Analysis of multistage pooling studies of biological specimens for estimating disease incidence and prevalence

The testing of pooled samples of biological specimens for the purpose of estimating disease prevalence may be more cost effective than testing individual samples, particularly if the prevalence of disease is low. Multistage pooling studies involve testing pools and then sequentially subdividing and testing the positive pools. A simple estimator of disease prevalence and its variance are derived for general multistage pooling studies and are shown to be natural generalizations of Thompson's (1962) original estimators for single-stage pooling studies. The reduction in variance associated with each additional stage is calibrated. The results are extended to estimating disease incidence rates. The methods are used to estimate HIV incidence rates from a prevalence study of early HIV infection using a PCR assay for HIV RNA.     

多重环介导核酸等温扩增技术检测血液中常见病原体

背景：血液安全性筛查是输血前必要检测项目。目前临床采用血清学检测技术,存在较长的检测窗口期,易产生假阴性检测结果,造成输血交叉感染。目的：建立多重环介导核酸等温扩增技术,实现在一管反应体系内同时检测四种病原体：乙肝病毒,丙肝病毒,艾滋病毒和梅毒螺旋体。方法：通过限制性酶切处理多重环介导核酸等温扩增产物,利用酶切产物的长度分析扩增产物的种类,从而分析待测样本中含有何种血液病原体。结果：检测164例临床样本,其检测结果可以通过琼脂糖电泳,聚丙烯酰胺凝胶电泳及芯片电泳分析,且均可实现对多重扩增产物的酶切片段进行区分和鉴别。结论：多重环介导核酸等温扩增技术可以同时单管检测多种待测血液病原体,可以为临床提高简单、快速、高灵敏和高特异的检测技术。     

Anti LAV/HTLV III antibodies in blood donors: preliminary results of pool screening of 5 samples

Serological performances obtained with five reagents for anti-LAV/HTLVIII antibody screening were compared in individual test and in pool. A panel of 55 selected samples and 2,079 pools prepared from 10,395 unselected samples of blood donors was studied. A first dilution is achieved by pooling, then a second dilution allows to obtain the exact working dilution recommended for the test. The sensitivity in pool method is always similar to the sensitivity in individual test, no false negative was observed. The specificity, evaluated on unselected samples, is slightly inferior to that observed in individual test: false-positive rate is in generally less than 3% compared to 2% average rate routinely observed with individual test. These results allow to propose this method, which save about 75% of the reagent cost, for blood donor screening in all laboratories and especially in developing countries.     

Preparation and Pathogen Inactivation of Double Dose Buffy Coat Platelet Products using the INTERCEPT Blood System

Blood centers are faced with many challenges including maximizing production yield from the blood product donations they receive as well as ensuring the highest possible level of safety for transfusion patients, including protection from transfusion transmitted diseases. This must be accomplished in a fiscally responsible manner which minimizes operating expenses including consumables, equipment, waste, and personnel costs, among others.Several methods are available to produce platelet concentrates for transfusion. One of the most common is the buffy coat method in which a single therapeutic platelet unit (≥ 2.0 x10¹¹ platelets per unit or per local regulations) is prepared by pooling the buffy coat layer from up to six whole blood donations. A procedure for producing "double dose" whole blood derived platelets has only recently been developed.Presented here is a novel method for preparing double dose whole blood derived platelet concentrates from pools of 7 buffy coats and subsequently treating the double dose units with the INTERCEPT Blood System for pathogen inactivation. INTERCEPT was developed to inactivate viruses, bacteria, parasites, and contaminating donor white cells which may be present in donated blood. Pairing INTERCEPT with the double dose buffy coat method by utilizing the INTERCEPT Processing Set with Dual Storage Containers (the "DS set"), allows blood centers to treat each of their double dose units in a single pathogen inactivation processing set, thereby maximizing patient safety while minimizing costs. The double dose buffy coat method requires fewer buffy coats and reduces the use of consumables by up to 50% (e.g. pooling sets, filter sets, platelet additive solution, and sterile connection wafers) compared to preparation and treatment of single dose buffy coat platelet units. Other cost savings include less waste, less equipment maintenance, lower power requirements, reduced personnel time, and lower collection cost compared to the apheresis technique.     

