Considerations in the Use of Laboratory Robots: Aspects of Safety and Accuracy1

Abstract. A general-purpose laboratory robot was configured to prepare blood samples for the HBsAg and anti-HIV tests. Several issues were studied in order to eliminate problems and optimize the system. These included pipetting accuracy, intersample carryover, reagent interference, splashing and aerosol generation and user-related issues. A number of general guidelines were developed to assist others in developing and implementing systems for this and similar applications.     

HTLV-III Antibody Testing in Three Danish Blood Banks

Abstract. The Organon Teknika Vironostika anti-HTLV-III/LAV test was evaluated in three Danish blood banks. The evaluation comprised in total 3,940 consecutive donors. In all three blood banks the tests were carried out exactly according to the manufacturer's instructions, using a low cut-off value defined as (4 + )/5, where and are means of optical densities of known negative and positive samples. By this method the overall frequency of repeatably positive samples was 0.30%. When tested by Western blot, however, none of these samples were shown to contain specific antibodies against HTLV-III/LAV proteins. When testing different categories of patients, only sera containing HLA antibodies gave rise to false-positive reactions. Finally, important differences in the results were observed regarding sample preparation, single or dual wavelength optical density readings, and the experience of the technical staff.     

Designing robots for the elderly: appearance issue and beyond

This paper provides the results of three focus groups organized in the framework of the ROBADOM project, aiming at designing a service type assistive robot for the elderly with mild cognitive impairment living at home. The main objective of these focus groups was to give some recommendations to engineers in charge of the design of the robot's appearance. Results showed that although many humanoid robots were criticized by most participants, some small creative humanoid robots were appreciated. However, beyond the issue of the robot appearance, many ethical and social issues were raised. These focus groups offered an opportunity for participants to discuss the very idea of an assistive robot and to challenge some implicit preconceptions of the roboticists. Finally, we discuss how assistive robots could be designed considering the social context of the elderly and how to implicate the elderly as future end-users in the design process.     

Preparation of in vivo cow control blood samples for cadmium analysis

Quality control is essential for any analysis in the laboratory. The objective of this study was to prepare in vivo cow control blood samples. The experiment was performed by feeding cows with a single dose of cadmium in the form of cadmium chloride, withdrawing the blood at an appropriate time to get the highest level of cadmium and detecting the level of cadmium in the blood. It was found that feeding the cow a single dose of 0.06 mg cadmium per kg body weight resulted in the highest cadmium level of 3.622 microg/l 30-60 minutes after feeding. The samples were homogeneous because feeding the cows with single dose of cadmium let the cadmium be absorbed and distributed naturally. In addition, the samples were stable during transport. Therefore, they may be used as quality control samples to detect cadmium levels without using a lyophilized process. They could be used for proficiency testing and to evaluate whole blood analysis in the laboratory.     

Ethical challenges in the use of social service robots for elderly people

Socially assistive robots are increasingly discussed as solutions in care and domestic use for the support of senior adults; however, this raises ethical questions which hitherto have not been considered or were not predictable. The most important questions are those of privacy and data protection, safety and responsibility as well as involvement of vulnerable persons and deception. Consequently, the ethical principles of nonmaleficence, beneficence, autonomy and fairness should be transposed to robotics. Clear answers and solutions are not yet available for every ethical challenge in robotics; however, the development of ethical guidelines for deployment of robots and research in the field of social service robots (SSR) are essential steps in order to embed ethics into dealing with socially assistive robots. This article provides some practical suggestions on this issue from a robotics project.     

On the use of simulation in robotics: Opportunities,challenges, and suggestions for moving forward

The last five years marked a surge in interest for and use of smart robots, which operate in dynamic and unstructured environments and might interact with humans. We posit that well-validated computer simulation can provide a virtual proving ground that in many cases is instrumental in understanding safely, faster, at lower costs, and more thoroughly how the robots of the future should be designed and controlled for safe operation and improved performance. Against this backdrop, we discuss how simulation can help in robotics, barriers that currently prevent its broad adoption, and potential steps that can eliminate some of these barriers. The points and recommendations made concern the following simulation-in-robotics aspects: simulation of the dynamics of the robot; simulation of the virtual world; simulation of the sensing of this virtual world; simulation of the interaction between the human and the robot; and, in less depth, simulation of the communication between robots. This Perspectives contribution summarizes the points of view that coalesced during a 2018 National Science Foundation/Department of Defense/National Institute for Standards and Technology workshop dedicated to the topic at hand. The meeting brought together participants from a range of organizations, disciplines, and application fields, with expertise at the intersection of robotics, machine learning, and physics-based simulation.     

