PO BOX 2549 • FAIRFAX, VIRGINIA 22031-0549Winter 2012 • Volume 15 Number 1

In ThIs Issue...

Con’t on pg 5

United Nations Security Council Resolution 1540 –

A Primer For Armed Forces Medical Laboratory Scientists

MAJ Dana Perkins (USAR, MS) and LTC Selwyn Jamison (USA, Ret.)

The United Nations Security Council Resolution (UNSCR) 15401 was unanimously adopted on 28 April 2004 by the UN Security Council to address the risk that terrorists and illicit networks would acquire Weapons of Mass Destruction (WMD). UNSCR 1540 established for the first time legally binding obligations on all UN Member States (regardless of their membership status in a treaty or convention) to develop and to enforce effective measures against the proliferation of nuclear, chemical, and biological WMDs, their means of delivery, and related materials. The main obligations under UNSCR 1540 are contained in operative paragraphs (OP) 1 to 3. OP1 prohibits States to provide “any form of support to non-State actors that attempt to develop, acquire, manufacture, possess, transport, transfer or use nuclear, chemical or biological weapons and their means of delivery” OP2 requires States to adopt and enforce appropriate and effective laws to prohibit such activities under their national legislation in order to prevent any non-state actor from engaging in these acts autonomously (i.e. without State support). OP3 prescribes that UN members implement and enforce a comprehensive system of domestic controls on WMD and related materials. All States are also called upon to include in their national reports, as appropriate, information relating to the implementation of OP 6, 7, 8, 9 and 10 of UNSCR 1540. For biological weapons (BW) and related materials the following areas were identified where domestic controls should be implemented and enforced:

Measures to account for/secure production, use, storage, and transport•Regulations for physical protection of facilities/materials/transports•Licensing/registration of facilities/persons handling biological •materialsReliability check of personnel•Measures to account for/secure/physically protect means of delivery•

1Resolution 1540 (2004) Adopted by the Security Council at its 4956th meeting, on 28 April 2004; online at: http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N04/328/43/PDF/N0432843.pdf?OpenElement

1 United Nations Security Council Resolution 1540 — A Primer For Armed Forces Medical Laboratory Scientists

2 Editor’s Page

3 President’s Message

4 Consultant’s Corner

8 Deployment of the 47th Combat Support Hospital to Sather AFB, Baghdad, Iraq

10 Professional Advancement: Three Overlooked Options for Medical Laboratory Professionals

11 2012 SAFMLS Annual Meeting Master Schedule

12 2012 SAFMLS Workshops

31 2012 SAFMLS Clinical Posters

35 2012 SAFMLS Research Posters

41 Guess the Unknown

45 Calendar

Society of Armed ForcesMedical Laboratory Scientists

Board of DirectorsPresident: Maj Marybeth Luna, USAFVice-President: LTC Eric Lee, USATreasurer: Maj Denise Lennon USAFSecretary: LCDR Stacie Milavec, USNPresident Elect: LCDR Aaron Harding, USNVice President-Elect: Maj Katie Shaw, USAFPast President: COL Helen Viscount, USA

Members-at-Large:CPT Vanessa Melanson, USACPT Jennifer Evans, USALCDR Corey Jenkins, USNLCDR Arlene Lopez, USNLtCol Imelda Catalasan, USAFMaj Shane Hendricks, USAFSGM Jesus Perez, USA

Ex-Officio Members:COL Dan Deuter, USACOL Donald Taillon, USACAPT Cindy Wilkerson, USNCDR Patrick Lawson, USN Col Bailey Mapp, USAFCol Joseph Pelletier, USAF

Chairman, Exhibits/Site SelectionMaj Jeannette Watterson, USAF

Historian: COL Kevin McNabb, USA

PACE Coordinators: Lt Col Richard Schoske, USAFLTC Eric Lee, USA

Web Master: CAPT Michael Finch, USN

Newsletter StaffEditor: LTC Paul Mann, USAscope@safmls.orgOffice 210-808-3178

SOCIETY SCOPE is published three times per year by the Society of Armed Forces Medical Laboratory Scientists (SAFMLS). Send SCOPE correspondence to scope@safmls.org. Address changes and annual dues ($20) for SAFMLS membership can be paid via http://www.safmls.org/secretarys_page.html

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Greetings from the Office of the Society Scope! It’s almost time for the annual SAFMLS meeting and I’d like to take this opportunity to discuss what the SAFMLS organization contributes to our profession. Our current President Maj Mary Beth Luna set this year’s theme as Lead, Collaborate, and Educate. This is an excellent theme that truly represents what the mission of our organization is about. Let’s look closely at the elements in this triad and discuss how each relates to our profession. Leadership is a cornerstone of the military profession. As laboratory science officers, we are expected to not only be highly competent in our specialty areas, but we are also expected to provide the supervision required to operate clinical laboratories in austere or unique environments or direct laboratory research on topics of relevance to military medicine. SAFMLS members are the leaders who provide DOD with the supervision that military labs need to meet the unique missions assigned. Many of our Society’s leaders are also key players in their service’s laboratory science career fields. I doubt that this correlation is a coincidence. SAFMLS provides leadership opportunities that develop skills that translate to success in our military missions. Collaboration is defined by Webster as “to work jointly with others or together especially in an intellectual endeavor “. This is a perfect definition for what we do in this organization. SAFMLS is truly a joint effort between the laboratory science professionals of the U.S. Army, Navy and Air Force. We are a much stronger and professional organization as a result of our collaborative efforts. The relationships we develop as a result of this Society continue to serve us well at multiple levels; from the Directors at CCLM, to regional laboratory sharing opportunities, to deployed laboratory support of Joint operations. The collaborative efforts of SAFMLS have improved laboratory services across the military and will continue to result in improved laboratory services for our DOD customers in the years ahead. And lastly, we have Educate. Education is a lifelong process. In order to maintain relevancy, we must all seek new educational opportunities. The rewards of education are both tangible and intangible. Our annual meeting is designed primarily to provide educational opportunities for our officers. We have a great continuing education program that provides CEU credits from P.A.C.E. This helps our members meet the continuing education requirements for their certification maintenance. More importantly our conference allows us to share the successes and challenges that we encounter in our daily professional lives. We get the opportunity to learn from each other. We also get the opportunity to teach, or educate. I ask that each of you consider taking the opportunity to educate our membership. There are many ways to do this: workshops & short topics at the conference, posters that highlight clinical or research projects, and articles submitted to the Scope. Please take the time to read the interesting articles in this edition that were submitted by other SAFMLS members and be sure to check out the educational opportunities available at this year’s conference in the form of workshops and posters. I will see you all soon in Memphis. This is a new venue for our annual meeting. LTC Eric Lee, this year’s vice president and planning committee chairman has coordinated a great set of events. While you are enjoying the conference please take time to thank him and the committee members for their efforts. LTC Lee is on the ballot for President Elect this year, please support his efforts to continue providing the excellent leadership that this Society deserves.

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President’s MessageMaj MaryBeth Luna

Visit Our WEBSITEat

www.safmls.org

Greetings and welcome to the summer edition of the SAFMLS Scope! This year’s Vice President, LTC Eric Lee, and the SAFMLS Planning Committee have set the course for the meeting’s theme, “Lead, Collaborate, and Educate”. Your committee members have crossed service lines and juggled their everyday responsibilities to ensure that SAFMLS’ annual meeting will be a success. With the talented leadership of LTC Lee at the helm, committee members have made great strides ensuring that event planning and execution are conducted in an efficient manner. I’d like to give special thanks to CAPT Mike Finch, Lt Col Richard Schoske, LTC Eric Lee, LCDR Aaron Harding, Maj Donna Fox, and Maj Jeannette Watterson in their efforts to modernize the SAFMLS registration process and PACE program. It has taken a herculean effort to transform these programs from the old, manual process to the digital programs that we now enjoy. From the strategic level, the timing of our meeting coincides with the latest move towards a unified health organization. A recent Pentagon task force has suggested the establishment of a broad, single health agency for the armed forces. While there is still much debate surrounding this announcement, there are several points we can extrapolate from this development. One, it’s inevitable that we will work closer in ways that we haven’t yet fathomed. Secondly, this is an opportunity for lab professionals to pave the way in an uncharted territory marked with political and budgetary challenges. Lastly, we can use this chance to refine something that SAFMLS has done so well since its inception in 1971: influence change through successful collaboration and education. In just a few short weeks, the finest military, Public Health, and Veterans Administration professionals will convene at the Memphis Cook Convention Center for our Society’s annual meeting. We welcome renowned speaker, Dr. Brad Nieder, known for injecting (sorry, I couldn’t resist) a healthy dose of humor into a variety of healthcare topics. Dr. Nieder’s unique blend of medical knowledge and side-splitting humor will surely set our meeting on a positive note. Soon, you will be able to register via www.safmls.org. Check this site often for latest updates to our meeting and other pertinent information regarding the Society. Travel safely and we’ll see you in Memphis, Tennessee!

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Consultant’s CornerCAPT Cindy Wilkerson

Greetings from the Center for Clinical Laboratory Medicine (CCLM)! In case you haven’t heard, there are big changes here at CCLM. We are currently in temporary space in the TMA building at Skyline in Falls Church, VA. We will be moving to the new Defense Health Headquarters building in mid-April. Some of you may not know the history of this office or what we do here at CCLM. I’d like to take this opportunity to explain it all to you. CCLM was originally called the Clinical Laboratory Improvement Program (CLIP) office (CLIPO). It was established in Jan 1993 in response to the Congressional approval of the Clinical Laboratory Improvement Amendments (CLIA) of 1988. The Department of Defense (DoD) and the Department of Health and Human Services (DHHS) have an agreement with Center for Medicare/Medicaid Services (CMS) to enforce civilian equivalent standards within the DoD/DHHS via the CLIP. CCLM’s main function, according to DoD Instruction 6440.2, is to enact the DoD CLIP policy and CLIA comparable regulations within their respective Service’s Active and Reserve Components to include oversight, inspections, proficiency testing, personnel standards, and training in clinical laboratories. One of the main things that we do here is identify, register, and certify all appropriate clinical laboratory testing sites within the DoD. We issue CLIP certificates for any laboratory within the three services that performs clinical diagnostic testing. Hospital and clinic based laboratories are our main customers but also labs outside of those areas that you may not realize (think Army WTUs and Navy EMPUs). If a lab reports out a result on a patient and someone uses a lab result to provide patient care, they must have a CLIP certificate. We also administer the College of American Pathologist (CAP) contracts from CCLM. We pay for all of your proficiency testing and your bi-annual inspections. We monitor your proficiency testing results and issue warning letters when necessary. CCLM was originally created as a department under the Armed Forces Institute of Pathology (AFIP). The 2005 Base Realignment and Closure (BRAC) commission directed that AFIP be closed by Sept 2011. The functions of CCLM had to continue and were moved to the Office of the Chief Medical Officer (OCMO), Tricare Management Authority (TMA), Office of the Assistant Secretary of Defense for Health Affairs (OASD(HA)) in the Spring 0f 2011. Currently, the CCLM staff consists of COL Cathy Leppiaho, USA, Director Col Bailey Mapp, USAF Director and myself. In addition to our CCLM jobs, Col Mapp is the Clinical Laboratory Consultant to the Air Force Surgeon General and I serve as the Medical Technology Specialty Leader to the Navy Surgeon General. The Air Force Management fellow is Maj Ramil Codina, who serves as the Deputy Director, CCLM. There are also four enlisted members of the staff. MSG Lance Thomas, USA, Msgt Chris Bartley, USAF and HMC Ruben Layug, USN. They each serve as Program Managers for their respective service. We also have an additional support person, she is HM1 Rebecca Foster. In our new location and command, CCLM is much more visible within the OASD (HA) and we have been actively involved in several projects. Currently we are working on the Laboratory Developed Tests (LDTs) demonstration project, the integrated Electronic Health Record (iEHR) way ahead, Essentris-Lab Interface 3D mapping upgrade, the Joint Pathology Center (JPC) Molecular Lab proposal, Pain Management lab testing, establishing the Lab System Service Center (LSSC) - which would replace the old Tricare Medical System Support Center (TMSSC), and preparing a Business Case Analysis (BCA) for a Joint Clinical Reference Lab (JCRL) to name a few. Our goal is to have a positive effect on any and all matters that concern Medical Laboratories within the DoD. We are here to lookout for your best interests and continually pursue excellence in lab medicine. Besides being a lesson in military acronyms, I hope that this has educated you on the history of CCLM and just what it is that the office does and is responsible for. If you need any help or support from any of us, please let us know!

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Society ScopeCon’t from pg 1

Regulations for genetic engineering work•Other legislation/ regulations related to safety and security of biological materials•

UNSCR 1540 is thus a framework that facilitates a “strategy of prevention based on each individual state accepting responsibility for implementing measures against the proliferation of materials and weapons”2. Compliance with the UNSCR 1540 requires that States implement such measures “without delay” after entry-into-force and report them to the 1540 Committee (established per UNSCR 1540). Also, States are to provide, at any time or upon request of the 1540 Committee, additional information on UNSCR 1540 implementation. The 1540 Committee is aided by a Group of Experts and is charged with promoting the full implementation by all States of UNSCR 1540 through its program of work, which includes the monitoring the status of States’ implementation of the resolution, outreach, dialogue, assistance and cooperation. Of note, the 10th Program of Work of the 1540 Committee3 for the period from 1 June 2011 to 31 May 20124 calls for “encouraging States to promote dialogue and cooperation, including with civil society, academia and industry, to address the threat posed by illicit trafficking in nuclear, chemical or biological weapons and their means of delivery, and related materials” and also to “increase efforts to raise awareness among parliamentarians and other high-level decision makers”. On 12-16 September 2011, the Committee and its Group of Experts visited Washington, DC area5. The US visit, coordinated and led by the State Department, allowed the Committee and its Experts to gain a better understanding of how the US Government implements its obligations under the resolution. During the visit, the UN visitors were briefed by the Departments of State, Defense, Commerce, Justice, Homeland Security (DHS), Agriculture (USDA), and Health and Human Services (HHS), on the US efforts to implement the Resolution, including: US laws and regulations related to prohibiting the illicit transfer of WMD-related materials; enforcement of these laws and regulations; and measures to prevent proliferation—including export controls, security and financial measures, border controls, and other measures. Legislation, policy and regulatory measures and programs which are implemented domestically to manage biological risks and secure sensitive biological materials are critical to effective implementation of UNSCR 1540 (as reviewed and discussed in the reference below6). Examples include measures designed to combat biological threats, bioterrorism and BW proliferation as well as specific programs such as the Select Agent Regulatory Program7 (which implements and enforces UNSCR 1540 provisions by regulating the secure possession, use, storage, and transport of select agents and toxins to minimize the risk of use for terrorism or criminal purposes); the Laboratory Response Network8 (an integrated national and international network of laboratories that are fully equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies); and the National Biosafety and Biocontainment Training Program9 (which prepares personnel to work safely in high and maximum containment laboratories while ensuring biosecurity). DOD laboratory training such as inter alia, the USAMRIID’s Biological Agent Identification and Counterterrorism Training (BAIT) and the Field Identification of Biological Warfare Agents (FIBWA) courses10 as well as ECBC’s Advanced CBRNE Training Program11 are also illustrative examples of training activities in support of UNSCR 1540 implementation. As the requisite capacity building necessary to prevent the proliferation of biological WMD to non-state actors is directly related to our efforts on strengthening biological risk management both domestically and internationally, the Armed