Highly cost-efficient genome-wide association studies using DNA pools and dense SNP arrays

Genome-wide association (GWA) studies to map genes for complex traits are powerful yet costly. DNA-pooling strategies have the potential to dramatically reduce the cost of GWA studies. Pooling using Affymetrix arrays has been proposed and used but the efficiency of these arrays has not been quantified. We compared and contrasted Affymetrix Genechip HindIII and Illumina HumanHap300 arrays on the same DNA pools and showed that the HumanHap300 arrays are substantially more efficient. In terms of effective sample size, HumanHap300-based pooling extracts >80% of the information available with individual genotyping (IG). In contrast, Genechip HindIII-based pooling only extracts ~30% of the available information. With HumanHap300 arrays concordance with IG data is excellent. Guidance is given on best study design and it is shown that even after taking into account pooling error, one stage scans can be performed for >100-fold reduced cost compared with IG. With appropriately designed two stage studies, IG can provide confirmation of pooling results whilst still providing ~20-fold reduction in total cost compared with IG-based alternatives. The large cost savings with Illumina HumanHap300-based pooling imply that future studies need only be limited by the availability of samples and not cost.     

A statistical method for the estimation of window-period risk of transfusion-transmitted HIV in donor screening under non-steady state

Human immunodeficiency virus (HIV) can be transmitted by transfusion of blood even if the blood unit is test-negative for HIV. This is largely due to a time period following an infection, called the window period, during which antibodies against HIV are not detectable. Window-period risk refers to the probability for a test-negative blood unit to be infectious because of its donation during the window period. Estimation of window-period risk is important in public health for evaluating the safety of donated blood. The standard method for this estimation problem has been based on so-called incidence/window-period (IWP) models in which blood-donation and HIV-infection processes are assumed to be stochastically stationary and independent. Here we propose a new approach in which we relax this key assumption of the IWP models. We estimate window-period risk for each unit of donated blood using a given distribution of window-period risk. The proposed method utilizes the actual observed donation intervals including those of seroconversions, thereby relaxing the assumption that may not be met in practice. Bootstrap is used to compute confidence intervals without specifying the complex dynamics of the donation and infection processes. A simulation study illustrates the usefulness of the proposed method over the IWP method in scenarios where the IWP assumptions do not hold. A real application of the proposed method is presented using blood bank data from a province of northern Thailand. Advantages and limitations of the proposed method are discussed and compared with the IWP models.     

Bayesian inference for prevalence and diagnostic test accuracy based on dual-pooled screening

We propose a useful protocol for the problem of screening populations for low-prevalence characteristics such as HIV or drugs. Current HIV screening of blood that has been donated for transfusion involves the testing of individual blood units with an inexpensive enzyme-linked immunosorbent assay test and follow-up with a more accurate and more expensive western blot test for only those units that tested positive. Our cost-effective pooling strategy would enhance current methods by making it possible to accurately estimate the sensitivity and specificity of the initial screening test, and the proportion of defective units that have passed through the system. We also provide a method of estimating the distribution of prevalences for the characteristic throughout the population or subpopulations of interest.     

Development of a sample pooling strategy for the serodiagnosis of small ruminant lentiviral infections using the ELITEST-MVV ELISA

To reduce the costs of using the ELITEST-MVV, we explored the possibilities of sample pooling. Straight forward pooling applying the manufacturer's test conditions resulted in a significant loss of sensitivity. This was solved by using lower pre-dilutions of the samples than prescribed. Although an increase of background signal was encountered, discrimination between positive and negative samples was even better at pre-dilutions up to 12.5× as compared to the standard pre-dilution of 100×. This implied that pooling of up to eight samples was feasible. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for the testing of pooled serum samples.

A model for cost-benefit analysis of pooling was applied which combines the economics of the technical performance of the modified assay and other additional cost factors connected with pooling such as hands-on time for composing the pools, expected seroprevalence in the test population, sample tracing and testing the individual samples of positive pools.

