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Evaluation of automated large-scale screening tests for syphilis.

Two methods of performing serological screening tests for syphilis are compared. One consisted of the Venereal Diseases Reference Laboratory (VDRL) slide test, the cardiolipin Wassermann reaction (CWR), and the Reiter protein complement fixation test (RPCFT) performed manually; the other was a fully automated system using two Technicon AutoAnalyzers (AAII), one for the automated reagin test (ART) and the other for automated complement fixation tests. The absorbed fluorescent treponemal antibody test (FTA-ABS) was used as a final arbiter in all cases found to be seropositive by either method. A pooled antigen consisting of a mixture of cardiolipin and Reiter protein was used for the automated complement fixation test, thus increasing the scope and capacity of the system. The AutoAnalyzer was shown to be capable of performing 400 cardiolipin and Reiter complement fixation tests and 700 automated reagin tests in an 8-hour day. Modification of the complement fixation test method to take advantage of the highly sensitive colorimeter resulted in a significant increase in sensitivity and a corresponding saving in reagents. Of the 7843 sera tested, 258 gave a positive result in one or more of the screening tests. The automated test detected many more Reiter positive sera (127) than the manual test (83). Conversely, fewer CWR positive sera were detected by the automated test (60) than by the manual test (82). There was little difference between the number of positive sera detected by the ART (73) and the VDRL slide test (71). In 19 instances the automated tests detected positive sera which registered as completely negative in the manual tests, and four seropositive cases which the automated tests had failed to detect were detected by the manual tests, and four seropositive cases which the automated tests had failed to detect were detected by the manual tests. It was concluded that a combination of the ART and automated Reiter protein complement fixation test (ARPCFT) would be ideal for use in a large-scale screening programme for the detection of syphilis.

Autoanalysis

Laboratory automation systems. An introduction to concepts and terminology.

The concept of laboratory automation has existed for years; such automation has been used primarily in nonclinical and industrial settings. The next step is to implement automation systems in the clinical laboratory. A laboratory automation system consists of robots, conveyor systems, machine vision, and computer hardware and software. Specimen movement and result reporting are based on the identification of specimens using bar coded specimens and bar coded specimen carriers. The implementation of a laboratory automation system is dependent on the presence of a laboratory information system. An interface between the laboratory information system and the laboratory automation system provides the information required to move the specimen through the laboratory. The reporting of results is dependent on the laboratory information system or manual input, depending on the type of work cell in which the results are produced. The greatest hurdle to overcome in developing and implementing a laboratory automation system is the integration of systems, including commercial laboratory instrumentation and user-defined work cells. The barriers to implementation primarily are proprietary in nature: instrument software and instrument hardware. When the instrument manufacturers realize the necessity for development of electronic and physical integration, the proliferation of laboratory automation systems will occur. Several opportunities exist for the reduction in laboratory expenses and the development of new positions, such as "robotechnologist," a staff member who would function in a manner similar to the current laboratory information systems manager. This article describes the author's concepts of laboratory automation.

Automation

Effects of automated massage chair therapy on mental health and physical health: A comprehensive study.

BACKGROUND AND OBJECTIVE: Automated massage chair therapy is a non-pharmacological intervention widely believed to enhance wellness, yet evidence regarding its effects remains limited. This 3-part study evaluated the effects of automated massage chair therapy on mental and physical health. METHODS: In Part 1, 20 moderately stressed students were randomized to receive a 20-minute automated massage chair therapy session followed by a 20-minute control session, or vice versa, with a 48-hour washout period. Blood pressure (BP), heart rate (HR), electroencephalogram (EEG), State-Trait Anxiety Inventory (STAI), and Visual Analog Scale (VAS) were measured. In Part 2, 20 hypertensive hospital staff received three 20-minute automated massage chair therapy sessions on alternate days. BP, HR, and skin blood flow (SBF) were measured. In Part 3, 20 hospital staff with chronic low back pain received three 20-minute automated massage chair therapy sessions on alternate days. Electromyogram (EMG) and VAS were measured. RESULTS: Automated massage chair therapy significantly reduced diastolic blood pressure (DBP), HR, stress, and anxiety among moderately stressed students. In hospital staff with hypertension, SBF did not change significantly, whereas BP and HR decreased significantly after automated massage chair therapy. In hospital staff with chronic low back pain, low back function improved, and pain was significantly reduced after automated massage chair therapy. CONCLUSION: These findings indicate that automated massage chair therapy may help reduce stress, lower blood pressure, and alleviate low back pain.