2 Bakanidze L., Imnadze P., Perkins D. 2010. Biosafety and biosecurity as essential pillars of international health security and cross-cutting elements of biological nonproliferation. BMC Public Health 2010, 10 (Suppl 1):S12 http://www.biomedcentral.com/content/pdf/1471-2458-10-S1-S12.pdf3 http://www.un.org/sc/1540/index.shtml4 Letter dated 17 June 2011 from the Chair of the Security Council Committee established pursuant to resolution 1540 (2004) addressed to the President of the Security Council, online at: http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N11/386/32/PDF/N1138632.pdf?OpenElement 5 The UNSCR 1540 Committee Visit to the U.S.: How the U.S. Combats WMD Terrorism, September 15, 2011, State Department press release, online at: http://fpc.state.gov/172523.htm6 Perkins D. and Danskin K. 2011. “On the Front Line of Biodefense: The U.S. Department of Health and Human Services Support to International Biological Risk Management Regimes”. J Bioterr Biodef 2:3; online at: http://www.omicsonline.org/2157-2526/2157-2526-2-111.pdf 7 National Select Agents Registry; website: http://www.selectagents.gov8 CDC, Laboratory Response Network; website: http://www.bt.cdc.gov/lrn9 National Biosafety and Biocontainment Training Program; website: http://www.nbbtp.org10 US Army Medical Research Institute of Infectious Diseases (USAMRIID), Education and Training; website: http://www.usamriid.army.mil/educa-tion/index.cfm 11 Edgewood Chemical Biological Center- Advanced CBRNE Training Program, website: http://www.edgewood.army.mil/ps/svcs_advanced_cbrn_training.htm

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Society ScopeForces Medical Laboratory Scientists are de facto “implementers” of UNSCR 1540 obligations and its tenets. Preventing the misuse of biological materials and of science and technology advances as well as reinforcing a culture of safe and responsible conduct at facilities that work with hazardous biological agents constitute an individual responsibility of Armed Forces Medical Laboratory Scientists predicated by the National Strategy for Countering Biological Threats12 and DOD policies and regulations13. The biosecurity measures needed to be taken to prevent loss, theft or misuse of microorganisms, other biological materials, and research-related information, are not solely the responsibility of laboratorians or research facilities but a national and global responsibility. In this regard, the States Parties to the Biological Weapons Convention (BWC)14 agreed on the importance of awareness-raising and education of life scientists as stated in their Final Declaration of the Second Review Conference of the BWC in 1986 where: “The Conference notes the importance of ...inclusion in textbooks and in medical, scientific and military educational programmes of information dealing with the prohibition of microbial or other biological agents or toxins and the provisions of the Geneva Protocol”. Also, at the Sixth Review Conference in 2006, States Parties were urged to: “promote the development of training and education programmes for those granted access to biological agents and toxins relevant to the Convention and for those with the knowledge or capacity to modify such agents and toxins, in order to raise awareness of the risks, as well as of the obligations of States Parties under the Convention”. The FBI WMD Directorate is actively involved in engaging the life sciences community (academia, industry, amateur biologists) in an open dialogue about the dual use risks as well as the benefits for inter-sectoral collaborations in combating biological threats15. The Biological Sciences and Academic Biosecurity Workshop initiatives undertaken by the FBI WMD Directorate aim to build partnerships between the FBI and the life sciences research communities, improve situational awareness, and develop a mechanism to report suspicious activities at research entities that could represent an emerging national security threat. These initiatives focus on the vulnerability of terrorist acquisition of biological agents or material housed in research facilities (academic, industrial, private, and clinical); attempts at the exploitation of those with the expertise and/or access to such agents or materials; and the ability of an insider to remove agents of concern for nefarious purposes. A proactive approach on encouraging and enabling members of the community at large to help protect themselves by identifying and reporting (to military or civilian law enforcement agencies) suspicious behavior that is known to be associated with terrorist activities, is undertaken by the US Army’s iWatch campaign16. By raising public awareness and urging all citizens, government agencies, public and private institutions, and businesses to invest in the power of prevention, the Army’s iWatch campaign contributes to making our communities safer, stronger, and more caring. iWatch information, including posters, brochures and videos, can be found on the Army’s Antiterrorism Enterprise page on AKO17. Biosecurity is also addressed by the US Army’s iWatch campaign via posters highlighting the objective of the National Strategy for Countering Biological Threats to empower an informed, involved, and observant citizenry. The three versions of the biosecurity posters (featuring a military and a civilian scientist and a non-personalized general version, respectively) as well as additional iWatch information and training materials (including brochures and videos) can be found on the Army’s Antiterrorism Enterprise Page on AKO (login required) at: https://www.us.army.mil/suite/page/605757 Through their commitment to a safe and secure laboratory environment and work practices as well as the enforcement of measures preventing un-authorized access to sensitive biological materials and resources needed to acquire or develop dangerous weapons and the means to deliver them, the Armed Forces Medical Laboratory Scientists effectively contribute to the objectives of US non-proliferation and counter-terrorism policies as well as our national efforts to prevent, prepare for, and respond to bioterrorism.

12 National Strategy for Countering Biological Threats; online at: http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Counter-ing_BioThreats.pdf 13 Perkins D. 2010. Biological Risk Management Overhaul, SAFMLS Scope pp 52, winter issue; online at: http://www.safmls.org/Scopes/Scope%20-%202010%20Winter.pdf14 BWC website: http://www.unog.ch/bwc 15 http://www.fbi.gov/news/testimony/ten-years-after-9-11-and-the-anthrax-attacks-protecting-against-biological-threats 16 Army Approves iWatch Program, Army News, July 20, 2010; online at:http://www.military.com/news/article/army-approves-iwatch-program.html17 US Army’s Antiterrorism Enterprise page on AKO (login required): https://www.us.army.mil/suite/page/605757

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Dr. Deborah Wilson, Director, Division of Occupational Health & Safety, NIH, briefs the 1540 Committee and its Group of Experts on the National Biosafety & Bio-containment Training Program

United Nations visitors and interagency guests tour the NIH BSL-4 Training Facility

MAJ Dana Perkins serves as the Surgeon for the HHC, 7th Civil Support Command, USAREUR. As a civilian, she works for the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, as the Chief of the Biological Weapons Nonproliferation and Counterterrorism Branch in Washington, DC. She can be reached at dana.s.perkins@us.army.mil LTC (USA, ret) Selwyn (“Jamie”) Jamison is the Manager of the Bioterrorism Prevention Program with the FBI WMD Directorate. He can be reached at: Selwyn.Jamison@ic.fbi.gov

Disclaimer: The views expressed in this article are those of the authors and may not reflect the official policy or position of the FBI, U.S. Army, or the U.S. Government.

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Deployment of the 47th Combat Support Hospital to Sather AFB, Baghdad Iraq

LTC Mark Hickman

The 47th Combat Support Hospital (“Bridge Medics”) was deployed to Iraq in August of 2011 to provide medical services during the final four months of the Dept of Defense’s presence in this country. This mission included an unusual and unprecedented handoff of responsibilities from the Dept. of Defense to a Dept. of State contractor, Comprehensive Health Solutions (CHS). This group photo includes both military members of the 47th CSH and employees of CHS.

The handoff of health care responsibilities from the Dept. of Defense to the Dept. of State’s contractor, CHS, involved all aspects of health care including the laboratory. In this picture, military members of the 47th CSH laboratory (from right to left, LTC Mark Hickman, SPC Jared Miller, and SSG Andrey Alonzo) are shown along with a CHS lab tech, Mr. Josh Faul.

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Society Scope In August 2011, Task Force 47 MED took over health care responsibilities for the remaining US forces throughout Iraq, and the 47th Combat Support Hospital (“Bridge Medics”) assumed responsibility for the CSH at Sather AFB in Baghdad, Iraq, from the 87th Combat Support Hospital. With the closure of many sites throughout Iraq including inpatient facilities at Balad, Al Assad, and Camp Adder, the Level III hospital at Sather AFB became the largest inpatient facility left in Iraq at the end of the military mission in this country. The mission assigned to the 47th went beyond providing health care to US forces and contractors in Iraq and included the very unique assignment of transferring in-patient health care responsibilities conducted at Sather and at three other smaller hospitals in Iraq (Basra, Kirkuk, and Tikrit) from the Dept. of Defense (DOD) to a Dept. of State (DOS) contractor, Comprehensive Health Solutions (CHS). The Dept. of State currently has 15,000 personnel in Iraq, and CHS has the responsibility of providing health care to the Dept. of State diplomatic personnel and contractors remaining in Iraq. This assumption of responsibilities began with a complete transfer of the equipment and supplies in the hospital, and included a training mission to insure the new CHS employees were adequately trained and briefed so they would be successfully prepared to provide health care services in a deployed environment. In order for this transfer of responsibilities to be successful, new processes had to be put in place to insure that services commonly provided to deployed medical units by the DOD were re-created by CHS for the hospital to function. Two of the most important processes to be re-created included provision of medical supplies from pharmaceuticals and laboratory reagents to blood products, and evacuation of patients from theater. Blood products, for example, are provided to deployed units in theater by Blood Support Detachment units which no longer exist in Iraq, and other medical supplies were provided in Iraq by the US Army Medical Materiel Center-Southwest Asia (USAMMC-SWA) in Qatar. Blood supplies for the DOS hospital are still provided by DOD (for a fee), and the blood products are flown in by CHS from Kuwait. CHS has created their own supply chain using a prime vendor to provide all other medical supplies required for DOS health care facilities in Iraq. Patient evacuation, both tactical and strategic, in Iraq was provided through a complex network of ground and aviation assets provided by both the US Army and the US Air Force. To recreate this capability, DOS implemented a contractor helicopter fleet staffed to evacuate patients from outlying facilities to Sather and the other three DOS inpatient facilities left in Iraq. Final strategic evacuation of these patients out of country will be conducted through contractor- provided aeromedical evacuation services. These are two examples of processes that must be re-created by a medical contractor assuming health care responsibilities from a DOD facility, but there are certainly others that must be considered (repair of biomedical equipment, facility maintenance, etc). Transitioning those responsibilities from DOD to the DOS contractor in Iraq took considerable planning which may be a model for the transition of health care responsibilities from DOD in Afghanistan. As US military involvement in Iraq has ended and will end in 2014 in Afghanistan, the transition of responsibilities for provision of health care services from DOD to a contractor hired by DOS will likely be repeated, and laboratory personnel will be required to be a part of that transition. Consideration of how all aspects of health care in a deployed environment must be re-created by a civilian contractor will require out of the box thinking oriented toward insuring the contractor has come up with a rational plan oriented for success.

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Professional Advancement: Three Overlooked Options For Medical Laboratory Professionals

Capt Karen Chisholm and Lt Col Nathan Johnson

In the world of the clinical laboratory, there are enough challenges inside the laboratory walls to last a lifetime. Sometimes we forget to look outside those walls to the detriment of our subordinates and our own careers. This is not unique to the military and we will all be civilians at some point. At any national lab conference, ask your civilian counterparts if the laboratorians get the same respect as the administrators or nurses? The answer is a resounding “No”! In our opinion, laboratorians are both well equipped and suited for leadership roles in healthcare facilities. We have two options, either accept this or change others perceptions of our capabilities. This article will discuss three often overlooked options for clinical laboratory professionals. The first option is the Diplomate in Laboratory Management certification from the American Society for Clinical Pathology (ASCP). There are six different routes to qualify to sit for the examination, so there is plenty of opportunity for individuals with diverse backgrounds (http://www.ascp.org/pdf/ProceduresforExaminationCertification.aspx). You will be surprised if you have not looked at the eligibility requirements recently, many more are now eligible to sit for the exam. This certification is a great differentiator for those seeking promotion to manager- or director-level positions, because it demonstrates competency in many areas of laboratory administration. Only 953 individuals have received their Diplomate in Laboratory Management (DLM) since its inception in 1989. Many of these individuals will be retiring the in the next 10 years and will need to be replaced. At the same time, the pass rate has been declining in recent years, so there are few with this certification replacing those who are retiring. This is an eye-catching certification that clearly differentiates applicants from those without advanced credentials. Our suggestion for a great study guide is Medical Laboratory Management and Supervision, 2nd Edition, by Lionel A. Varnadoe (http://www.amazon.com/Medical-Laboratory-Management-Supervision-2nd/dp/1605855472/ref=ntt_at_ep_dpt_1). The second option is an advanced certification in quality improvement. We are all facing budgetary constraints and are being asked to do more with less. In this day and age it is even more vital to look at how our organizations are operat-ing and think out of the box for ways to meet the mission with fewer resources. We must implement initiatives that will improve our organization’s efficiency and effectiveness while remaining flexible. Since the 1970s the business world has used Six Sigma. The methodology of Six Sigma provides the tools to improve the capability of their business processes. We have seen the deployment of Six Sigma into healthcare facilities at a rapid pace. This has led to a need for healthcare professionals trained in Six Sigma techniques. Can you think of a better career field to pick from than the laboratory pro-fessional? There are many ways to get this training and we certainly do a good job in the military of providing it. For example, there have been many workshops on the topic at SAFMLS. What are employers looking for? Consider a recent advertisement for a Quality Outcome Coordinator. One of the qualifications was “Certification in Healthcare Quality or eligibility after five years experience in QM. Certification as a green or black belt in lean Six Sigma methods”. We have also seen similar requirements for positions ranging from Director of Lab Services to CEO of a large hospital. One labo-ratory leader and pioneer in the field is Sue Kozlowski. She is a six sigma consultant and frequent lecturer on the topic. Sue is a Certified Six Sigma Black Belt and. She is certified by ASQ, the sole administrator of the Malcolm Baldrige Na-tional Quality Program Award. To qualify as an ASQ black belt, you must have led two six sigma projects or have led one six sigma project and have three years experience. We think there are many in military laboratory leadership who would qualify for this. The exams are offered several times a year. Please see the ASQ website for specifics on the costs and other qualifications for the exam (http://prdweb.asq.org/certification/control/six-sigma/index). The last option is for those who want to advance in Hospital Administration. There are several options available, but the Gold Standard is to become a Fellow of the American College of Healthcare Executives (FACHE). In order to become a FACHE, you must meet two qualification stages. The first stage requires qualifying and passing the Board of Governors Examination in Healthcare Management. The second stage involves obtaining qualified continuing education units and tenure. Unlike the other two options listed for laboratory professionals, FACHE status requires a Masters Degree. You will also need three years tenure as a ACHE member, 40 hours of continuing educations credits, 12 of which are ACHE Category I credits, active participation in community and healthcare activities, and five years of management experience in a healthcare facility. This credential is powerful. A good way to demonstrate the power of this credential is to search “FACHE” in one of the meta job search engines like indeed (www.indeed.com). The American College of Healthcare Executives has a great site that explains their certification process and specific requirements. (http://www.ache.org/mber-ship/credentialing/criteria.cfm). In conclusion, there are many ways for laboratory professionals to climb the career ladder. We should never shortchange the ability of laboratorians to serve in leadership roles in or outside the laboratory.

