Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : June | Volume : 6 | Issue : 5 | Page : 801 - 804

Evaluation of Sonicated and Heat Extracted Lipopolysaccharide Brucella Abortus Antigens by an In House Enzyme Linked Immunosorbant Assay

Supriya Christopher, B.L. Umapathy, K.L. Ravikumar

1. Assistant Professor, Department of Microbiology, Kemepegowda Institute of Medical Sciences, Bangalore, India. 2. HOD and Professor ESI-PGIMSR, Rajajinagar, Bangalore, India. 3. HOD and Professor, Department of Microbiology, Kemepegowda Institute of Medical Sciences, Bangalore, India.

Correspondence Address :
Dr. Supriya Christopher
Department of Microbiology,
Kempegowda Institute of Medical Sciences,
Bangalore, India - 560070.
Phone: 080-9845487326


Aim: Brucellae are small gram negative coccobacilli that are known to cause brucellosis, the most common zoonotic disease world wide. The multisystem involvement and the protean and the unusual clinical presentation of the disease pose significant diagnostic challenges. Although the isolation of the causative organism is the definitive proof of the disease aetiology, practical difficulties are encountered. Hence, serological tests remain the most commonly used methods for its laboratory diagnosis. The standard tube agglutination test (STT) is the conventional serological test which is used.

Method: The present study was carried out to evaluate the two different antigenic preparations from the smooth stains of B. abortus S99 for standardizing the enzyme linked immunosorbant assay (ELISA) as an alternative for STT. The standard tube agglutination test antigen and the standard antibrucella serum which were obtained from IVRI, Izathnagar, were used as the controls for the standardization of the ELISA.

A sonicated lipopolysaccharide antigen (LPS-SE) and a heat extracted lipopolysaccharide antigen (LPS-HE) were evaluated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and they were used to coat the micro titre plates for the enzyme linked immunosorbant assay. 81 human sera from people who were working in organized farms (cases), hundred human sera from apparently healthy persons (controls) and 100 Widal positive samples were selected to check for the crossreactivity for this study. All the serum samples (the cases , controls and the WIDAL positive samples ) were tested by the standard tube agglutination test (STT).This study was conducted over a period of four years at a tertiary care hospital in India.

Results: Among the 81 cases, eight (9.87%) sera gave a titre of ≥ 1:80 by STT, whereas by ELISA, 10(12.34%) and 9 (11.11%) cases showed significant titres on the LPS-SE and the LPS-HE coated plates respectively. The accuracy of the ELISA by using both LPS-SE and LPS –HE was 93.83% and 95.86%, with a p value of > 0.001, as compared to STT.

Conclusion: The overall seroprevalence with ELISA was 12.34% and 11.11% with the LPS-SE and the LPS-HE antigens, whereas it was 9.87% with STT. Hence, ELISA can be considered as a better diagnostic serological test for the diagnosis of brucellosis. It is cheap and reproducible and the antigen coated plates can be stored for longer periods.


Lipopolysaccharide sonicated extract, lipopolysaccharide heat extract, STT, ELISA, brucellosis

Human brucellosis continues to be a major health problem worldwide. The endemicity is limited to some areas of the Mediterranean basin and the developing countries in Asia, Africa and Latin America. Sporadic cases may develop where the disease is nonendemic. At least half a million new cases of brucellosis annually are estimated by the World Health Organization to occur globally (1). Thus, this illness is currently included among the travellers diseases (2). One may also consider it to be an occupational, food borne or a laboratory acquired illness.

Phylogenetically, Brucella is classified within the α 2 subdivisions of the Proteobacterium, which includes Agrobacterium, Rickettsia, Rhodobacterium, and Rhizobium (3). Establishing a relationship within the genus has been challenging, because of the relatively few genetic polymorphisms that distinguish each species (4). Six species have been recognized within the genus Brucella: B. abortus, B. melitensis, B. suis, B. ovis, B. canis, and B. neotomae. This classification is based on the differences in the pathogenicity and the host preferences of the organism (5). In recent times, two new species have been added to this genus, B. cetaceae and B. pinnipediae, which have been isolated from marine mammals, cetaceans, and pinnipeds (6).The Brucella genome consists of two circular chromosomes without plasmids, thus suggesting a remarkable difference as compared to the single chromosome of many bacteria. It is an infectious disease (International Classification of Diseases) ICD-9 023 or ICD-10 A23 that carries high morbidity and low mortality (7).

