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Automated entry of hospital infection surveillance data.

OBJECTIVE: To assess the accuracy of an automated data entry system employing optical scanning technology and to provide an analysis of its costs as compared to manual data entry. DESIGN: The accuracy and cost of automated data entry of 100 surgical-wound infection surveillance questionnaires was compared to manual entry. SETTING: The Surgical Directorate, The Royal Hospitals, Belfast, Northern Ireland. RESULTS: The use of optical scanning technology greatly improved the speed and accuracy of data entry. The time spent by the keyboard operator on data entry was reduced substantially. For each surgical-wound infection questionnaire automatically processed, there was a saving in clerical time equivalent to $0.63. The automated data entry process resulted in a 22-fold productivity increase compared to manual data entry with validation. After validation, an error rate of < 0.2 errors per 1,000 responses was detected in automatically entered data compared to a rate of 12.4 errors per 1,000 responses for manually entered data. The automated system, including validation, provided a seven-fold productivity increase compared to "quick-and-dirty" manual data entry without validation. CONCLUSION: Hospital information technology systems may achieve total integration of data management, but realistically this would appear to be very much in the future. Until then, in view of the accuracy and substantial savings in time and money, we recommend the use of automated data entry technology. This system would be especially useful where data are transported from outlying hospitals to a central receiving center for collation and analysis.

Cost-Benefit Analysis↗

Comparison of semi-automated image analysis and manual methods for tissue quantification in pancreatic carcinoma.

Objective measurements of tissue area during histological examination of carcinoma can yield valuable prognostic information. However, such measurements are not made routinely because the current manual approach is time consuming and subject to large statistical sampling error. In this paper, a semi-automated image analysis method for measuring tissue area in histological samples is applied to the measurement of stromal tissue, cell cytoplasm and lumen in samples of pancreatic carcinoma and compared with the standard manual point counting method. Histological samples from 26 cases of pancreatic carcinoma were stained using the sirius red, light-green method. Images from each sample were captured using two magnifications. Image segmentation based on colour cluster analysis was used to subdivide each image into representative colours which were classified manually into one of three tissue components. Area measurements made using this technique were compared to corresponding manual measurements and used to establish the comparative accuracy of the semi-automated image analysis technique, with a quality assurance study to measure the repeatability of the new technique. For both magnifications and for each tissue component, the quality assurance study showed that the semi-automated image analysis algorithm had better repeatability than its manual equivalent. No significant bias was detected between the measurement techniques for any of the comparisons made using the 26 cases of pancreatic carcinoma. The ratio of manual to semi-automatic repeatability errors varied from 2.0 to 3.6. Point counting would need to be increased to be between 400 and 1400 points to achieve the same repeatability as for the semi-automated technique. The results demonstrate that semi-automated image analysis is suitable for measuring tissue fractions in histological samples prepared with coloured stains and is a practical alternative to manual point counting.

Algorithms↗

Detection of early "significant" antibody responses in paired sera by the use of an automated bovine parainfluenza-3 hemagglutination-inhibition system.

An automated bovine parainfluenza-3 hemagglutination-inhibition system was used to detect small increases (15--20%) in specific antibody titer between paired bovine sera collected three days apart. Automated and manual parainfluenza-3 hemagglutination-inhibition test procedures were compared as methods for the serologic diagnosis of parainfluenza-3 infection. Fifteen daily serum specimens from each of three animals were analyzed as various possible manual-test and automated-test serum pairs. With the sera from two of the animals, considered to be parainfluenza-3 hemagglutination-inhibition-positive, the manual microtiter test procedure made 18 (69%) false negative diagnoses when using the standard manual-test criteria for "evidence of infection." When a 20% titer increase between three-day serum pairs was considered "serologically significant," the automated system made three (17%) false-negative diagnoses. At a 15% "serologically significant" increase, no false-negative diagnosis was made. The utilization of automated serology for the routine diagnosis of disease should permit treatment and control measures to be initiated early, thereby reducing losses due to infectious disease.

Animals↗

The in vitro cytokinesis-block micronucleus assay: a detailed description of an improved slide preparation technique for the automated detection of micronuclei in human lymphocytes.