Humans

Miles Technicon H.2 automated hematology analyzer.

Automated hematology analyzers are used in all large hospitals and most commercial laboratories, as well as in most smaller hospitals and laboratories, to perform complete blood counts (including white blood cell, red blood cell, and platelet counts; hemoglobin concentration; and RBC indices) and white blood cell differential counts. Our objectives in this study are to provide user guidance for selecting, purchasing, and using an automated hematology analyzer, as well as to present an overview of the technology used in an automated five-part differential unit. Specifications for additional automated units are available in ECRI's Clinical Laboratory Product Comparison System. We evaluated the Miles Technicon H.2 unit and rated it Acceptable. The information in this Single Product Evaluation is also useful for purchasing other models; our criteria will guide users in assessing components, and our findings and discussions on some aspects of automated hematology testing are common to many available systems. We caution readers not to base purchasing decisions on our rating of the Miles unit alone, but on a thorough understanding of the issues surrounding automated hematology analyzers, which can be gained only by reading this report in its entirety. The willingness of manufacturers to cooperate in our studies and the knowledge they gain through participating lead to the development of better products. Readers should refer to the Guidance Section, "Selecting and Purchasing an Automated Hematology Analyzer," where we discuss factors such as standardization, training, human factors, manufacturer support, patient population, and special features that the laboratory must consider before obtaining any automated unit; we also provide an in-depth review of cost issues, including life-cycle cost analyses, acquisition methods and costs of hardware and supplies, and we describe the Hemacost and Hemexmpt cost worksheets for use with our PresValu and PSV Manager CAHDModel software. Readers should also review the Clinical and Technical Overview and the articles "Miles Technicon H.2 Reports" and "Developing the Evaluation Reference Method."

Blood Cell Count

Alarms and alarm management with automated versus conventional ventilation in neurocritical care patients.

INTRODUCTION: False or clinically irrelevant alarms are a major driver of ICU alarm fatigue and nursing workload. Ventilator alarms make up a large share, and although automated ventilation modes can reduce manual adjustments, their effect on alarm burden is still unclear. This issue can be particularly relevant in neurocritical care patients, where precise ventilator and alarm management is imperative for patient safety. OBJECTIVES: This explorative post hoc analysis of a randomized clinical trial compared alarm frequency and management between automated ventilation and conventional ventilation in neurocritical care patients. METHODS: Ventilator alarms and manual ventilator changes were captured continuously from the ventilator for up to 24 h per patient. The primary endpoint was a composite of workload-relevant alarms; with alarm management interventions at the ventilator as a key secondary outcome. Additional endpoints included redundant alarms, alarm duration and ventilator management. RESULTS: 13 patients received automated ventilation and 24 received conventional ventilation. No difference was observed in workload-relevant alarm frequency between automated and conventional ventilation (3.28 [2.87 to 4.30] vs 3.73 [1.66 to 7.33] alarms per hour; P = 0.81), while alarm management interventions at the ventilator were lower with automated ventilation (0.14 [0.10 to 0.15] vs 0.21 [0.17 to 0.31] interventions per hour; P = 0.01). Other alarm frequencies, duration of alarms and ventilator management were similar. CONCLUSIONS: In this exploratory post hoc analysis of a randomized clinical trial in neurocritical care patients during the early phase of mechanical ventilation, automated ventilation did not reduce the frequency of total or workload-relevant alarms, nor their duration, but was associated with fewer alarm management interventions compared to conventional ventilation. IMPLICATIONS FOR CLINICAL PRACTICE: Automated ventilation may not reduce alarm frequency in neurocritical care patients, but the observed reduction in alarm-related bedside interventions suggests a potential benefit for nursing workload.

Humans

Laboratory systems integration: robotics and automation.

