International practice variation in perioperative laboratory testing in glioblastoma patients-a retrospective cohort study.

PURPOSE: Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary academic centers-Brigham and Women's Hospital (BWH), Boston, USA, and University Medical Center Utrecht (UMCU), Utrecht, the Netherlands. METHODS: All glioblastoma patients treated according to standard-of-care between 2005 and 2013 were included. We compared the number of blood drawings and laboratory tests performed during the 70-day perioperative period using a Poisson regression model, as well as the estimated laboratory costs per patient. Additionally, we compared the likelihood of an abnormal test result using a generalized linear mixed effects model. RESULTS: After correction for age, sex, IDH1 status, postoperative KPS score, length of stay, and survival status, the number of blood drawings and laboratory tests during the perioperative period were 3.7-fold (p < 0.001) and 4.7-fold (p < 0.001) higher, respectively, in BWH compared to UMCU patients. The estimated median laboratory costs per patient were 82 euros in UMCU and 256 euros in BWH. Furthermore, the likelihood of an abnormal test result was lower in BWH (odds ratio [OR] 0.75, p < 0.001), except when the prior test result was abnormal as well (OR 2.09, p < 0.001). CONCLUSIONS: Our results suggest a substantially lower clinical threshold for ordering laboratory tests in BWH compared to UMCU. Further investigating the clinical consequences of laboratory testing could identify over and underuse, decrease healthcare costs, and reduce unnecessary discomfort that patients are exposed to.

Automating Clinical Chart Review: An Open-Source Natural Language Processing Pipeline Developed on Free-Text Radiology Reports From Patients With Glioblastoma.

PURPOSE: The aim of this study was to develop an open-source natural language processing (NLP) pipeline for text mining of medical information from clinical reports. We also aimed to provide insight into why certain variables or reports are more suitable for clinical text mining than others. MATERIALS AND METHODS: Various NLP models were developed to extract 15 radiologic characteristics from free-text radiology reports for patients with glioblastoma. Ten-fold cross-validation was used to optimize the hyperparameter settings and estimate model performance. We examined how model performance was associated with quantitative attributes of the radiologic characteristics and reports. RESULTS: In total, 562 unique brain magnetic resonance imaging reports were retrieved. NLP extracted 15 radiologic characteristics with high to excellent discrimination (area under the curve, 0.82 to 0.98) and accuracy (78.6% to 96.6%). Model performance was correlated with the inter-rater agreement of the manually provided labels (ρ = 0.904; P < .001) but not with the frequency distribution of the variables of interest (ρ = 0.179; P = .52). All variables labeled with a near perfect inter-rater agreement were classified with excellent performance (area under the curve > 0.95). Excellent performance could be achieved for variables with only 50 to 100 observations in the minority group and class imbalances up to a 9:1 ratio. Report-level classification accuracy was not associated with the number of words or the vocabulary size in the distinct text documents. CONCLUSION: This study provides an open-source NLP pipeline that allows for text mining of narratively written clinical reports. Small sample sizes and class imbalance should not be considered as absolute contraindications for text mining in clinical research. However, future studies should report measures of inter-rater agreement whenever ground truth is based on a consensus label and use this measure to identify clinical variables eligible for text mining.

Swe1p responds to cytoskeletal perturbation, not bud size, in S. cerevisiae.

BACKGROUND: S. cerevisiae cells must grow to a critical size in G1 in order to pass start and enter the cell cycle. A recent study proposed that in addition to the mother size control in G1, the bud must grow to a critical bud size in G2 in order to enter mitosis. Insufficient bud size would cause G2 arrest enforced by the mitotic inhibitor Swe1p, explaining previous findings that some perturbations that block bud growth also trigger Swe1p-dependent cell-cycle arrest. RESULTS: We tested the critical-bud-size hypothesis. We found that halting bud growth by inactivation of the myosin Myo2p did not trigger Swe1p-dependent arrest in budded cells, even when the buds were very small. Moreover, Swe1p did not affect cell-cycle progression in unstressed cells, even when bud size was decreased by overriding G1 size control. Actin depolymerization did cause Swe1p-dependent arrest in small-budded but not large-budded cells, as previously reported. However, we found that the key determinant of cell-cycle arrest in those circumstances was not bud size, but rather the relative abundance of the Swe1p mitotic inhibitor and the mitosis-promoting cyclins. CONCLUSIONS: Swe1p does not respond to insufficient bud size. Instead, actin stress empowers Swe1p to promote arrest. The effectiveness of Swe1p in promoting that arrest declines as cells progress through the cell cycle.

Effective intra-S checkpoint responses to UVC in primary human melanocytes and melanoma cell lines.

The objective of this study was to assess potential functional attenuation or inactivation of the intra-S checkpoint during melanoma development. Proliferating cultures of skin melanocytes, fibroblasts, and melanoma cell lines were exposed to increasing fluences of UVC and intra-S checkpoint responses were quantified. Melanocytes displayed stereotypic intra-S checkpoint responses to UVC qualitatively and quantitatively equivalent to those previously demonstrated in skin fibroblasts. In comparison with fibroblasts, primary melanocytes displayed reduced UVC-induced inhibition of DNA strand growth and enhanced degradation of p21Waf1 after UVC, suggestive of enhanced bypass of UVC-induced DNA photoproducts. All nine melanoma cell lines examined, including those with activating mutations in BRAF or NRAS oncogenes, also displayed proficiency in activation of the intra-S checkpoint in response to UVC irradiation. The results indicate that bypass of oncogene-induced senescence during melanoma development was not associated with inactivation of the intra-S checkpoint response to UVC-induced DNA replication stress.

Limited math skills: a prescription for change.

New and recent graduates of schools of nursing have limited mathematical skills for medication administration. The purpose of this article is to provide a prescription for change to address the issue of limited math skills for medication administration. The authors recommend three areas of needed change: relationships, practice, and expectations. These three areas require attention from both the hiring agency and the educational institution.