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Society Scope

2012 SAFMLS WORKSHOPS

2 Apr 12 (Monday)

1300-1500 2-Hour Workshops

#1 HiSto…WE WANt A PiECE of you. No CutS, No gLory!Confirmation Number: 39535010

Presenter(s): MSgt Tina Romero SSgt Julia Hilt SSgt Christiane Shoenhair

Abstract: The goal of this workshop is to showcase Air Force histopathology operations to the Tri-Service audience. The brief will not only highlight common histology functions and intriguing case studies, it will explain our metamorphosis to digital pathology. Similar to tele-radiology, this innovative technology will slice through technical and geographic limitations to offer distant pathologists real-time consultation. By the end of the brief, the audience will understand histopathology’s role in patient care and its transition to digital pathology. PowerPoint will augment the presentation

objectives: 1. At the end of this workshop, the attendee will be able to know the processes involved in preparing a surgical biopsy for diagnosis.2. At the end of this workshop, the attendee will be able to know the steps in processing a surgical specimen.3. At the end of this workshop, the attendee will be able to understand how digital pathology will change the way pathologists consult with one another.

#2 CHCS - LABorAtory CritiCAL fixES AND ENHANCEMENtSConfirmation Number: 39115104

Presenter(s): Mr. Rusty Tenney

Abstract: For many years, the laboratory community has waited for Critical Fixes to the CHCS Laboratory Functionality to be addressed. Many of the fixes were needed to address Patient Safety issues within CHCS. With the delay in the acquisition of a Commercial-Off-the-Shelf Laboratory Information System, which was to replace CHCS Lab, the time has come to see the new enhancements developed to resolve many of the CHCS System Change Requests (SCRs) that have been submitted. Some of the fixes include: Positive Patient/Specimen Identification, Ward/Clinic Patient Specimen Label Print, Non-Numeric Lab Result Delta Checks, Performing Lab Name and Address on Lab Reports, Multiple Result Codes Per Test, CPT-Coded Workload from CoPath, Multiple Entry of CPT Codes, Batch Patient Registration with Batch Order Entry, and Lab Result Autoverification.

objectives: 1. At the end of this workshop, the attendee will be able to cite the CHCS Lab Enhancements for Phase 1 Release.2. At the end of this workshop, the attendee will be able to cite the CHCS Lab Enhancements for Phase 2 Release.3. At the end of this workshop, the attendee will be able to state how Autoverification will work in CHCS Lab functionality.

#3 tHE EvoLutioN of DgMC CHEMiStry AutoMAtioN: WHErE AMAziNg HAPPENS!Confirmation Number: 38826976

Presenter(s): Maj Troy D. ChinevereMs. Ruth Ann Alexander

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Society ScopeAbstract: In 2010, the clinical laboratory at Travis AFB was moved into a renovated space that was reduced by 40%. This presented numerous challenges to work performance and workflow. The addition of state-of-the-art chemistry automation and pre-analytics has facilitated overcoming some of the challenges presented. However, the implementation of automation presented many unforeseen challenges related to: 1) learning a more sophisticated system; 2) interfacing with CHCS; 3) changes in work practices; 4) training; and 5) addition of middleware. In this workshop, we will discuss the positives, negatives, and lessons learned the implementation has brought us over the last year. We will also discuss the reinvention of our Core Lab, Chemistry training program that provides a more thorough assessment of competency.

objectives: 1. Recognize challenges involved in converting to full chemistry automation.2. Discuss useful tips for overcoming and/or adapting to unforeseen challenges during the early stages of automated chemistry implementation.3. Showcase DGMC’s chemistry training plan and provide ideas to modify/adapt dated training plans.

#4 DEvELoPiNg tHE SuCCESSfuL fiNANCiAL BuSiNESS CASE to DrivE MAJor CHANgES iN LABorAtory oPErAtioNSConfirmation Number: 38804839

Presenter(s): Leroy Mell, PhD, MBA, HCLD(ABB) Ms. Kelly Barbian

Abstract: This is a 2-part session. This workshop is intended for laboratory directors, pathologists, physicians, laboratorians, and others who have fiscal responsibility for laboratory operations and who must provide senior leadership (the final decision makers) the management, technical and financial resource information required to successfully promote and obtain infrastructure change within the laboratory such as instrument acquisition, introduction of new programs, and expansion of personnel capabilities. The first part of the course explores the organizational and operational aspects of fiscal analysis and internal financial control for clinical laboratories. The presentation will develop in moderate detail the essential elements of laboratory financial operations as well as present an overview of cost accounting principles and an in-depth description of laboratory organizational costs to include procedures for developing cost of testing, establishing operating and capital budgets as well as identifying specific financial benchmarks that enable laboratory leadership to present business cases to senior administration. The second part will cover criteria for instrument selection, workflow and test menu changes and return on investment based on real-life experiences of one laboratory.

objectives: 1. Demonstrate expanded financial skills required to assemble, identify and interpret the appropriate quantitative financial information for use in decision-making related to laboratory operations, budgets and management decisions.2. Understand the importance of developing and successfully communicating complete financial analyses for developing budgets and program changes.3. Determine the most important criteria for instrument selection and demonstrate the use of automation to improve daily workflow logistics.

#5 uSAr MiCroBioLogiStS oN tHE froNt LiNE of BioDEfENSE AND HEALtH CArE SuPPortConfirmation Number: 38254934

Presenter(s): BG John J. Donnelly III BG David L. Smalley COL James W. Snyder LTC Francis Klotz MAJ Dana Perkins CPT Brian J. Robinson

14

Society ScopeAbstract: This workshop will provide a broad overview of the diverse assignments and missions supported by the US Army Reserve (USAR) Microbiologists and their respective USAR units. Several USAR Microbiologists will present and reflect on their military careers as well as their specialized skills, knowledge, and abilities acquired in their military and civilian careers, which serve as valuable capabilities multipliers for the Army Reserve and the overall Army mission.

objectives: 1. At the end of the workshop, the attendee should be able to identify the diverse assignments and missions supported by the USAR Microbiologists.2. At the end of the workshop, the attendee should be able to identify the military career options available in the USAR Microbiology AOC.3. At the end of the workshop the attendee should be able to describe the valuable contributions of USAR Microbiologists to the Army Reserve and the overall Army mission.

1300-1730 4-Hour Workshops

#6 ArMED SErviCES BLooD ProgrAM uPDAtEConfirmation Number: 39282732

Presenter(s): COL Frank Rentas LCDR Aaron J. Harding

Abstract: The Armed Services Blood Program Office (ASBPO) was established by the Assistant Secretary of Defense for Health Affairs to coordinate the blood programs of the Military Services and the Combatant Commands. ASBP facilities collect, manufacture, test, and distribute blood products in support of world-wide military activities and operations. In this workshop, ASBP and industry leaders will provide updates on performance improvement and business practice transformation initiatives currently taking place and will share the vision of the ASBP as we move into the future. Challenges, lessons learned, and success stories from blood operations in world-wide will be shared; providing attendees valuable information from real-life experiences. Research and technology development, as well as, policy initiatives and strategies will be discussed.

objectives: 1. Describe the challenges, lessons learned, and success stories of deployed Armed Services Blood Program functional units, i.e. EBTS, MDBS and BPD.2. Understand the way ahead for ASBP initiatives for research and development.3. Discuss developing policies and business practices advancing the ASBP.

#7 ArMy BioCHEMiSt (71B) CArEEr ASSigNMENt oPPortuNitiESConfirmation Number: 39114497

Presenter(s): COL Beau Freund COL Timothy Lyons COL (Ret) Ronald Shippee LTC Claudia L. Henemyre-Harris LTC David A. Smith MAJ Michael VanZile MAJ Kelly Wilhelms CPT Angela Davis CPT William English CPT Jeffery Froude

Abstract: A career as an Army biochemist gives a scientist an opportunity to explore and work in a wide range of career fields throughout the world. In many instances, an Army biochemist may find that he or she is the only 71B

15

Society Scopeassigned to a research facility or medical center. To complicate matters, many specialties exist within the 71B functional area such as chemistry, biochemistry, physiology, and molecular biology. With so much diversity in the 71B arena, where can an Army biochemist work? This workshop will describe the various career assignments for Laboratory Sciences Officers within the 71B functional area. The intended audience is all 71B officers and individuals interested in a career in biochemistry and/or the military. The format for the workshop will be several short presentations by various 71B speakers followed by a break-out session to ask more in-depth questions of the speakers. Speakers will present information regarding assignments at a Medical Center (MEDCEN) clinical laboratory, a Medical Research and Materiel Command (MRMC) basic research position, and on Forensic Toxicology Drug Testing Laboratory (FTDTL) program management. Overseas assignment topics will include presentations on the 1st Area Medical Laboratory (AML) deployment, the MRMC Engineer/Scientist Exchange Program (ESEP) position in France, and a unique deployment as a medical service combat advisor to the Iraqi Federal Police. A status report of the multi-disciplinary tiger team working to establish laboratory testing of pain management drugs in support of wounded warrior clinics will also be provided. In addition, a retired 71B officer will share his perspectives on military assignments to include his extensive forensic toxicology laboratory management experience.

objectives: 1. Describe position duties and responsibilities for three Army biochemist (71B) assignments.2. List six career assignments available for Army biochemists (71Bs).3. Discuss advantages and disadvantages of three Army biochemist (71B) assignments.

#8 offiCEr ProfESSioNAL DEvELoPMENtConfirmation Number: 39624715

Presenter(s): Col Bailey Mapp Col Patricia Reilly Lt Col Lucia More Lt Col Brian Casleton Maj Ramil Codina

Abstract: This workshop is for lab officers who are relatively new to the military. It is intended to provide tools for becoming more effective, confident leaders. It is presented by a panel of senior USAF Lab Officers who have a wealth of valuable experience and information between them. It will cover writing effective OPRs/PRFs, BSC force structure and career path, rank appropriate education and training to build your career, clinical investigations and research opportunities, and developing leadership skills.

objectives: 1. Understand the BSC officer career path and career development strategies.2. List the characteristics of an exceptional officer.3. Learn effective appraisal writing techniques.

1530-1730 2-Hour Workshops

#9 tHE PuBLiSHiNg WorKSHoPConfirmation Number: 39248307

Presenter(s): Mr. Robert Stewart

Abstract: This workshop is designed for someone interested in navigating the labyrinthine world of publication and getting their writing efforts into print. The publishing industry is in a state of flux and the rules and standards change almost daily. In fact, it commonly takes as much effort to get something published as it did to write the original document in the first place. Topics to be covered include the classes and styles of content, the use of agents and agencies, publishing methods, the editorial processes and managing expectations.

16

Society Scopeobjectives: 1. At the end of the workshop the attendee should be able to identify the various classes of writings that can be published.2. At the end of the workshop the attendee should be able to utilize the various resources available to the prospective author.3. At the end of the workshop the attendee should be able to navigate the routes to publishing manuscripts.

#10 ovErviEW of zooNotiC iNfECtioNSConfirmation Number: 39295781

Presenter(s): LTC Carl Brinkley CPT Candelaria Daniels CPT Christopher Hatcher CPT Nabil Latif

Abstract: Zoonotic infections are associated with infectious diseases that are naturally transmitted between vertebrate non-human animals and humans. Infectious agents that may be zoonotic do not exclusively depend on the human host for their life cycle, but naturally exist in animals and possess the ability to infect humans. Clearly, a significant amount of classical and emerging infections may have a zoonotic origin due to human exposure and proximity to wild or domesticated animals. Zoonoses can be caused by bacterial, viral, parasitic, or fungal agents and therefore represent a significant public health threat. Zoonotic diseases include (1) those which can be transmitted directly from animals to humans (e.g. rabies), (2) those acquired indirectly by humans through ingestion, inhalation or contact with infected animal products, soil, water or other environmental surfaces contaminated with animal waste or a dead animal (e.g., leptospirosis, anthrax), and (3) diseases which require biological vectors to transmit the disease from animals to humans (e.g. Rocky Mountain spotted fever and West Nile fever). During this 2-hour workshop, a review of select bacterial and viral etiologic agents associated with zoonotic diseases will occur to include etiology, epidemiology, clinical manifestation and the role of the laboratory.

objectives: 1. Review bacterial, viral, parasitic, and fungal pathogens associated with zoonotic disease with primary focus on representative bacterial and viral source pathogens.2. Define the disease characteristics, transmission, pathogenic mechanism, laboratory diagnosis, and recommended treatment for selected zoonotic infections.3. Describe the impact of emerging zoonotic infections from a world public health and military operational perspective.

#11 QuALity MANAgEMENt & QuALity CoNtroL uPDAtESConfirmation Number: 39629198

Presenter(s): COL Danny Deuter LTC Paul Mann Ms. Mercuria Castaneto

Abstract: This workshop is targeted for clinical laboratory officers who are relatively new to the military and who are assigned to facilities as the lone laboratory officer or who anticipate such an assignment in the near future. The workshop is intended to provide a more thorough understanding of Quality Management and Quality Control. It is presented by a panel of senior Army Lab Officers who have diverse experience and information in these areas. This workshop will cover the 12 Clinical Laboratory Quality System Essentials and how to incorporate them into your Quality Plan. Special attention will be placed on Quality Control and the future requirements to develop Quality Control Plans that incorporate Risk Management tools when designing and implementing quality control procedures.

17

Society Scopeobjectives: 1. Define the 12 Clinical Laboratory Quality System Elements (QSE).2. Design a Quality Management plan incorporating the 12 QSEs.3. Define Risk Management Based Quality Control.

#12 HEMogLoBiN A1c, A DiABEtiC MArKEr of iNCrEASiNg iMPortANCEConfirmation Number: 38804602

Presenter(s): Dr. Alvin Michael Spiekerman

Abstract: Hemoglobin A1C (HbA1C) has evolved into one of the premier tests for the care of diabetics. The volume of this test has increased in the last 5 years in dramatic fashion. In 2009-2010 this analyte will become more important in that it is becoming the test used for diagnosis of diabetes. With this development, it is equally important to have the most precise and accurate method in determination of HbA1C. This includes verifying that there is no interference with biological molecules or drugs. By studying diabetic patients with autoimmune diseases some interesting findings can be noted.

objectives: 1. Summarize the increasing occurrence of diabetes in the United States.2. Describe the present usage of HbA1c.3. Evaluate the importance of correctly determining the amount of HbA1c; list some of the other tools and markers used in monitoring a diabetic patient.

3 Apr 12 (tuesday)

0730-0930 2-Hour Workshops

#13 SAy CHEESE! iMAgiNg DNA for CoMPArAtivE gENoMiC ANALySiS, EPiDEMioLogy AND gENoME ASSEMBLyConfirmation Number: 39491799

Presenter(s): CPT Matthew C. Riley

Abstract: This workshop is targeted at clinicians and researchers who have or may desire to conduct whole genome analysis on a variety of infectious diseases. The focus of the workshop will be on whole genome optical mapping and its various uses within medical and scientific research. In the first half of the workshop, an introduction to the technology will precede examples of published findings from various researchers, with emphasis placed on uses and limitations of the technology. In the second half, a demonstration of the technology will involve learning how to assemble mapcards, judge the quality of DNA preparations and perform a run. Analysis of data will include instruction on genome alignment, next-generation sequencing contig assembly, construction of phylogenetic trees and detection of genomic insertion/deletion events and rearrangements. By the end of the workshop, attendees should have gained an understanding of what whole genome optical mapping is and how it can be used in support of clinical missions, as well as learn how to conduct various types of investigations using the Argus™ system and related software.

objectives: 1. At the end of this workshop, the attendee should be able to identify uses of whole genome optical mapping.2. At the end of this workshop, the attendee should be able to perform a mapping run of a bacterial DNA sample.3. At the end of this workshop the attendee should be able to analyze optical mapping data.