Exploring perceptions toward home-care robots for older people in Finland,Ireland, and Japan: A comparative questionnaire study

PurposeTo clarify potential users’ perceptions toward the development and social implementation of home-care robots in Japan, Ireland, and Finland.MethodsUnsigned, self-administered questionnaires were distributed to adults aged 65 or older, family caregivers, and home-care/health and social care professionals (HSCPs). A total of 1004 responses were collected.ResultsIn Japan, many people were already familiar with robots in their daily lives. The most notable finding about their perspectives on home-care robots was related to safety. Moreover, 93.7 % of the Japanese respondents said, “If the user cannot decide whether to use a home-care robot, family members who know the user well should decide,” followed by 76.4 % in Ireland and 83.1 % in Finland (p < .001). In Ireland, 81.8 % of the respondents said, “I want to help other people and society by participating in the research and development of home-care robots” (Japan: 69.9 %; Finland: 67.5 %) (p = .006). In Finland, many people had a negative impression of robots compared to the other two countries. Finland had the highest percentage (75.4 %) of respondents who said, “Health care professionals should be allowed to use secondary information collected by a home-care robot” (Japan and Ireland: 64 %) (p = .024). Moreover, Ireland and Finland emphasized the need to guarantee the entitlement to receive human care.ConclusionsDevising optimal strategies for the development and social implementation of home-care robots by incorporating various perspectives while valuing human dignity will require examination of each country’s characteristics with respect to history, culture, policies, and values related to robots.     

A Simple Strategy to Look Back on Posttransfusion Hepatitis B in a Multitransfused Patient

Background and Objectives: In January 1996, a case of hepatitis B virus (HBV) seroconversion in a multitransfused patient was reported to the blood bank. From March through October 1995, the patient had received 23 units of red cells and 30 units of pooled platelet concentrates, encompassing an exposure to a total of 200 whole blood donations. Materials and Methods: In order to trace hepatitis B surface antigen (HBsAg)-negative but HBV-infectious blood donation(s), we tested samples of the donors obtained ≥3 months after the implicated donations for anti-HBc (Corezyme EIA, Abbott). From 172/200 donors, archived samples of subsequent donations were available for this purpose. The remaining 28 donors were reinvited to the blood bank to obtain an additional blood sample for anti-HBc testing. Results: 1/200 follow-up donor samples was anti-HBc-positive. Retrospective testing of the implicated HBsAg-negative blood donation of this donor revealed anti-HBc-negative and HBV-DNA-positive results. The patient was transfused with the platelets of the HBV-infectious donation. On looking back, the other blood products prepared from this HBV-infectious donation caused posttransfusion HBV infection (PT-HBV) in 2 additional patients. Conclusion: Anti-HBc testing on mainly archived follow-up samples of 200 donors implicated in PT-HBV was a rapid, simple, cost-effective and donor friendly method to identify an infectious but HBsAg-negative, anti-HBc-negative and HBV-DNA PCR-positive blood donation. Routine anti-HBc screening would not have prevented this HBV transmission.     

Patient safety and quality in laboratory and hemostasis testing: a renewed loop?

More than three decades ago, George Lundberg first introduced the concept of the brain-to-brain loop for laboratory diagnostics. According to this pioneering model, the first step in the loop involves the selection of laboratory tests in the brain of the physician caring for the patient, and the final step is the transmission of test results back to the ordering physician. There are several intermediary steps, some of which are preanalytical (e.g., identification of patient and blood samples, the process of blood collection, and specimen handling); some are analytical and relate to the actual performance of the test(s); whereas others are postanalytical and involve release of test results into the medical record and further steps such as the physician's reaction to laboratory information, their interpretation of these results, and subsequent appropriate clinical action. Hemostasis testing should also be viewed within such a paradigm, so that quality throughout the total testing process can be assured. For hemostasis testing, particular attention is required to ensure provision of appropriate test samples in the preanalytical phase. Nevertheless, the timeliness of testing and an appropriate interpretation of test results are also paramount. This article overviews the concept of quality testing within hemostasis as critical to ensuring patient safety and optimal clinical and therapeutic management.     