We concluded that pooling of samples was only feasible for monitoring SRLV-free accredited flocks because of their very low prevalence of infection. A pool consisting of five samples turned out to be the economical optimum although technically pool sizes of 10 samples were permitted.     

Application of Polymerase Chain Reaction to Detect HIV-1 DNA in Pools of Dried Blood Spots

Nucleic acid tests that detect HIV infection at an early phase are available and have been applied on individual dried blood spot (DBS). The present study was undertaken with an aim to evaluate the feasibility of performing PCR for HIV-1 DNA on pools of DBS as an alternative to individual testing. Standardization of PCR by a modified Amplicor HIV-1 DNA assay version 1.5 (Roche molecular diagnostics, USA), on pooled DBS was performed using five confirmed HIV reactive samples with known low viral load of HIV-1 and HIV non-reactive samples in pools of 5, 10 and 20 DBS. After successful standardization of pooling procedure, a total of 183 pools (of 10 DBS each) were prepared from 1,823 DBS samples, collected from a population-based study that tested negative for HIV antibodies and p24 antigen. All these pools were screened for HIV-1 DNA by the Amplicor assay. Standardization of pooling procedure indicated that pooling of 10 DBS gave an optimum result. Out of 183 pools tested, one pool of 10 samples was positive and of these ten DBS that were tested individually to identify the positive DBS, one sample was detected to be positive for HIV-1 DNA. Our study demonstrates that PCR for HIV-1 DNA can be successfully performed on pools of DBS. However, this may be needed only on specialized studies of HIV and not for routine epidemiology studies as only a very small fraction of cases would be missed if only antibody/antigen testing were done.     

Optimal DNA pooling-based two-stage designs in case-control association studies

Study cost remains the major limiting factor for genome-wide association studies due to the necessity of genotyping a large number of SNPs for a large number of subjects. Both DNA pooling strategies and two-stage designs have been proposed to reduce genotyping costs. In this study, we propose a cost-effective, two-stage approach with a DNA pooling strategy. During stage I, all markers are evaluated on a subset of individuals using DNA pooling. The most promising set of markers is then evaluated with individual genotyping for all individuals during stage II. The goal is to determine the optimal parameters (pi(p)(sample ), the proportion of samples used during stage I with DNA pooling; and pi(p)(marker ), the proportion of markers evaluated during stage II with individual genotyping) that minimize the cost of a two-stage DNA pooling design while maintaining a desired overall significance level and achieving a level of power similar to that of a one-stage individual genotyping design. We considered the effects of three factors on optimal two-stage DNA pooling designs. Our results suggest that, under most scenarios considered, the optimal two-stage DNA pooling design may be much more cost-effective than the optimal two-stage individual genotyping design, which use individual genotyping during both stages.     

A Permutation Test for Oligoset DNA Pooling Studies

Case-control association studies often suffer from population stratification bias. A previous triple combination strategy of stratum matching, genomic controlling, and multiple DNA pooling can correct the bias and save genotyping cost. However the method requires researchers to prepare a multitude of DNA pools—more than 30 case-control pooling sets in total (polyset). In this paper, the authors propose a permutation test for oligoset DNA pooling studies. Monte-Carlo simulations show that the proposed test has a type I error rate under control and a power comparable to that of individual genotyping. For a researcher on a tight budget, oligoset DNA pooling is a viable option.     

The economic side of blood banking and plasma fractionation.

While cellular components have a relatively short half-life, must be necessarily administered group-specifically and kept available on a round-the-clock basis, all of which add significantly to the basic cost per unit, products isolated from plasma are not handicapped by these disadvantages. Another important advantage for the production of plasma components lies in the fact that the raw material may be also collected through plasmapheresis, a process which allows the collection of significantly greater amounts of plasma from one donor as compared to conventional whole blood collection. Quite understandably, the maintenance of whole blood and cellular component supplies has been left to national and/or non-profit organizations, while commercial firms run a profitable business with the production and distribution of plasma fractions. The method for the selective isolation of plasma fractions developed in our blood transfusion service solves the high cost problems involved in conventional fractionation methods but does not solve the ethical and economical problem related to discarding precious unused raw material.     