18

Society Scope#14 LABorAtory SurvivAL guiDEConfirmation Number: 38814717

Presenter(s): Ms. Ruth Ann Alexander

Abstract: This workshop is targeted to officers who are relatively new to the military or to the clinical lab. It is also a great opportunity for lab quality assurance officers and NCOs to expand their skill sets. The session is taught by a 25-year lab veteran and is intended to provide tools for surviving in your clinical setting. Included are overviews and pointers on calibration, quality control, operating instructions, method validation, CLIP, and CAP, to include both proficiency surveys and accreditation requirements. Each participant will receive a copy of the Laboratory Survival Guide, a new pocket manual developed by the author to ensure success of even the most inexperienced laboratorian. After this session, you will be on your way to finding solutions to your toughest problems – so bring your hard questions and be ready to load up your toolbox!

objectives: 1. At the end of this workshop, the attendee should be able to troubleshoot calibration and QC problems.2. At the end of this workshop, the attendee should be able to interpret CAP survey results and investigate failures or near misses.3. At the end of this workshop, the attendee should be able to plan and execute a method validation.

#15 ProfESSioNAL CErtifiCAtioNS: tHrEE ovErLooKED CErtifiCAtioNS for MiLitAry LABorAtoriANS tHAt WiLL turBoCHArgE your PoSt MiLitAry oPtioNS!Confirmation Number: 38976037

Presenter(s): Lt Col Nathan Johnson Capt Karen Chisholm

Abstract: In the world of the clinical laboratory, there are enough challenges inside the laboratory walls to last a lifetime. At any national lab conference, ask your civilian counterparts if the laboratorians get the same respect as the administrators or nurses? The answer is a resounding “No”! In our opinion, laboratorians are both well equipped and suited for leadership roles in healthcare facilities. This presentation will cover three overlooked options for professional advancement for laboratory professionals in the military or as civilians. The certifications covered are the Diplomat in Laboratory Medicine, the Certified Six Sigma Black Belt, and the Fellow, American College of Healthcare Executives. In addition to the workshop, all attendees will receive a personalized study reference for each certification.

objectives: 1. Participants should be able to discuss the paths to obtain a Diplomat in Laboratory Medicine certification.2. Participants should be able to discuss what a Certified Six Sigma Black Belt position entails.3. Participants will be able to identify the requirements needed to obtain a Fellow, American College of Healthcare Executives.

#16 CHCS LAB – iNtroDuCtioN/BASiCConfirmation Number: 38379070

Presenter(s): Maj (Ret) Charles R. Hopkins Capt Karen B. Chisholm

Abstract: The Composite HealthCare System (CHCS) is the Laboratory Information System (LIS) for the DoD. This workshop is geared toward individuals who are new to CHCS, individuals running their own labs and a refresher for those who have not worked with CHCS in a few years. This introductory overview of CHCS Lab will provide an understanding of some of the basic functions needed to run your laboratory more efficiently. This will include running administrative, workload and status reports which are useful for the entire lab staff. The lab file and table build

19

Society Scopeinformation will be very basic and include reference lab test building. CHCS tips and time savers will also be discussed; Q&A will be available throughout the workshop.

objectives: 1. Participants will gain the knowledge to update basic lab test’s file and table information.2. Participants will have a basic understanding of Lab Interoperability. 3. Participants will gain the knowledge to run workload/status reports.

#17 CAMP CLiN MiCro—BrEAKiNg NEW grouNDConfirmation Number: 39563483

Presenter(s): LTC Wade Aldous

Abstract: Early in 2011, 62 professionals from the field of clinical microbiology attended the meeting “Camp Clin Micro—Breaking New Ground” to discuss three primary objectives leading to important future initiatives in the discipline. These objectives included: 1) plot a new way forward for the profession of clinical microbiology over the next 5 years; 2) to encourage positive and lasting interactions between laboratory professionals and partners from industry; and 3) develop plans for collaborations to address clinically relevant unanswered questions in the field using evidence based practices. Five primary topics were identified with additional subtopics defined to make a total of 19 different topics that were addressed. The 5 main topics were: 1) Antimicrobial susceptibility testing; 2) The role of the clinical microbiology laboratory in the diagnosis of selected infectious processes; 3) Conventional versus molecular methods for pathogen detection and the role of clinical microbiology in infection control; 4) Clinical microbiology in the year 2015; and 5) The business of clinical microbiology. The proceedings of this meeting were later published as a supplement to the Journal of Clinical Microbiology in September 2011. This workshop will summarize the results of this meeting and identify the important take-away information applicable for use in the clinical laboratory.

objectives: 1. Recognize the evolutionary technological changes occurring in the microbiology laboratory.2. Review the molecular testing currently available in the microbiology laboratory and the projected testing methodologies.3. Identify the role of the microbiology laboratory in providing timely diagnostic results and its contribution towards infection control and antimicrobial stewardship.

#18 ENtErPriSE BLooD MANAgEMENt SyStEMS (EBMS): tHE HCLL trANSfuSioN SyStEM APPLiCAtioN WorKSHoPConfirmation Number: 39559992

Presenter(s): Mr. Chester C. Alexander III (Chuck) Mr. Steve Rizner Mr. Russell Tilgner T. Kim Thomas

Abstract: This 2-hour workshop is repeated. The purpose of this workshop is to provide a general overview of the HCLL™ enterprise-wide application system utilized within the transfusion process. Participants will explore the HCLL™ application and its key features that include transfusion, managing inventory, testing, patient administration, enterprise reporting, and user training compliance. Upon the completion of this workshop, attendees will have a basic understanding of how to access training from within the HCLL™ application and how to effectively implement the process of transfusion, managing inventory, testing, patient administration, enterprise reporting, and user training compliance. HCLL™ is a 510(k)-cleared blood establishment computer system (BECS) that will be deployed to MHS blood bank facilities. HCLL™ is used by some of the largest blood bank facilities in the United States and across the world. HCLL™ supports transfusion, managing inventory, testing, patient administration, enterprise reporting, and user training compliance.

20

Society Scopeobjectives: 1. Overview of BMBB/TS application within the Transfusion process. Attendees will be introduced to the new blood establishment computer software (BECS) and gain understanding of how new technology can improve current business practices at DoD Blood Banking and Transfusion Services sites.2. Introduction and overview of BMBB/TS application functions of transfusion, managing inventory, testing, patient administration, enterprise reporting, and user training compliance. Attendees will gain an understanding of quality assurance improvements for the new system.3. Demonstration of some of the HCLL™ application features to transfuse blood and blood products. Attendees will obtain knowledge on how the system can improve and standardize DoD blood bank and transfusion practices.

0730-1200 4-Hour Workshops

#19 MAKiNg tHE WorLD’S fiNESt LABorAtory tECHNiCiANSConfirmation Number: 39380190

Presenter(s): LTC Audra L. Taylor LT Trent K. Freeman Bradley D. Whiteside

Abstract: Medical Education and Training Campus (METC) Mission: To produce the world’s finest Medics, Corpsmen and Technicians, supporting our Nation’s ability to engage globally. The goal of the 311-68K10/8506 Joint Service Medical Laboratory Technician (MLT) Program is to prepare graduates for certification and to function as technically proficient and professional entry-level MLTs. The complete support of the laboratory community is required to meet the goal and simultaneously support the METC Mission. This workshop will provide a thorough oversight of the consolidated MLT Program and will focus on the following: The National Accrediting Agency for Clinical Laboratory Sciences Accreditation Process, The George Washington University Academic Affiliation, Program Outcome Measures (Attrition, Student Survey Data, CLS Simulator, ASCP BOC), Course Updates, Challenges and Initiatives. This workshop will take a close look at Phase II Training that is currently conducted in 32 locations with a focus on streamlining and standardizing training, testing and preparation for the MLT Certification exam.

objectives: 1. Provide a detailed overview of the 311-68K10 / HM8506 Joint Service MLT Program and discuss the challenges associated with the transition to the newly consolidated course. Discuss the accreditation status of the consolidated program and outline the successful transfer of sponsorship of NAACLS.2. Report Program Outcome Measures such as attrition, student survey data, Clinical Laboratory Science Simulator results and ASCP BOC performance. Provide a detailed overview of program performance reports and other tracking mechanisms utilized to monitor student and program performance.3. Give an overview the consolidation of Army / Navy Clinical Training and discuss standardization of Phase II training and testing. Outline the MLT Certification Exam application process and discuss effective MLT Exam preparation techniques.

#20 WHAt ArE you goiNg to Do WHEN you groW uP?Confirmation Number: 39368738

Presenter(s): Col (Ret) Michael H. Caldwell Col (Ret) Charles A.Watkins Lt Col (Ret) Robert Mathis Dr. Robert Steward, PhD Mr. Todd Ritter

Abstract: This workshop is presented by a selected group of Emeritus members that have been successful in post retirement careers in their specialty or areas of interest/talents. Attendees will be afforded the opportunity to assess

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Society Scopevarious post military career paths and be able to ask questions and establish mentorships to aid in their second career selections.

objectives: 1. Attendees will be exposed to methods for assessing post military careers.2. Presenters will review post military career opportunities.3. Attendees will understand their suitability for various post military careers.

1000-1200 2-Hour Workshops

#21 “CorE” KNoWLEDgE - WHAt you NEED to KNoW to CoMPLy WitH CAP ACCrEDitAtioN rEQuirEMENtS iN tHE CorE LABorAtoryConfirmation Number: 39517501

Presenter(s): Dr. Gregory A. Gagnon, MD, FCAP Ms. Nancy Yeransian

Abstract: This interactive session will focus on the impact of the All Common Checklist as well as accreditation requirements that apply to a Core Laboratory situation. It will review commonly cited inspection deficiencies, explain their intent and address practical compliance approaches. This course will include how to use Evidence of Compliance to effectively document compliance and how to maintain continuous compliance. You will have opportunities to determine if your own laboratory’s practices are in compliance and what you need to do to correct them if they are not.

objectives: 1. Describe the impact of the All Common Checklist.2. Explain and apply approaches to prevent the most commonly cited deficiencies and often misunderstood accreditation requirements.3. Describe the use of effective documentation to demonstrate compliance with accreditation

#22 ArMy offiCEr ProMotioN MoCK BoArDConfirmation Number: 39608310

Presenter(s): LTC Eva Kristina Calero LTC Paul Mann

Abstract: The target audience is US ARMY Officers, all ranks. The purpose of this presentation is to conduct a mock board promotion process. The first portion of the presentation will be administrative updates in regards to promotion boards. This will lead into an actual board process in which all audience members will have a chance to review and score actual packets of Officers that were part of previous boards. The audience will be able to compare the scores they give against what the official board results were. The last portion of the presentation will be a led discussion with the audience on their impressions in regards to a board process. This presentation should be of value to both junior and senior Officers alike.

objectives: 1. Describe Army Officer promotion and selection board process.2. Identify critical issues relating to promotion board process selection.3. Identify tools that facilitate promotion board process preparation.

#23 MEtHoD vALiDAtioN StuDiESConfirmation Number: 38662463

Presenter(s): COL Donald L. Taillon Maj Ramil C. Codina

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Society ScopeAbstract: This workshop is targeted for laboratorians who are interested in making sound decisions about the acceptability of method performance. These decisions are based on comparison of the analytic errors of a method to the medically allowable error for the analyte being measured. It is presented by a Senior Pathologist and Laboratory Officer. The goal of this workshop is to learn and understand CAP/TJC/CLIA requirements, the process of selecting and evaluating clinical laboratory methods, and then make correct decisions about the acceptability of method performance.

objectives: 1. Following the presentation, the attendees will be able to recognize CAP/TJC/CLIA-CLIP validation requirements.2. Following the presentation, the attendees will be able to interpret method validation (MV) data.3. Following the presentation, the attendees will be able to assess analytic and medically allowable errors.

#24 CHCS LAB – ADvANCEDConfirmation Number: 38379070

Presenter(s): Maj (Ret) Charles R. Hopkins Capt Karen B. Chisholm

Abstract: The Composite HealthCare System (CHCS) is the Laboratory Information System (LIS) for the DoD. This workshop is geared toward individuals who are familiar with CHCS Lab, those who need additional information regarding lab tests and using Lab Interoperability (LIO). The focus to include: in-house and LIO Lab Test File/Table build, LIO related topics, commercial lab test set-up, troubleshooting Lab Tests and LIO, and understanding/running troubleshooting reports which are useful when resolving LIO issues. CHCS tips and time savers will also be discussed; Q&A will be available throughout the workshop.

objectives: 1. Participants will gain the knowledge to update their more difficult lab test’s file/table and Microbiology.2. Participants will gain the knowledge to troubleshoot LIO problems.3. Participants will gain the knowledge to perform other functions in CHCS, including Label configuration.

#25 WHy i SiNg tHE BLuES: tHE CoNtAgiouS rHytHM of iNfECtiouS DiSEASES AffLiCtiNg MuSiCiANSConfirmation Number: 39563483

Presenter(s): LTC Wade Aldous

Abstract: Blues music has been around for over 100 years now and continues to influence the music industry today. In Memphis, mention of the name BB King is synonymous with blues music. His rendition of “Why I Sing The Blues” is always a fan favorite. But what are the Blues really about? The individuals who sang the blues, sang about the various troubles and suffering in their lives. This rumination allowed them to work through their issues through song as an emotional healing process. One topic that BB King could be singing about is lamenting the loss of fellow musicians who’ve expired from the causes of many different infectious diseases of their day. The most common of these diseases include syphilis, tuberculosis, HIV, and viral hepatitis. Although not infectious, many others succumbed to the effects of drugs, alcohol, and carefree lifestyles. It’s been mentioned that musical innovation is often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses. This workshop will review the origins of blues music and its long term effects on the music industry today. Several audio/video clips of past and present blues music will be interspersed over a timeline while discussing the epidemiology, pathogenesis, and diagnostic markers of the diseases listed above that affected many musicians who sang the blues or were influenced by the blues. Additionally, a few case studies of some lesser known musicians who expired from other infectious diseases of bacterial or viral agents will be discussed.

objectives: 1. Review the history of blues music and its contribution to musical styles of today.

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Society Scope2. Review some of the common infectious diseases afflicting musicians throughout the ages and today: syphilis, tuberculosis, HIV, and hepatitis C. 3. Identify some specific musicians and the unique infectious diseases that they were afflicted with.

#26 tHE Air forCE LABorAtory MANPoWErConfirmation Number: 39054524

Presenter(s): Col Bailey H. Mapp MSgt Christopher A. Bartley

Abstract: This program will give an overview of the Air Force Laboratory Manpower Standard. After this presentation the attendee will be able to paraphrase the history of the AF Manpower Standard, interpret the effect changes to the AF Laboratory Manpower Standard will have on manning and be able to compile data for and analyze the Clinical Laboratory Management Indicators report.

objectives: 1. Explain the history of the AF Laboratory Manpower Standard.2. Extrapolate the effect changes to the AF Laboratory Manpower Standard will have on manning.3. Draft/analyze the Clinical Laboratory Management Indicators report.