Socialization between toddlers and robots at an early childhood education center

A state-of-the-art social robot was immersed in a classroom of toddlers for >5 months. The quality of the interaction between children and robots improved steadily for 27 sessions, quickly deteriorated for 15 sessions when the robot was reprogrammed to behave in a predictable manner, and improved in the last three sessions when the robot displayed again its full behavioral repertoire. Initially, the children treated the robot very differently than the way they treated each other. By the last sessions, 5 months later, they treated the robot as a peer rather than as a toy. Results indicate that current robot technology is surprisingly close to achieving autonomous bonding and socialization with human toddlers for sustained periods of time and that it could have great potential in educational settings assisting teachers and enriching the classroom environment.     

Human immunodeficiency virus-1 and hepatitis C virus RNA among South African blood donors: estimation of residual transfusion risk and yield of nucleic acid testing

BACKGROUND AND OBJECTIVES: South Africa is an endemic area for human immunodeficiency virus 1 (HIV-1) infection, which has an impact on the safety of the blood supply. We studied the presence of HIV-1 and hepatitis C virus (HCV) RNA, and recent HIV seroconversion, in blood donors in order to estimate transfusion risk and to determine whether nucleic acid testing (NAT) could effectively improve blood safety. MATERIALS AND METHODS: Unlinked samples collected in 1999 from 9077 HIV-low prevalence (LP) and 10,632 HIV-high prevalence (HP) donors were studied. Donor demographic information and serology results were collected prior to breaking the linkage. All samples were individually tested using a multiplex NAT assay for HIV-1 and HCV RNA. HIV antibody-positive samples were further tested using a 'detuned' (less sensitive) enzyme immunoassay (EIA) procedure to determine whether a donor had recently acquired infection. Data were used to estimate the residual transfusion risk and to project NAT yield. RESULTS: HIV was 45 times more prevalent in the HP- than in the LP donor group; and among the HP group, female donors had a significantly higher prevalence of HIV than male donors. All seven HIV-1 p24 antigen-positive samples in the study were also HIV NAT positive. Two HIV NAT-positive samples were anti-HIV negative; both of these samples were from HP donors. Assuming that 10% of the 900,000 annual donations in South Africa are from the HP group, we projected an annual NAT yield of 8.5 cases over the current screening of antibody and p24 antigen. However, if p24 antigen testing were to be eliminated, this number would be increased to 17 cases per year. Based on 'detuned' EIA results, the incidence rate for HIV infection was estimated at 1.29 and 51.12 per 10,000 per year for the LP and HP donor groups, respectively. Assuming a 15-day earlier detection by HIV NAT compared with antibody tests, these incidence rates project that NAT may intercept an additional 23 (95% confidence interval: 15-33) HIV-positive donations per year. For HCV, two viral RNA and antibody-positive samples (one from the LP group and one from the HP group) and no NAT yield cases were found in the study. CONCLUSIONS: Implementation of routine NAT blood screening would allow elimination of HIV-1 p24 antigen testing and improve the safety of the blood supply in South Africa. However, the cost-benefit ratio of introducing such an expensive technology in a country with a limited health budget will have to be carefully considered.     

Hepatitis C virus-polymerase chain reaction minipool testing: 3 years in the largest Swiss blood transfusion service

BACKGROUND AND OBJECTIVES: Hepatitis C virus-polymerase chain reaction (HCV-PCR) minipool testing can improve the safety of labile blood products owing to a reduction in the diagnostic preseroconversion window period. In Switzerland, HCV-PCR minipool testing for the release of labile blood components became mandatory in September 1999. In the largest Swiss blood transfusion centre, HCV-PCR minipool testing began in January 1999. This report analyses the performance of the test during a 3-year period: 1 January 1999 to 31 December 2001. MATERIALS AND METHODS: EDTA-blood was collected in either standard tubes or plasma preparation (PPT) tubes from 10 blood transfusion services in Switzerland and then sent to the Blood Transfusion Service SRC Berne. Up to 48 donor samples were pooled overnight using Tecan Genesis RSP 200/8 pipettors. Viral RNA was extracted by using the Qiagen QIAamp 96 viral RNA BioRobot kit on a BioRobot 9604. For PCR amplification and detection of HCV or internal control (IC) sequences, the Roche Cobas Amplicor v2.0 test kit was used. Data management, pool resolution and identification of positive samples were performed using the PMS Software from Tecan. RESULTS: In the 3-year period from 1 January 1999 to 31 December 2001, 839056 blood donor samples were tested in minipools of up to 48 samples. Thirty-five HCV-PCR-positive donations were identified. Thirty-four samples had antibodies against HCV and were therefore also detected by screening for antibody to HCV (anti-HCV). In October 2001, one seronegative (but PCR-positive) donor was detected. CONCLUSIONS: HCV-PCR minipool testing was successfully introduced in the largest Swiss blood transfusion service. It was shown that the release of HCV-PCR minipool results can be accomplished concurrently with the results of serological analysis. The challenge with a seronegative, but PCR-positive, donor demonstrates that the minipool testing strategy adds additional safety to blood products.     