Effective High-Throughput Blood Pooling Strategy before DNA Extraction for Detection of Malaria in Low-Transmission Settings

In the era of (pre) elimination setting, the prevalence of malaria has been decreasing in most of the previously endemic areas. Therefore, effective cost- and time-saving validated pooling strategy is needed for detection of malaria in low transmission settings. In this study, optimal pooling numbers and lowest detection limit were assessed using known density samples prepared systematically, followed by genomic DNA extraction and nested PCR. Pooling strategy that composed of 10 samples in 1 pool, 20 µl in 1 sample, was optimal, and the parasite density as low as 2 p/µl for both falciparum and vivax infection was enough for detection of malaria. This pooling method showed effectiveness for handling of a huge number of samples in low transmission settings (<9% positive rate). The results indicated that pooling of the blood samples before DNA extraction followed by usual nested PCR is useful and effective for detection of malaria in screening of hidden cases in low-transmission settings.     

Needle exchange programs: an economic evaluation of a local experience

OBJECTIVE: To determine whether providing a needle exchange program to prevent HIV transmission among injection drug users would cost less than the health care consequences of not having such a program. DESIGN: Incidence outcome model to estimate the number of cases of HIV infection that this program would prevent over 5 years, assuming that the HIV incidence rate would be 2% with the program and 4% without it, and that an estimated 275 injection drug users would use the service over this time. SETTING: Hamilton, Ont. OUTCOME MEASURES: Estimated number of cases of HIV infection expected to be prevented with and without the program over 5 years; estimated lifetime health care costs of treating an AIDS patient. The indirect costs of AIDS to society (e.g., lost productivity and informal caregiving) were not included. Projected costs were adjusted (discounted) to reflect their present value. In a sensitivity analysis, 3 parameters were varied: the estimate of the HIV transmission rate if no needle exchange program were provided, the number of injection drug users participating in the program, and the discount rate. RESULTS: With very conservative estimates, it was predicted that the Hamilton needle exchange program will prevent 24 cases of HIV infection over 5 years, thereby providing cost savings of $1.3 million after the program costs are taken into account. This translates into a ratio of cost savings to costs of 4:1. The sensitivity analysis confirmed that these findings are robust. CONCLUSION: Needle exchange programs are an efficient use of financial resources.     

A non-parametric method for the reconstruction of age- and time-dependent incidence from the prevalence data of irreversible diseases with differential mortality.

A method is proposed for reconstructing the time and age dependence of incidence rates from successive age-prevalence cross sections taken from the sentinel surveys of irreversible diseases when there is an important difference in mortality between the infected and susceptible subpopulations. The prevalence information at different time-age points is used to generate a surface; the time-age variations along the life line profiles of this surface and the difference in mortality rates are used to reconstruct the time and age dependence of the incidence rate. Past attempts were based on specified parametric forms for the incidence or on the hypothesis of time-invariant forms for the age-prevalence cross sections. The proposed method makes no such assumptions and is thus capable of coping with rapidly evolving prevalence situations. In the simulations carried out, it is found to be resilient to important random noise components added to a prescribed incidence rate input. The method is also tested on a real data set of successive HIV age-prevalence cross sections from Burundi coupled to differential mortality data on HIV(+) and HIV(-) individuals. The often-made assumption that the incidence rate can be written as the product of a calendar time component and an age component is also examined. In this case, a pooling procedure is proposed to estimate the time and the age profiles of the incidence rate using the reconstructed incidence rates at all time-age points.     

时间分辨荧光免疫分析法确定血痕种属

采时时间分辨荧光免疫分析法（ＴＲＦＩＡ）鉴定微量血痕种属。固相和铕标记抗体均采用抗人ＩｇＧ抗体。通过检测可确定血痕是否来源于人体。使用本法检测血清样品的灵敏度达５０万倍稀释度,检测血痕样品达２０万倍稀释度,时间分辨荧光免疫分析法具有无放射性污染,标记物保存期长,特异性好,结果稳定,操作简便等优点,适于法医学的常规检测。     

