Accounting for nonignorable verification bias in assessment of diagnostic tests

A "gold" standard test, providing definitive verification of disease status, may be quite invasive or expensive. Current technological advances provide less invasive, or less expensive, diagnostic tests. Ideally, a diagnostic test is evaluated by comparing it with a definitive gold standard test. However, the decision to perform the gold standard test to establish the presence or absence of disease is often influenced by the results of the diagnostic test, along with other measured, or not measured, risk factors. If only data from patients who received the gold standard test were used to assess the test performance, the commonly used measures of diagnostic test performance--sensitivity and specificity--are likely to be biased. Sensitivity would often be higher, and specificity would be lower, than the true values. This bias is called verification bias. Without adjustment for verification bias, one may possibly introduce into the medical practice a diagnostic test with apparent, but not truly, high sensitivity. In this article, verification bias is treated as a missing covariate problem. We propose a flexible modeling and computational framework for evaluating the performance of a diagnostic test, with adjustment for nonignorable verification bias. The presented computational method can be utilized with any software that can repetitively use a logistic regression module. The approach is likelihood-based, and allows use of categorical or continuous covariates. An explicit formula for the observed information matrix is presented, so that one can easily compute standard errors of estimated parameters. The methodology is illustrated with a cardiology data example. We perform a sensitivity analysis of the dependency of verification selection process on disease.     

A molecular marker diagnostic of a specific isolate of an arbuscular mycorrhizal fungus,Gigaspora margarita

To investigate the auto-ecology of a strain of Gigaspora margarita in a commercial inoculum, we found a pair of PCR primers amplifying a sequence of 235 bp diagnostic of the isolate. We designed an oligonucleotide probe based on the DNA sequence. The combination of PCR and the probing successfully detected the diagnostic sequence from both DNA preparations of single spores and colonized roots. This protocol enabled us to distinguish the isolate among several isolates from Japan, Nepal and the USA.     

Biopharming the SimpliRED™ HIV diagnostic reagent in barley, potato and tobacco

This is the first report of an antibody-fusion protein expressed intransgenic plants for direct use in a medical diagnostic assay. By the use ofgene constructs with appropriate promoters, high level expression of ananti-glycophorin single-chain antibody fused to an epitope of the HIV virus wasobtained in the leaves and stems of tobacco, tubers of potato and seed ofbarley. This fusion protein replaces the SimpliRED diagnostic reagent,used for detecting the presence of HIV-1 antibodies in human blood. The reagentis expensive and laborious to produce by conventional means since chemicalmodifications to a monoclonal antibody are required. The plant-produced fusionprotein was fully functional (by ELISA) in crude extracts and, for tobacco atleast, could be used without further purification in the HIV agglutinationassay. All three crop species produced sufficient reagent levels to be superiorbioreactors to bacteria or mice, however barley grain was the most attractivebioreactor as it expressed the highest level (150 g of reagentg^-1), is inexpensive to produce and harvest, poses aminuscule gene flow problem in the field, and the activity of the reagent islargely undiminished in stored grain. This work suggests that barley seed willbe an ideal factory for the production of antibodies, diagnosticimmuno-reagents, vaccines and other pharmaceutical proteins.     

Distribution-free ROC analysis using binary regression techniques

Receiver operating characteristic (ROC) regression methodology is used to identify factors that affect the accuracy of medical diagnostic tests. In this paper, we consider a ROC model for which the ROC curve is a parametric function of covariates but distributions of the diagnostic test results are not specified. Covariates can be either common to all subjects or specific to those with disease. We propose a new estimation procedure based on binary indicators defined by the test result for a diseased subject exceeding various specified quantiles of the distribution of test results from non-diseased subjects with the same covariate values. This procedure is conceptually and computationally simplified relative to existing procedures. Simulation study results indicate that the approach has fairly high statistical efficiency. The new ROC regression methodology is used to evaluate childhood measurements of body mass index as a predictive marker of adult obesity.     

