Search results for: data sensitivity
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 25502

Search results for: data sensitivity

25262 Implementation of CNV-CH Algorithm Using Map-Reduce Approach

Authors: Aishik Deb, Rituparna Sinha

Abstract:

We have developed an algorithm to detect the abnormal segment/"structural variation in the genome across a number of samples. We have worked on simulated as well as real data from the BAM Files and have designed a segmentation algorithm where abnormal segments are detected. This algorithm aims to improve the accuracy and performance of the existing CNV-CH algorithm. The next-generation sequencing (NGS) approach is very fast and can generate large sequences in a reasonable time. So the huge volume of sequence information gives rise to the need for Big Data and parallel approaches of segmentation. Therefore, we have designed a map-reduce approach for the existing CNV-CH algorithm where a large amount of sequence data can be segmented and structural variations in the human genome can be detected. We have compared the efficiency of the traditional and map-reduce algorithms with respect to precision, sensitivity, and F-Score. The advantages of using our algorithm are that it is fast and has better accuracy. This algorithm can be applied to detect structural variations within a genome, which in turn can be used to detect various genetic disorders such as cancer, etc. The defects may be caused by new mutations or changes to the DNA and generally result in abnormally high or low base coverage and quantification values.

Keywords: cancer detection, convex hull segmentation, map reduce, next generation sequencing

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25261 A Comparative Study of Mental Health and Well-Being between Qugong Practitioners and Non-Practitioners

Authors: Masoumeh Khosravi

Abstract:

Introduction: The complementary therapies and Qigong exercises is important in order to maintain physical and mental health. Objective: This study was done to compare and investigate well-being and mental health's state between practitioners of a Qigong practice (Falun Dafa) and non-practitioners. Method: It was a comparative study with 60 samples (30 practitioners of Falun Dafa, and 30 non-practitioners), who were selected by random sampling from Tehran city of Iran. Data were collected by mental health inventory (SCL90) and well-being questionnaire. Multivariate variance analyzing and t-test were used for analyzing data. Results: Results showed significant differences in most components of mental health including anxiety, aggressiveness, obsessive-compulsion, interpersonal sensitivity, somatization disorder, depression, phobia between practitioners and non-practitioners. Well-being was significantly higher in practitioners than non-practitioners. Conclusion: Accordingly, we concluded Falun Gong exercises have high impact on mental health and well-being in people.

Keywords: mental health, well-being, Qigong, Falun Dafa

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25260 Household Climate-Resilience Index Development for the Health Sector in Tanzania: Use of Demographic and Health Surveys Data Linked with Remote Sensing

Authors: Heribert R. Kaijage, Samuel N. A. Codjoe, Simon H. D. Mamuya, Mangi J. Ezekiel

Abstract:

There is strong evidence that climate has changed significantly affecting various sectors including public health. The recommended feasible solution is adopting development trajectories which combine both mitigation and adaptation measures for improving resilience pathways. This approach demands a consideration for complex interactions between climate and social-ecological systems. While other sectors such as agriculture and water have developed climate resilience indices, the public health sector in Tanzania is still lagging behind. The aim of this study was to find out how can we use Demographic and Health Surveys (DHS) linked with Remote Sensing (RS) technology and metrological information as tools to inform climate change resilient development and evaluation for the health sector. Methodological review was conducted whereby a number of studies were content analyzed to find appropriate indicators and indices for climate resilience household and their integration approach. These indicators were critically reviewed, listed, filtered and their sources determined. Preliminary identification and ranking of indicators were conducted using participatory approach of pairwise weighting by selected national stakeholders from meeting/conferences on human health and climate change sciences in Tanzania. DHS datasets were retrieved from Measure Evaluation project, processed and critically analyzed for possible climate change indicators. Other sources for indicators of climate change exposure were also identified. For the purpose of preliminary reporting, operationalization of selected indicators was discussed to produce methodological approach to be used in resilience comparative analysis study. It was found that household climate resilient index depends on the combination of three indices namely Household Adaptive and Mitigation Capacity (HC), Household Health Sensitivity (HHS) and Household Exposure Status (HES). It was also found that, DHS alone cannot complement resilient evaluation unless integrated with other data sources notably flooding data as a measure of vulnerability, remote sensing image of Normalized Vegetation Index (NDVI) and Metrological data (deviation from rainfall pattern). It can be concluded that if these indices retrieved from DHS data sets are computed and scientifically integrated can produce single climate resilience index and resilience maps could be generated at different spatial and time scales to enhance targeted interventions for climate resilient development and evaluations. However, further studies are need to test for the sensitivity of index in resilience comparative analysis among selected regions.

Keywords: climate change, resilience, remote sensing, demographic and health surveys

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25259 A Data-Driven Compartmental Model for Dengue Forecasting and Covariate Inference

Authors: Yichao Liu, Peter Fransson, Julian Heidecke, Jonas Wallin, Joacim Rockloev

Abstract:

Dengue, a mosquito-borne viral disease, poses a significant public health challenge in endemic tropical or subtropical countries, including Sri Lanka. To reveal insights into the complexity of the dynamics of this disease and study the drivers, a comprehensive model capable of both robust forecasting and insightful inference of drivers while capturing the co-circulating of several virus strains is essential. However, existing studies mostly focus on only one aspect at a time and do not integrate and carry insights across the siloed approach. While mechanistic models are developed to capture immunity dynamics, they are often oversimplified and lack integration of all the diverse drivers of disease transmission. On the other hand, purely data-driven methods lack constraints imposed by immuno-epidemiological processes, making them prone to overfitting and inference bias. This research presents a hybrid model that combines machine learning techniques with mechanistic modelling to overcome the limitations of existing approaches. Leveraging eight years of newly reported dengue case data, along with socioeconomic factors, such as human mobility, weekly climate data from 2011 to 2018, genetic data detecting the introduction and presence of new strains, and estimates of seropositivity for different districts in Sri Lanka, we derive a data-driven vector (SEI) to human (SEIR) model across 16 regions in Sri Lanka at the weekly time scale. By conducting ablation studies, the lag effects allowing delays up to 12 weeks of time-varying climate factors were determined. The model demonstrates superior predictive performance over a pure machine learning approach when considering lead times of 5 and 10 weeks on data withheld from model fitting. It further reveals several interesting interpretable findings of drivers while adjusting for the dynamics and influences of immunity and introduction of a new strain. The study uncovers strong influences of socioeconomic variables: population density, mobility, household income and rural vs. urban population. The study reveals substantial sensitivity to the diurnal temperature range and precipitation, while mean temperature and humidity appear less important in the study location. Additionally, the model indicated sensitivity to vegetation index, both max and average. Predictions on testing data reveal high model accuracy. Overall, this study advances the knowledge of dengue transmission in Sri Lanka and demonstrates the importance of incorporating hybrid modelling techniques to use biologically informed model structures with flexible data-driven estimates of model parameters. The findings show the potential to both inference of drivers in situations of complex disease dynamics and robust forecasting models.

