Current Testing Practices Research Articles

Implementing Genomic Testing for Lung Cancer Into Routine Clinical Practice – The Welsh Experience

AimsOver the last decade there has been a rapid expansion of clinically actionable driver mutations in non-small cell lung cancer (NSCLC), with an unprecedented number of corresponding targeted therapies approved and funded for use in the clinic. Here we summarise the approach taken in Wales to embed a NSCLC biomarker testing pathway within the National Optimal Pathway for Lung Cancer. Materials and methodsThe Welsh Thoracic Oncology Group established a working group tasked with progressing the standardisation of genomic testing. In July 2021, the 10 lung cancer multidisciplinary teams (MDTs) were invited to take part in a national survey of current biomarker testing practices and a retrospective audit of the next generation sequencing (NGS) pathway in Wales was conducted. ResultsSeventy per cent of MDTs completed the survey, which confirmed variability in the approach to testing with respect to timing of requests, patient selection and testing technologies used. Only 43% reported having pathology-initiated reflex testing, but 87% had adopted DNA and RNA NGS testing as their standard-of-care genomic testing strategy. Data from 53 patients with stage III–IV NSCLC with genomic testing requested between October 2020 and May 2021 were analysed in the NGS pathway audit. Forty (75.5%) patients had both DNA and RNA NGS requested, with a median turnaround time from biopsy to results of 26 days (range 19–37 days) and 25 days (range 16–38 days), respectively. The geographical location of MDT did not influence turnaround times and MDTs with reflex testing had shorter biopsy-to-result times. DNA NGS testing was successful in 51 (96.2%) patients; in those who had RNA NGS, testing was successful in 30 (75%) patients. ConclusionSignificant progress has been made within Wales to implement a national biomarker testing pathway, with reflex testing becoming standard of care. However, challenges remain in optimising the quantity and quality of tissue available for testing, together with a need to reduce turnaround times. This will need to be addressed to ensure all eligible patients are tested at the right time in the diagnostic pathway to facilitate optimal treatment strategies and ultimately improve outcomes.

EP16.03-005 Australian Non-Small Cell Lung Cancer (NSCLC) Biomarker Testing Practices - A Survey of Medical Oncologists and Pathologists

NSCLC is associated with an increasing number of molecularly defined subsets, several of which now have approved targeted therapies. Variation in how different biomarker assays are utilised is likely. We sought to determine the current biomarker testing practices from the perspective of medical oncologists (MO) and pathologists (P) at Australian sites to understand variations in practice and potential influencing factors.

Testing research software: a survey

BackgroundResearch software plays an important role in solving real-life problems, empowering scientific innovations, and handling emergency situations. Therefore, the correctness and trustworthiness of research software are of absolute importance. Software testing is an important activity for identifying problematic code and helping to produce high-quality software. However, testing of research software is difficult due to the complexity of the underlying science, relatively unknown results from scientific algorithms, and the culture of the research software community.AimsThe goal of this paper is to better understand current testing practices, identify challenges, and provide recommendations on how to improve the testing process for research software development.MethodWe surveyed members of the research software developer community to collect information regarding their knowledge about and use of software testing in their projects.ResultsWe analysed 120 responses and identified that even though research software developers report they have an average level of knowledge about software testing, they still find it difficult due to the numerous challenges involved. However, there are a number of ways, such as proper training, that can improve the testing process for research software.ConclusionsTesting can be challenging for any type of software. This difficulty is especially present in the development of research software, where software engineering activities are typically given less attention. To produce trustworthy results from research software, there is a need for a culture change so that testing is valued and teams devote appropriate effort to writing and executing tests.

Diagnosis and management of idiopathic recurrent pregnancy loss (RPL): Current immune testing and immunomodulatory treatment practice in the United Kingdom

Recurrent pregnancy loss (RPL) affects 1.9 % of couples. Despite the severe physical, psychological, and economic impact of RPL, miscarriage care provision remains highly heterogeneous. Due to the absence of strong scientific evidence, national and international guidelines on the diagnosis and treatment of this condition remain unclear and often contradictory. In the absence of identifiable RPL-associated risk factors, when the condition is termed “idiopathic”, immunological tests and immunomodulatory treatments are sometimes suggested even though the contribution of aberrant immune activity to this condition remains undetermined. Through an online survey, distributed across the UK (37.7% response rate), a high variation in clinical practice was detected, with multiple RPL definitions utilized and different tests employed for potential risk factor identification. Immunological testing was found to be provided in 7.9 %(N = 3) of the included clinics. Moreover, multiple therapies, including immunomodulatory ones were utilized for the management of idiopathic RPL. These findings highlight a need for additional research on the implication of immune activity in this condition. The high variation between clinics regarding the tests employed for the diagnosis and management of idiopathic RPL also underlines the need for guidelines to direct clinical practice, taking into consideration both the patients’ needs but also the strength of the available scientific evidence.

