Integrating molecular diagnostics into histopathology training: the Belfast model

Molecular medicine is transforming modern clinical practice, from diagnostics to therapeutics. Discoveries in research are being incorporated into the clinical setting with increasing rapidity. This transformation is also deeply changing the way we practise pathology. The great advances in cell and molecular biology which have accelerated our understanding of the pathogenesis of solid tumours have been embraced with variable degrees of enthusiasm by diverse medical professional specialties. While histopathologists have not been prompt to adopt molecular diagnostics to date, the need to incorporate molecular pathology into the training of future histopathologists is imperative. Our goal is to create, within an existing 5-year histopathology training curriculum, the structure for formal substantial teaching of molecular diagnostics. This specialist training has two main goals: (1) to equip future practising histopathologists with basic knowledge of molecular diagnostics and (2) to create the option for those interested in a subspecialty experience in tissue molecular diagnostics to pursue this training. It is our belief that this training will help to maintain in future the role of the pathologist at the centre of patient care as the integrator of clinical, morphological and molecular information.

In situ diagnostics and prognostics of solder fatigue in IGBT modules for electric vehicle drives

This paper proposes an in situ diagnostic and prognostic (D&P) technology to monitor the health condition of insulated gate bipolar transistors (IGBTs) used in EVs with a focus on the IGBTs' solder layer fatigue. IGBTs' thermal impedance and the junction temperature can be used as health indicators for through-life condition monitoring (CM) where the terminal characteristics are measured and the devices' internal temperature-sensitive parameters are employed as temperature sensors to estimate the junction temperature. An auxiliary power supply unit, which can be converted from the battery's 12-V dc supply, provides power to the in situ test circuits and CM data can be stored in the on-board data-logger for further offline analysis. The proposed method is experimentally validated on the developed test circuitry and also compared with finite-element thermoelectrical simulation. The test results from thermal cycling are also compared with acoustic microscope and thermal images. The developed circuitry is proved to be effective to detect solder fatigue while each IGBT in the converter can be examined sequentially during red-light stopping or services. The D&P circuitry can utilize existing on-board hardware and be embedded in the IGBT's gate drive unit.

AgriSense: Multichannel disposable sensors for animal health disease diagnostics

Rapid and sensitive detection of viral infections associated with Bovine Respiratory Disease (BRD) in live animals is recognized as key to minimizing the impact of this disease. ELISA-based testing is limited as it typically relies on the detection of a single viral antibody subtype within an individual test sample and testing is relatively slow and expensive. We have recently initiated a new project entitled AgriSense to develop a novel low-cost and label-free, integrated bimodal electronic biosensor system for BRD. The biosensor system will consist of an integrated multichannel thin-film-transistor biosensor and an electrochemical impedance spectroscopy biosensor, interfaced with PDMS-based microfluidic sample delivery channels. By using both sensors in tandem, nonspecific binding biomolecules must have the same mass to charge ratio as the target analyte to elicit equivalent responses from both sensors. The system will target simultaneous multiplexed sensing of the four primary viral agents involved in the development of BRD: bovine herpesvirus-1 (BHV-1), bovine parainfluenza virus-3 (BPIV-3), bovine respiratory syncytial virus (BRSV), and bovine viral diarrhea (BVD). Optimized experimental conditions derived through model antigen-antibody studies will be applied to the detection of serological markers of BRD-related infections based on IgG interaction with a panel of sensor-immobilized viral proteins. This rapid, “cowside” multiplex sensor capability presents a major step forward in disease diagnosis, helping to ensure the integrity of the agri-food supply chain by reducing the risk of disease spread during animal movement and transport.

Molecular diagnostics of myeloproliferative neoplasms

Since the discovery of the JAK2 V617F mutation in the majority of the myeloproliferative neoplasms (MPN) of polycythemia vera, essential thrombocythemia and primary myelofibrosis ten years ago, further MPN-specific mutational events, notably in JAK2 exon 12, MPL exon 10 and CALR exon 9 have been identified. These discoveries have been rapidly incorporated into evolving molecular diagnostic algorithms. While many of these mutations appear to have prognostic implications, establishing MPN diagnosis is of immediate clinical importance with selection, implementation and the continual evaluation of the appropriate laboratory methodology to achieve this diagnosis similarly vital. The advantages and limitations of these approaches in identifying and quantitating the common MPN-associated mutations is considered herein with particular regard to their clinical utility. The evolution of molecular diagnostic applications and platforms has occurred in parallel with the discovery of MPN-associated mutations and it therefore appears likely that emerging technologies such as next-generation sequencing and digital PCR will in the future, play an increasing role in the molecular diagnosis of MPN. 