Robotic technology is going to have a profound impact on the clinical laboratory of the future. Faced with increased pressure to reduce health care spending yet increase services to patients, many laboratories are looking for alternatives to the inflexible or "fixed" automation found in many clinical analyzers. Robots are being examined by many clinical pathologists as an attractive technology which can adapt to the constant changes in laboratory testing. Already, laboratory designs are being altered to accommodate robotics and automated specimen processors. However, the use of robotics and computer intelligence in the clinical laboratory is still in its infancy. Successful examples of robotic automation exist in several laboratories. Investigators have used robots to automate endocrine testing, high performance liquid chromatography, and specimen transportation. Large commercial laboratories are investigating the use of specimen processors which combine the use of fixed automation and robotics. Robotics have also reduced the exposure of medical technologists to specimens infected with viral pathogens. The successful examples of clinical robotics applications were a result of the cooperation of clinical chemists, engineers, and medical technologists. At the University of Virginia we have designed and implemented a robotic critical care laboratory. Initial clinical experience suggests that robotic performance is reliable, however, staff acceptance and utilization requires continuing education. We are also developing a robotic cyclosporine which promises to greatly reduce the labor costs of this analysis. The future will bring lab wide automation that will fully integrate computer artificial intelligence and robotics. Specimens will be transported by mobile robots. Specimen processing, aliquotting, and scheduling will be automated.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence

Four radionuclide methods for left ventricular volume determination: comparison of a manual and an automated technique.

This study compared the accuracy and reproducibility of three previously described and one new radionuclide method of measuring left ventricular volumes in 19 subjects using contrast ventriculographic volumes (n = 38, mean volume = 126.6 ml) as the gold standard. The four methods were compared using both manual and automated ROIs. For manual ROIs, the Links (189.7 ml, r = 0.85), Starling (183.2 ml, r = 0.77) and the new count ratio method (141.4 ml, r = 0.90) overestimated contrast volumes, while the Massardo method (122.5 ml, r = 0.91) provided accurate volumes. For the automated ROIs, we performed an interpolative background subtraction and used a 50% threshold of the highest count pixel to define the ventricular regions. The automated Massardo method severely underestimated the contrast volume (59.5 ml, r = 0.90), while the other automated methods yielded accurate volumes: Links (122.4 ml, r = 0.89), Starling (118.1 ml, r = 0.81) and the new count ratio method (125.0 ml, r = 0.90). The interobserver reproducibility of the automated methods was excellent (mean difference = 1%-4%) compared to the manual methods (2%-8%). Because no additional images, blood counting, attenuation, or decay correction were necessary, the manual Massardo method and the automated count ratio method are the simplest to perform. We conclude that automated determination of left ventricular volumes using the new count ratio method is rapid, accurate, reproducible and could readily be incorporated into routine clinical use.

Algorithms

Multicenter trial of automated nitroprusside infusion for postoperative hypertension. Titrator Multicenter Study Group.

Hypertension is common after a cardiac operation and may result in postoperative hemorrhagic and other complications. Most often this problem has been treated using manually controlled doses of intravenous sodium nitroprusside. To evaluate the clinical impact of an automated closed-loop administration system on patients after cardiotomy, a prospective trial was conducted at nine clinical centers. Patients with hypertension were managed by either manual nitroprusside titration (n = 532) or a closed-loop automated titration system (n = 557). Patient groups were not significantly different in age, weight, or height. Moreover, the types of surgical procedures were comparable: primary coronary artery bypass grafting, 59.2% and 58.9%, manual group versus automated group; repeat coronary artery bypass grafting, 10.5% and 8.6%, respectively; valve procedures, 11.3% and 15.1%, respectively; and other cardiac procedures, 19.0% and 17.4%, respectively (all p = not significant). The automated group showed a significant reduction in the number of hypertensive episodes per patient (1.8 +/- 0.2 versus 0.6 +/- 0.07; p = 0.0001. At the same time, the number of hypotensive episodes per patient was reduced with automated closed-loop titration (0.40 +/- 0.05 versus 0.30 +/- 0.03; p = 0.02). Chest tube drainage (866 +/- 37 mL versus 693 +/- 23 mL [mean +/- standard error of the mean]; p = 0.0001), percentage of patients receiving transfusion (40.0% versus 33.0%; p = 0.02), and total amount transfused (2.4 +/- 0.12 units versus 2.0 +/- 0.10 units; p = 0.0003) were all reduced significantly by the use of an automated titration system.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion

Evaluation of an automated method of percent reactive antibody determination.