An improved slide preparation technique is described for the automated detection of micronuclei in binucleate cytokinesis-blocked human lymphocytes. This automated system (Discovery Image Analyser, Becton-Dickinson Image Cytometry Systems, Leiden, The Netherlands) searches for the pattern of two touching nuclei in binucleate cells instead of the edges of the cytoplasm. For this purpose several ratios of the fixative mixture, methanol/acetic acid, were checked. After fixation with a ratio of 25:1, touching nuclei were obtained in almost 100% of the binucleate cells. A hydrolysis treatment with 5 N HCl before staining with Romanowsky-Giemsa resulted in binucleate cells with dark-stained nuclei and micronuclei and a vaguely stained cytoplasm. The high visual contrast between cytoplasm and nuclear material obtained by this staining procedure makes an accurate automated detection of micronuclei feasible. Additionally, a 64 h culture time resulted in an optimal yield of binucleate cells. The results of manual micronucleus scoring on slides prepared with the 'manual protocol' and with the 'automation protocol' indicate no significant differences between both sets of data supporting the validity of the automation protocol.

Cell Division↗

Assessment of automated scoring of polysomnographic recordings in a population with suspected sleep-disordered breathing.

STUDY OBJECTIVES: To assess the accuracy of an automated system (Morpheus I Sleep Scoring System) for analyzing and quantifying polysomnographic data from a population with sleep-disordered breathing. SETTING: Sleep laboratory affiliated with a tertiary care academic medical center. MEASUREMENTS AND RESULTS: 31 diagnostic polysomnograms were blindly analyzed prospectively with the investigational automated system and manually by 2 registered polysomnography technologists (M1 & M2) from the same laboratory. Sleep stages, arousals, periodic limb movements, and respiratory events (apneas and hypopneas) were scored by all 3. Agreement, Cohen kappa, and intraclass correlation coefficients were tabulated for each variable and compared between scoring pairs (A-M1, A-M2, M1-M2). The 26,876 epochs (224 hours of recording time) were analyzed. For sleep staging, agreement/kappa were A-M1: 78%/0.67, A-M2: 73%/0.61, and M1-M2: 82%/0.73. The mean respiratory disturbance indexes were M1: 20.6+/-23.0, M2: 22.5+/-24.5, and A: 23.7+/-23.4 events per hour of sleep. The respiratory disturbance index concordance between each scoring pair was excellent (intraclass correlation coefficients > or = 0.95 for all pairs), although there was disagreement in the classification of moderate sleep-disordered breathing (percentage of positive agreement: A-M1, 37.5% and A-M2, 44.4%) defined as a respiratory disturbance index between 15 and 30 events per hour of sleep. For respiratory-event detection, agreement/kappa were A-M1 and A-M2: 90%/0.66 and M1-M2: 95%/0.82. The agreement and kappa for limb movement detection were A-M1: 93%/0.68, A-M2: 92%/0.66, and M1-M2: 96%/0.77. The scoring of arousals was less reliable (agreement range: 76%-84%, kappa range: 0.28-0.57) for all pairs. CONCLUSIONS: Agreement between manual scorers in a population with moderate sleep-disordered breathing was close to the average pairwise agreement of 87% reported in the Sleep Heart Health Study. The automated classification of sleep stages was also close to this standard. The automated scoring system holds promise as a rapid method to score polysomnographic records, but expert verification of the automated scoring is required.

Adult↗

Rapid estimation of left ventricular contractility from end-systolic relations by echocardiographic automated border detection and femoral arterial pressure.