#27 NEW tECHNoLogiES iN ELECtroPHorESiS tEStiNg - AutoMAtED SPE AND iMMuNotyPiNg WitH CAPiLLAry ELECtroPHorESiSConfirmation Number:

Presenter(s): Dr. Aigars Brants, PhD

Abstract: This presentation covers an overview of Capillary electrophoresis theory. Within the program, specific protein electrophoresis cases illustrating specific disease states will be reviewed. This presentation will include an overview of Immunotyping (IT) as compared to Immunofixation (IFE) with specific cases presented.

objectives: 1. By the end of the presentation, the participant will be able to understand the principles of capillary electrophoresis.2. By the end of the presentation, the participant will be able to discriminate between abnormal and normal protein electrophoresis results.3. By the end of the presentation, the participant will be able to compare capillary electrophoresis immunotyping(IT) testing to traditional immunofixation (IFE) testing

#28 DEfENSE HEALtH iNforMAtioN MANAgEMENt SyStEM (DHiMS)/ ENtErPriSE BLooD MANAgEMENt SyStEMS (EBMS): tHE BLooD DoNor MANAgEMENt SyStEM (BDMS) APPLiCAtioN WorKSHoPConfirmation Number: 39559992

Presenter(s): Chester C. Alexander III Ms. Heather Kauffman Mr. Steve Rizner Mr. Russell Tilgner

Abstract: This 2-hour workshop is repeated. The purpose of the workshop is to provide attendees with an introductory look at the BDMS (LifeTrak) and its core capabilities as configured for the upcoming DoD implementation. Upon completion of this workshop, attendees will have a better understanding of system navigation; the features of the system; and the steps used to perform core tasks in BDMS such as donor registration and product manufacturing.

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Society Scopeobjectives: 1. Provide a tour of BDMS, including overview of the core features and system navigation. Attendees will be introduced to the new blood establishment computer software (BECS) and gain understanding of how new technology can improve current business practices at DoD Donor Centers2. Demonstrate how to register and process a donor at a blood drive. Attendees will see and understand quality assurance improvements for donor registration with new system.3. Demonstrate how to manufacture, store, and ship a blood product. Attendees will learn and be able to apply new concepts of product management and distribution with new system.

#29 Essentris 3D Mapping Standard operating ProcedureConfirmation Number:

Presenter(s): CAPT Cindy Wilkerson Col Bailey Mapp LTC (Ret) Michael Miller

Abstract: The current CHCS to Essentris unidirectional interface is built on a database that has to be manually mapped and maintained. Tests are mapped to an Essentris laboratory flowsheet by mapping an Essentris Database Item (DBI) to a CHCS lab test Internal Entry Number (IEN). The current mapping of only one data point is insufficient to ensure accurate mapping exists between the two systems. Other limitations also exist. For example, alpha results such as ‘QNS’ or ‘<’ or ‘>’ from CHCS are not accepted by Essentris when DBIs are set to “float”. This can change the meaning of lab results. The maximum character length of some DBIs is less than the maximum result length allowed by CHCS resulting in a truncated result displaying in Essentris. Essentris mapping should be based on more than one dimension (D) to address and correct identified patient safety issues. The current solution is 3D Mapping. It is based on mapping to three (3) data points: Test IEN, specimen source, and units of measure. It also changes all Essentris DBIs to character and expands the result length to exceed that allowed in CHCS. The Center for Clinical Laboratory Medicine (CCLM) and the Essentris laboratory specialty content advisory group (sCAG) has approved a standard lab flowsheet and summary screen and developed a 3D mapping Standard Operating Procedure. This allows for the implementation of a standardized/optimized display of Laboratory results within Essentris, validation accuracy of data transfer from CHCS and provides a detailed SOP for each hospital laboratory to follow when implementing Essentris 3D mapping.

objectives: 1. Explain the history of patient safety issues with current Essentris Laboratory Module.2. Explain rationale for 3D Mapping in Essentris.3. Present 3D Mapping Standard Operating Procedure.

4 Apr 12 (Wednesday)

1300-1500 2-Hour Workshops

#30 HCLL trANSfuSioN trAiNiNgConfirmation Number: 38704703

Presenter(s): Peggy Nemode, MT(ASCP) SBB

Abstract: The purpose of this workshop is to provide a general overview of the HCLL™ Transfusion system including an overview of the Active Patient, Testing, Product Fulfillment, Inventory and Quality modules. Upon the completion of this workshop, attendees will have a basic understanding of how to effectively process blood product orders as well as specimens and tests; and, how to effectively issue blood products using the HCLL™ Transfusion software. HCLL™ Transfusion is a 510(k)-cleared transfusion management system that will be deployed to MHS blood bank facilities. HCLL™ Transfusion is used by academic medical centers and integrated delivery networks throughout the

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Society ScopeUnited States including New York City Health and Hospital Corporation, NYU Medical Center, Massachusetts General Hospital, SSM Healthcare, Shands Healthcare, North Shore Long Island Jewish Health System, Iasis Healthcare, Exempla Healthcare, Oregon Health & Sciences University Hospital (OHSU) and Providence Health System. HCLL™ Transfusion aids in the management of single, multi-site, or centralized transfusion services. HCLL™ Transfusion addresses all transfusion services activities involved in registration and tracking of blood recipients and manufacture and distribution of blood and blood products. HCLL™ Transfusion also addresses all phases of transfusion services activities as specified by the College of American Pathologists (CAP), AABB (formerly known as the American Association of Blood Banks), FDA and the ASBP.

objectives: 1. Learn how to process blood product orders.2. Learn how to process specimens and tests.3. Learn how to effectively distribute blood products.

#31 A DiAgNoStiC JourNEyConfirmation Number: 38034271

Presenter(s): Col (Ret) Bill Huff Mr. Jason Roos

Abstract: This workshop is for anyone who performs diagnostic testing in a deployed field environment. The workshop will be conducted by representatives from the Joint Science and Technology Office-CBD, the Joint Program Executive Office-CBD, and the AF Surgeon General’s Office-Medical Modernization. Performing diagnostics in the deployed environment is fraught with operational challenges. There is disparity between methods and platforms for analyzing samples against infectious disease and biological warfare agents, there are different CONOPS, TTPs and SOPs that direct the testing and reporting of FDA approved and non-FDA approved assays; there is a disconnect in the ability of healthcare providers to order microbiological tests for routine versus biodefense agents, and more. Most of this burden falls on members of SAFMLS who serve as the front-line diagnostic community across these operational barriers. This has not gone unnoticed by the CBD program. Our offices are investing in research strategies to counter these threats through technical solutions that protect the force, provide medical countermeasures and develop rapid response capabilities. The workshop is intended to expand the horizons of medical laboratory scientists on the realm of technology possibility and stimulate ideas and cross-talk for emerging threats and technical solutions.

objectives: 1. State the approach to develop, acquire and field operational capability2. List current and future diagnostic systems.3. Identify operational challenges through open discussion.

#32 tHEAtEr BLooD APPLiCAtioN (AKA) EMoASConfirmation Number: 39624220

Presenter(s): Mr. Matt Rauls Ms. Olga Deviatkova LCDR Aaron Harding

Abstract: The Armed Services Blood Program Office (ASBPO) was established by the Assistant Secretary of Defense for Health Affairs to coordinate the blood programs of the Military Services and the Combatant Commands. ASBP facilities collect, manufacture, test and distribute blood products in support of world-wide military activities and operations. In this workshop, ASBP leaders will provide updates on performance improvement and business practice transformation initiatives currently taking place and will share the vision of the ASBP as we move into the future. Challenges, lessons learned, and success stories from blood operations in OND and OEF will be shared; providing attendees valuable information from real-life experiences. Information technology initiatives and strategies involving

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Society ScopeEMOAS, COTS blood donor/transfusion information management systems and BIP will be discussed.

objectives: 1. At the end of this workshop, the attendee should be able to describe the challenges, lessons learned and success stories from blood operations in OND and OEF.2. At the end of this workshop, the attendee should be able to discuss current ASBP information technology issues such as: EMOAS, COTS deployment, and BIP.3. At the end of this workshop, the attendee should be able to understand the way ahead for ASBP initiatives such as: frozen blood use/management and research and development.

#33 HoW to StArt AND MANAgE A CoNSuLtiNg PrACtiCEConfirmation Number: 39368738

Presenter(s): Col (Ret) Michael H. Caldwell

Abstract: This workshop will enable attendees to understand the key elements of becoming a consultant and manage a successful consulting practice. Area of emphasis will include: administrative, legal, taxation, marketing and psychological attributes of consulting. The presenter is founder and managing partner of The Strategic Partnership Group, LLC (circa 1998). SPG consist of a consortium of established consultants in the laboratory and biotechnology specialty.

objectives: 1. Attendees will understand the elements of consulting.2. Attendees will be able to identify their suitability for consulting.3. Attendees will be given tool and resources to manage a consulting practice.

#34 EMErgiNg iNfECtioNSConfirmation Number: 39515346

Presenter(s): COL Helen B. Viscount

Abstract: Emerging infectious diseases have captured the world’s attention. The threats of outbreaks and pandemics and the realization that new infectious diseases may be recognized at any time, in any place, have dramatically raised our awareness. Global travel and climate change alter the environment as ecosystems are disturbed and vector and host ranges shift. Just as diseases cross national boundaries, they transcend species barriers. Microbial threats that were near the edge of control or even eradication continue to be problematic. This workshop describes a few emerging disease threats that have spilled over from their wildlife reservoirs.

objectives: 1. List 3 emerging infections of bat origin.2. Describe 2 factors in the emergence of infectious diseases.3. Discuss a zoonotic infection.

1300-1730 4-Hour Workshops

#35 EffECtivE WritiNg for Air forCE LABorAtory offiCErSConfirmation Number: 38153258

Presenter(s): Maj Paul R Eden Maj Steven Dezell 1Lt Adam Irvin

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Society ScopeAbstract: As Air Force laboratory officers we are expected to lead our labs to mission success. Part of that success involves taking care of our careers and the careers of our Airmen and civilians. An important part of career advancement revolves around evaluations, promotions, and awards. This workshop has been designed by laboratory officers with executive officer experience. It will provide insight into the process of general drafting, formatting, reviewing, and coordinating the important documents that can make or break an Air Force career. The workshop will start out with a discussion on basic evaluation structure, bullet formatting, and push lines. The next discussion will lead into promotion recommendation forms and the basic components, process development and what makes up the best forms. Finally, the discussion will end with basic awards preparation, drafting and formatting for the win. Samples will be provided for each topic and crowd input and interaction is highly encouraged.

objectives: 1. Review basic OPR structure including bullet writing.2. Review format and template decoration and award writing.3. Discuss PRF generation including recent MLR observations.

#36 DoD CLiNiCAL LABorAtory iMProvEMENt ProgrAMConfirmation Number: 39279152

Presenter(s): COL Cathy Leppiaho

Abstract: The first half of the presentation will give an overview of the components of the DoD CLIP program. The second half of the presentation will cover the 1) procedures for placing PT orders for the upcoming calendar year and any subsequent modifications, 2) required response to a notification of PT failure from CCLM.

objectives: 1. At the end of this workshop, the attendee should be able to describe the components of DOD CLIP.2. At the end of this workshop, the attendee should be able to describe the procedures for ordering and modifying proficiency testing materials through the Center for Clinical Laboratory Medicine.3. At the end of this workshop, the attendee should be able to describe the required response to a notification of proficiency testing failure from CCLM.

#37 CASE StuDiES iN CLiNiCAL MiCroBioLogyConfirmation Number: 39441238

Presenter(s): LTC Wade Aldous LTC Carl Brinkley LTC Steven Mahlen CPT Brook Danboise CPT Samandra Demons CPT Christopher Hatcher CPT Anthony Jones CPT Nabil Latif 1LT Christine Hulseberg

Abstract: Clinical microbiologists and technologists continually encounter unusual or interesting cases involving microorganisms. In many cases, recovered microorganisms are unexpected, and may require both conventional and molecular methods for accurate identification. This workshop will focus on unusual microbiological cases and the techniques used for detection. Cases will be presented in an educational and informational format, and attendees will be able to more efficiently discern unusual aspects of clinical cases and determine what methods should be used to more accurately identify microorganisms.

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Society Scopeobjectives: 1. Associate laboratory and clinical findings with diseases caused by microbes.2. Learn how to enhance organism identification using different methods.3. Recognize unusual infectious disease processes and organisms.

#38 MEPrS: MorE tHAN JuSt tiMECArDSConfirmation Number:

Presenter(s): Deirdre Baker LTC Robert L. Nace

Abstract: This workshop is targeted towards junior lab officers and anyone new to the MEPRS reporting process. The primary purpose is to provide an overview of basic MEPRS concepts; MEPRS data sources, Applications and Data Quality implications; a basic working knowledge of EAS IV Repository and Business Objects; and how MEPRS and EAS IV data are being used at the enterprise level to perform analyses to support decision making and assess efficiency and productivity. Attendees will also learn how MEPRS and EAS IV data relates to their lab’s bottom line for both productivity and costs as well as discuss various tools available to monitor, validate and evaluate their laboratory’s data and performance. At the conclusion of the workshop, participants should have a basic understanding of the function and purpose of MEPRS and EASIV and how these can be used as tools for the ongoing management and assessment of their laboratory’s performance.

objectives: 1. Gain a better understanding of the MEPRS system.2. Gain a basic working knowledge of EASIV Repository and Business Objects.3. Gain an understanding of the relationships between MEPRS, EASIV and performance management and how these relates to lab management and the decision making process.

1530-1730 2-Hour Workshops

#39 LifEtrAK trAiNiNgConfirmation Number: 38704703

Presenter(s): Cindy Cullum

Abstract: The purpose of this workshop is to provide a general overview of the LifeTrak® system including key features for Registration, Donor Management, Testing, Recruiting, Labeling and Inventory Management. Upon the completion of this workshop, attendees will have a basic understanding of how to effectively register donors, process blood products and distribute blood products using LifeTrak®. LifeTrak® is a 510(k)-cleared blood establishment computer system (BECS) that will be deployed to MHS blood donor facilities. LifeTrak® is used by some of the largest blood center facilities in the world including organizations in the United States such as Carter BloodCare and the BloodCenter of Wisconsin. LifeTrak® meets or exceeds all FDA blood management donor services requirements. LifeTrak® supports the collection and processing of blood and blood products as specified by the College of American Pathologists (CAP), AABB (formerly known as the American Association of Blood Banks), FDA and the ASBP.

objectives: 1. Learn how to effectively register Donors.2. Learn how to effectively process blood products.3. Learn how to effectively distribute blood products.

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Society Scope#40 uSAMMDA AND NEW BLooD ProDuCtS CoMiNg to youConfirmation Number: 39475298

Presenter(s): COL Richard Gonzales Dr. Victor MacDonald

Abstract: This workshop is targeted for laboratorians who may find themselves deployed to a combat environment. The workshop will describe the mission of the US Army Medical Material Development Activity and how the organization brings products thru FDA approval and fielding. This workshop will describe new blood products under Advanced Development, their unique characteristics, method of employment to improve tactical Transfusion Medicine capabilities. New additive solutions for collection of blood (RBCXL), Freeze Dried Plasma, Cryo-Preserved Platelets, Whole Blood Pathogen Reduction and Rapid Transfusion Transmitted Disease Diagnostics will be characterized and their intended method of employment will be discussed.

objectives: 1. At the end of this workshop, attendees should be able to state the mission of the US Army Medical Material Development Activity.2. At the end of this workshop, attendees should be able to describe new blood products being developed for use in combat.3. At the of this workshop, attendees should be able to describe how the DOD is developing safer process for Fresh Whole Blood Collection in the prevention of Transfusion Transmitted Diseases.