Keywords: compartmental model, climate, dengue, machine learning, social-economic

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25258 Evaluation of Diagnostic Values of Culture, Rapid Urease Test, and Histopathology in the Diagnosis of Helicobacter pylori Infection and in vitro Effects of Various Antimicrobials against Helicobacter pylori

Authors: Recep Kesli, Huseyin Bilgin, Yasar Unlu, Gokhan Gungor

Abstract:

Aim: The aim of this study, was to investigate the presence of Helicobacter pylori (H. pylori) infection by culture, histology, and RUT (Rapid Urease Test) in gastric antrum biopsy samples taken from patients presented with dyspeptic complaints and to determine resistance rates of amoxicillin, clarithromycin, levofloxacin and metronidazole against the H. pylori strains by E-test. Material and Methods: A total of 278 patients who admitted to Konya Education and Research Hospital Department of Gastroenterology with dyspeptic complaints, between January 2011-July 2013, were included in the study. Microbiological and histopathological examinations of biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in biopsy samples was investigated by culture (Portagerm pylori-PORT PYL, Pylori agar-PYL, GENbox microaer, bioMerieux, France), histology (Giemsa, Hematoxylin and Eosin staining), and RUT(CLOtest, Cimberly-Clark, USA). Antimicrobial resistance of isolates against amoxicillin, clarithromycin, levofloxacin, and metronidazole was determined by E-test method (bioMerieux, France). As a gold standard in the diagnosis of H. pylori; it was accepted that the culture method alone was positive or both histology and RUT were positive together. Sensitivity and specificity for histology and RUT were calculated by taking the culture as a gold standard. Sensitivity and specificity for culture were also calculated by taking the co-positivity of both histology and RUT as a gold standard. Results: H. pylori was detected in 140 of 278 of patients with culture and 174 of 278 of patients with histology in the study. H. pylori positivity was also found in 191 patients with RUT. According to the gold standard criteria, a false negative result was found in 39 cases by culture method, 17 cases by histology, and 8 cases by RUT. Sensitivity and specificity of the culture, histology, and RUT methods of the patients were 76.5 % and 88.3 %, 87.8 % and 63 %, 94.2 % and 57.2 %, respectively. Antibiotic resistance was investigated by E-test in 140 H. pylori strains isolated from culture. The resistance rates of H. pylori strains to the amoxicillin, clarithromycin, levofloxacin, and metronidazole was detected as 9 (6.4 %), 22 (15.7 %), 17 (12.1 %), 57 (40.7 %), respectively. Conclusion: In our study, RUT was found to be the most sensitive, culture was the most specific test between culture, histology, and RUT methods. Although we detected the specificity of the culture method as high, its sensitivity was found to be quite low compared to other methods. The low sensitivity of H. pylori culture may be caused by the factors affect the chances of direct isolation such as spoild bacterium, difficult-to-breed microorganism, clinical sample retrieval, and transport conditions.

Keywords: antimicrobial resistance, culture, histology, H. pylori, RUT

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25257 The Molecular Rationale for Steroid Based Therapy of Leukemia: Diagnostic and Therapeutic Implications

Authors: Eitan Yefenof

Abstract:

Glucocorticoid (GC) hormones, e.g. Dexamethasone and Prednisone, are widely used in the therapy of leukemia and lymphoma owing to their apoptogenic effect on lymphoid cells. However, the emergence of GC resistant cells during therapy is a major cause for treatment failure, urging the need for novel strategies that maintain leukemia sensitivity to the pro-apoptotic activity of GCs. GCs act by binding to the GC receptor (GR), which, in its inactive state, is sequestered in the cytosol by a multi-subunit complex of heat shock proteins. Upon ligand binding, the complex dissociates, allowing GR activation and translocation to the nucleus, where it regulates transcription of multiple genes. We demonstrated that in addition to gene expression, GR also regulates microRNA (miR) expression. Deep-sequencing analysis revealed 14 miRs that are regulated in GC-sensitive but resistant leukemias upon treatment with GC. GC up-regulates miR-103, miR-15~16 and miR-30e/d, while down-regulates miR-17, mir-18a, miR-19a, miR-19b, miR-20a and miR-92a (members of the miR-17∼92a multi-cistron). Upon transfection, miR-103 confers GC apoptotic sensitivity to otherwise GC-resistant cell. Furthermore, knocking down miR-103 expression reduces the GC apoptotic response of sensitive cells. miR-103 abrogates c-Myc expression, an oncogenic transcription factor which is deregulated in many cancers. In addition, miR-103 up-regulates Bim, a pro-apoptotic protein crucial for GC-induced death. Activated glycogen synthase kinase 3 (GSK3) is also crucial for GC-induced apoptosis. GSK3 is active in GC-sensitive but not in GC-resistant cells. We found that GSK3 associates with the GR multi-subunit complex. Upon GC exposure, it dissociates from the GR and interacts with Bim to enable activation of the mitochondrial apoptosis pathway. miR-103 mediated c-Myc ablation is followed by down-regulation of the multi-cistron miR-17~92a, in particular miR-18a and miR-20a. miR-18a targets GR for degradation whereas miR-20a targets Bim degradation. Hence, miR-103 acts, in concert with Bim and GR, as a "tumor suppressor" that leads to reduced proliferation, cell-cycle arrest and cell death. We suggest that miR-103 can provide a diagnostic tool that predicts the sensitivity of leukemia to GC based therapy. Furthermore, exosomal delivery of miR-103 or up-regulation of the endogenous miR-103 could confer apoptotic sensitivity to resistant cells at the outset, thus becoming a useful therapeutic tool combined with GCs.

Keywords: apoptosis, leukemia, micro-RNA, steroids

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25256 Highly Linear and Low Noise AMR Sensor Using Closed Loop and Signal-Chopped Architecture

Authors: N. Hadjigeorgiou, A. C. Tsalikidou, E. Hristoforou, P. P. Sotiriadis

Abstract:

During the last few decades, the continuously increasing demand for accurate and reliable magnetic measurements has paved the way for the development of different types of magnetic sensing systems as well as different measurement techniques. Sensor sensitivity and linearity, signal-to-noise ratio, measurement range, cross-talk between sensors in multi-sensor applications are only some of the aspects that have been examined in the past. In this paper, a fully analog closed loop system in order to optimize the performance of AMR sensors has been developed. The operation of the proposed system has been tested using a Helmholtz coil calibration setup in order to control both the amplitude and direction of magnetic field in the vicinity of the AMR sensor. Experimental testing indicated that improved linearity of sensor response, as well as low noise levels can be achieved, when the system is employed.