BACKGROUND: Automated echocardiographic measures of left ventricular (LV) cavity area are closely correlated with changes in volume and can be coupled with LV pressure to construct pressure-area loops in real time. The objective was to rapidly estimate LV contractility from the end-systolic relations of cavity area (as a surrogate for LV volume) and femoral arterial pressure (as a surrogate for LV pressure) in patients undergoing cardiac surgery. METHODS: Studies were attempted on 18 consecutive patients with recordings of LV pressure, LV area, and femoral arterial pressure on a computer workstation interfaced with the ultrasound system. End-systolic pressure-area relations (in terms of pressure-area elastance [E'es]) from pressure-area loops during inferior vena caval occlusions were determined before and immediately after cardiopulmonary bypass using both LV and arterial pressure by semiautomated and automated iterative linear regression methods. RESULTS: Data sets were available for 13 patients before and 8 patients after bypass (21 studies in 14 patients). E'es by arterial pressure was closely correlated with E'es by LV pressure: r = 0.96, standard error of the estimate = 2 mmHg/cm2, y = 1.01 x -0.7 by the semiautomated method and r = 0.94, standard error of the estimate = 3 mmHg/cm2, y = 1.02 x -0.5 by the automated method. Analysis of semiautomated and automated estimates of E'es from arterial pressure and E'es using LV pressure by the Bland-Altman method showed no systematic measurement bias and calculated limits of agreement of 8 and 9 mmHg/cm2, respectively. Similar decreases in E'es by arterial and LV pressure occurred from before to after bypass in 7 patients with paired data sets: 32 +/- 12 to 15 +/- 6 mmHg/cm2 and 32 +/- 15 to 15 +/- 7 mmHg/cm2, respectively (P < 0.05 for both). CONCLUSIONS: On-line femoral arterial pressure and LV area data by echocardiographic automated border detection may be used to rapidly calculate E'es as a means to estimate LV contractility in selected patients.

Adult↗

Contrast enhancement of the liver. Evaluation by automated contiguous pixel search.

Eight dogs were infused with one of three different contrast agents: meglumine diatrizoate, iosulamide meglumine, or an ethiodized oil emulsion (EOE 13). Image intensity in the liver was evaluated globally and regionally by means of an automated pixel sampling method to determine differences in the rate of enhancement produced by the three agents. The results of the automated method were compared with those of the standard manual cursor method. The automated method showed that liver parenchyma was enhanced uniformly by all three contrast agents. The maximum degree of enhancement (Mean +/- SEM) for the three agents was diatrizoate, 12.0 +/- 3.5 Hounsfield units (HU); iosluamide, 21.3 +/- 3.5 HU; and EOE 13, 37.2 +/- 4.25 HU. With the manual cursor method, contrast enhancement was about 20% more than estimated by the automated method. The automated method is better for evaluating the magnitude and pattern of contrast agent enhancement of the entire liver, since the currently employed cursor technique requires multiple evaluations to evaluate the entire liver.

Animals↗

Automated image registration: II. Intersubject validation of linear and nonlinear models.

PURPOSE: Our goal was to validate linear and nonlinear intersubject image registration using an automated method (AIR 3.0) based on voxel intensity. METHOD: PET and MRI data from 22 normal subjects were registered to corresponding averaged PET or MRI brain atlases using several specific linear and nonlinear spatial transformation models with an automated algorithm. Validation was based on anatomically defined landmarks. RESULTS: Automated registration produced results that were superior to a manual nine parameter variant of the Talairach registration method. Increasing the degrees of freedom in the spatial transformation model improved the accuracy of automated intersubject registration. CONCLUSION: Linear or nonlinear automated intersubject registration based on voxel intensities is computationally practical and produces more accurate alignment of homologous landmarks than manual nine parameter Talairach registration. Nonlinear models provide better registration than linear models but are slower.

Adult↗

Automated measurement of volume flow in the ascending aorta using MR velocity maps: evaluation of inter- and intraobserver variability in healthy volunteers.

PURPOSE: An automated contour detection algorithm was developed for the objective and reproducible quantitative analysis of velocity-encoded MR studies of the ascending aorta. METHOD: The only user interaction required is the manual definition of a center point inside the cross-section of the aorta in one of the available images. The automated contour detection algorithm detects an initial model contour in this image and subsequently corrects for motion and deformation of the aortic cross-section in each of the acquired images over the complete cardiac cycle using dynamic programming techniques. Integrating the flow velocity values for each pixel within the detected contour results in an instantaneous flow value. Next, by integrating the instantaneous flow values for each acquired phase over the complete cardiac cycle, left ventricular stroke volume measurement could be obtained. The results of the automated method were compared with results derived from manually traced contours in MR studies from 11 healthy volunteers. RESULTS: An excellent agreement in stroke volume measurements was observed: signed difference 0.61+/-1.15%. Inter- and intraobserver variabilities were <2% for both manual and automated image analysis methods. Manual tracing of contours required on the order of 10 min; the analysis time for automated contour detection was <6 s/study. CONCLUSION: The present contour detection allows fast and reliable left ventricular stroke volume measurements from aortic flow studies using velocity-encoded MR studies in healthy volunteers. Further study is required to assess the accuracy and reproducibility of the algorithm in patients with aortic and aortic valve disease.