A fluorescence-based automated method of percent reactive antibody (PRA) analysis is described. This method utilizes the conventional antibody-mediated, C'-dependent lymphocyte microcytotoxicity assay to detect alloantibodies, but replaces the eosin-based method for detection of cell death with a fluorescence-based method. To identify viable cells, lymphocytes were pretreated with carboxy fluorescein diacetate (CFDA), which fluoresces green, to identify viable cells. To identify dead cells after the reaction with antibody and C', they were treated with propidium iodide (PI), which fluoresces red. Pretreatment of lymphocytes with CFDA did not affect their ability or interact with alloantibodies in the microcytotoxicity assays. When visually analyzed, detection of cell death by fluorescence was as sensitive as detection by eosin exclusion. However electronic detection of fluorescence was slightly more sensitive than visual detection. Automation of the fluorescent method required a calculation that converts electronic data to an ASHI score for cell death. One such method is described and evaluated. Both the automated and the conventional methods of analysis were used to obtain PRA values for various sera. There was good correlation between the PRA values obtained with the automated method versus the conventional method. Further, there was good correlation for PRA-derived alloantibody specificities obtained with the automated method versus the conventional method. These data demonstrate that automated fluorescence-based PRA analysis is an effective and practical alternative to conventional PRA analysis.

Antibodies

Influence of operator- and patient-dependent variables on the suitability of automated quantitative coronary arteriography for routine clinical use.

This study was designed to elucidate the operator- and patient-dependent variables inherent in clinical application of quantitative coronary arteriography. Digital arteriograms from 25 consecutive patients undergoing diagnostic catheterization were analyzed by four experienced angiographers utilizing an automated coronary edge detection system to measure percent area stenosis. The identification of potentially significant lesions for quantitation constituted a major source of variability, with unanimous agreement on the presence of a greater than or equal to 50% stenosis occurring at 38 (29%) of the 130 reported sites. Selection of an optimal frame for quantitative analysis resulted in disagreement for every lesion reported. Frame selection by the operator, as opposed to measurement of preselected frames, increased the interobserver variability from 5% to 7% for automated geometric analysis (p less than 0.01), and from 8% to 10.5% for automated densitometric analysis (p less than 0.01). Fully automatic arterial border detection was possible for only 20 (52.5%) of the 38 unanimously identified stenoses. The 18 failures involved one or more of the following factors: 1) stenosis at a bifurcation (13 [72%]); 2) diffuse, severe disease (8 [44%]); 3) excessive vessel tortuosity or overlap or both (4 [22%]); and 4) poor image quality (5 [28%]). In contrast, the same automated border detection algorithm successfully traced all 15 preselected frames of discrete stenoses referred for coronary angioplasty. Automated quantitative coronary arteriography performs well when carefully selected, discrete stenoses are presented to the computer for analysis. However, quantitative analysis of routine clinical coronary arteriograms is limited by operator-dependent variability in stenosis identification and frame selection, as well as by complex coronary anatomy and suboptimal image quality. These limitations make automated quantitative coronary arteriography impractical for routine clinical use.

Adult

Evaluation of the difference between automated and measured QTc intervals in children.

BACKGROUND: The corrected QT interval (QTc) is obtained through automated ECG computations or manual physician measurements. We hypothesized that differences exist in children between the measured and automated QTc intervals within and between Healthy and hypertrophic cardiomyopathy (HCM) subjects with greater differences for HCM due to structural abnormalities. METHODS: QT measurements - Bazett correction- automated (aQTc) and measured (mQTc), were extracted from the GE MUSE database for 385 Healthy pediatric (single ECG) and 208 HCM subjects (2 ECGs), stratified by age&#xa0;<&#xa0;12 and&#xa0;&#x2265;&#xa0;12&#xa0;yrs., sex, race, and ethnicity. QTc means (SD), automated and measured differences, and the difference of the differences of aQTc and mQTc were analyzed overall and by subgroups. All ECGs were read by one pediatric cardiologist with a second cardiologist reading a random subset of HCM ECGs to evaluate intraclass correlations and agreement. RESULTS: The mQTc intervals were shorter than aQTc intervals within Healthy (p&#xa0;<&#xa0;0.001) and within first HCM ECGs (p&#xa0;<&#xa0;0.001) with both aQTc and mQTc shorter in Healthy than HCM (p&#xa0;<&#xa0;0.001). The difference in these differences was significant overall using HCM ECG 1 but not HCM ECG 2. Healthy subject aQTc and mQTc intervals differed by age, sex, and race (p&#xa0;<&#xa0;0.002). HCM ECG 1 aQTc- mQTc intervals differed for age&#xa0;<&#xa0;12&#xa0;yrs., as well as by sex and race. HCM ECG 2 intervals differed only for age&#xa0;<&#xa0;12&#xa0;yrs. CONCLUSIONS: Compared to measured values, automated QTc values were significantly longer in both Healthy and HCM subjects. Automated measurements may overestimate the QTc.