#41 Af LAB CBrN StEEriNg CoMMittEE uPDAtEConfirmation Number: 39134127

Presenter(s): Col Patricia Reilly Maj Sean Chickery Dr. Elizabeth Macias, PhD

Abstract: The AF Laboratory Biodefense Steering Committee serves as an advisory body to AF/SG3 on issues related to laboratory biodefense. It is chartered to develop and facilitate expeditionary and fixed site homeland defense plans, projects and procedures. This workshop will update attendees on issues related to the Home Station Laboratory Response teams, the CDC Laboratory Response Network, JBAIDS/Next Generation Diagnostics System, proficiency testing, training and sustainment.

objectives: 1. Understand current AF Lab biodefense policy issues.2. List the most current initiatives affecting biodefense training, sustainment and proficiency testing.3. Understand lab LRN issues applicable to each facility.

#42 CASE rECorDS iN iNfECtiouS DiSEASESConfirmation Number: 39515346

Presenter(s): COL Helen B. Viscount CPT Michael Backlund MAJ Vanessa Melanson

Abstract: The interactive clinical case workshop will present patient cases seen in military MEDCENS. Cases will cover a variety of pathogens and will broaden knowledge on current microbiological techniques for diagnosis. Presentations will include patient history, clinical presentation, differential diagnosis, tests ordered and laboratory results. Presenters will discuss classic and molecular techniques for identification, any challenges that developed and lessons learned.

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Society ScopeAdditional discussion will include a brief review of the pathogen, its pathogenesis, clinical features, epidemiology and/or recommendations for prevention.

objectives: 1. Describe 3 diagnostic procedures to identify microbes.2. Discuss 2 recent advances in clinical microbiology.3. List 3 methods for antimicrobial susceptibility testing.

#43 DEvELoPMENt of A LABorAtory PErforMANCE/ProDuCtivity APPLiCAtioN uSiNg MiCroSoft ACCESS 2007Confirmation Number: 38700415

Presenter(s): LTC David A. Smith MAJ Kelly W. Wilhelms

Abstract: Microsoft Access 2007 was employed to develop an semi-automated Runtime Environment tool used to analyze data collected from CHCS, manual/automated quality metric entries, and DHMRSi information. The capabilities and functional use of this database are demonstrated to familiarize the audience with a newly developed tool that may be deployed and leveraged in quality management systems at other locations. The potential use of metrics and data collated in the system to improve quality processes and compare facility performance are discussed.

objectives: 1. Understand the functional use of three (3) major components of the Performance/Productivity Analysis Tool.2. Develop an understanding of the two (2) major components of productivity calculations using this tool.3. Familiarize with the quantitative and qualitative quality metric monitor analysis component.

#44 BLooD BANK WorKSHoP SPoNSorED By Bio-rADConfirmation Number: 38804898

Presenter(s): TBD

Abstract: TBD

objectives: 1. TBD2. TBD3. TBD

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Society Scope

Clinical Posters SAFMLS 2012C-1 AutHor: CPT Willie Agee, USA, MS; Carlos Barrera, CPT, USA, MS; Catherine Staege; George Kallstrom, MAJ, USA, MS. titLE: CHROMID STREPTO B IS MORE SENSITIVE THAN ACCUPROBE® STREPTOCOC-CUS ASSAY FOR DETECTION OF GROUP B STREPTOCOCCUS IN PREGNANT WOMEN. LoCAtioN: Tripler Army Medical Center, Honolulu, HI. ABStrACt: Group B Streptococcus (GBS) is a leading cause of meningitis, pneu-monia, and septicemia in infants. The Centers for Disease Control (CDC) and the American College of Gynecologists (ACOG) recommends that all women between 35 and 37 weeks of gestation be screened for vaginal and rectal coloniza-tion with GBS. Women who are colonized with GBS are treated with (antibiotics) intravenous penicillin prior to delivery. In this study we compared the ability of ChromIDTM Strepto B agar (bioMérieux, Inc) to overnight LIM enrichment broth culture followed by Accuprobe® Streptococcus Assay (GEN-PROBE, Inc) to detect GBS colonization in pregnant women. We hypothesized the molecular Accuprobe® Streptococcus Assay would be more sensitive than chromIDTM Strepto B agar in detecting GBS in pregnant women. However, we found that ChromIDTM Strepto B agar identified 10% more GBS than LIM enrichment/Accuprobe® Streptococcus Assay. We have changed our screening algorithm to perform ChromIDTM Strepto B agar culture in addition to traditional LIM enrichment broth culture/Accuprobe in order to maxi-mize our ability to detect GBS colonization in order to minimize the potential for GBS disease in newborns.

C-2 AutHor: Mr. Lou Banks1, M. Vaughn1, J. Gardner1, B. Harrel1, R. Wallace1, R. Crisp1, A. Pavia2, T. Bar-ney3, G. Alger3,2, J. Daly3,2; M. Rogatcheva1 titLE: Rapid Multi-target Detection of Gastrointestinal Pathogens in Patients Presenting with Diarrhea LoCAtioN: 1Idaho Technology Inc, Salt Lake City, UT, 2Univ. of Utah, Salt Lake City, UT, 3Primary Children’s Med. Ctr., Salt Lake City, UT. ABStrACt: The FilmArray® GI Detection System was developed for rapid simultaneous identification of a broad range of gastrointestinal (GI) pathogens including Food- and Waterborne Category B pathogens. Targeted organisms are viruses, protozoa, and bacteria including 5 diarrheagenic E. coli pathotypes. The performance of the FilmArray GI System was compared to conventional diagnostic methods using 118 residual pediatric stool specimens. FilmArray GI System testing was 97% (451/464) concordant with conventional methods and yielded a 26% positivity rate in previously undiagnosed specimens. Multi-target detection revealed multiple infections in about 30% of specimens with up to 5 pathogens in a single sample. The FilmArray GI System detected 43 additional pathogens in specimens where corresponding testing was not requested or not available. The FilmArray GI System may provide rapid and accurate detection of GI pathogens and improve treatment of patients presenting with diar-rhea.

C-3 AutHor: CPT Carlos Barrera titLE: Comparison of Two Commercially Available Automated ANA Screen-ing MethodsComparison of Two Commercially Available Automated ANA Screening Methods LoCAtioN: TRIPLER AMC, Honolulu, HI. ABStrACt: Background: Diagnosing systemic lupus erythematosus (SLE) can be challenging as laboratory screening methods, although sensitive, lack specificity. Purpose:To evaluate two screening assays to reduce the number of false positives while maintaining high sensitivity. Material and Methods: In this study we evaluated two immunoassays.We tested 391 consecutive serum specimens. All positive screening results were compared to immuno-flourescent ANA testing. A chart review was performed to determine clinical diagnosis. Results: Both automated assays we evaluated were perfectly sensitive in detecting patients with SLE. However, both test systems yielded a substantial number of false positive results. The QuantaLiteTM ANA ELISA was less specific than the AtheNA Multi-Lyte® ANA Test System, producing nearly 87.5% more false positive results. Based on our results we changed our algorithm in order to reduce the number of false positive results in our institution.

C-4 AutHor: Capt Karen Chisholm titLE: MACDILL AFB LABORATORY PATIENT WAIT TIME RAPID IM-PROVEMENT EVENT LoCAtioN: MacDill AFB, Valrico, FL. ABStrACt: Every laboratory is faced with monitor-ing patient wait times. At MacDill AFB, a move into a new facility brought unique challenges related to patient waiting times. Our laboratory conducted a Rapid Improvement Event to streamline and improve our efficiency in our specimen collections process. The poster depicts our process before the improvement and our outcomes after the recommendations of the Rapid Improvement Event.

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Society ScopeC-5 AutHor: CPT Vivian Cintron titLE: Evaluation of HPV-16 and HPV-18 Genotyping for the Triage of High-risk HPV- Positive Cytology-Negative Women (NILM) LoCAtioN: Roche Diagnostics, Indianapolis, IN. ABStrACt: The ATHENA HPV study evaluated the clinical utility of the cobas® HPV Test for high-risk human papillomavirus (HR-HPV) testing (14 high-risk types) and individual HPV-16/HPV-18 genotyping in women undergoing routine cervical cy-tology screening in the United States. 47,208 women were recruited, including 32,260 women aged 30 years or older with negative cytology (NILM). All those testing positive for HR-HPV (n=4,219) plus a subset of HR-HPV– women (n=886) were referred for colposcopy and biopsy. The overall prevalence of HR-HPV was 6.7% and of HPV-16/HPV-18 was 1.5%. Cervical intraepithelial neoplasia grade 2 (CIN 2) or worse was found in 1.2% of women examined. The estimated absolute risk of CIN 2 or worse in HPV-16+ and/or HPV-18+ women was 11.4% (95% CI, 8.4–14.8) compared with 6.1% (95% CI, 4.9–7.2) in HR-HPV+ and 0.8% (95% CI, 0.3–1.5) in HR-HPV– women.

C-6 AutHor: CPT Matt Cooley titLE: Arsenic Exposure LoCAtioN: Madigan Army Medical Center, Dupont, WA. ABStrACt: Arsenic is a metalloid that may form numerous compounds that may lead varying degrees of toxicity depending on its form. Arsenic fractionation allows clinicians to determine if the arsenic source is organic or inorganic. Severity and source of arsenic exposure can then be determined. Several inorganic arsenic compounds have common industrial uses. Organic arsenic compounds are naturally occurring and found in marine organisms. A husband and wife presented to their physician with difficulty maintaining balance and dizziness. The husband was referred to Neurology and 24hour urine for heavy metal analysis was collected. Urine arsenic fractionation was ordered to further investigate. C-7 AutHor: CPT Brooke Danboise titLE: CLINICAL DIAGNOSIS OF TRICHOMONAS VAGINALIS Lo-CAtioN: Ft Bragg, Ft Bragg, NC. ABStrACt: Trichomonas vaginalis (T. vag), the most prevalent sexually transmitted disease, is responsible for 180 million cases annually. Infection and delayed diagnosis create an increase in risk for certain types of cancer and impacts male and female reproductive health. Over 200 random specimens collected from symptom-atic and asymptomatic women were compared using the recent FDA approved APTIMA assay, a nucleic acid amplifica-tion assay targeting T. vag rRNA against the cost effective wet mount method. Diagnosis of T. vag increased with the use of NAAT testing; 3% of samples tested using APTIMA were positive for T. vag compared to 1% using wet mount. Sensi-tivity of microscopic wet mounts were compared with APTIMA results, sensitivity was 40%. The significant increase in detection coupled with increased sensitivity supports the use of the APTIMA assay for clinical diagnosis of T. vaginalis.

C-8 AutHor: 1LT Alan Vaughn and SFC Ryan Doutt titLE: The Journey of a Downrange Sample LoCAtioN: LRMC, APO, . ABStrACt: The life of a “send out” downrange laboratory sample has evolved just as much as health-care practices in our theater of operations. During the multiple troop surges, it was clear that the OCONUS laboratory mission had transformed into direct theater medical support for hospitals and bases in Iraq, Afghanistan and SW Asia as opposed to medical assistance. As Providers were asked to treat more complex medical cases without patient evacuation, Landstuhl stepped up to the challenge to become the sole referral lab for the multiple theaters. At the peak of the surge, the laboratory was processing over 2,500 specimens monthly. See a snapshot of the trials, errors and developments that have made the current system for “downrange” laboratory samples a success. Walk away with a basic knowledge of the process and challenges of handling reference samples that you may encounter while deployed.

C-9 AutHor: 1LT Christine Hulseberg titLE: DEVELOPMENT AND VALIDATION OF A MULTIPLEX REAL-TIME PCR ASSAY FOR DETECTION AND DIFFERENTIATION OF Bordetella SPECIES LoCAtioN: Madigan Army Medical Center, Ft. Lewis, WA. ABStrACt: The diagnosis of pertussis infection requires an assay that is both sensitive. Common targets for many Bordetella spp. PCR assays are the chromosomal insertion sequences, IS481 and IS1001, which are found in high-copy number in B. pertussis and B. parapertussis, respectively. However, because these sequences may also be present in isolates of B. holmesii and B. bronchiseptica, it is necessary to include additional targets in order to correctly speciate Bordetella in clinical specimens. Therefore, we selected two additional primer-probe sets targeting different regions of the pertussis toxin promoter which allows for the resolution of all four clinically relevant Bordetella spp. We tested 28 clinical Bordetella samples previously identified by the Washington Public Health Labora-tory to validate our assay. In addition to attaining a 100% correlation with their results, we established a limit of detection for B. pertussis that was eight times more sensitive than culture.

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Society ScopeC-10 AutHor: SSG Raymond Manalo titLE: Can Point of Care instruments accurately assess analytes in non-blood matrices traditionally evaluated by FDA approved analytical platforms? LoCAtioN: A CO TAMC, Tripler AMC, HI. ABStrACt: Deployed medical units must provide quality care with limited resources. POCT devices are whole-blood based FDA approved assays. However, synovial, pleural, or cerebrospinal fluid are not FDA cleared for POCT. These laws do not apply to deployed units. This study evaluates the accuracy of non-serum samples on POCT devices. This study illustrates the potential testing impacts for deployed units through expanded use of POCT devices.

C-11 AutHor: 1LT Jacquelyn Messenger titLE: Establishing a Community Based Medical Home Laboratory Lo-CAtioN: Madigan Healthcare System, Tacoma, WA. ABStrACt: The community based medical home model was de-signed to bring patient centered medicine to the outlining communities in order to better facilitate the military community and their families. One of the large advantages of this model is the ability to offer all healthcare services in one central-ized location. Laboratory services, a vital part in assessing and treating most medical conditions, is one of the healthcare services that this model brings to the community. This presentation will identify the fundamental aspects necessary to establish a community based medical home laboratory as well as lessons learned for future clinics.

C-12 AutHor: LT Babatunde Oloyede, James Rohrer, PhD, and Nancy Rea. titLE: Impact of a Hand Hygiene Intervention on the Risk of Transmitting a Positive Methicillin-Resistant Staphylococcus aureus Culture LoCAtioN: USPHS, Butner, NC. ABStrACt: Purpose: The purpose of the study was to test the effectiveness of placing hand-hygiene products in patient rooms on positive MRSA cultures on the hands of health care workers. Methods: This study used an experimental, single-site intervention. The final sample was composed of 97 people over 18 years of age. Results: Hand hygiene intervention aimed to impact the incidence of MRSA positive culture on the hands of health care workers was supported by the results of this study that there was a statistical difference between the intervention group and the comparison group. Employees exposed to the hand hygiene products were less likely to have positive cultures Conclu-sions: This study challenges the premise that the low incidences of MRSA in health care workers’ hands was achieved by the introduction of the approved hand hygiene products in patient rooms, which allows proximity, and easy access.

