recommendation of a more accurate collection of information on these technologies in order to establish a solid investment plan. If the lack of basic instrumentation is confirmed, priority must be given to rectifying the situation before procuring any other equipment, as EIA analyzers.
Number of case studies complying with requirements of standard for district laboratory equipment. It is worth highlighting that even where a technology is present, it is often not well-maintained or functional. For instance, there is a CD4 counter at the Lui laboratory but workers cannot adopt it because it is located in a crumbling, dark room, making it useless.
A similar situation exists at Pujehun laboratory, where microscopists must use an obsolete microscope-with damaged lenses — because there is not sufficient power to support the newly purchased one. Clearly, in this latter case an adequate, correctly sized, reliable power system — possibly based on solar energy, will have to be provided.
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