Keywords: AMR sensor, closed loop, memory effects, chopper, linearity improvement, sensitivity improvement, magnetic noise, electronic noise

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25255 Evaluation of 18F Fluorodeoxyglucose Positron Emission Tomography, MRI, and Ultrasound in the Assessment of Axillary Lymph Node Metastases in Patients with Early Stage Breast Cancer

Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

Abstract:

Purpose: 18F Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a noninvasive imaging modality that can identify nodal metastases in women with primary breast cancer. The aim of this study was to compare the accuracy of FDG-PET with MRI and sonography scanning to determine axillary lymph node status in patients with breast cancer undergoing sentinel lymph node biopsy or axillary lymph node dissection. Patients and Methods: Between January and December 2012, ninety-nine patients with breast cancer and clinically negative axillary nodes were evaluated. All patients underwent FDG-PET, MRI, ultrasound followed by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Results: Using axillary lymph node assessment as the gold standard, the sensitivity and specificity of FDG-PET were 51.4% (95% CI, 41.3% to 65.6%) and 92.2% (95% CI, 82.7% to 97.4%) respectively. The sensitivity and specificity of MRI and ultrasound were 57.1% (95% CI, 39.4% to 73.7%), 67.2% (95% CI, 54.3% to 78.4%) and 42.86% (95% CI, 26.3% to 60.7%), 92.2% (95% CI, 82.7% to 97.4%). Stratification according to hormone receptor status showed an increase in specificity when negative (FDG-PET: 42.3% to 77.8%, MRI 50% to 77.8%, ultrasound 34.6% to 66.7%). Also, positive HER2 status was associated with an increase in specificity (FDG-PET: 42.9% to 85.7%, MRI 50% to 85.7%, ultrasound 35.7% to 71.4%). Conclusions: The sensitivity and specificity of FDG-PET compared with MRI and ultrasound was high. However, FDG-PET is not sufficiently accurate to appropriately identify lymph node metastases. This study suggests that FDG-PET scanning cannot replace histologic staging in early-stage breast cancer, but might have a role in evaluating axillary lymph node status in hormone receptor negative or HER-2 overexpressing subtypes.

Keywords: axillary lymph node metastasis, FDG-PET, MRI, ultrasound

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25254 Effects of Opuntia ficus-indica var. Saboten on Glucose Uptake and Insulin Sensitivity in Pancreatic β Cell

Authors: Kang-Hyun Leem, Myung-Gyou Kim, Hye Kyung Kim

Abstract:

The prickly pear cactus (Opuntia ficus-indica) has a global distribution and have been used for medicinal benefits such as artherosclerosis, diabetes, gastritis, and hyperglycemia. However, very little information is currently available for their mechanism. The prikly pear variety Opuntia ficus-indica var. Saboten (OFS) is widely cultivated in Cheju Island, southwestern region of Korea, and used as a functional food. Present study investigated the effects of OFS on pancreatic β-cell function using pancreatic islet β cells (HIT cell). Alpha-glucosidase inhibition, glucose uptake, insulin secretion, insulin sensitivity, and pancreatic β cell proliferation were determined. The inhibitory effect of ethanol extract of OFS stem on α-glucosidase enzyme was measured in a cell free system. Glucose uptake was determined using fluorescent glucose analogue, 2-NBDG. Insulin secretion was measured by ELISA assay. Cell proliferation was measured by MTT assay. Ethanol extracts of OFS dose-dependently inhibited α-glucosidase activity as well as glucose uptake. Insulinotrophic effect of OFS extract was observed at high glucose media in pancreatic β-islet cells. Furthermore, pancreatic β cell regeneration was also observed.These results suggest that OFS mediates the antidiabetic activity mainly via α-glucosidase inhibition, glucose uptake, and improved insulin sensitivity.

Keywords: prickly pear cactus, Opuntia ficus-indica var. Saboten, pancreatic islet HIT cells, α-glucosidase, glucose uptake, insulinotrophic

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25253 Applying Sociometer Theory to Different Age Groups and Groups Differences regarding State Self-Esteem Sensitivity

Authors: Yun Yu Stephanie Law

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Sociometer Theory is well tested among young adults in western population, however, limited research is found for other age groups, like adolescent and middle-adulthood in Asia population. Thus, one of the main purposes of this study is to verify the validity of Sociometer Theory in different age groups among Asian. To be specific, we hypothesized that an increase in one’s perceived social rejection is associated to a decrease in his/her state self-esteem among all age groups in Asian population. And we expected that this association can be found among all age groups including adolescent, young adults and middle-adults group in our first study. In this way, we can verify the validity of Sociometer Theory across different age groups as well as its significance in Asian population. Furthermore, those participants who received rejection about ‘mate-role’ would also receive some negative feedbacks regarding their current/future capacity of being a good mate. Results suggested that participants’ state self-esteem sensitivity for mating-capacity rejection is higher when comparing to that of friend-capacity rejection, i.e. greater drop in state self-esteem when receiving mating-capacity feedbacks then receiving friend-capacity feedbacks. These results, however, is just applicable on young adults. Thus, the main purpose of study two would be testing the state self-esteem sensitivity towards social rejection in different domains among three age groups. We hypothesized that group differences would be found for three age groups regarding state self-esteem sensitivity. Research question 1: perceived social rejection is associated to decrease in state self-esteem, is applicable among different age groups in Asia population. Research question 2: there are significant group differences for three age groups regarding state self-esteem sensitivity. Methods: 300 subjects are divided into three age groups, adolescents group, young adult group and middle-adult group, with 100 subjects in each group. Two questionnaires were used in testing this fundamental concept. Subjects were then asked to rate themselves on questionnaire in measuring their current state self-esteem in order to obtain the baseline measurements for later comparison. In order to avoid demand characteristics from subjects, other unrelated tasks like word matching were also given after the first test. Results: A positive correlation between scores in questionnaire 1 and questionnaire 2 among all age groups. Conclusion: State self-esteem decrease to both imagined social rejection (study1) and experienced social rejection (study2). Moreover, level of decrease in state self-esteem vary when receiving different domains of social rejection. Implications: a better understanding of self-esteem development for various age group might bring insights for education systems and policies for teaching approaches and learning methods among different age groups.