C-13 AutHor: Col Joseph Pelletier titLE: WORKFLOW ASSESSMENT PRIOR TO IMPLEMENTATION OF A DIGITAL PATHOLOGY SYSTEM WITHIN AFMS PATHOLOGY: IDENTIFY NEEDS AND WORK PRACTICES LoCAtioN: 59 MDW/LSQ/SGVLH, Lackland AFB, TX. ABStrACt: Background: Digital pathology (DP) is defined as the scanning of whole glass slides into whole digitalized slide images with a total digital environment for managing and interpreting pathology information contained in the digitalized slides. Recent advances in DP are accelerating a move towards wide spread adoption and implementation of DP in anatomic pathology practices. UPMC is supporting Air Force Medical Service (AFMS) efforts to adopt DP into its pathology practice.Objective: To optimize the implementation of a DP system, knowledge about the unique needs of the AFMS pathologist and AFMS pathology system is required. Prior studies have identified the needs of the pathologist/pathology laboratory in civilian academic medical settings; however, the needs may differ in the unique military/AFMS medical settings. Methods: Contextual Inquiry (CI) is a method for collecting, interpreting, and aggregating qualitative data about work. Results: A total of 22 pathologists, 4 residents, and 7 histotechs were observed. A total of 1132 affinity notes were documented. Notes were generalized into statements and grouped into 27 second level, 9 first level, and finally 5 main level categories including Communication, Military Culture, Quality, Technology, and Workflow and Workload Distribution. Analysis of the data showed that many of the needs of AFMS pathologists are similar to the needs of civilian pathologists, including the need to deliver accurate diagnosis in a timely manner, track and manage cases, consult with other pathologists, communicate effectively with clinicians, and con-duct quality assurance. However, other needs of AFMS pathology system are different than the civilian pathology system. The main differences are their need to serve a large patient population distributed across the globe and their unique staff-ing challenges (i.e., difficultly predicting long-term staffing needs due to lengthy time required to recruit and train new pathologists in conjunction with difficulty predicting the number of currently enlisted AFMS pathologists that will choose to serve beyond their required commitment to the military). Conclusions: Adoption of digital pathology will be highly beneficial and transformative for AFMS pathology. AFMS pathologists and the AFMS pathology system may benefit more than their civilian counterparts due to their unique practice requirements and need for global workload distribution. The CI findings were used to establish key requirements for a DP system that will ensure future wide adoption into AFMS pathol-ogy practice.

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Society ScopeC-14 AutHor: Capt Anthony Polito titLE: Application of Lean Manufacturing Principles to Laboratory Opera-tions LoCAtioN: Wilford Hall Ambulatory Surgical Center, San Antonio, TX. ABStrACt: “Lean” manufacturing originated in Toyota factories in 1960s, today Lean practices are used in all industries including healthcare. Lean assists in the elimination of “muda” (waste). This creates processes that need less human effort, space, capital, and time with much fewer defects. Essentially, Lean is centered creating more value with less work and fewer resources. Value Stream Mapping, poka-yoke and the 6 Ss were applied to determine if Lean would enhance Lab processes. This resulted in a reduction in many forms of waste. For example wasted motion was reduced by up to 46%. Evaluating 4 processes the modifications resulted in a reduction of 122 miles per year. All of these Lean modifications combined had a synergistic effect resulting in a 75% increase in efficiency, decreased Cycle Time and virtual elimination of process related defects. This study suggests that the application Lean to Lab departments could create more value for our customers with less work and fewer resources.

C-15 AutHor: Mr. Gary Uzzell titLE: Clinical evaluation of the JBAIDS Influenza A & B Detection Kit and JBAIDS Influenza A Subtyping Kit LoCAtioN: Idaho Technology, Inc., Salt Lake City, UT. ABStrACt: In order to be effective, the Joint Biological Agent Identification and Diagnostic System (JBAIDS) Influenza A & B Detection Kit and JBAIDS Influenza A Subtyping Kit must demonstrate a high degree of sensitivity (detecting influenza viruses when they are present) and specificity (giving negative results when influenza viruses are not present). The aim of this study was to establish clinical sensitivity and specificity of the JBAIDS kits when testing nasopharyngeal swabs (NPS) or nasopha-ryngeal washes (NPW) obtained from individuals with influenza like illness (ILI). Respiratory specimens were analyzed from over 800 subjects suspected of influenza infections or presenting with influenza-like illness (ILI) at five geographi-cally distinct U.S. sites during the 2010/2011 influenza season (December through April). Due to the lack of circulating seasonal influenza A H1, additional archived and contrived clinical specimens were used to evaluate this analyte. The specimens were first purified using either the IT 1-2-3™ Platinum Path Sample Purification kit or Roche MagNA Pure Compact Nucleic Acid Isolation kit I and then tested using the JBAIDS assays. Each specimen was also analyzed using the Centers for Disease Control and Prevention (CDC) Human Influenza Virus Real-time RT-PCR Detection and Charac-terization Panel (rRT-PCR Flu Panel) and influenza A positives were further analyzed with subtype-specific PCR followed by bi-directional sequencing as a comparator assay. Positive percent agreement (PPA) and negative percent agreement (NPA) between the JBAIDS system and comparator testing results were calculated for each analyte. PPA for all JBAIDS influenza assays in both sample types using both purification methods was greater than 99%. NPA was at least 93% for all assays in both matrixes using both purification methods. This study demonstrated that the JBAIDS Influenza A & B Detection Kit and JBAIDS Influenza A Subtyping Kit are robust, highly sensitive, and highly specific in vitro diagnostic devices for the detection of influenza viruses.

C-16 AutHor: LTC Chunlin Zhang titLE: Intra-genotypic variation of predominant genotype II strains of dengue type-3 virus isolated during different epidemics in Thailand from 1973-2001 LoCAtioN: AMEDD Student Detachment, Fort Sam Houston, TX. ABStrACt: A comparative analysis of the complete genomic sequences of 28 DENV-3 predom-inant genotype II strains previously collected during different DENV-3 epidemics in Thailand from 1973 to 2001 was per-formed to define mutations that might correlate with virulence, transmission frequency and epidemiological impact. The results revealed (1) forty amino acid and seven nucleotide substitutions adopted and fixed in the virus genome after their initial substitutions over the nearly 30-year sampling period; (2) the presence of more amino acid and nucleotide substitu-tions in recent virus isolates compared with earlier isolates; (3) six amino acid substitutions in capsid (C), pre-membrane (prM), envelope (E), and nonstructural (NS) proteins NS4B and NS5, which appeared to be associated with periods of high DENV-3 epidemic activity; (4) the highest degree of conservation in C, NS2B and the 5’-untranslated region (UTR); and (5) the highest percentage of amino acid substitutions in NS2A protein.

C-17 AutHor: 1LT Elizabeth Delaney titLE: Evaluation of the IDS-ISYS Total 25-OH Vitamin D Assay for Use at Madigan Healthcare System LoCAtioN: Madigan Healthcare System, Tacoma, WA. ABStrACt: Serum concentra-tion of 25-Hydroxy Vitamin D (25-OHD) is considered to be the most reliable measure of overall vitamin D status and is commonly used to determine vitamin D sufficiency. A variety of methods are used to measure 25-OHD, such as immu-noassay and chromatography. The IDS-iSYS 25-Hydroxy Vitamin D Assay (IDS-iSYS 25-OHD) is a chemiluminescent assay intended for quantitative determination of total 25-OHD to include other hydroxylated metabolites in human serum or plasma on the IDS-iSYS automated analyzer. In pursuit of reduced reference testing costs, the Department of Patholo-

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Society Scopegy at Madigan Healthcare System has evaluated the performance characteristics of this assay and its associated analytical platform (IDS-iSYS) in contrast to results obtained using the current reference method of Liquid Chromatography/Tan-dem Mass Spectrometry (LC/MS/MS). A summary of this evaluation is presented. Benefits and pitfalls are discussed.

C-18 AutHor: CPT Mary Guyton, CPT Uma Ramadorai, Dr. James McPherson. titLE: FAR-FORWARD THER-APY TO PREVENT OSTEOMYELITIS IN OPEN FRACTURE WOUNDS LoCAtioN: Dept of Clinical Investiga-tions, Fort Gordon, GA. ABStrACt: Open fracture injuries (OFI) are a major combat casualty for US military and pathogenic bacteria carried by projectiles may lead to osteomyelitis (OM). The purpose of this study was to determine if local administration of bone seeking antibiotics bound to nanoparticles can decrease OM development or severity. We hypothesized that E41 [ciprofloxacin (antibiotic) + bisphosphonate (bone targeting)] bound to NanOssTM (bone resorb-ing) would reduce OM in an OFI. Briefly, a tibial OFI was induced and inoculated with S aureus to produce OM. Ani-mals were divided into untreated groups or E41-NanOss was applied locally 30 minutes after inoculation. While 100% rats with untreated tibiae were infected (24 hours), 84% of E41-NanOss treated tibiae were sterile (p<0.01). Treatment also significantly decreased bacteria loads and gross pathology scores (day 21). These studies indicate that E41-NanOss may be a far-forward therapy for the prevention and treatment of OM following OFI.

Research Posters SAFMLS 2012r-1 AutHor: MAJ Jason DeBoer, Belshan, Michael, PhD. titLE: DEVELOPMENT OF AN IN-VITRO NUCLE-AR IMPORT ASSAY USING INTACT HIV CORES LoCAtioN: Creighton University, Papillion, NE. ABStrACt: Nuclear import of the viral genome is essential for productive HIV infection, however, this process is poorly understood. This study examined optimization methods in isolating intact GFP-labeled HIV viral cores for nuclear binding and viral import experiments. HIV-1 cores were labeled by co-transfection of pNLX with GFP/HIV-1 Vpr protein construct. 293T cells were transfected with the GFP/pNLX clone, cultured and supernatants collected. Virions were concentrated and cores isolated by a modified equilibrium sucrose density gradient using varying concentrations of detergent and multiple buffer solutions. Sedimentation of virions and cores were determined by Western Blot and presence of viral RNA deter-mined by real-time RT-PCR. These studies demonstrate that density gradients containing buffers without divalent cations and detergent concentrations < 1% are most effective in isolating intact HIV-1 GFP-cores. Additional studies on gradient formulation and the use of EDTA are planned.

r-2 AutHorS: Maj Steven Dezell, MS, Yong-Oon Ahn, PhD, Scott Jackson, MS, Jeffrey S. Miller M.D., Michael R. Verneris, M.D. titLE: Comparative Analysis of Heparin Based Versus Stromal Cell Supported Methods for Natural Killer Cell Generation from Umbilical Cord Blood Stem Cells LoCAtioN: University of Minnesota, Minneapolis, MN. ABStrACt: Cell therapy utilizing adoptive Natural Killer (NK) cell transfusion has been proven to be effective for killing acute myeloid leukemia (AML). Developing a stromal cell supported method (stroma method) that can grow NK cells for clinical trials has many costly regulatory hurdles. These hurdles can be bypassed by eliminating stromal cells and using a clinical grade heparin based media (heparin method). Here we show that a heparin method can be just as effective at developing hematopoietic stem cells (HSC) into NK cells when compared with the standard stroma method. We com-pared both methods phenotypically and functionally utilizing magnetic bead separation, antibody staining, flow cytometry, cytokines, and killing assays. Collectively, these studies show that the heparin method can be an effective replacement for the stroma method. This research brings us closer to a clinical trial utilizing the heparin method to grow NK cells for adoptive NK cell transfusion into AML patients.

r-3 AutHor: Maj Paul Eden titLE: Association of organochlorine compound body burden and adipokines with prevalence of Type 2 diabetes mellitus LoCAtioN: Mississippi State University, Starkville, MS. ABStrACt: Most organochlorine (OC) insecticides have been banned for over 30 years in the United States but still bioaccumulate in blood and adipose tissue. The OC compounds p,p’-DDE, transnonachlor, and oxychlordane, have been associated with increased prevalence of Type 2 diabetes mellitus (T2DM). This study examined 149 T2DM and 151 non-diabetic subjects for OC compounds as well as adipose cytokines. In addition, inflammatory markers associated with increased T2DM prevalence were measured on non-diabetic subjects. Overall 81% of subjects had measurable concentrations of at least one of the

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Society Scopestudied OC compounds. DDE was significantly higher in T2DM subjects (319.0 ± 40.6 ng/g) than in non-diabetic sub-jects (139.0± 19.2 ng/g), p<0.01. The inflammatory marker MCP-1 was significantly associated with higher DDE levels (p=0.01) as was leptin (p=0.001). The OC compound levels as well as adipose and inflammatory marker testing support the association of higher OC body burden with T2DM development.

r-4 ABStrACt: CPT Richard Foucault, Cyril Ronco, Geoffroy Sorin, Florian Nachon, Ludovic Jean, Anthony Romieu,Pierre-Yves Renard titLE: SYNTHESIS AND STRUCTURE –ACTIVITY RELATIONSHIP OF HUPRINE DERIVATIVES AS HUMAN ACETYLCHOLINESTERASE INHIBITORS LoCAtioN: Dwight David Army Medi-cal Center, Augusta, GA. ABStrACt: New series of Huprine (12-amino-6,7,10,11-tetrahydro-7,11-methanocycloocta[b]quinolines) derivatives have been synthesized and their inhibiting activities toward recombinant human acetylcholinest-erase (rh-AChE) are reported. We have synthesized two series of Huprine analogues; in the first one, the benzene ring of the quinoline moiety has been replaced by different heterocycles or electron-withdrawing or electron-donating substituted phenyl group. The second one has been designed in order to evaluate the influence of modification at position 12 where different short linkers have been introduced on the Huprine X, Y skeletons. All these molecules have been prepared from ethyl- or methyl-bicyclo[3.3.1]non-6-en-3-one via Friedländer reaction involving selected o-aminocyano aromatic com-pounds. The synthesis of two heterodimers based on these Huprines has been also reported. Activities from moderate to same range than the most active Huprines X and Y taken as references have been obtained, the most potent analogue being about three times less active than parent Huprines X and Y. Topologic data have been inferred from molecular dockings and variations of activity between the different linkers suggest future structural modifications for activity improvement.

r-5 AutHor: MAJ Bryan Gnade , Allen Mueller, Helen Freyberger, Dipali Patel, Stacy Crawford, Mikeljon P. Nikolich, and Carmen M. Fernandez-Prada titLE: Aerosol challenge of wild-type C57Bl/6 mice with Francisella tular-ensis SchuS4 and LVS strains LoCAtioN: Walter Reed Army Institute of Research, Silver Spring, MD. ABStrACt: F. tularensis appears to have developed ways to suppress the pulmonary immune response by mechanisms not well under-stood. In this study C57Bl/6 mice were challenged by aerosol with LVS and SchuS4 to determine the LD50 for these F. tularensis strains. The LD50 for LVS following aerosol challenge was 1575 and 2680 cfu for experiment 1 and 2 respec-tively, while the LD50 for SchuS4 was 72 and 69 for experiment 1 and 2 respectively. When body, lungs and lung/body ratio weights of mice succumbing to infection with SchuS4 and LVS were compared, the differences were statistically significant. The average weight loss was higher for mice infected with LVS than those infected with SchuS4. However, lung weights of LVS groups had a higher increase compared to SchuS4 (p<0.003). The present study presents a model for future studies of the respiratory form of tularemia and to investigate the immunosuppressive mechanisms exhibited by this pathogen in the lung.

r-6 AutHor: SSG Orlando Hernandez, Rodolfo DeGuzman, Amy Polykratis, M. Dale Prince, Shanelle D. McNair, Jill L. Sondeen. titLE: THE EFFECTS OF LEUKOREDUCTION POLYURETHANE ON BLOOD COMPONENTS AND CLOTTING FACTORS IN PORCINE BLOOD LoCAtioN: Institute of Surgical Research, Fort Sam Houston, TX. ABStrACt: Leukocyte reduced blood and blood products have played an important role in reducing blood transfu-sion reactions. One of the methods applied for leukocyte depletion is whole blood (WB) filtration. The primary objective of our study was to determine the effect of clotting factor activity in plasma produced from swine WB before and after exposure to polyurethane filters. The secondary objective was to evaluate the plasma quality after whole-blood filtration in terms of leukoreduction and platelet reduction capacity. Sixteen units of whole blood were collected from anesthetized female Yorkshire-cross swine into 500-mL blood bags containing 70 mL of CPD anticoagulant with an incorporated whole blood filter. Two pre-filtration and two post-filtration samples of whole blood were drawn from each of the 16 units for cell count and coagulation assays. A paired t-test was performed to determine differences between pre and post filtra-tion samples, with p<0.05 considered significant. . Data are given as means ± SEM. There were no significant differences in hemoglobin, hematocrit or red blood cell values between the pre and the post samples. Leukocyte and platelet counts in the pre-filter sample were significantly reduced by filtration. There were no significant differences in all clotting factors between the pre and the post samples. We concluded that filtration of whole blood using the Terumo Imuflex filter pro-vides a good method for the production of leukocyte and platelet depleted whole blood and plasma without compromising coagulation factors.