Gamma-ray diagnostics of Type Ia supernovae. Predictions of observables from three-dimensional modeling

Context. Although the question of progenitor systems and detailed explosion mechanisms still remains a matter of discussion, it is commonly believed that Type Ia supernovae (SNe Ia) are production sites of large amounts of radioactive nuclei. Even though the gamma-ray emission due to radioactive decays is responsible for powering the light curves of SNe Ia, gamma rays themselves are of particular interest as a diagnostic tool because they directly lead to deeper insight into the nucleosynthesis and the kinematics of these explosion events. Aims: We study the evolution of gamma-ray line and continuum emission of SNe Ia with the objective of analyzing the relevance of observations in this energy range. We seek to investigate the chances for the success of future MeV missions regarding their capabilities for constraining the intrinsic properties and the physical processes of SNe Ia. Methods: Focusing on two of the most broadly discussed SN Ia progenitor scenarios - a delayed detonation in a Chandrasekhar-mass white dwarf (WD) and a violent merger of two WDs - we used three-dimensional explosion models and performed radiative transfer simulations to obtain synthetic gamma-ray spectra. Both chosen models produce the same mass of 56Ni and have similar optical properties that are in reasonable agreement with the recently observed supernova SN 2011fe. We examine the gamma-ray spectra with respect to their distinct features and draw connections to certain characteristics of the explosion models. Applying diagnostics, such as line and hardness ratios, the detection prospects for future gamma-ray missions with higher sensitivities in the MeV energy range are discussed. Results: In contrast to the optical regime, the gamma-ray emission of our two chosen models proves to be quite different. The almost direct connection of the emission of gamma rays to fundamental physical processes occurring in SNe Ia permits additional constraints concerning several explosion model properties that are not easily accessible within other wavelength ranges. Proposed future MeV missions such as GRIPS will resolve all spectral details only for nearby SNe Ia, but hardness ratio and light curve measurements still allow for a distinction of the two different models at 10 Mpc and 16 Mpc for an exposure time of 106 s. The possibility of detecting the strongest line features up to the Virgo distance will offer the opportunity to build up a first sample of SN Ia detections in the gamma-ray energy range and underlines the importance of future space observatories for MeV gamma rays.

A potentiometric biosensor for rapid on-site disease diagnostics

Quantitative point-of-care (POC) devices are the next generation for serological disease diagnosis. Whilst pathogen serology is typically performed by centralized laboratories using Enzyme-Linked ImmunoSorbent Assay (ELISA), faster on-site diagnosis would infer improved disease management and treatment decisions. Using the model pathogen Bovine Herpes Virus-1 (BHV-1) this study employs an extended-gate field-effect transistor (FET) for direct potentiometric serological diagnosis. BHV-1 is a major viral pathogen of Bovine Respiratory Disease (BRD), the leading cause of economic loss ($2 billion annually in the US only) to the cattle and dairy industry. To demonstrate the sensor capabilities as a diagnostic tool, BHV-1 viral protein gE was expressed and immobilized on the sensor surface to serve as a capture antigen for a BHV-1-specific antibody (anti-gE), produced in cattle in response to viral infection. The gE-coated immunosensor was shown to be highly sensitive and selective to anti-gE present in commercially available anti-BHV-1 antiserum and in real serum samples from cattle with results being in excellent agreement with Surface Plasmon Resonance (SPR) and ELISA. The FET sensor is significantly faster than ELISA (<10 min), a crucial factor for successful disease intervention. This sensor technology is versatile, amenable to multiplexing, easily integrated to POC devices, and has the potential to impact a wide range of human and animal diseases.