Keywords: state self-esteem, social rejection, stage theory, self-feelings

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25252 Air Pollutants Exposure and Blood High Sensitivity C-Reactive Protein Concentrations in Healthy Pregnant Women

Authors: Gwo-Hwa Wan, Tai-Ho Hung, Fen-Fang Chung, Wan-Ying Lee, Hui-Ching Yang

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Air pollutant exposure results in elevated concentrations of oxidative stress and inflammatory biomarkers in general populations. Increased concentrations of inflammatory biomarkers in pregnant women would be associated with preterm labor and low birth weight. To our best knowledge, the associations between air pollutants exposure and inflammation in pregnant women and fetuses are unknown, as well as their effects on fetal growth. This study aimed to evaluate the influences of outdoor air pollutants in northern Taiwan areas on the inflammatory biomarker (high sensitivity C-reactive protein, hs-CRP) concentration in the blood of healthy pregnant women and how the biomarker impacts fetal growth. In this study, 38 healthy pregnant women who are in their first trimester and live in northern Taiwan area were recruited from the Taipei Chang Gung Memorial Hospital. Personal characteristics and prenatal examination data (e.g., blood pressure) were obtained from recruited subjects. The concentrations of inflammatory mediators, hs-CRP, in the blood of healthy pregnant women were analyzed. Additionally, hourly data of air pollutants (PM10, SO2, NO2, O3, CO) concentrations were obtained from air quality monitoring stations in Taipei area, established by the Taiwan Environmental Protection Administration. The definition of lag 0 and lag 01 are the exposure to air pollutants on the day of blood withdrawal, and the average exposure to air pollutants one day before and on the day of blood withdrawal, respectively. The statistical analyses were conducted using SPSS software version 22.0 (SPSS, Inc., Chicago, IL, USA). This analytical result indicates that the healthy pregnant women aged between 28 and 42 years old. The body mass index before pregnancy averaged 21.51 (sd = 2.51) kg/m2. Around 90% of the pregnant women had never smoking habit, and 28.95% of them had allergic diseases. Approximately around 84% and 5.26% of the pregnant women worked at indoor and outdoor environments, respectively. The mean hematocrit level of the pregnant women was 37.10%, and the hemoglobin levels were ranged between 10.1 and 14.7 g/dL with 12.47 g/dL of mean value. The blood hs-CRP concentrations of healthy pregnant women in the first trimester ranged between 0.32 and 32.5 mg/L with 2.83 (sd = 5.69) mg/L of mean value. The blood hs-CRP concentrations were positively associated with ozone concentrations at lag 0-14 (r = 0.481, p = 0.017) in healthy pregnant women. Significant lag effects were identified in ozone at lag 0-14 with a positive excess concentration of blood hs-CRP.

Keywords: air pollutant, hs-CRP, pregnant woman, ozone, first trimester

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25251 The Response of Optical Properties to Temperature in Three-Layer Micro Device Under Influence of Casimir Force

Authors: Motahare Aali, Fatemeh Tajik

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Here, we investigate the sensitivity the Casimir force and consequently dynamical actuation of a three-layer microswitch to some ambient conditions. In fact, we have considered the effect of optical properties on the stable operation of the microswitch for both good (e.g. metals) and poor conductors via a three layer Casimir oscillator. Indeed, gold (Au) has been chosen as a good conductor which is widely used for Casimir force measurements, and highly doped conductive silicon carbide (SiC) has been considered as a poor conductor which is a promising material for device operating under harsh environments. Also, the intervening stratum is considered ethanol or water. It is also supposed that the microswitches are frictionless and autonomous. Using reduction factor diagrams and bifurcation curves, it has been shown how performance of the microswitches is sensitive to temperature and intervening stratum, moreover it is investigated how the conductivity of the components can affect this sensitivity.

Keywords: Casimir force, optical properties, Lifshitz theory, dielectric function

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25250 Use of Linear Programming for Optimal Production in a Production Line in Saudi Food Co.

Authors: Qasim M. Kriri

Abstract:

Few Saudi Arabia production companies face financial profit issues until this moment. This work presents a linear integer programming model that solves a production problem of a Saudi Food Company in Saudi Arabia. An optimal solution to the above-mentioned problem is a Linear Programming solution. In this regard, the main purpose of this project is to maximize profit. Linear Programming Technique has been used to derive the maximum profit from production of natural juice at Saudi Food Co. The operations of production of the company were formulated and optimal results are found out by using Lindo Software that employed Sensitivity Analysis and Parametric linear programming in order develop Linear Programming. In addition, the parameter values are increased, then the values of the objective function will be increased.

Keywords: parameter linear programming, objective function, sensitivity analysis, optimize profit

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25249 Comparative Evaluation of EBT3 Film Dosimetry Using Flat Bad Scanner, Densitometer and Spectrophotometer Methods and Its Applications in Radiotherapy

Authors: K. Khaerunnisa, D. Ryangga, S. A. Pawiro

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Over the past few decades, film dosimetry has become a tool which is used in various radiotherapy modalities, either for clinical quality assurance (QA) or dose verification. The response of the film to irradiation is usually expressed in optical density (OD) or net optical density (netOD). While the film's response to radiation is not linear, then the use of film as a dosimeter must go through a calibration process. This study aimed to compare the function of the calibration curve of various measurement methods with various densitometer, using a flat bad scanner, point densitometer and spectrophotometer. For every response function, a radichromic film calibration curve is generated from each method by performing accuracy, precision and sensitivity analysis. netOD is obtained by measuring changes in the optical density (OD) of the film before irradiation and after irradiation when using a film scanner if it uses ImageJ to extract the pixel value of the film on the red channel of three channels (RGB), calculate the change in OD before and after irradiation when using a point densitometer, and calculate changes in absorbance before and after irradiation when using a spectrophotometer. the results showed that the three calibration methods gave readings with a netOD precision of doses below 3% for the uncertainty value of 1σ (one sigma). while the sensitivity of all three methods has the same trend in responding to film readings against radiation, it has a different magnitude of sensitivity. while the accuracy of the three methods provides readings below 3% for doses above 100 cGy and 200 cGy, but for doses below 100 cGy found above 3% when using point densitometers and spectrophotometers. when all three methods are used for clinical implementation, the results of the study show accuracy and precision below 2% for the use of scanners and spectrophotometers and above 3% for precision and accuracy when using point densitometers.