Another Step Toward Hepatitis C Elimination: An Economic Evaluation of an Irish National Birth Cohort Testing Program

ObjectivesWe aimed to evaluate the cost-effectiveness of offering once-off birth cohort testing for hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985, the cohort with the highest reported prevalence of undiagnosed chronic HCV infection. MethodsSystematic and opportunistic HCV birth cohort testing programs, implemented over a 4-year timeframe, were compared with the current practice of population risk-based testing only in a closed-cohort decision tree and Markov model hybrid over a lifetime time horizon. Outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented from the health system’s perspective in 2020 euro (€). Uncertainty was assessed via deterministic, probabilistic, scenario, and threshold analyses. ResultsIn the base case, systematic testing yielded the largest cost and health benefits, followed by opportunistic testing and risk-based testing. Compared with risk-based testing, the incremental cost-effectiveness ratio for opportunistic testing was €14 586 (95% confidence interval €4185-€33 527) per QALY gained. Compared with opportunistic testing, the incremental cost-effectiveness ratio for systematic testing was €16 827 (95% confidence interval €5106-€38 843) per QALY gained. These findings were robust across a range of sensitivity analyses. ConclusionsBoth systematic and opportunistic birth cohort testing would be considered an efficient use of resources, but systematic testing was the optimal strategy at willingness-to-pay threshold values typically used in Ireland. Although cost-effective, any decision to introduce birth cohort testing for HCV (in Ireland or elsewhere) must be balanced with considerations regarding the feasibility and budget impact of implementing a national testing program given high initial costs and resource use.

A Review of Language Testing and Assessment in Online Teaching

In line with the increased importance of language testing and assessment in online learning, the paper sets out to present an overview of the landscape of online language testing and assessment based on available scholarship in global and Vietnamese contexts. Several benefits of online language testing and assessment are reported, including promotion of learner autonomy, evaluation of students’ progress, and convenience. Methods of online language assessment encompass collecting evidences of learning and using rubrics. A number of problems with current language testing and assessment practices in an online environment are delineated, including cheating/plagiarism, preference for selected response items, lack of validity and reliability, and increased workload for teachers. Recommendations for relevant stakeholders including teachers and teacher education institutions to improve the quality of online language assessment are accordingly presented.

A survey on the practices of software testing: a look into Brazilian companies

[Context:] Software testing is essential for all software development, and techniques and criteria have been proposed to ensure its quality in different application domains. [Objective:] This survey aims at the identification of software testing practices in Brazilian industries, towards an overview of the latest testing techniques, selection processes, challenges faced, tools and metrics used by testers. [Methodology:] Survey questions were carefully designed for providing relevant information to both industry and academy and evaluated by testers for improving the quality of the survey. [Results and Conclusions:] Our study provides insights into the current software testing practices in Brazilian software companies. The results show testers select a testing technique according to the project scope under development; however, most companies have shown a lack of importance and priority regarding to the testing activity. Some challenges raised will foster new research topics, outlined by the needs faced by testers in practice.

Mainstreaming Genetic Testing for Epithelial Ovarian Cancer by Oncology Providers: A Survey of Current Practice.

With limitations in early detection and poor treatment response, ovarian cancer is associated with significant morbidity and mortality. Up to 25% of epithelial ovarian cancer (EOC) is related to a hereditary predisposition. Current National Comprehensive Cancer Network guidelines recommend that all individuals diagnosed with EOC be offered germline genetic testing. Although this would ideally be performed by genetics professionals, a shortage of genetic counselors can affect timely access to these services. This study sought to investigate the current genetic testing practices of oncology providers to determine the feasibility of oncologist-led genetic testing for patients with EOC. A survey was distributed to members of the Society of Gynecologic Oncologists with questions regarding timing, frequency, and type of cancer genetic testing, referrals to genetics professionals, confidence with aspects of genetic testing, and any barriers to these processes. We received 170 evaluable responses. Eighty-five percent of providers always ordered genetic testing for patients with EOC. Most providers ordered germline multigene panel testing (95.8%), generally at diagnosis (64.5%). Provider confidence with the genetic testing process was generally high and significantly differed by providers' testing practices, namely, respondents who reported always ordering genetic testing tended to be more confident in ordering testing (P = .008), interpreting results (P = .005), and counseling a patient (P = .002). Patient disinterest and concerns for insurance coverage were commonly cited as barriers to testing and referrals. The findings from this study suggest that oncologist-led genetic testing for patients with EOC, with referrals to genetics professionals when appropriate, has the potential to be a viable alternative service delivery model to increase access to genetic testing for patients diagnosed with EOC.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania.

Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania. Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive. Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive. Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.

The benefit of genetic testing using next-generation sequencing in patients with dilated cardiomyopathies: A multicentric international study

Over the past several years, genetic testing has emerged as an essential tool in the etiological study of dilated cardiomyopathy (DCM). Being able to pinpoint the etiology of DCM may lead to a specific individualized treatment, besides the prognostic and family implications, if a genetic cause is identified. Discovery of new genes, alongside improvements in genetic sequencing, implies a higher benefit than previously reported. Determining and quantifying the current yield of genetic studies in an international cohort of patients with DCM. Observational study of retrospective cohorts in two university hospitals (France and Spain). All genetic panels indicated in the study of DCM, carried out between December 2018 and December 2020, have been reviewed. Both centers have used the next-generation sequencing technique, involving panels of 80 and 83 genes, depending on the availability in each center. The encountered variants were classified by each center as: benign, of uncertain significance or disease-causing (DCV). 79 patients have undergone genetic testing. Mean age was of 52 years, with 29% of females. One quarter of the patients had family history of DCM. A cardiac magnetic resonance imaging (CMRI) was performed in 72%. In 54% of the cases ( n = 43), a mutation was found, giving rise to 64 variants, of which 51% were described as DCV ( n = 33, 42% of the total cohort– Fig. 1 ). More than half (54%) of the DCV concerned genes encoding the titin, myosin binding protein C, and filamin C. We identified a DCV in 8/14 (57%) of patients with family history of DCM and in 15/18 (83%) of patients with late gadolinium enhancement in the CMRI. Our results reflect the current practice of genetic testing, suggesting a higher yield (42%) compared with what is described in literature.

The Implementation of a State-wide Rapid Initiation of Antiretroviral Therapy as a Best Practice in Primary Care Practices Using an Academic Detailing Approach: Lessons Learned from NewYork State, United States

Background:New York State Department of Health AIDS Institute policy recommends that primary care clinicians should initiate same-day-antiretroviral treatment (ART) of a new HIV diagnosis or at the next clinical visit as the standard of care. However, non-HIV-specialized primary care clinicians might not be sufficiently trained to initiate a specialized ART with a newly HIV diagnosed patient. We assessed clinicians’ knowledge and attitudes toward the rapid initiation of ART and provided academic sessions as a training method to guide clinicians through the implementation of a new standard of care.Methods:A Research Electronic Data Capture (REDCap), Health Insurance Portability and Accountability Act (HIPAA)-compliant, online survey was sent to primary care clinicians to assess their knowledge and attitudes towards Rapid Initiation of ART (RIA). We provided personalized academic detailing sessions, addressing questions and concerns gathered from both the initial survey and the individual pre-assessment questionnaire completed prior to the sessions.Results:The survey was initially distributed in February 2019, followed by 4 weekly reminders. Approximately 585 providers completed the survey. Subsequently, 552 health care providers from 25 out of 62 counties in NY State were detailed between March 2019 and March 2021. Lessons learned from the sessions included the identification of pragmatic strategies that could be used in the design of effective detailing sessions, followed by enhanced clinical knowledge, which improved patient care.Conclusion and Global Health Implications:Inconsistencies in the current testing practices result in missed HIV diagnoses and an increased risk of HIV transmission. Academic detailing-training techniques can be used to respond to clinician-identified key issues/attitudes that may result in a new intervention, suggesting a promising approach in addressing the implementation barriers of of rapid-treatment initiation as the standard of care. The academic detailing approach can be easily adapted and can be beneficial in global public health, HIV/ AIDS control, and other conditions that require a medical practice change.