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Society Scoper-7 AutHor: MAJ Edwin Kamau titLE: Development of a TaqMan Allelic Discrimination Assay for detection of Single Nucleotides Polymorphisms associated with anti-malarial drug resistance LoCAtioN: WRAIR, Silver Spring, MD. ABStrACt: Anti-malarial drug resistance poses a threat to current global efforts towards control and elimination of malaria. Several methods are used in analysis of SNP associated with anti-malarial drug resistance. However, there is still need to improve and/or develop new methods that will close the gap found in the current methods. TaqMan Allelic Discrimination assay for detection of SNPs associated with anti-malarial drug resistance was developed. To test the sensi-tivity and specificity of each SNP assay, 12 clinical samples were sequenced at codons of interest and used in the analysis. Plasmid DNAs were used to LoD for each assay. The sensitivity and specificity of each SNP assay was establish at 100%. LoD for each assay was established at less than 1 parasite/μL. SNP assays performed well in detecting mixed infection and analysis of clinical samples. TaqMan Allelic Discrimination assay provides a good alternative tool in detection of SNPs associated with anti-malarial drug.

r-8 AutHor: CPT David Kingery titLE: HOST PLATELET-DERIVED GROWTH FACTOR RECEPTOR BETA AS A THERAPEUTIC TARGET FOR NEW WORLD ALPHAVIRUS INFECTION LoCAtioN: USAMRIID, Fort Detrick, MD. ABStrACt: Alphaviruses are highly pathogenic to humans and are classified by the CDC as Category B select agents for their potential to pose a threat to public health. Our laboratory goal is to find drug-like small molecule therapeutics and our studies are guided by the following hypothesis: We can perform large scale screens of available compound libraries to find lead anti-virals for alphaviruses. We tested our hypothesis using three representative New World alphaviruses. After in cellulo screening and dose-response experiments, the narrowed candidate list had a signifi-cant subset of compounds that target receptor tyrosine kinases (RTKs). The host target of the best hit was PDGFR-β and its knockdown by siRNA inhibited viral infection. Current experiments are characterizing the host PDGFR-β response to viral challenge. This work demonstrates that PDGFR-β plays a role in the ability of New World alphaviruses to infect host cells and may be a broad spectrum target for combination therapies.

r-9 AutHor: CPT BC Kirkup Jr., EM Wood, JK Moon, L Biggeman, AM Summers, MAJ CC Black titLE: Rat Model of Traumatic Wound Infection LoCAtioN: Walter Reed Army Institute of Research, Silver Spring, MD. AB-StrACt: Traumatic wound infection animal models have historically failed because the animals do not become reliably infected without some other, exogenous, unrealistic insult. A new rat model is under development to allow for the study of realistic traumatic wound infections. The rat model has been built upon clinical observations of factors which worsen outcomes in trauma, particularly proximal nerve and vascular disruption and total level of hemorrhage, even when com-pensated for by transfusion. Transfusion of fresh leukodepleted blood is provided to the animal immediately following blood withdrawal. The model is supported by continuous data monitoring of blood pressure, pulse, and temperature oc-curs an abdominally implanted radio transmitting probe. As of this time, survival through the surgery has become routine. Some infection data from early pilot studies has been analyzed; it showed a partially reproducible pattern of polymicrobial colonization and healing across four animals. Staphylococci are the dominant flora prior to wounding and during late heal-ing; in three animals, Streptococci become prominent in the wounds prior to healing.

r-10 AutHor: TSgt Avri McKnight titLE: Exploring Orexin A as a BioMarker of Cognition LoCAtioN: 711 Human Performance Wing, WPAFB, OH. ABStrACt: Determine the relationship between fluctuating changes in Orex-in A, measured in blood and saliva, and changes in vigilance performance using biochemical analysis (ELISA or Western Analysis) and will be correlated with vigilance performance.

r-11 AutHor: CPT Vanessa Melanson, Nathan Grubaugh, Lawrence Petz, Lewis Long, Sarah Pisarcik, Monica O’Guinn, and John Lee. titLE: Oligonucleotide Microarrays for Detection and Confirmation of Arboviral Pathogens in the Field LoCAtioN: Walter Reed Army Institute of Research, Silver Spring, MD. ABStrACt: With the emergence and re-emergence of arthropod-borne disease throughout the world, it is critical to be able to detect arthropod-transmitted pathogens in a timely manner. Standardized field-diagnostic protocols for identifying arthropod-borne pathogens within any given region of the world are indispensable tools for obtaining real-time information for health-care providers and preventive medicine specialists in field settings. Arboviruses are responsible for major outbreaks of acute, febrile disease throughout most areas of the world. Here we report the development and filed-testing of an oligonucleotide microarray for the detection and confirmation of arboviruses in pools of field collected mosquitoes. During the field evaluation, mosquito pools were screened by using generic PCR assays and then by using virus-specific real-time PCR assays. The phyloge-

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Society Scopenetic relationships among these viruses, their mosquito hosts, and their possible role in causing human disease are also presented.

r-12 AutHor: MAJ Jean Muderhwa titLE: FORMULATION DEVELOPMENT OF ALCOHOL-FREE OIL-IN-WATER MICROEMULSIONS AS POTENTIAL ADJUVANTS AND VEHICLES FOR VACCINES LoCAtioN: Brooke Army Medical Center, Fort Sam Houston, TX. ABStrACt: An alcohol-free, oil-in-water micro-emulsion was formulated with mineral oil and Span 80/Tween 60 as surfactant system. Using glycerol as co-surfactant, the amount of water solubilized depended on the surfactant system to glycerol ratio, the oil chain length, the oil content and the salinity of the water. With this system, one can formulate an isotropic, shear thinning dispersion containing 20% (w/w) of min-eral oil and up to 25% (w/w) of water at surfactant to glycerol ratio of 0.50. Interestingly, the inclusion of prototypical model antigens, such as conalbumin and lysozyme, at immunizing dose of 0.025 mg/ml did not affect the formation or the stability of the micro-emulsions. Likewise, addition of aluminum adjuvants, such as aluminum hydroxide and aluminum phosphate, at a dose of 1 mg/ml did not have an effect either. Overall, the results suggest that these dispersions have the potential of being versatile adjuvants and carriers for vaccine in a composite adjuvant formulation.

r-13 AutHor: Ms Kassie Pfluger titLE: Time and Temperature Stability of In Vitro Red Blood Cell-Acetylcholin-esterase LoCAtioN: PHCR-S, San Antonio, TX. ABStrACt: The Department of Defense Cholinesterase Reference Laboratory at the Public Health Command Region-South monitors red blood cell cholinesterase (RBC-ChE) activity for occupational health surveillance. Since enzymes retain different activities outside the body, information about the in vitro stability of RBC-ChE over time at various environmental conditions becomes critical. A time and temperature stability study monitored the stability of RBC-ChE for 30 days at seven different temperature conditions in order to develop ef-fective processing, shipping, and handling procedures for specimens. Storage temperatures evaluated include: -20, 4, 10, 25, 37, and 55°C. Repeated freezing and thawing was also examined for effects on RBC-ChE activity. The results of this study suggests specimens exposed to a maximum temperature of 10°C and minimum temp of -20°C for 30 days are stable. Results from specimens subjected to temperature >37°C or repeated freeze/thaw cycles were unreliable.

r-14 AutHor: CPT Ken Nguyen titLE: THE ROLE OF T CELLS IN SHIGELLA VACCINE DEVELOPMENT LoCAtioN: Walter Reed Army Institute of Research, Silver Spring, MD. ABStrACt: The Shigella ssp. bacteria are food borne pathogens that cause severe bacterial dysentery and are a major threat to the military health care system. Our primary goals are to develop live-attenuated vaccines against Shigella. Great efforts have been made throughout the military and private sectors for the past several decades; however, effective vaccines remain in their infancy. Two of the greatest challenges in the generation of such vaccines are that current vaccines fail to elicit effective T-cell meditated immune responses and these vaccines are serotype specific. To circumvent these challenges, we investigate the molecu-lar mechanisms that control T cell activation and the role of T cells following Shigella infections. We show that the actin cytoskeletons and integrins cooperatively sensitize T cell responses to antigen by prolonging signal transduction.

r-15 AutHor: MAJ Tony Pierson titLE: Effect of Cigarette Smoke on Antimicrobial Peptide Gene Expression in A549 Lung Epithelial Cells LoCAtioN: WRAIR, Silver Springs, MD. ABStrACt: This study measures the in vitro antimicrobial peptide (AMP) gene expression of both novel and new AMPs in A549 lung epithelial cells exposed to ciga-rette smoke. AMPs are part of the innate immune response to infection, and alterations in antimicrobial peptide produc-tion may lead to an altered immune response to infection. In the current study, we use real time reverse transcriptase PCR to measure mRNA production in a class of HBDs called Human Beta Defensins (hBDs). We tested the following hBDs; 1-6, 8,9,18 as well as the cathelicidin LL-37 (another class of AMPs). We further use fluorescent microscopy to visualize antimicrobial peptide production within cells. Our data suggests that changes in AMP gene expression leads to changes in protein production. We further hypothesize that these changes may play a role in the pathological effect observed in smok-ers.

r-16 AutHor: MAJ Tony Pierson titLE: Applied and Theoretical use of Francisella Outer Membrane Vesicles in Human and Fish Vaccine Development LoCAtioN: WRAIR, Silver Springs, MD. ABStrACt: F. tularensis is a high-ly infectious gram negative bacterium which causes tularemia. F. tularensis is a potential biothreat agent due to its ease of transmission and low infectious dose. We recently demonstrated that Francisella produces outer membrane vesicles (OMVs). With the ultimate goal of developing a human Francisella vaccine, our experimental data characterizes Franci-

39

Society Scopesella OMVs and demonstrates that they can be protective as a vaccine in a mouse model. Francisellosis is also an emer-gent naturally occurring threat to farm raised fish, and is responsible for millions of dollars of crop losses. We extrapolate on our mouse data as well as other recently published data to present a novel hypothesis that Francisella derived OMVs could be used in the development of a Francisella vaccine for farm raised fish. Development of a fish vaccine would also provide data from an additional vertebrate model to reinforce the original hypothesis that OMVs could be used to vacci-nate humans as well.

r-17 AutHor: CPT Matthew Riley titLE: Reducing cost and increasing throughput of whole genome optical map-ping technology LoCAtioN: Walter Reed Army Institute of Research, Silver Spring, MD. ABStrACt: Whole genome optical mapping has been used in a variety of studies that have had a scientific impact on our understanding of infectious agents. However, commercial services are prohibitively expensive and standard protocols for owners of the Argus™ system prevent widespread use as a clinical support tool. Mixing DNA from multiple organisms on a single run as well as physically splitting runs on a card was performed and quality checked. Modifications to assembly and analysis proto-cols produced fully assembled genomes in less time than with default settings.Using our adapted methods and assembly protocols, we were able to reduce the cost to approximately $300.00 per genome, depending on the size. Also, we reduced average assembly times from 1-3 days to less than 24 hours. This represents a significant reduction in cost and labor that brings this technology into the realm of support for clinical microbiology laboratories.

r-18 AutHor: CPT Scott Seronello titLE: Development of a semi-continuous, luciferase-based P. beghei-HepG2 assay for determining stage specificity for antimalarials. LoCAtioN: WRAIR, Silver Spring, MD. ABStrACt: Plasmodium falciparium begins with an intrahepatocytic infection when a mosquito transmits sporozoites during a blood meal during which typically less than 1,000 malaria sporozoites are released and fewer make it to the hepatocyte. Dur-ing hepatocyte stage, parasite replicates 10,000-fold with millions of merozoites exiting the liver and invading the red cells. The small number of parasites in the intrahepatocytic infection provides an excellent target for therapeutic interven-tion. To determine the exoerthryocytic stage specific in vitro potency of antimalarials, we developed a non-lytic, semi-continuous, luciferase-based P. berghei-HepG2 assay. Luciferin, a small soluble luciferase substrate with no demonstrated toxicity in the liver stage assay, was used to repeatedly measure parasite response to potential antimalarials. Atovaquone, pyrimethamine, and artesunate were examined and the results are discussed including demonstrating stage specificity for liver stage acting antimalarials.

41

Society Scope

Just for Funguess the unknown

A 5 year old was evaluated the in Emergency Room for severe cough that persisted for over 2 weeks. The severity had worsened in the last 72 hours and the coughing had induced episodes of vomiting. The patient vitals were: BP of 120/72, pulse was 96, respirations were 34, and temperature was 100.4. Routine labs were normal with the exception of a CBC with mild lymphocytosis and small number of atypical lymphocytes (cleaved lymps or Butt Cells) were seen on the peripheral smear.

Gram stain of the sputum revealed small gram negative rods.

Routine respiratory culture exhibited no significant growth on blood agar, chocolate agar, or Mackonkey agar.

What is the most likely cause of the child’s cough?

What special agar types should be used to isolate this organism?

Is there another diagnostic test available?

Should antibiotics be prescribed for this patient, if so which ones?

What contributing factors likely caused the child’s susceptibility to this disease?

The answers to Last Editions Guess the Unknown are:

What type of crystals are these? Cystine

What is the disorder known as and what is the cause? Cystinuria

Is this disorder the likely cause of previous renal stones? Yes

Bonus Question: What US City is mentioned in more songs than any other city in the world – more than 400 - according to Billboard magazine. Memphis TN

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44

Society Scope

Nobody does it better.

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Calendar of Events

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2013St. Louis, MO

2014Reno, NV

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Winter Vol X Number 1 Deadline: 1 DecSummer Vol X Number 2 Deadline: 1 AprFall Vol X Number 3 Deadline: 1 Aug