Brucellosis is a multisystem disease with a broad spectrum of clinical manifestations. The clinical findings of the disease are non specific and highly variable. The diagnosis depends on either the isolation of the bacteria from blood or tissue samples or on the demonstration of the presence of the Brucella antibodies by several serological tests.

The definite diagnosis of this disease is based on the isolation of the Brucella sps in blood cultures, but its sensitivity varies from 20 % to 70 %. PCR remains promising for the rapid diagnosis of acutebut not chronic brucellosis (8). Thus, serological tests continue to play a relevant role in the diagnosis and the management of patients with brucellosis (9).

The most widely used serological techniques are the standard tube agglutination test (STT) and the Coombs anti-Brucella test, which can be used for detecting the antibodies against the smooth lipopolysaccharide antigen (S-LPS). S-LPS is the main antigenic and immunogenic structure on the surface of Brucella (10). However, these techniques present some interpretation problems and the antibody titre can remain elevated over long periods even after the recovery of the disease (11). This also causes difficulties in the diagnosis of a reccurrence /reinfection.

Enzyme linked immunosorbant assay (ELISA) has become an increasingly popular, as well as a standardized assay for the diagnosis of brucellosis. It measures IgG, IgM, and IgA, which allows a better interpretation of the clinical situation. The specificity of ELISA, however, seems to be less than that of the agglutination tests. As the diagnosis of Brucella is based on the detection of the antibodies against the smooth LPS, the cut-off value needs to be adjusted, to optimize the specificity, when this method is used in endemic areas (12).

In the present study, the LPS of Brucella abortus S99 was extracted by two classic and well known methods. (Diaz 1967, Taylor 1960) The diagnostic utility of the in house antigen coated plates in ELISA was standardized by using the standard antibrucella serum which was obtained from IVRI, Izathnagar, UP as the control.

This study was conducted from July 2005 to July 2010 at a tertiary hospital in India.
1. 81 blood samples were obtained from individuals who were working in organized farms in and around Bangalore, Karnataka, India, who were considered as the high risk group. A detailed history of these patients like the nature of their work, occupation, consumption of raw milk, history of fever and joint pain etc, was obtained (cases).
2. 100 blood samples were also collected from healthy individuals whose blood was sent for routine haematological investigations (controls).
3. 25 Widal positive samples were collected from the Kempegowda Institute of Medical Sciences, Bangalore, India, to check for false positivity. Several studies have shown that the outer membrane of Brucella contains Lipopolysaccharide (LPS), which is its major virulence factor which cross reacts with the lipopolysaccahride from non-Brucella bacteria. Apart from Yersinia .enterocolitica, a number of other bacteria cross react with Brucella in the standard agglutination tests and these include E. coli O: 157 and O:116, Salmonella spp with the Kauffman White group N serotypes, Pseudomonas maltophilia, (13) Francisella tularensis (14) and Vibrio cholerae (15).

A total number of 206 samples were included in the study, which included the cases and the controls.

A drop of 1:10,000 mertiolate was added to all the serum samples and they were stored at -20°C till they were processed. The serum samples from the cases and the controls, along with the international standard antibrucella serum (ISAbs), were tested by the Standard tube agglutination test (STT) which was procured from IVRI, Izatnagar, UP. The antigen was procured from the Institute of Animal Health and Veterinary Biologicals, Hebbal, Bangalore. A titre of 1:80 or greater was taken as a significant titre (16).