Humans

Asteroid hyalosis and axial length measurement using automated biometry.

Accurate axial length measurements are needed before intraocular lens implantation in patients with asteroid hyalosis requiring cataract extraction. We suspected that falsely short axial length measurements may be obtained using automated A-scan biometry when we found an automated measurement of 15.90 mm in a patient with severe unilateral asteroid hyalosis. A manual biometry measurement of 21.90 mm was obtained for comparison; this was within 0.2 mm of the manual reading in the opposite uninvolved eye. A case-control study was performed on 20 unilateral asteroid hyalosis subjects using the uninvolved eye as the control, comparing automated biometry and manual A-scan biometry to assess the effect of asteroid hyalosis on automated biometry measurements. Five subjects (25%) with asteroid hyalosis had falsely short axial length measurements of more than 1.00 mm using automated biometry. This would result in more than 2.50 diopters of error in the implanted lens power. This case-control study demonstrates that falsely short axial length measurements may be obtained using automated biometry in patients with asteroid hyalosis, leading to significant error in intraocular lens power calculations.

Aged

Clinical comparison of automated and manual keratometry in pre-operative ocular biometry.

Corneal measurements, using the manual (Topcon OM-4) and automated (Canon RK-1) keratometers was performed on 104 eyes of 104 patients undergoing cataract and implant surgery to assess the role of automated keratometry in pre-operative ocular biometry. Four eyes of four patients were excluded from statistical analyses for various reasons. The time taken to perform automated keratometry was a mean of 61 (SD 21) seconds compared to 205 (SD 37) seconds for manual keratometry; the difference was statistically significant (p < 0.001). In terms of the various keratometry values compared, mean K (corneal refractive power), flattest K, steepest K, astigmatism and the axis of astigmatism, 65% to 75% of the cases on automated keratometry were within 0.26 dioptres or 11 degrees of manually determined values; the difference was statistically significant (p < 0.001). Although automated keratometry was significantly quicker than manual keratometry, we continue to use manual keratometry values for intraocular lens power calculations as the accuracy demonstrated by automated keratometry was considered inadequate for this purpose.

Aged

MetaChrome: An Open-Source, User-Friendly Tool for Automated Metaphase Chromosome Analysis.

DNA Fluorescence In Situ Hybridization (FISH) is an essential technique to study chromosome biology and genetics, enabling precise visualization of specific genomic loci to study structural abnormalities, gene mapping, and chromosomal rearrangements. High-Throughput Imaging (HTI) can automate the analysis of DNA-FISH chromosome images, but the accurate and automated segmentation of mitotic chromosomes and simultaneous colocalization of FISH signals remains a challenge. While several commercial automated karyotyping tools partially solve these issues, open-source software that effectively combines robust chromosome segmentation with comprehensive colocalization analysis capabilities remains necessary. To address this unmet need, we developed MetaChrome, an open-source software platform built around a graphical user interface and explicitly designed for automated metaphase chromosome analysis. MetaChrome leverages fine-tuned deep learning models to automate metaphase chromosome segmentation, together with colocalization analysis of chromosome-specific FISH probes and immunofluorescent-labeled proteins. Importantly, MetaChrome achieves enhanced segmentation accuracy compared to traditional image processing methods by adopting a Cellpose segmentation model fine-tuned with manually annotated metaphase chromosome datasets. The fine-tuned model ensures precise assignment of DNA-FISH spots to individual chromosomes in an automated manner. This facilitates rapid identification of chromosomal abnormalities, reduces human error, and advances high-throughput chromosome analysis workflows, addressing a key bottleneck in chromosome biology research.

Chromosome segmentation

Use of an automated image analyser to quantitate cellular hyperplasia in urinary bladder epithelium.