Keywords: Callibration Methods, Film Dosimetry EBT3, Flat Bad Scanner, Densitomete, Spectrophotometer

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25248 Evaluation of Symptoms, Laboratory Findings, and Natural History of IgE Mediated Wheat Allergy

Authors: Soudeh Tabashi, Soudabeh Fazeli Dehkordy, Masood Movahedi, Nasrin Behniafard

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Introduction: Food allergy has increased in three last decades. Since wheat is one of the major constituents of daily meal in many regions throughout the world, wheat allergy is one of the most important allergies ranking among the 8 most common types of food allergies. Our information about epidemiology and etiology of food allergies are limited. Therefore, in this study we sought to evaluate the symptoms and laboratory findings in children with wheat allergy. Materials and methods: There were 23 patients aged up to 18 with the diagnosis of IgE mediated wheat allergy that were included enrolled in this study. Using a questionnaire .we collected their information and organized them into 4 groups categories of: demographic data identification, signs and symptoms, comorbidities, and laboratory data. Then patients were followed up for 6 month and their lab data were compared together. Results: Most of the patients (82%) presented the symptoms of wheat allergy in the first year of their life. The skin and the respiratory system were the most commonly involved organs with an incidence of 86% and 78% respectively. Most of the patients with wheat allergy were also sensitive to the other type of foods and their sensitivity to egg were most common type (47%). in 57% of patients, IgE levels were decreased during the 6 month follow-up period. Conclusion: We do not have enough information about data on epidemiology and response to therapy of wheat allergy and to best of our knowledge no study has addressed this issue in Iran so far. This study is the first source of information about IgE mediated wheat allergy in Iran and It can provide an opening for future studies about wheat allergy and its treatments.

Keywords: wheat allergy, food allergy, IgE, food allergy

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25247 Fabrication of Tin Oxide and Metal Doped Tin Oxide for Gas Sensor Application

Authors: Goban Kumar Panneer Selvam

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In past years, there is lots of death caused due to harmful gases. So its very important to monitor harmful gases for human safety, and semiconductor material play important role in producing effective gas sensors.A novel solvothermal synthesis method based on sol-gel processing was prepared to deposit tin oxide thin films on glass substrate at high temperature for gas sensing application. The structure and morphology of tin oxide were analyzed by X-ray diffraction (XRD), Fourier transforms infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). The SEM analysis of how spheres shape in tin oxide nanoparticles. The structure characterization of tin oxide studied by X-ray diffraction shows 8.95 nm (calculated by sheers equation). The UV visible spectroscopy indicated a maximum absorption band shown at 390 nm. Further dope tin oxide with selected metals to attain maximum sensitivity using dip coating technique with different immersion and sensing characterization are measured.

Keywords: tin oxide, gas sensor, chlorine free, sensitivity, crystalline size

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25246 Micro-Ribonucleic Acid-21 as High Potential Prostate Cancer Biomarker

Authors: Regina R. Gunawan, Indwiani Astuti, H. Raden Danarto

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Cancer is the leading cause of death worldwide. Cancer is caused by mutations that alter the function of normal human genes and give rise to cancer genes. MicroRNA (miRNA) is a small non-coding RNA that regulates the gen through complementary bond towards mRNA target and cause mRNA degradation. miRNA works by either promoting or suppressing cell proliferation. miRNA level expression in cancer may offer another value of miRNA as a biomarker in cancer diagnostic. miRNA-21 is believed to have a role in carcinogenesis by enhancing proliferation, anti-apoptosis, cell cycle progression and invasion of tumor cells. Hsa-miR-21-5p marker has been identified in Prostate Cancer (PCa) and Benign Prostatic Hyperplasia (BPH) patient’s urine. This research planned to explore the diagnostic performance of miR-21 to differentiate PCa and BPH patients. In this study, urine samples were collected from 20 PCa patients and 20 BPH patients. miR-21 relative expression against the reference gene was analyzed and compared between the two. miRNA expression was analyzed using the comparative quantification method to find the fold change. miR-21 validity in identifying PCa patients was performed by quantifying the sensitivity and specificity with the contingency table. miR-21 relative expression against miR-16 in PCa patient and in BPH patient has 12,98 differences in fold change. From a contingency table of Cq expression of miR-21 in identifying PCa patients from BPH patient, Cq miR-21 has 100% sensitivity and 75% specificity. miR-21 relative expression can be used in discriminating PCa from BPH by using a urine sample. Furthermore, the expression of miR-21 has higher sensitivity compared to PSA (Prostate specific antigen), therefore miR-21 has a high potential to be analyzed and developed more.

Keywords: benign prostate hyperplasia, biomarker, miRNA-21, prostate cancer

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25245 International Comparison in Component of Design-Potential

Authors: Kazuko Sakamoto

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It is difficult to explain the factor of design preference only in culture or a geographical environment. It is necessary to turn one's eyes also to the factor in an individual. The purpose of this research is to clarify design potential which is inherent in consumers. Design potential is the consciousness and interpretation to an individual design. That is, it catches quantitatively the preparatory state which faces design. For example, a mobile phone differs in designs, such as a color and a form, by the country or the area. It is considered because a regional consumer taste exists. The root is design potential. This consists of design participation, design knowledge, and design sensitivity. Having focused this time is by design sensitivity, and international comparison of the Netherlands, Bangladesh, China, and Japan was performed. As a result, very interesting finding has been derived. For example, although Bangladesh caught the similarity of goods by the color, other three nations were caught in the form. Moreover, although the Netherlands, Bangladesh, and China liked symmetry, only Japan liked asymmetry. This shows that history and a cultural background have had big influence to the design.

Keywords: design-potential, cultural difference, form characteristic, product development

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25244 Evaluation of the Diagnostic Potential of IL-2 after Specific Antigen Stimulation with PE35 (Rv3872) and PPE68 (Rv3873) for the Discrimination of Active and Latent Tuberculosis

Authors: Shima Mahmoudi, Babak Pourakbari, Setareh Mamishi, Mostafa Teymuri, Majid Marjani

Abstract:

Although cytokine analysis has greatly contributed to the understanding of tuberculosis (TB) pathogenesis, data on cytokine profiles that might distinguish progression from latency of TB infection are scarce. Since PE/PPE proteins are known to induce strong humoral and cellular immune responses, the aim of this study was to evaluate the diagnostic potential of interleukin-2 (IL-2) as biomarker after specific antigen stimulation with PE35 and PPE68 for the discrimination of active and latent tuberculosis infection (LTBI). The production of IL-2 was measured in the antigen-stimulated whole-blood supernatants following stimulation with recombinant PE35 and PPE68. All the patients with active TB and LTBI had positive QuantiFERON-TB Gold in Tube test. The level of IL-2 following stimulation with recombinant PE35 and PPE68 were significantly higher in LTBI group than in patients with active TB infection or control group. The discrimination performance (assessed by the area under ROC curve) for IL-2 following stimulation with recombinant PE35 and PPE68 between LTBI and patients with active TB were 0.837 (95%CI: 0.72-0.97) and 0.75 (95%CI: 0.63-0.89), respectively. Applying the 12.4 pg/mL cut-off for IL-2 induced by PE35 in the present study population resulted in sensitivity of 78%, specificity of 78%, PPV of 78% and NPV of 100%. In addition, a sensitivity of 81%, specificity of 70%, PPV of 67% and 87% of NPV was reported based on the 4.4 pg/mL cut-off for IL-2 induced by PPE68. In conclusion, peptides of the antigen PE35 and PPE68, absent from commonly used BCG strains, stimulated strong IL-2- positive T cell responses in patients with LTBI. This study confirms IL-2 induced by PE35 and PPE68 as a sensitive and specific biomarker and highlights IL-2 as new promising adjunct markers for discriminating of LTBI and Active TB infection.