Antigen extraction
The smooth strain of B. abortus S99 which was obtained from IVRI, Izathnagar , UP, India ,was used to prepare various soluble antigens .The organisms were grown on Trypticase Soya agar for 72 hrs in Roux bottle flasks at 37°C in 5 % CO2. The culture was harvested in double distilled water and it was centrifuged at 500xg for 10min.The supernatant was then centrifuged at 7000g x 30 min at 4°C and the deposit was resuspended again in double distilled water, so as to obtain a final concentration of 10 mg/ml (W/V) (Sutherland 1967) (17). The washed bacterial suspension was used for different antigen preparations. The entire procedure was carried out in a class II biosafety cabinet.
1. The lipopolysaccharide sonicated extract (LPS- SE) (Diaz 1967) (18).
The bacterial suspension was sonicated and centrifuged at 7000g for 10 min at 4°C and the supernatant which was obtained after dialysis formed the LPS-SE.
2. The lipopolysacharide heat extract antigen (LPS-HE) (Taylor 1960) (19).
For this, instead of using distilled water, physiological saline was used and it was heated for 1 hr at 100° C and centrifuged at 7000g for 10 min at 4°C. The supernatant which was obtained after dialysis was used as the LPS-HE antigen.
3. SDS-polyacrylamide gel elecrtophorosis of the antigens was done to characterize the extracted antigens.
Protein estimation was carried out on the antigens which were extracted by the Biuret method.

The plates for casting the gel were assembled and they were held together tightly. It was ensured that this assembly was leak proof. 50 μl of ammonium persulphate (APS) was mixed thoroughly with 5 ml of separating gel. The gel solution was poured between the plates till the label was below 3-4 cm from the top of the notched plate. 200 – 250 μl of water was added to make the surface even. After the gel had set, the top of the separating gel was washed with distilled water and it was completely drained. 20 μl of APS solution was mixed with 2ml of the staking gel and this mixture was poured directly on the polymerized separating gel. A comb was inserted into the gel carefully without trapping air bubbles about 1 cm above the separating gel. This was allowed to set for 10 min.

50 μl of the test sample was mixed with 10 μl of the the standard protein and 15μl of the loading buffer and this mixture was heated at 85ÂşC-95ÂşC for 1 min. After the stacking gel had set, the comb was carefully removed.

It was then placed in the PAGE apparatus with running buffer at the bottom of the reservoir. The samples were loaded, the electrophorosis was started at 100v when the dye front reached to about 0.5 cm above the bottom of the gel and then the power was turned off. It was then transferred to a tray which contained 20 ml of Coomassie brilliant blue and was left to stain for 30-60 min . It was left overnight as the bands appeared light . Destaining was done with a destaining solution (200ml of methanol and 70 ml of glacial acetic acid and the volume was adjusted to 1 lt) and it was left for 24 hrs.

Enzyme linked immunosorbant assay
The reagents for ELISA were commercially procured to develop the kit. The goat antihuman HRP conjugate, tetramethyl benzidine /H2O2 (Genie Lab, India) and 96 well ELISA plates (NUNC) were used. Positive serum samples from confirmed cases of brucellosis (by culture) were obtained from IVRI, Izatnagar, as positive controls for standardization of the ELISA

The optimal working dilutions of the LPS-SE and the LPS-HE, as well as the conjugate, were found out by checker board titration for their use in ELISA.

2 sets of microtitre plates were then coated with the LPS-SE and the LPS –HE antigens of B. abortus S99 by delivering 100μl/ well (1μg) of each in the antigen coating buffer (carbonate –bicarbonate buffer) pH 9.6 separately and they were incubated at 4°C overnight. The plates were then washed thrice with PBS-Tween. The remaining protein binding sites were blocked by adding 100μl of 5% skimmed milk with 0.1% Tween 20 respectively to all wells of the plate and the plates were incubated at 4°C for 1hr. The plates were then washed as has described above. The test sera and the control sera were diluted to 1:100 and they were added to the wells . The plates were then incubated at 37°C for 1 hr. The plates were washed thrice and then, the goat antihuman globulin in HRP (1:10000), which was diluted in the blocking buffer, was added to all the wells and the plates were incubated at 37°C for 1hr. The plates were washed thrice and they were treated with 100μl of TMB/H2O2 for 20 min. Finally, the reaction was stopped by adding 100μl of 1M H2SO4.