Genetic testing before epilepsy surgery – An exploratory survey and case collection from German epilepsy centers

IntroductionGenetic testing in people with epilepsy may support presurgical decision-making. It is currently unclear to what extent epilepsy centres use genetic testing in presurgical evaluation. MethodsWe performed an exploratory survey among members of the German Society for Epileptology to study the current practice of genetic testing in presurgical evaluation at the respective sites. Survey participants contributed educational case reports. ResultsThe majority of participants consider genetic testing to be useful in individuals with familial syndromes or phenotypic features suggesting a genetic etiology. We report 25 cases of individuals with a confirmed genetic diagnosis that have previously undergone epilepsy surgery. Our cases demonstrate that a genetic diagnosis has an impact on both the decision-making process during presurgical evaluation, as well as the postoperative outcome. ConclusionGenetic testing as part of the presurgical work-up is becoming increasingly established in epilepsy centres across Germany. mTORopathies and genetic hypothalamic hamartomas seem to be associated with a generally favourable surgical outcome. Synaptopathies and channelopathies may be associated with a worse outcome and should be considered on a case-by-case level. Prospective studies are needed to examine the impact of an established genetic diagnosis on postsurgical outcome.

85. Evaluation of Urinalysis and Urine Culture Use at a Community Health-system

BackgroundThe Infectious Diseases Society of America asymptomatic bacteriuria (ASB) guidelines recommend against screening for or treating ASB in most patients without symptoms of a urinary tract infection (UTI). The purpose of this study was to characterize current urine testing practices and their potential impact on identification and treatment of asymptomatic bacteriuria on hospitalized adults.MethodsThis retrospective, point prevalence study conducted at a 4 hospital community health-system that included all inpatients ≥ 18 years old present on November 13th, 2019. Patients were excluded if they were admitted or transferred to either a labor & delivery or mother-baby unit. A chart review was performed for a sub-group of patients with abnormal urine testing, with a target sample size of 200 (n=50 from each hospital). The primary outcome was the prevalence of patients with a urinalysis, urine culture, or both performed during their admission. Secondary outcomes included abnormal urine testing in the overall cohort and symptomatology and antibiotic use in the sub-group (Figure 1). Results947 patients met inclusion criteria. Of those patients, 516 (54%) had urine testing performed during their admission. 322 (34%) patients had abnormal urine testing results (Table 1). In the sub-group, 192 patients with abnormal urine tests were included. Antibiotics with a documented indication of UTI were administered to 66 (34%) patients. Of those given antibiotics with a UTI indication, 49/66 (74%) did not have documented signs or symptoms of a UTI (Figure 2). ConclusionUrine testing was performed on the majority of admitted adult patients. Unnecessary testing likely contributes to guideline discordant screening and treatment of ASB. Future studies are needed to identify effective diagnostic stewardship interventions to decrease screening and treatment of ASB.Disclosures Ashley Wilde, PharmD, BCPS-AQ ID, Nothing to disclose

An Investigation into Current Sand Control Testing Practices for Steam Assisted Gravity Drainage Production Wells

Sand control screens (SCD) have been widely installed in wells producing bitumen from unconsolidated formations. The screens are typically designed using general rules-of-thumb. The sand retention testing (SRT) technique has gained attention from the industry for the custom design and performance assessment of SCD. However, the success of SRT experimentation highly depends on the accuracy of the experimental design and variables. This work examines the impact of the setup design, sample preparation, near-wellbore stress conditions, fluid flow rates, and brine chemistry on the testing results and, accordingly, screen design. The SRT experiments were carried out using the replicated samples from the McMurray Formation at Long Lake Field. The results were compared with the test results on the original reservoir samples presented in the literature. Subsequently, a parametric study was performed by changing one testing parameter at a test, gradually making the conditions more comparable to the actual wellbore conditions. The results indicate that the fluid flow rate is the most influential parameter on sand production, followed by the packing technique, stress magnitude, and brine salinity level. The paper presents a workflow for the sand control testing procedure for designing the SCD in the steam-assisted gravity drainage (SAGD) operations.

P60.13 MYLUNG Consortium: Molecularly Informed Lung Cancer Treatment in a Community Cancer Network. Pragmatic Prospective RWR Study