The feasibility of using an automated image analyser to evaluate quantitatively hyperplasia caused by N-butyl-N-(4-hydroxybutyl) nitrosamine in bladder epithelium was studied. The number of cells per unit length of epithelium was counted manually, and compared with automated measurements of: (1) the number of nuclei, (2) the number of positive tangents to the lower edge of nuclei, (3) the nuclear cross-sectional area, and (4) the epithelial cross-sectional area per unit length respectively. Regression of each of the automated measurements on the manual counts all revealed close linear relationships with correlation coefficients in excess of 0-9. Coefficients of variation for repetitive automated measurements were less than or equal to 0-06 in each of the four modes. The automated system resulted in a great saving in time over manual counting. It is concluded that the automated image analyser provides an accurate, precise, and efficient tool for estimating epithelial cell numbers in normal and hyperplastic bladder epithelia.

Animals

Automation of the Kaolin Clotting Time.

An automated Kaolin Clotting Time (KCT) has been developed to simplify screening for the Lupus Anticoagulant (LA). The assay is performed on the ACL300 Research coagulation analyser, but may be modified for other centrifugal analysers. Automation of the KCT allows up to 17 delta KCT (delta KCT) screens (Gibson J, Starling E, Date L et al. Simplified screening procedure for detecting lupus inhibitor. J Clin Pathol 1988; 44: 226-31) or 2 full Exner curves (Exner T, Rickard KA, Kronenberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol 1978; 40: 143-51) to be performed in one test cycle. An automated and manual delta KCT screen was performed on 17 patients with a previously diagnosed LA, 41 hospital patients having routine coagulation studies and 37 blood donors. In addition, 11 patients on full-dose heparin and 12 patients with stable warfarin anticoagulation were tested. The correlation between the automated delta KCT and the manual delta KCT was 0.958 (p less than 0.001). A full Exner curve was performed on 5 of the patients with a LA and 1 blood donor which demonstrated that the automated KCT produced results entirely comparable with the manual method. The automated KCT is a quick, inexpensive approach to screening patients for the presence of LA.

Blood Coagulation Tests

A fully automated method for mononuclear bone marrow cell concentration.

We describe our experience in processing 40 bone marrow aspirates harvested for autotransplantation from patients with several hematological diseases using the CS-3000 blood cell separator. The bone marrow of the first 30 patients was processed by a semiautomated method, and a fully automated procedure was used for the remaining 10 cases. Both procedures were developed in our laboratory and yielded a similar average mononuclear cell recovery of 87.78% and 86.98%, respectively, and similar nucleated cell recovery (27.39% and 27.11%). The cloning efficiency of hematopoietic progenitor cells, measured as the total CFU-GM colony recovery in the in vitro cultures, did not differ between processed and recovered mononuclear cells. On the other hand, all the patients with transplants showed complete hematologic recovery, and the time to engraftment was similar to that described for other procedures. The automated procedure resulted in an average red cell removal of 97.81%, similar to the semiautomated procedure (94.19%), though with a narrower range (96.31-98.6% vs. 80.34-98.34%). The time taken to process a similar amount of bone marrow cell suspension was very different for each method: 1 hour for the fully automated vs. 2 1/2 hours for the semiautomated method to process 1,000 ml. Furthermore, the semiautomated procedure required the addition of homologous or irradiated plasma in a laminar air flow chamber, while the automated method is performed in a closed sterile system. We conclude that our procedure using the CS-3000 processor is an efficient method for fully automated large-scale processing of human bone marrow cells.

Adolescent

Automation in clinical microbiology.

Automation was introduced into the clinical microbiology laboratory in the 1960s but initially met with limited success. Today, instruments are an integral part of many clinical laboratories and are used for microbial detection, identification, and susceptibility testing; detection of positive blood cultures; screening urine samples for potential pathogens; and assaying levels of antimicrobial agents in body fluids. Automation has allowed more rapid diagnosis and elimination of the subjective interpretation of many manual tests. In addition, in some cases, automated tests are more sensitive and specific than manual techniques. However, automated testing often is more expensive than manual testing and is associated with the possibility of mechanical failure. Automation will continue to be an important part of the clinical microbiology laboratory and in the future will include more molecular biology technologies, such as the polymerase chain reaction. Perhaps practical applications of flow cytometry will be identified.

Automation