The readings were taken on a spectrophotometer at a wavelength of 450nm by using an ELISA microtitre plate reader (Teflon 96 microELISA plate reader)

Material and Methods

Statistical software:
The Statistical softwares, namely, SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver. 2.11.1 were used for the analysis of the data and Microsoft Word and Excel were used to generate graphs, tables, etc.


As per the SDS-PAGE profile of the Brucella S-LPS, two types of banding profiles which displayed diffuse and discrete bands had been described by earlier workers.

In the present study, the SDS-PAGE of the S-LPS of B. abortus S99 displayed diffuse bands from 25-43kDa and from 43- 97 kDa.

The optimal cut off value for the ELISA was calculated by the mean + 3SD, and it was found to be 0.257 in LPS-SE and 0 .380 in LPS –HE. Eight (9.87%) sera gave a titre of ≥ 1:80 by STT, whereas by ELISA, 10(12.34%) and 9(11.11%) sera showed positivity for the LPS-SE and the LPS-HE antigens respectively (Table/Fig 1). A correlation between the standard tube test and ELISA has been shown in (Table/Fig 2),(Table/Fig 3).

The diagnostic potential of the test and its accuracy were determined by the Receiver operating Curve (ROC). This is always used to compare the different assays shows the ROC curve.

Later, according to the interpretation of the curve, the Confidence interval and the accuracy were found out.

These have been shown in (Table/Fig 4).


This study showed that as compared to the alternative immunoassays, ELISA was the most versatile method and that its results were available within a short time. It also had the advantage of being readily automated, thus enabling its use as a screening test, with the results being numerically quantifiable. As compared to the SAT, ELISA was found to yield higher sensitivity and specificity (20).

There are many other techniques that increase either the specificity or the sensitivity of the ELISA, which include the use of various enzymes and washing methods. An important source of the non-specific background was the use of the phosphatase-conjugated second antibodies in ELISA. This non-specific background could be drastically reduced by using peroxidase-conjugated antibodies and by including skimmed milk as a blocking reagent. The background with the phosphatase assays easily arises from small contaminations, because phosphatases are ubiquitous enzymes which occur in all the body fluids, which includes the sweat on the finger tips, which was implemented in this study.

ELISA with purified S-LPS was developed from Brucella, basically for the serosurveillance of brucellosis in humans and this appeared to be a useful tool in its diagnosis. ELISA has several advantages over the other techniques e.g. the antibody being diluted, it reacts with the antigen without performing secondary functions such as agglutination, precipitation and activation of the compliments. Moreover the sera need not to be heat inactivated as is required for the CF test or pretreated as is required for the 2-mercaptoethanol test (2ME). The RBPT and SAT are subjected to prozoning and they detect the reactors as false negative.

In the present study, the S- LPS was used for the development of ELISA for humans. Both the antigens ie the LPS-HE and the sonicated extracted antigen seemed to be good antigens for the detection.

According to [Table/Fig-3], it was found that there were no false negatives with ELISA, but however, there was 3 false positives when it was compared with STT, with their sensitivities being 100 and their specificities being of 95.95 and 97.30, with p value of 0.001.

In our study, it was found that out of the 81 human sera, 7 (8.53%) were positive by STT, 10 (12.34%) was positive with the sonicated extracted antigen and 9(11.11%) were positive with the lipolpolysaccahride heat extracted antigen (Table/Fig 1). The Widal positive samples which were usedto check for the cross reactivity, showed negative results. No positives were seen either with STT or ELISA .

With reference to the ROC [Table/Fig 5] and (Table/Fig 4), ELISA seemed to be a good test as the AUC was 1.0 and as the 95% CI was 0.95-1.00. So, it can be considered as an excellent test. The results of this study were in accordance with those of a study which was done by S Isloor et al in 2007, where the overall seroprevalence was 15.69% (21).


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Date of Submission: Aug 24, 2011
Date of Peer Review: Oct 15, 2011
Date of Acceptance: Apr 07, 2012
Date of Publishing: Jun 22, 2012

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