Keywords: IL-2, PE35, PPE68, tuberculosis

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25243 Evaluation and Assessment of Bioinformatics Methods and Their Applications

Authors: Fatemeh Nokhodchi Bonab

Abstract:

Bioinformatics, in its broad sense, involves application of computer processes to solve biological problems. A wide range of computational tools are needed to effectively and efficiently process large amounts of data being generated as a result of recent technological innovations in biology and medicine. A number of computational tools have been developed or adapted to deal with the experimental riches of complex and multivariate data and transition from data collection to information or knowledge. These bioinformatics tools are being evaluated and applied in various medical areas including early detection, risk assessment, classification, and prognosis of cancer. The goal of these efforts is to develop and identify bioinformatics methods with optimal sensitivity, specificity, and predictive capabilities. The recent flood of data from genome sequences and functional genomics has given rise to new field, bioinformatics, which combines elements of biology and computer science. Bioinformatics is conceptualizing biology in terms of macromolecules (in the sense of physical-chemistry) and then applying "informatics" techniques (derived from disciplines such as applied maths, computer science, and statistics) to understand and organize the information associated with these molecules, on a large-scale. Here we propose a definition for this new field and review some of the research that is being pursued, particularly in relation to transcriptional regulatory systems.

Keywords: methods, applications, transcriptional regulatory systems, techniques

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25242 Nonparametric Quantile Regression for Multivariate Spatial Data

Authors: S. H. Arnaud Kanga, O. Hili, S. Dabo-Niang

Abstract:

Spatial prediction is an issue appealing and attracting several fields such as agriculture, environmental sciences, ecology, econometrics, and many others. Although multiple non-parametric prediction methods exist for spatial data, those are based on the conditional expectation. This paper took a different approach by examining a non-parametric spatial predictor of the conditional quantile. The study especially observes the stationary multidimensional spatial process over a rectangular domain. Indeed, the proposed quantile is obtained by inverting the conditional distribution function. Furthermore, the proposed estimator of the conditional distribution function depends on three kernels, where one of them controls the distance between spatial locations, while the other two control the distance between observations. In addition, the almost complete convergence and the convergence in mean order q of the kernel predictor are obtained when the sample considered is alpha-mixing. Such approach of the prediction method gives the advantage of accuracy as it overcomes sensitivity to extreme and outliers values.

Keywords: conditional quantile, kernel, nonparametric, stationary

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25241 Applications of Big Data in Education

Authors: Faisal Kalota

Abstract:

Big Data and analytics have gained a huge momentum in recent years. Big Data feeds into the field of Learning Analytics (LA) that may allow academic institutions to better understand the learners’ needs and proactively address them. Hence, it is important to have an understanding of Big Data and its applications. The purpose of this descriptive paper is to provide an overview of Big Data, the technologies used in Big Data, and some of the applications of Big Data in education. Additionally, it discusses some of the concerns related to Big Data and current research trends. While Big Data can provide big benefits, it is important that institutions understand their own needs, infrastructure, resources, and limitation before jumping on the Big Data bandwagon.

Keywords: big data, learning analytics, analytics, big data in education, Hadoop

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25240 Analytical Validity Of A Tech Transfer Solution To Internalize Genetic Testing

Authors: Lesley Northrop, Justin DeGrazia, Jessica Greenwood

Abstract:

ASPIRA Labs now offers an en-suit and ready-to-implement technology transfer solution to enable labs and hospitals that lack the resources to build it themselves to offer in-house genetic testing. This unique platform employs a patented Molecular Inversion Probe (MIP) technology that combines the specificity of a hybrid capture protocol with the ease of an amplicon-based protocol and utilizes an advanced bioinformatics analysis pipeline based on machine learning. To demonstrate its efficacy, two independent genetic tests were validated on this technology transfer platform: expanded carrier screening (ECS) and hereditary cancer testing (HC). The analytical performance of ECS and HC was validated separately in a blinded manner for calling three different types of variants: SNVs, short indels (typically, <50 bp), and large indels/CNVs defined as multi-exonic del/dup events. The reference set was constructed using samples from Coriell Institute, an external clinical genetic testing laboratory, Maine Molecular Quality Controls Inc. (MMQCI), SeraCare and GIAB Consortium. Overall, the analytical performance showed a sensitivity and specificity of >99.4% for both ECS and HC in detecting SNVs. For indels, both tests reported specificity of 100%, and ECS demonstrated a sensitivity of 100%, whereas HC exhibited a sensitivity of 96.5%. The bioinformatics pipeline also correctly called all reference CNV events resulting in a sensitivity of 100% for both tests. No additional calls were made in the HC panel, leading to a perfect performance (specificity and F-measure of 100%). In the carrier panel, however, three additional positive calls were made outside the reference set. Two of these calls were confirmed using an orthogonal method and were re-classified as true positives leaving only one false positive. The pipeline also correctly identified all challenging carrier statuses, such as positive cases for spinal muscular atrophy and alpha-thalassemia, resulting in 100% sensitivity. After confirmation of additional positive calls via long-range PCR and MLPA, specificity for such cases was estimated at 99%. These performance metrics demonstrate that this tech-transfer solution can be confidently internalized by clinical labs and hospitals to offer mainstream ECS and HC as part of their test catalog, substantially increasing access to quality germline genetic testing for labs of all sizes and resources levels.

