Prognostic gene expression profiling in melanoma: necessary steps to incorporate into clinical practice

Prognostic gene expression profiling (GEP) tests for cutaneous melanoma (CM) are not recommended in current guidelines outside of a clinical trial. However, their use is becoming more prevalent and some practitioners are using GEP tests to guide patient management. Thus, there is an urgent need to bridge this gap between test usage and clinical guideline recommendations by obtaining high-quality evidence to guide us toward best practice use of GEP testing in CM patients. We focus here on the opportunities and uncertainties associated with prognostic GEP testing in CM, review how GEP testing was incorporated into clinical care guidelines for uveal melanoma and breast cancer and discuss the role of clinical trials to determine best use in patients with CM.

Utilization of Laboratory Testing Algorithms for Celiac Disease in a Pediatric Hospital

Background At Texas Children’s Hospital in Houston, numerous celiac tests are ordered from a wide range of nonspecialty healthcare providers. Objective To retrospectively examine the ordering of celiac tests before and after a test ordering initiative at our institution, to determine whether the initiative impacted appropriate usage of those tests and affected costs. Methods We carefully scrutinized all orders for comprehensive celiac testing from July 2016 through September 2017, implemented an in-house celiac-disease screening cascade, and reflexed it to the comprehensive celiac testing panel if an abnormal screening result was obtained. Results A total of 60 celiac test orders were issued during the 14-month study period. The ordering physician was a gastroenterologist in 6 cases and a nongastroenterologist in 54 cases. Of the 60 orders, only 4 were approved for sending out for comprehensive celiac testing; in 52 of the 60 cases, the order was altered to celiac screening. In the remaining 4 cases, the tests were canceled as a result of incorrect orders. Only 1 of the 52 celiac screenings yielded a positive result and thus was reflexed to the comprehensive panel. Conclusions We were able to induce appropriate celiac test usage by implementing a celiac-reflexive cascade. Also, our strategy proved to be extremely cost effective.

Multipurpose virtual reality environment for biomedical and health applications

Virtual reality is a trending, widely accessible, contemporary technology of increasing utility to biomedical and health applications. However, most implementations of VR environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test usage cases: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific regions of interest. The resulting test applications suggest that the implemented approach is robust, versatile and efficient. Both applications are publicly available via a GitHub repository, in support of the Open Science initiative. We anticipate our contribution to catalyze further progress and replicability with regards to the usage of virtual reality in biomedical and health applications.Index Terms— Motor rehabilitation, neurofeedback, virtual reality.

Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups

ObjectivesThere are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands.SettingData were collected in four different studies among the general population (S1–2) and sexual risk groups (S3–4).ParticipantsS1–Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2–Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011–2015; n=17 603); S3–Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4–STI clinic clients participating in a cross-sectional survey (2007–2012; n=5655).Primary and secondary outcome measuresPrevalence of HIV/STI self-test usage and its determinants.ResultsThe prevalence of HIV/STI self-test usage in the preceding 6–12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1–2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5–9% used a self-test.ConclusionsDespite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and about the pros and cons of self-testing.

Tuberculosis Test Usage and Medical Expenditures from Outpatient Insurance Claims Data, 2013

Objective. To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US). Methods. We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan® commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits. Results. Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT® was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests (≈74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million). Conclusions. We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests.

Deverbal compound comprehension in preschool children

When English-speaking children first attempt to produce deverbal compound words (like muffin maker), they often misorder the noun and the verb (e.g., make-muffin, maker muffin, or making-muffin). The purpose of the present studies was to test Usage-based and Distributional Morphology-based explanations of children’s errors. In Study 1, we compared three to four-year old children’s interpretations of Verb-Noun (e.g., push-ball) to Verb-erNoun (e.g., pusher-ball). In Study 2, we compared three- to five-year old children’s interpretations of Verb-erNoun (e.g., pusher-ball) to Noun-Verb-er (e.g., ball pusher). Results from both studies suggest that while preschool children’s understanding of deverbal compounds is still developing, they already show some sensitivity to word ordering within compounds. We argue that these results are interpretable within Usage-based approaches.