Adult↗

The repeatability of automated and clinician refraction.

PURPOSE: Auto-refractors are used as a starting point for clinicians' refractions and in studies of refractive error. We investigated the repeatability of the Hoya AR-570 and clinician refraction. METHODS: Eighty-six subjects, aged 11 to 60 years, were recruited by mailing inquiries to 500 randomly selected patients who had received recent examinations at the University of California Optometric Eye Center. Contact lens wearers, patients with best corrected visual acuity worse than 20/30 in either eye, and patients with a history of diabetes were excluded. Each subject was examined by two clinicians during one visit. The first clinician obtained five auto-refractor readings for each eye (which were later averaged), performed a balanced subjective refraction (with spherical masking lenses in the phoropter), and repeated the automated refractor measurements. This protocol was then repeated by the second clinician. Clinicians were randomized with regard to testing order and masked to automated refractor results, each other's refractions, and previous spectacle prescriptions. RESULTS: To quantify repeatability, we used mixed model analyses of variance to estimate the appropriate variance components while accounting for the correlation among, for example, repeated measurements of the same eye. Astigmatic data were analyzed by converting into Fourier form: two cross-cylinders at axis 0 degrees (J0) and axis 45 degrees (J45). For mean spherical equivalent, the average difference between five averaged automated refractor readings, taken by two different optometrists, was +0.02 D (95% limits of agreement = -0.36 to +0.40 D). The average difference between the two optometrists' subjective refractions was -0.12 D (95% limits of agreement = -0.90 to +0.65 D). The 95% limits of agreement for the automated refractor were about half those of the clinician for both astigmatic terms (J0 and J45) and for all comparisons. CONCLUSIONS: Automated refraction is more repeatable than subjective refraction and therefore more appropriate for studies of myopia progression.

Adolescent↗

Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial.

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

Adult↗

Methodological aspects of 3D and automated 2D analyses of white matter neuronal density in temporal lobe epilepsy.

White matter neuronal density has been correlated with clinical outcome after temporal lobectomy for refractory epilepsy. Both morphometric 2D (two-dimensional) and stereological 3D (three-dimensional) analyses of neuronal density have been performed. 3D analyses are thought to be more accurate than 2D counts, but more time-consuming. We compared 3D and automated 2D measurements in the same specimens. Adjacent 20-microm (for 3D analyses) and 5-microm (for 2D analyses) sections from 10 temporal lobectomies were stained for NeuN immunohistochemistry. Analysis of 100% of a region of interest (ROI) in deep white matter was performed using an image analysis system (Histometrix, Kinetic Imaging, UK). 3D analyses were undertaken using x 63 magnification (6 h/case). Automated 2D analyses were undertaken using automatic neuronal identification at x 10 magnification with three to four repeats (1.5 h/case). The range of neuronal densities for 3D measurements was 2120-4910 neurones/mm(3), and for automated 2D measurements 17.4-47.1 neurones/mm2. There was a linear correlation between the two methods with an r2 of 0.58. [corrected] Count-recount variability was 1.4-9.9% for the 3D and 5.1-36.6% for the automated 2D measurements. We found a wide range of white matter neuronal densities using either analysis. The low agreement between methods, and the high count-recount variability for the automated 2D analyses, indicate that despite being more time-consuming, rigorous 3D stereological analyses have to be performed to obtain reliable results. These findings have implications for studies requiring neuronal counts in normal and disease states.

Adult↗

An automated microaneurysm detector as a tool for identification of diabetic retinopathy in rural optometric practice.