LIFE IN ZERO MAGNETIC FIELD. III. EFFECT ON ZINC AND COPPER IN HUMAN BLOOD SERUM DURING IN VITRO AGING

The purpose of the work was to further investigate the effect of zero magnetic field (ZMF) on the concentration of ions in the human blood compared to the effect of the normal geomagnetic field (GMF). We have investigated the total Zn and Cu concentrations in the blood serum during in vitro aging of blood. The investigation was carried out both on blood from healthy donors as well as from chronic bronchial asthma (BA) patients. Blood samples were kept for 48 hours in a Helmholtz coil compensating system to remove the static component of the geomagnetic field, at room temperature. We found that zinc concentrations in the plasma were not significantly influenced by the exposure to ZMF compared to GMF for both healthy and pathological samples. In contrast, copper concentration was found to be significantly sensitive to the magnetic environment. Healthy blood showed a slight loss of copper from the blood serum in GMF, which further increased in ZMF. BA pathology is characterized by four distinct types of disease, which showed both qualitative and quantitative distinctive sensitivity to the magnetic environment, as compared to healthy blood. The aging effect appeared to be slowed down for most of the BA types of pathologies. These results point to the sensitivity of ion binding to serum proteins and/or transport through cell membranes in the magnetic environment, in our case in the absence of the normal geomagnetic field.     

Evaluation of DNA pooling for the estimation of microsatellite allele frequencies: a case study using striped bass (Morone saxatilis)

Using striped bass (Morone saxatilis) and six multiplexed microsatellite markers, we evaluated procedures for estimating allele frequencies by pooling DNA from multiple individuals, a method suggested as cost-effective relative to individual genotyping. Using moment-based estimators, we estimated allele frequencies in experimental DNA pools and found that the three primary laboratory steps, DNA quantitation and pooling, PCR amplification, and electrophoresis, accounted for 23, 48, and 29%, respectively, of the technical variance of estimates in pools containing DNA from 2-24 individuals. Exact allele-frequency estimates could be made for pools of sizes 2-8, depending on the locus, by using an integer-valued estimator. Larger pools of size 12 and 24 tended to yield biased estimates; however, replicates of these estimates detected allele frequency differences among pools with different allelic compositions. We also derive an unbiased estimator of Hardy-Weinberg disequilibrium coefficients that uses multiple DNA pools and analyze the cost-efficiency of DNA pooling. DNA pooling yields the most potential cost savings when a large number of loci are employed using a large number of individuals, a situation becoming increasingly common as microsatellite loci are developed in increasing numbers of taxa.     

A rapid method for repeated collection of blood from the tail vein of rats

A method was developed for obtaining serial blood samples from the tail vein of rats. Seventy microliters of blood were collected at the rate of approximately one sample per minute for the quantitative determination of whole blood clearance of radiolabeled compounds. The technique was rapid, reproducible, and kept stress to the test animals at a minimum.     

Malaria diagnosis from pooled blood samples: comparative analysis of real-time PCR, nested PCR and immunoassay as a platform for the molecular and serological diagnosis of malaria on a large-scale

Malaria diagnoses has traditionally been made using thick blood smears, but more sensitive and faster techniques are required to process large numbers of samples in clinical and epidemiological studies and in blood donor screening. Here, we evaluated molecular and serological tools to build a screening platform for pooled samples aimed at reducing both the time and the cost of these diagnoses. Positive and negative samples were analysed in individual and pooled experiments using real-time polymerase chain reaction (PCR), nested PCR and an immunochromatographic test. For the individual tests, 46/49 samples were positive by real-time PCR, 46/49 were positive by nested PCR and 32/46 were positive by immunochromatographic test. For the assays performed using pooled samples, 13/15 samples were positive by real-time PCR and nested PCR and 11/15 were positive by immunochromatographic test. These molecular methods demonstrated sensitivity and specificity for both the individual and pooled samples. Due to the advantages of the real-time PCR, such as the fast processing and the closed system, this method should be indicated as the first choice for use in large-scale diagnosis and the nested PCR should be used for species differentiation. However, additional field isolates should be tested to confirm the results achieved using cultured parasites and the serological test should only be adopted as a complementary method for malaria diagnosis.