Keywords: clinical genetics, genetic testing, molecular genetics, technology transfer

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25239 Retrospective Study of Positive Blood Cultures Carried out in the Microbiology Department of General Hospital of Ioannina in 2017

Authors: M. Gerasimou, S. Mantzoukis, P. Christodoulou, N. Varsamis, G. Kolliopoulou, N. Zotos

Abstract:

Purpose: Microbial infection of the blood is a serious condition where bacteria invade the bloodstream and cause systemic disease. In such cases, blood cultures are performed. Blood cultures are a key diagnostic test for intensive care unit (ICU) patients. Material and method: The BacT/Alert system, which measures the production of carbon dioxide with metabolic organisms, is used. The positive result in the BacT/Alert system is followed by culture in the following selective media: Blood, Mac Conkey No 2, Chocolate, Mueller Hinton, Chapman and Sabaureaud agar. Gram staining method was used to differentiate bacterial species. The microorganisms were identified by biochemical techniques in the automated Microscan (Siemens) system and followed by a sensitivity test on the same system using the minimum inhibitory concentration MIC technique. The sensitivity test is verified by a Kirby Bauer-based test. Results: In 2017 the Laboratory of Microbiology received 3347 blood cultures. Of these, 170 came from the ICU. 116 found positive. Of these S. epidermidis was identified in 42, A. baumannii in 27, K. pneumoniae in 12 (4 of these KPC ‘Klebsiella pneumoniae carbapenemase’), S. hominis in 8, E. faecium in 7, E. faecalis in 5, P. aeruginosa in 3, C. albicans in 3, S. capitis in 2, K. oxytoca in 2, P. mirabilis in 2, E. coli in 1, S. intermidius in 1 and S. lugdunensis in 1. Conclusions: The study of epidemiological data and microbial resistance phenotypes is essential for the choice of therapeutic regimen for the early treatment and limitation of multivalent strains, while it is a crucial factor to solve diagnostic problems.

Keywords: blood culture, bloodstream, infection, intensive care unit

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25238 Investigation of the Functional Impact of Amblyopia on Visual Skills in Children

Authors: Chinmay V. Deshpande

Abstract:

Purpose: To assess the efficiency of visual functions and visual skills in strabismic & anisometropic amblyopes and to assess visual acuity and contrast sensitivity in anisometropic amblyopes with spectacles & contact lenses. Method: In a prospective clinical study, 32 children ageing from 5 to 15 years presenting with amblyopia in a pediatric department of Shri Ganapati Netralaya Jalna, India, were assessed for a period of three & half months. Visual acuity was measured with Snellen’s and Bailey-Lovie log MAR charts whereas contrast sensitivity was measured with Pelli-Robson chart with spectacles and contact lenses. Saccadic movements were assessed with SCCO scoring criteria and accommodative facility was checked with ±1.50 DS flippers. Stereopsis was assessed with TNO test. Results: By using Wilcoxon sign rank test p-value < 0.05 (< 0.001), the mean linear visual acuity was 0.29 (≈ 6/21) and mean single optotype visual acuity found to be 0.36 (≈ 6/18). Mean visual acuity of 0.27(≈ 6/21) with spectacles improved to 0.33 (≈ 6/18) with contact lenses in amblyopic eyes. The mean Log MAR visual acuity with spectacles and contact lens were found to be 0.602( ≈6/24) and 0.531(≈ 6/21) respectively. The contrast threshold out of 20 amblyopic eyes shows that mean contrast threshold changed in 9 patients from spectacles 0.27 to contact lens 0.19 respectively. The mean accommodative facility assessed was 5.31(± 2.37). 24 subjects (75%) revealed marked saccadic defects on the test applied. 78% subjects didn’t show even gross stereoscopic ability on TNO test. Conclusion: This study supports the facts about amblyopia and associated deficits in visual skills which are claimed in previous studies. In addition, anisometropic amblyopia can be managed better with contact lenses.

Keywords: strabismus, anisometropia, amblyopia, contrast sensitivity, saccades, stereopsis

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25237 Evidence Theory Enabled Quickest Change Detection Using Big Time-Series Data from Internet of Things

Authors: Hossein Jafari, Xiangfang Li, Lijun Qian, Alexander Aved, Timothy Kroecker

Abstract:

Traditionally in sensor networks and recently in the Internet of Things, numerous heterogeneous sensors are deployed in distributed manner to monitor a phenomenon that often can be model by an underlying stochastic process. The big time-series data collected by the sensors must be analyzed to detect change in the stochastic process as quickly as possible with tolerable false alarm rate. However, sensors may have different accuracy and sensitivity range, and they decay along time. As a result, the big time-series data collected by the sensors will contain uncertainties and sometimes they are conflicting. In this study, we present a framework to take advantage of Evidence Theory (a.k.a. Dempster-Shafer and Dezert-Smarandache Theories) capabilities of representing and managing uncertainty and conflict to fast change detection and effectively deal with complementary hypotheses. Specifically, Kullback-Leibler divergence is used as the similarity metric to calculate the distances between the estimated current distribution with the pre- and post-change distributions. Then mass functions are calculated and related combination rules are applied to combine the mass values among all sensors. Furthermore, we applied the method to estimate the minimum number of sensors needed to combine, so computational efficiency could be improved. Cumulative sum test is then applied on the ratio of pignistic probability to detect and declare the change for decision making purpose. Simulation results using both synthetic data and real data from experimental setup demonstrate the effectiveness of the presented schemes.

Keywords: CUSUM, evidence theory, kl divergence, quickest change detection, time series data

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25236 Electronic Device Robustness against Electrostatic Discharges

Authors: Clara Oliver, Oibar Martinez

Abstract:

This paper is intended to reveal the severity of electrostatic discharge (ESD) effects in electronic and optoelectronic devices by performing sensitivity tests based on Human Body Model (HBM) standard. We explain here the HBM standard in detail together with the typical failure modes associated with electrostatic discharges. In addition, a prototype of electrostatic charge generator has been designed, fabricated, and verified to stress electronic devices, which features a compact high voltage source. This prototype is inexpensive and enables one to do a battery of pre-compliance tests aimed at detecting unexpected weaknesses to static discharges at the component level. Some tests with different devices were performed to illustrate the behavior of the proposed generator. A set of discharges was applied according to the HBM standard to commercially available bipolar transistors, complementary metal-oxide-semiconductor transistors and light emitting diodes. It is observed that high current and voltage ratings in electronic devices not necessarily provide a guarantee that the device will withstand high levels of electrostatic discharges. We have also compared the result obtained by performing the sensitivity tests based on HBM with a real discharge generated by a human. For this purpose, the charge accumulated in the person is monitored, and a direct discharge against the devices is generated by touching them. Every test has been performed under controlled relative humidity conditions. It is believed that this paper can be of interest for research teams involved in the development of electronic and optoelectronic devices which need to verify the reliability of their devices in terms of robustness to electrostatic discharges.