Recent improvements in lung cancer mortality can be ascribed to the discovery of molecular drivers, immunotherapy and utilization of drugs targeting these alterations. Despite national organizations endorsing comprehensive biomarker testing for patients with NSCLC, obstacles remain to routine testing and their use in driving therapeutic decisions. Engaging community practices within the US Oncology Network, we initiated a real world research program aimed to pragmatically identify and overcome barriers to timely and appropriate comprehensive biomarker testing in a large community-based diverse population of patients with lung cancer. Over the next 5 years, the MYLUNG program will evaluate biomarker testing workflows and algorithms, provider acceptance and use of biomarker results to inform treatment decisions, and appropriate adoption of new treatments as they become approved for use in patients with NSCLC. The program is comprised of three principal and integrated components: Protocol 1 was a retrospective cohort study (N=3474 patients) evaluating biomarker testing patterns, results, and initial treatment over a 2-year period that ended in March 31, 2020. Protocol 2 is a prospective, non-interventional cohort study (described below) studying the current testing practices of patients with newly diagnosed NSCLC who are candidates for systemic therapy. Protocol 3 is a platform of prospective interventional trials, engaging 20-30 resource and geographically diverse practices in The US Oncology Network, which will enroll approximately 7500 patients. Protocol 2 practices will serve as their own controls for subsequent interventional trials in Protocol 3. Protocol 2 is a prospective, non-interventional study that will enroll approximately 1000 patients with histologically or cytologically documented early stage, locally advanced, and advanced non-squamous NSCLC who are eligible for active systemic therapy across 10 community practices in The US Oncology Network. The primary objective is to examine the proportion of patients who receive biomarker testing results prior to initiating systemic therapy or death, as well as reasons for initiating systemic therapy without biomarker test results, in order to define the operational feasibility of comprehensive biomarker testing. Secondary objectives include determining the proportion of patients that receive appropriate biomarker-directed treatment, and reasons for not receiving appropriate treatment. We will also examine timelines for the patient journey from initial presentation to diagnosis, biomarker test order and results, first medical oncology visit, and treatment initiation. Additionally, we will examine single versus multi-gene biomarker testing, progression-free survival (PFS) and overall survival (OS) of patients with molecular targets who receive FDA-approved targeted therapy versus patients receiving systemic therapy without biomarker results. We will quantify differences in biomarker testing rates based on socioeconomic status, ethnic diversity, and practice resources. Enrollment began in January 2021 and is expected to enroll for 9-12 months. Information obtained from Protocol 2 will be used to identify an initial set of workflow and technology interventions to be tested in Protocol 3, which is targeted to begin enrollment in the fall of 2021. ▪▪▪ ▪▪▪

Genetic testing for amyotrophic lateral sclerosis in Canada – an assessment of current practices

Objective: To understand current genetic testing practices at Canadian ALS clinics. Methods: An online survey and phone interviews, with clinicians practicing in 27 ALS clinics in Canada, were employed to collect data. Quantitative and qualitative analyses were conducted. Results: Ninety-three percent (25/27) of ALS clinics in Canada are routinely ordering genetic testing for familial ALS, while 33% (9/27) of clinics are routinely ordering genetic testing for sporadic ALS. Barriers to genetic testing include a perceived lack of an impact on treatment plan, difficulty in obtaining approvals, primarily from provincial Ministries of Health, and limited access to genetic counseling. Predictive testing practices were found to be the most variable across the country. The average wait time for a symptomatic patient living with ALS to see a genetic counselor in Canada is 10 months (range 0–36 months). Conclusions: Access to genetic testing, and testing practices, vary greatly across Canadian ALS clinics. There may be patients with a monogenetic etiology to their ALS who are not being identified given that genetic testing for patients diagnosed with ALS is not routinely performed at all clinics. This study highlights potential inequities for patients with ALS that can arise from variability in health care delivery across jurisdictions, in a federally-funded, but provincially-regulated, health care system. Clinical trials for both symptomatic ALS patients and pre-symptomatic ALS gene carriers are ongoing, and ALS clinicians in Canada are motivated to improve access to genetic testing for ALS.

Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis.

BackgroundThe cost and complexity of the polymerase chain reaction (PCR) test are barriers to diagnosis and treatment of hepatitis C virus (HCV) infection. We investigated the cost-effectiveness of testing strategies using antigen instead of PCR testing.MethodsWe developed a mathematical model for HCV to estimate the number of diagnoses and cases of liver disease. We compared the following testing strategies: antibody test followed by PCR in case of positive antibody (baseline strategy); antibody test followed by HCV-antigen test (antibody-antigen); antigen test alone; PCR test alone. We conducted cost-effectiveness analyses considering either the costs of HCV testing of infected and uninfected individuals alone (A1), HCV testing and liver-related complications (A2), or all costs including HCV treatment (A3). The model was parameterized for the country of Georgia. We conducted several sensitivity analyses.ResultsThe baseline scenario could detect 89% of infected individuals. Antibody-antigen detected 86% and antigen alone 88% of infected individuals. PCR testing alone detected 91% of the infected individuals: the remaining 9% either died or spontaneously recovered before testing. In analysis A1, the baseline strategy was not essentially more expensive than antibody-antigen. In analysis A2, strategies using PCR became cheaper than antigen-based strategies. In analysis A3, antibody-antigen was again the cheapest strategy, followed by the baseline strategy, and PCR testing alone.ConclusionsAntigen testing, either following a positive antibody test or alone, performed almost as well as the current practice of HCV testing. The cost-effectiveness of these strategies depends on the inclusion of treatment costs.