暗娼人群外展干预单位成本研究

目的初步研究暗娼人群外展干预工作的单位成本,为艾滋病防治项目预算制定和资源分配提供经济学依据。方法采用Bottom-up法(自下而上法)。首先根据暗娼干预指南和实际情况将暗娼外展干预单位成本分解为可加和的各个子成本,采用现场观察法和关键人物访谈法测算各子成本,最终加和形成总的单位成本,并计算单位成本的构成。结果根据场所类别、是否抽血两个因素分层。在抽血情况下,对一名暗娼开展一次完整的外展干预的单位成本中位数为52.26元(中高档场所)和52.92元(低档场所);不抽血情况下,分别为18.07元和18.73元。结论暗娼外展干预单位成本变动范围较大,受是否采血、工作方式、地方经济水平等因素影响。下一步可对不同模式暗娼外展干预成本开展深入的比较研究。     

The use of care robots in aged care: A systematic review of argument-based ethics literature

BackgroundAs care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care.MethodsWe conducted a systematic literature search for argument-based ethics publications focusing on care robot use in aged-care practices. We used an innovative methodology that consisted of three steps: (a) identifying conceptual-ethical questions, (b) conducting a literature search, and (c) identifying, describing and analyzing the ethical arguments in connection with the conceptual-ethical questions.ResultsTwenty-eight appropriate publications were identified. All were published between 2002 and 2016. Four primary ethical approaches were distinguished: (a) a deontological, (b) a principlist, (c) an objective-list, and (d) a care-ethical. All approaches were equally represented across the articles, and all used similar concepts that grounded their diverse ethical arguments. A small group of publications could not be linked to an ethical approach.ConclusionsAll included publications presented a strong ethical rationale based on fully elaborated normative arguments. Although the reviewed studies used similar grounding concepts, the studies’ arguments were very diverse and sometimes diametrically opposed. Our analysis shows how one envisions care robot use in aged-care settings is influenced by how one views the traditional boundaries of the ethical landscape in aged care. We suggest that an ethical analysis of care robot use employs “democratic spaces,” in which all stakeholders in aged care, especially care recipients, have a voice in the ethical debate.     

Rapid identification of hemoglobin variants by electrospray ionization mass spectrometry

The precise identification of human hemoglobin variants, over 700 human hemoglobin variants are known, is essential for prediction of their clinical and genetic significance. A systematic approach to their rapid identification is described. Traditionally this requires protein or DNA characterization which entails lengthy analytical procedures. To overcome these obstacles a rapid approach to variant hemoglobin identification has been developed using conventional phenotypic methods combined with electrospray ionization-mass spectrometry (ESI-MS). The latter requires only a small amount of whole blood (10 microl) but in most cases 2 microl would have been sufficient and no preanalytical steps, such as separation of red cells or globin chains, are necessary. Aged, hemolyzed blood samples can also be analyzed. This approach has been used to positively identify 95% of the variants in over 250 samples. The remaining 5% in which a variant was detected by phenotypic techniques were not resolved by mass spectrometry. Ninety-nine different abnormalities comprising 36 alpha-chain variants, 59 beta-chain variants (including 2 extensions), and 4 hybrid hemoglobins were identified. These include 15 novel variants. The application of ESI-MS described requires approximately 1 h to prepare and analyze each sample and has minimal reagent costs. The turnaround time on a single sample can be as little as 2 h. This technique can now be considered a useful additional tool for reference laboratories.     

Collection, processing and cryopreservation of umbilical cord blood for unrelated transplantation

Umbilical cord blood (UCB) transplantation is being used as an alternative source of hematopoietic stem cells for bone marrow reconstitution. Separation and processing of UCB samples in large numbers for storage in cord blood banks ideally needs to be partially automated. The aim of this study was to establish and standardize a method for unrelated cord blood banking as well as the biological characterization of the samples. Up to October 1999, a total of 938 UCB units (mean volume 84.6 +/- 23.6 ml, nucleated cell (NC) count 0.90 +/- 0.37 x 109, total CFU-GM 79 +/- 72 x 104, CD34+ cell count 2.46 +/- 2.72 x 106) had been collected. Twenty-three per cent of all UCB samples had a NC count below 0.4 x 109 and were discarded. The initial bacterial contamination rate was reduced to less than 5% as a result of extensive training in collection procedures. Using a modification of a triple bag system and adding a solution of 6% hydroxyethyl starch, the UCB was separated by two centrifugation steps into three components: buffy coat, red cell and plasma fractions. The overall recoveries for NC, CFU-GM and CD34+ cells were 87.4 +/- 8.5%, 88.8 +/- 6.6% and 90.3 +/- 12.4%, respectively, in a mean final volume of 27 +/- 4.2 ml.     