BACKGROUND: With the increase in the prevalence of diabetes, rural optometric clinics stand to increase their patient load and assessment of diabetic eye disease. This study aimed to assess whether automated identification of diabetic retinopathy based on the presence of microaneurysms is an effective tool in clinical practice. METHODS: We analysed 758 fundal images of 385 patients with diabetes attending the clinic obtained using a Canon CR5 with an EOS10 digital camera through a dilated pupil. Five optometrists employed in the clinic assessed the diabetic retinopathy using binocular indirect ophthalmoscopy. The sensitivity and specificity of the automated system used to analyse the retinal fundal images was determined by comparison with optometric and ophthalmologic assessment. RESULTS: The optometrists achieved 97 per cent sensitivity at 88 per cent specificity with respect to the ophthalmic classification for detecting retinopathy. CONCLUSION: The automated retinopathy detector achieved 85 per cent sensitivity at 90 per cent specificity at detecting retinopathy. The automated microaneurysm detector has a lower sensitivity compared to the optometrists but meets NHMRC guidelines. It may impact on the efficiency of rural optometric practices by early identification of diabetic retinopathy. Automated assessment can save time and be cost-effective, and provide a history of changes in the retinal fundus and the opportunity for instant patient education using the digital images.

Aneurysm↗

An automated injection system (with patient selection) for SPECT imaging in seizure localization.

PURPOSE: Ictal single-photon-emission computed tomography (SPECT) provides lateralization but has technical limitations: (a) a "truly ictal" injection must be shortly after seizure onset; (b) therefore, a seizure of brief duration may be missed; (c) more than one patient may need testing at any given time; (d) a trained health professional must stay next to each patient to inject; and (e) because the radionuclide is placed in the syringe in advance of the injection, decay of the radioactive element could result in less than optimal uptake, if the same volume of material were to be used regardless of the time after ligand preparation. METHODS: We developed an automated method of ligand injection that shortens time and increases efficiency of ictal SPECT ligand injection. By using an experimental setup, we compared manual injection times with times using an automated injection system. We determined relative costs and efficiency in work hours for the manual and automated methods. RESULTS: Injection times were 8-14 s with automated versus 19-26 s with manual injection. Readjusting volume for "ligand" decay was simple and accurate with the automated system. Injection times for clinical SPECT studies in three patients were 13, 13, and 12 s, respectively. The price of one pump equals 120 work hours of a nurse or 24 ictal injection attempts. Much of the nurse's time is "wasted" because no seizure occurs. CONCLUSIONS: The method can be more efficient of staff, shorten injection time, and facilitate obtaining "truly ictal" injections. It allows more cost-effective use of personnel.

Algorithms↗

Detection of weak D with a fully automated solid-phase red cell adherence system.

BACKGROUND: Microplate agglutination methods (MAMs) and column agglutination technology are widely employed for red cell typing and can be automated. Some tests, however, such as detection of weak D, require manual testing. The possibility of detecting weak D by a solid-phase RBC adherence (SPRCA) test was studied in a fully automated system. STUDY DESIGN AND METHODS: The results of 2609 blood samples, characterized as being D- or with a incomplete agglutination reaction, were analyzed for the presence of the weak D phenotype. The 2609 samples were tested by a weak D tube test (antiglobulin method) and a weak D-test with the new SPRCA method. When weak D was detected, which D epitope was involved and whether it was associated with a partial D phenotype were determined. RESULTS: Weak D was detected in 60 (2.3%) of the 2609 samples. The 60 samples that were weak D by the tube test were also weak D+ with the new automated SPRCA test. The sensitivity and specificity for the new weak D typing method were 100 percent, when compared with the standard weak D manual test. CONCLUSIONS: These results support the possibility of performing weak D detection with a SPRCA fully automated system. These preliminary results are encouraging, showing good sensitivity and specificity of the test. Detection of weak D will permit full automation of blood typing.

Blood Banking↗

Prevalence of low automated platelet counts in cats: comparison with prevalence of thrombocytopenia based on blood smear estimation.