Keywords: human body model, electrostatic discharge, sensitivity tests, static charge monitoring

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25235 Incorporation of Foundry Sand in Asphalt Pavement

Authors: L. P. Nascimento, M. Soares, N. Valério, A. Ribeiro, J. R. M. Oliveira, J. Araújo, C. Vilarinho, J. Carvalho

Abstract:

With the growing need to save natural resources and value waste that was previously worthless, waste recycling becomes imperative. Thus, with the techno-scientific growth and in the perspective of sustainability, it is observed that waste has the potential to replace significant percentages of materials considered “virgin”. An example is the replacement of crushed aggregates with foundry sand. In this work, a mix design study of two asphalt mixes, a base mix (AC 20) and a surface mix (AC14) was carried out to evaluate the maximum amount of foundry sand residue that could be used. Water sensitivity tests were performed to evaluate the mechanical behavior of these mixtures. For the superficial mixture with foundry sand (AC14FS), the maximum of sand used was 5%, with satisfactory results of sensitivity to water. In the base mixture with sand (AC20FS), the maximum of sand used was 12%, which had less satisfactory results. However, from an environmental point of view, the re-incorporation of this residue in the pavement is beneficial because it prevents it from being deposited in landfills.

Keywords: foundry sand, hot mix asphalt, industrial waste, waste valorization, sustainability

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25234 A Xenon Mass Gauging through Heat Transfer Modeling for Electric Propulsion Thrusters

Authors: A. Soria-Salinas, M.-P. Zorzano, J. Martín-Torres, J. Sánchez-García-Casarrubios, J.-L. Pérez-Díaz, A. Vakkada-Ramachandran

Abstract:

The current state-of-the-art methods of mass gauging of Electric Propulsion (EP) propellants in microgravity conditions rely on external measurements that are taken at the surface of the tank. The tanks are operated under a constant thermal duty cycle to store the propellant within a pre-defined temperature and pressure range. We demonstrate using computational fluid dynamics (CFD) simulations that the heat-transfer within the pressurized propellant generates temperature and density anisotropies. This challenges the standard mass gauging methods that rely on the use of time changing skin-temperatures and pressures. We observe that the domes of the tanks are prone to be overheated, and that a long time after the heaters of the thermal cycle are switched off, the system reaches a quasi-equilibrium state with a more uniform density. We propose a new gauging method, which we call the Improved PVT method, based on universal physics and thermodynamics principles, existing TRL-9 technology and telemetry data. This method only uses as inputs the temperature and pressure readings of sensors externally attached to the tank. These sensors can operate during the nominal thermal duty cycle. The improved PVT method shows little sensitivity to the pressure sensor drifts which are critical towards the end-of-life of the missions, as well as little sensitivity to systematic temperature errors. The retrieval method has been validated experimentally with CO2 in gas and fluid state in a chamber that operates up to 82 bar within a nominal thermal cycle of 38 °C to 42 °C. The mass gauging error is shown to be lower than 1% the mass at the beginning of life, assuming an initial tank load at 100 bar. In particular, for a pressure of about 70 bar, just below the critical pressure of CO2, the error of the mass gauging in gas phase goes down to 0.1% and for 77 bar, just above the critical point, the error of the mass gauging of the liquid phase is 0.6% of initial tank load. This gauging method improves by a factor of 8 the accuracy of the standard PVT retrievals using look-up tables with tabulated data from the National Institute of Standards and Technology.

Keywords: electric propulsion, mass gauging, propellant, PVT, xenon

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25233 The Diagnostic Utility and Sensitivity of the Xpert® MTB/RIF Assay in Diagnosing Mycobacterium tuberculosis in Bone Marrow Aspirate Specimens

Authors: Nadhiya N. Subramony, Jenifer Vaughan, Lesley E. Scott

Abstract:

In South Africa, the World Health Organisation estimated 454000 new cases of Mycobacterium tuberculosis (M.tb) infection (MTB) in 2015. Disseminated tuberculosis arises from the haematogenous spread and seeding of the bacilli in extrapulmonary sites. The gold standard for the detection of MTB in bone marrow is TB culture which has an average turnaround time of 6 weeks. Histological examinations of trephine biopsies to diagnose MTB also have a time delay owing mainly to the 5-7 day processing period prior to microscopic examination. Adding to the diagnostic delay is the non-specific nature of granulomatous inflammation which is the hallmark of MTB involvement of the bone marrow. A Ziehl-Neelson stain (which highlights acid-fast bacilli) is therefore mandatory to confirm the diagnosis but can take up to 3 days for processing and evaluation. Owing to this delay in diagnosis, many patients are lost to follow up or remain untreated whilst results are awaited, thus encouraging the spread of undiagnosed TB. The Xpert® MTB/RIF (Cepheid, Sunnyvale, CA) is the molecular test used in the South African national TB program as the initial diagnostic test for pulmonary TB. This study investigates the optimisation and performance of the Xpert® MTB/RIF on bone marrow aspirate specimens (BMA), a first since the introduction of the assay in the diagnosis of extrapulmonary TB. BMA received for immunophenotypic analysis as part of the investigation into disseminated MTB or in the evaluation of cytopenias in immunocompromised patients were used. Processing BMA on the Xpert® MTB/RIF was optimised to ensure bone marrow in EDTA and heparin did not inhibit the PCR reaction. Inactivated M.tb was spiked into the clinical bone marrow specimen and distilled water (as a control). A volume of 500mcl and an incubation time of 15 minutes with sample reagent were investigated as the processing protocol. A total of 135 BMA specimens had sufficient residual volume for Xpert® MTB/RIF testing however 22 specimens (16.3%) were not included in the final statistical analysis as an adequate trephine biopsy and/or TB culture was not available. Xpert® MTB/RIF testing was not affected by BMA material in the presence of heparin or EDTA, but the overall detection of MTB in BMA was low compared to histology and culture. Sensitivity of the Xpert® MTB/RIF compared to both histology and culture was 8.7% (95% confidence interval (CI): 1.07-28.04%) and sensitivity compared to histology only was 11.1% (95% CI: 1.38-34.7%). Specificity of the Xpert® MTB/RIF was 98.9% (95% CI: 93.9-99.7%). Although the Xpert® MTB/RIF generates a faster result than histology and TB culture and is less expensive than culture and drug susceptibility testing, the low sensitivity of the Xpert® MTB/RIF precludes its use for the diagnosis of MTB in bone marrow aspirate specimens and warrants alternative/additional testing to optimise the assay.

Keywords: bone marrow aspirate , extrapulmonary TB, low sensitivity, Xpert® MTB/RIF

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