Immunohistochemistry should undergo robust validation equivalent to that of molecular diagnostics

Immunohistochemistry (IHC) is a widely available and highly utilised tool in diagnostic histopathology and is used to guide treatment options as well as provide prognostic information. IHC is subjected to qualitative and subjective assessment, which has been criticised for a lack of stringency, while PCR-based molecular diagnostic validations by comparison are regarded as very rigorous. It is essential that IHC tests are validated through evidence-based procedures. With the move to ISO15189 (2012), not just of the accuracy, specificity and reproducibility of each test need to be determined and managed, but also the degree of uncertainty and the delivery of such tests. The recent update to ISO 15189 (2012) states that it is appropriate to consider the potential uncertainty of measurement of the value obtained in the laboratory and how that may impact on prognostic or predictive thresholds. In order to highlight the problems surrounding IHC validity, we reviewed the measurement of Ki67and p53 in the literature. Both of these biomarkers have been incorporated into clinical care by pathology laboratories worldwide. The variation seen appears excessive even when measuring centrally stained slides from the same cases. We therefore propose in this paper to establish the basis on which IHC laboratories can bring the same level of robust validation seen in the molecular pathology laboratories and the principles applied to all routine IHC tests.

Electron-Impact Uncertainty Analysis and its Impact on Certain Temperature Diagnostics

In this study we calculate the electron-impact uncertainties in atomic data for direct ionization and recombination and investigate the role of these uncertainties on spectral diagnostics. We outline a systematic approach to assigning meaningful uncertainties that vary with electron temperature. Once these uncertainty parameters have been evaluated, we can then calculate the uncertainties on key diagnostics through a Monte Carlo routine, using the Astrophysical Emission Code (APEC) [Smith et al. 2001]. We incorporate these uncertainties into well known temperature diagnostics, such as the Lyman alpha versus resonance line ratio and the G ratio. We compare these calculations to a study performed by [Testa et al. 2004], where significant discrepancies in the two diagnostic ratios were observed. We conclude that while the atomic physics uncertainties play a noticeable role in the discrepancies observed by Testa, they do not explain all of them. This indicates that there is another physical process occurring in the system that is not being taken into account. This work is supported in part by the National Science Foundation REU and Department of Defense ASSURE programs under NSF Grant no. 1262851 and by the Smithsonian Institution.

Line ratio diagnostics in helium and helium seeded argon plasmas

We investigate the potential use of line ratio diagnostics to evaluate electron temperature in either helium or helium seeded argon plasmas. Plasmas are produced in a helicon plasma source. A rf compensated Langmuir probe is used to measure both the electron temperature and plasma density while a spectrometer is used to measure He I line intensities from the plasma. For all plasma densities where the electron temperature remains at 5 ± 1 eV, three He line ratios are measured. Each experimental ratio is compared with the prediction of three different collisional radiative models. One of these models makes uses of recent R-matrix with pseudo-states calculations for collisional rate coefficients. A discussion related to the different observations and model predictions is presented.

The application of atomic physics within impurity diagnostics for fusion plasmas

With the focus of ITER on the transport and emission properties of tungsten, generating atomic data for complex species has received much interest. Focusing on impurity influx diagnostics, we discuss recent work on heavy species. Perturbative approaches do not work well for near neutral systems so non-perturbative data are required, presenting a particular challenge for these influx diagnostics. Recent results on Mo+ are given as an illustration of how the diagnostic applications can guide the theoretical calculations for such systems.

A high-value, low-cost bubble continuous positive airway pressure system for low-resource settings:technical assessment and initial case reports

Acute respiratory infections are the leading cause of global child mortality. In the developing world, nasal oxygen therapy is often the only treatment option for babies who are suffering from respiratory distress. Without the added pressure of bubble Continuous Positive Airway Pressure (bCPAP) which helps maintain alveoli open, babies struggle to breathe and can suffer serious complications, and frequently death. A stand-alone bCPAP device can cost $6,000, too expensive for most developing world hospitals. Here, we describe the design and technical evaluation of a new, rugged bCPAP system that can be made in small volume for a cost-of-goods of approximately $350. Moreover, because of its simple design--consumer-grade pumps, medical tubing, and regulators--it requires only the simple replacement of a <$1 diaphragm approximately every 2 years for maintenance. The low-cost bCPAP device delivers pressure and flow equivalent to those of a reference bCPAP system used in the developed world. We describe the initial clinical cases of a child with bronchiolitis and a neonate with respiratory distress who were treated successfully with the new bCPAP device.