True thrombocytopenia is uncommon in cats; however, low platelet counts frequently are found using automated cell counters. Although this discrepancy is a well known problem, the prevalence of low automated platelet counts in feline blood samples has not been documented. We retrospectively compared the prevalence of low automated platelet counts with low blood smear-estimated platelet counts in feline blood samples. Results of blood sample analysis from 359 cats during a 1-year period at the University of Glasgow Veterinary Haematology Laboratory were examined. Smear estimates of platelet number were done in those cases in which records did not indicate adequate platelet numbers. Platelet counts obtained with an impedance counter (Minos Vet, Abx Hematologie) were <200X10(9) cells/L in 256 samples (71%) and <50X10(9) cells/L in 43 samples (12%). However, based on estimation of platelet numbers from blood smears, only 11 samples (3.1%) had platelet counts of <200X10(9) cells/L and 9 samples (2.5%) had counts of <50X10(9) cells/L. Four cats with thrombocytopenia estimated by blood smear evaluation had clinical signs of a bleeding disorder. Disorders associated with thrombocytopenia included neoplasia, cytotoxic chemotherapy, and infectious diseases. There was no evidence that delay due to mailing of samples was associated with lower automated platelet counts than would have been obtained on the day of sampling. The high prevalence of apparent thrombocytopenia in automated platelet counts was attributed to a combination of platelet aggregation and the impedance method of cell differentiation by size. Vigilance and careful examination of blood smears is required to identify the few cats with true thrombocytopenia.

Journal Article↗

Algorithms for automated oximetry along the retinal vascular tree from dual-wavelength fundus images.

We present an automated method to perform accurate, rapid, and objective measurement of the blood oxygen saturation over each segment of the retinal vascular hierarchy from dual-wavelength fundus images. Its speed and automation (2 s per entire image versus 20 s per segment for manual methods) enables detailed level-by-level measurements over wider areas. An automated tracing algorithm is used to estimate vessel centerlines, thickness, directions, and locations of landmarks such as bifurcations and crossover points. The hierarchical structure of the vascular network is recovered from the trace fragments and landmarks by a novel algorithm. Optical densities (OD) are measured from vascular segments using the minimum reflected intensities inside and outside the vessel. The OD ratio (ODR=OD600/OD570) bears an inverse relationship to systemic HbO2 saturation (SO2). The sensitivity for detecting saturation change when breathing air versus pure oxygen was calculated from the measurements made on six subjects and was found to be 0.0226 ODR units, which is in good agreement with previous manual measurements by the dual-wavelength technique, indicating the validity of the automation. A fully automated system for retinal vessel oximetry would prove useful to achieve early assessments of risk for progression of disease conditions associated with oxygen utilization.

Algorithms↗

Rapid quantification of hepatitis B virus DNA by automated sample preparation and real-time PCR.

Monitoring of hepatitis B virus (HBV) DNA in serum by molecular methods has become the standard for assessment of the replicative activity of HBV. Several molecular assays for the detection and quantification of HBV DNA have been described. However, they usually lack automated sample preparation. Moreover, those assays, which are based on PCR, are limited by a short dynamic range (2 to 3 log units). In the present study, the use of RealArt HBV LC PCR Reagents in conjunction with automated extraction on the COBAS AMPLIPREP analyzer was evaluated. Members of an HBV proficiency program panel were tested; linearity, interassay, and intra-assay variations were determined. The performance of the assay in a routine clinical laboratory was evaluated with a total of 117 clinical specimens. When members of the HBV proficiency program panel were tested by the new molecular assay, the results were found to be within +/-0.5 log unit of the results obtained by reference laboratories. Determination of linearity resulted in a quasilinear curve over more than 6 log units. The interassay variation of the RealArt HBV LC PCR Reagents by use of the automated sample preparation protocol ranged from 16 to 73%, and the intra-assay variation ranged from 9 to 40%. When clinical samples were tested by the new assay with the automated sample preparation protocol and the results were compared with those obtained by the COBAS AMPLICOR HBV MONITOR Test with manual sample preparation, the results for 76% of all samples with positive results by both tests were found to be within +/-0.5 log unit and the results for another 18% were found to be within between 0.5 and 1.0 log unit. In conclusion, the real-time PCR assay with automated sample preparation proved to be suitable for the routine molecular laboratory and required less hands-on time.

DNA, Viral↗