Pooling Blood Donor Samples to Reduce the Cost of HIV-1 Antibody Testing

Accurate, low cost testing of donated blood is a goal of the global effort to reduce the spread of the human immunodeficiency virus (HIV-1). We describe a modified enzyme immunoassay (EIA) method for detecting HIV-1 antibody (anti-HIV-1) in 15-sample pools. In this preliminary study, the modified EIA was as sensitive for detecting weakly seropositive samples, and as specific for testing HIV-1 Western blot-negative or Western blot-indeterminate results, as testing individual samples by the standard EIA. A simulation of field operations was conducted using pools of blood donor samples collected in the United States and in Shanghai, People's Republic of China. Implementation of the modified EIA method and testing 15-sample pools for anti-HIV-1 is a reliable strategy for reducing the cost of large scale testing of donated blood for anti-HIV-1 in areas of low seropre valence.     

Filariasis and malaria sera from Orissa lack HTLV-III antibody reactivity

Reports exist indicating a correlation between seropositivity for human T-lymphotrophic virus (HTLV) antibodies and certain parasitic infections in some parts of the world. In 274 filariasis and 119 malaria sera examined from Orissa, none was reactive in a test for anti-HTLV-III antibodies.     

输入染虫成分血对BALB/c小鼠感染田鼠巴贝虫的影响

目的　观察静脉注射含田鼠巴贝虫的不同成分血对小鼠巴贝虫感染的影响。方法　以田鼠巴贝虫感染健康小鼠后眼眶采血，制备染虫全血、去除血清的成分血及纯红细胞。将27只小鼠随机分为3组，分别为全血组、无血清染虫组、纯红细胞组，每组9只；每组设3个亚组，每个亚组3只，每只分别通过尾静脉注射100 μL浓度为9.00、0.90、0.09只/μL（分别含900、90、9只巴贝虫虫体）的相应成分血。接种当天记为D0，自D1起每隔1 d于小鼠尾尖采血涂薄血涂片，吉氏染色液染色后镜检观察各组小鼠红细胞染虫率。结果　注射900只田鼠巴贝虫后，全血组、无血清组均于D3在外周血中查见巴贝虫，于D15虫密度开始升高，并于D21虫密度达高峰，红细胞染虫率分别为2.21%和1.76%；随后虫密度下降，D31染虫率趋于0；而纯红细胞组小鼠在观察期间未查见巴贝虫感染。注射90只田鼠巴贝虫，仅全血组于D3在外周血查见巴贝虫虫体，D15虫密度升高，D21虫血症达高峰，红细胞染虫率为1.35%，D31染虫率趋于0；无血清组和纯红细胞组实验期间外周血中未查见巴贝虫。注射9只田鼠巴贝虫，全血组、无血清组和纯红细胞组外周血中均未查见虫体。结论　血液成分及感染虫数可能对小鼠静脉注射感染巴贝虫有一定影响，输入成分血仍存在感染巴贝虫的风险。     

No evidence of West Nile virus infection in Dutch blood donors

BACKGROUND AND OBJECTIVES: West Nile virus (WNV) can be transmitted by transfusion through infected blood components. This study aimed to determine the prevalence of WNV infection among Dutch blood donors to assess whether WNV is a possible threat for the Dutch blood supply. MATERIALS AND METHODS: Plasma samples from 61 992 blood donations were pooled in 7,749 test pools of eight donations using a Tecan robot. These samples were collected between April and October 2004. The pools were tested for the presence of WNV RNA by using the Procleix WNV assay. RESULTS: No WNV RNA-positive pools were detected. Based on Poisson distribution statistics, extrapolation of our data to all the Dutch donations in 2004 revealed that between 0 and 55 cases of WNV infection could be expected. CONCLUSIONS: No evidence of the presence of WNV RNA in Dutch blood donor samples from 2004 was found. However, surveillance of this emerging infection is of importance to safeguard the blood supply in the future because the transmission cycle of WNV is complex and hard to predict.