Design and construction of novel molecular conjugates for signal amplification (II): use of multivalent polystyrene microparticles and lysine peptide chains to generate immunoglobulin-horseradish peroxidase conjugates

Spherical polystyrene microparticles expressing a large number of highly reactive functional groups were chemically engineered to generate antibody–enzyme conjugates as novel signal amplification systems. Chemically modified goat anti-human IgG and horseradish peroxidase (HRP) were combined in a 1:5 ratio and attached to 0.44 μm streptavidin microparticles or N-succinimidyl-S-acetylthioacetate (SATA)-activated 0.29 μm amino microparticles with highly reactive free sulfhydryl groups on their surface. The numbers of HRP molecules/microparticle were further increased by coupling HRP to primary amines on N-terminal biotinylated or bromoacetylated polypeptides containing 20 lysine residues prior to conjugation with streptavidin or sulfhydryl groups-containing microparticles. The antibody–poly-HRP immunoconjugates contained an estimated number of 10⁵ HRP/streptavidin microparticle and 10⁶ HRP/amino microparticle, respectively. These microparticle immunoconjugates efficiently bound to plasma anti-HIV-1 antibodies that had been captured by HIV antigens on 5 μm carboxyl magnetic microparticles and, upon reaction with orthophenyldiamine substrate, produced a detection signal with 5–8 times more sensitivity as compared to conventional HRP-conjugated goat anti-human IgG. The signal amplification technique by microparticle immunoconjugates may provide potentially novel tools for the development of highly sensitive diagnostic systems.     

The anthers of Senecio vulgaris (Asteraceae): saltatory evolution caught in the act

Anthers of the common annual weed, Senecio vulgaris, show an incomplete development of the two adaxial pollen sacs (microsporangia, MS). One or both adaxial MS can be missing, or they are replaced by sterile lobes. The reduction is stronger in the derived subspecies, S. vulgaris var. vulgaris than in the ancestral subspecies, S. vulgaris ssp. denticulatus. This character in S. vulgaris differs from the usual complete reduction of adaxial MS in other, independent instances of disporangiate anthers in the Asteraceae. It corresponds to the transition phenotypes associated with various recombinant genotypes derived from artificial crosses between tetrasporangiate (4 MS) and disporangiate (2 MS) species in the Asteracean genus Microseris. Senecio vulgaris could be a rare natural instance of homozygosity for a major gene permitting reduction of the adaxial MS in which the expression of the reduced phenotype is determined by different numbers of modifiers in the two subspecies.     

Should we take measurements at an intermediate design point?

It is well known that, for estimating a linear treatment effect with constant variance, the optimal design divides the units equally between the two extremes of the design space. If the dose-response relation may be nonlinear, however, intermediate measurements may be useful in order to estimate the effects of partial treatments. We consider the decision of whether to gather data at an intermediate design point: do the gains from learning about nonlinearity outweigh the loss in efficiency in estimating the linear effect? Under reasonable assumptions about nonlinearity, we find that, unless sample size is very large, the design with no interior measurements is best, because with moderate total sample sizes, any nonlinearity in the dose-response will be difficult to detect. We discuss in the context of a simplified version of the problem that motivated this work-a study of pest-control treatments intended to reduce asthma symptoms in children.     

Development of molecular methods for identification of Streptococcus bovis from human and ruminal origins

Streptococcus bovis has been identified as a causative agent in humans for a variety of diseases, including endocarditis, meningitis, and septicemia. Identification of S. bovis strains of human origin in clinical settings has been problematic due to variations in biochemical tests as compared to ruminal strains of S. bovis, and other streptococcal species. DNA-DNA hybridization with chromosomal DNA from various S. bovis strains indicates that strains of human origin are different from those of ruminal origin. Specific probes have been designed from S. bovis 16S rDNA gene sequences that differentiate strains of human and ruminal origin by direct hybridization and PCR analyses. These techniques now allow for rapid identification of S. bovis strains for clinical and other scientific investigations.     

新型戊型肝炎诊断试剂盒的研制及其应用

用ＨＥＶＯＲＦ３合成肽及ＯＲＦ２重组抗原研制成新型ＨＥＶＥＩＡ诊断试剂盒。与ＧｅｎｌａｂｓＨＥＶＥＩＡ检测比较,灵敏度和特异性均达１００％（６０／６０）。三批试剂精密性测定均＜１０％。该试剂盒置４℃８个月或３７℃４ｄ保持稳定。检测不同肝炎患者ＨＥＶ抗体,发现急性非甲非乙非丙肝炎中有６３．２％,甲肝有１３．４％,乙肝有８．３％,丙肝有６．６％,正常人群为２．９％。所研制的戊型肝炎诊断试剂盒,灵敏度高,特异性强,精密性好,稳定性合格。适用于戊型肝炎诊断及戊肝病毒感染的流行病学调查