Minimizing cost associated with management of heparin‐induced thrombocytopenia: A cost analysis of various laboratory testing models

Management of patients with suspected heparin-induced thrombocytopenia (HIT) can lead to significant costs. Reported cost-saving initiatives have focused on minimizing inappropriate testing in low-risk patients and optimizing alternative anticoagulant selection. We sought to further investigate how utilizing various HIT laboratory testing models would impact total cost of testing and alternative anticoagulant use. Utilizing a retrospective cohort of adult patients tested for HIT over three years within our institution, we evaluated how utilization of four distinct laboratory models impacted total number of HIT test combinations completed, time to HIT testing finalization, percentage of patients discharged from the hospital prior to HIT testing finalization, total alternative anticoagulant days, and total anticipated major bleed events. Additionally, we calculated cost of laboratory testing and alternative anticoagulant associated with each model. A total of 482 patients were included in our cohort. A laboratory testing model that utilized an in-house platelet factor 4 (PF4)-heparin enzyme-linked immunosorbent assay (ELISA) completed three days weekly, and reflex serotonin release assay (SRA) with a five-day turnaround resulted in the shortest mean time to HIT testing finalization, lowest percentage of patients discharged prior to HIT testing finalization, and lowest total alternative anticoagulant days. Institutions should evaluate current HIT laboratory testing practices and assess for opportunities for optimization. Testing models utilizing a PF4-heparin antibody ELISA with a reflex SRA for positive results may improve testing metrics and lead to lower utilization of alternative anticoagulants.

Challenges in Detecting Emergent Behavior in System Testing

AbstractSystem integration testing in the defense and aerospace industry is becoming increasingly complex. The long lifetime of the system drives the need for sub‐system modifications throughout the system life cycle. The manufacturer must verify that these modifications do not negatively affect the system's behavior. Hence, an extensive test regime is required to ensure reliability and robustness of the system. System behaviors that emerge from the interaction of sub‐systems can be difficult to pre‐define and capture in a test setup using acceptance criteria. Typical challenges with current test practice include late detection of unwanted system behavior, high cost of repetitive manual processes, and risk of release delays because of late error detection.This paper reviews the state of practice at a case company in the defense and aerospace industry. We use an industry‐as‐laboratory approach to explore the situation in the company. The research identifies the challenges and attempts to quantify the potential gain from improving the current practice. We find that the current dependency on manual analysis generates resources ‐and scheduling constraints and communication issues that hinder efficient detection of system emergent behavior. We explore two approaches to automate anomaly detection of system behavior from test data. The first approach looks at anomaly detection in a top‐down approach to give an indication of the system integrity. The second approach uses anomaly detection on system parts, resulting in the ability to localize the root causes. The work lays the foundation for further research of automated anomaly detection in system testing.

Immunogenomics in personalized cancer treatments.

Recent advances in next-generation sequencing technologies have led to significant improvements in cancer genomic research and cancer treatment. Through the use of comprehensive cancer genome data, precision medicine has become more of a reality; albeit, at present, only ~10-15% of patients can benefit from current genomic testing practices. Improvements in cancer genome analyses have contributed to a better understanding of antitumor immunity and have provided solutions for targeting highly cancer-specific neoantigens generated from somatic mutations in individual patients. Since then, numerous studies have demonstrated the importance of neoantigens and neoantigen-reactive T cells in the tumor microenvironment and how their presence influences the beneficial responses associated with various cancer immunotherapies, including immune checkpoint inhibitor therapy. Indeed, cancer immunotherapies that explicitly target neoantigens specific to individual cancer patients would lead to the ultimate form of cancer precision medicine. For this to be realized, several issues would need to be overcome, including the accurate prediction and selection of neoantigens that can induce cytotoxic T cells in individual patients. The precise prediction of target neoantigens will likely accelerate the development of personalized immunotherapy including cancer vaccines and T-cell receptor-engineered T-cell therapy for patients with cancer.