Connectivity for point-of-care testing results: a call for change.

This article hopes to minimise challenges such as result transcription errors, undocumented tests and results, delays in management and over-testing, by making seven recommendations in support of implementing nation-wide connectivity for point-of-care testing. The ultimate goal is to facilitate safer and equitable point-of-care medical laboratory testing throughout the patient journey and in all geographical locations of New Zealand. The recommendations have been endorsed by the New Zealand Society for Pathologists and The New Zealand Institute of Medical Laboratory Science.

FocA: A deep learning tool for reliable, near-real-time imaging focus analysis in automated cell assay pipelines.

The increasing use of automation in cellular assays and cell culture presents significant opportunities to enhance the scale and throughput of imaging assays, but to do so, reliable data quality and consistency are critical. Realizing the full potential of automation will thus require the design of robust analysis pipelines that span the entire workflow in question. Here we present FocA, a deep learning tool that, in near real-time, identifies in-focus and out-of-focus images generated on a fully automated cell biology research platform, the NYSCF Global Stem Cell Array®. The tool is trained on small patches of downsampled images to maximize computational efficiency without compromising accuracy, and optimized to make sure no sub-quality images are stored and used in downstream analyses. The tool automatically generates balanced and maximally diverse training sets to avoid bias. The resulting model correctly identifies 100% of out-of-focus and 98% of in-focus images in under 4 s per 96-well plate, and achieves this result even in heavily downsampled data (∼30 times smaller than native resolution). Integrating the tool into automated workflows minimizes the need for human verification as well as the collection and usage of low-quality data. FocA thus offers a solution to ensure reliable image data hygiene and improve the efficiency of automated imaging workflows using minimal computational resources.

Integrating deep learning and unbiased automated high-content screening to identify complex disease signatures in human fibroblasts.

Drug discovery for diseases such as Parkinson's disease are impeded by the lack of screenable cellular phenotypes. We present an unbiased phenotypic profiling platform that combines automated cell culture, high-content imaging, Cell Painting, and deep learning. We applied this platform to primary fibroblasts from 91 Parkinson's disease patients and matched healthy controls, creating the largest publicly available Cell Painting image dataset to date at 48 terabytes. We use fixed weights from a convolutional deep neural network trained on ImageNet to generate deep embeddings from each image and train machine learning models to detect morphological disease phenotypes. Our platform's robustness and sensitivity allow the detection of individual-specific variation with high fidelity across batches and plate layouts. Lastly, our models confidently separate LRRK2 and sporadic Parkinson's disease lines from healthy controls (receiver operating characteristic area under curve 0.79 (0.08 standard deviation)), supporting the capacity of this platform for complex disease modeling and drug screening applications.

The impact of a point-of-care testing device on CVD risk assessment completion in New Zealand primary-care practice: A cluster randomised controlled trial and qualitative investigation.

OBJECTIVES: To assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice. METHODS: We conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand general practices stratified by size and rurality and randomised to POC device plus usual practice or usual practice alone (controls). Patients aged 35-79 years were eligible if they met national guideline criteria for CVD risk assessment. Data on CVD risk assessments were aggregated using a web-based decision support programme common to each practice. Data entered into the on-line CVD risk assessment form could be saved pending blood test results. The primary outcome was the proportion of completed CVD risk assessments. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interviews and questionnaire. The POC testing was supported by a comprehensive quality assurance programme. RESULTS: A CVD risk assessment entry was recorded for 7421 patients in 10 POC practices and 6217 patients in 10 control practices; 99.5% of CVD risk assessments had complete data in both groups (adjusted odds ratio 1.02 [95%CI 0.61-1.69]). There were major external influences that affected the trial: including a national performance target for CVD risk assessment and changes to CVD guidelines. All practices had invested in systems and dedicated staff time to identify and follow up patients to completion. However, the POC device was viewed by most as an additional tool rather than as an opportunity to review practice work flow and leverage the immediate test results for patient education and CVD risk management discussions. Shortly after commencement, the trial was halted due to a change in the HbA1c test assay performance. The trial restarted after the manufacturing issue was rectified but this affected the end use of the device. CONCLUSIONS: Performance incentives and external influences were more powerful modifiers of practice behaviours than the POC device in relation to CVD risk assessment completion. The promise of combining risk assessment, communication and management within one consultation was not realised. With shifts in policy focus, the utility of POC devices for patient engagement in CVD preventive care may be demonstrated if fully integrated into the clinical setting. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000607774.

Point-of-care testing governance in New Zealand: a national framework.

Point-of-care testing (POCT) devices are in-vitro diagnostic devices used near the patient and for the most part distant from the pathology laboratory. By definition they have a large scope of settings and user profiles. POCT optimises care pathways and overcomes geographical barriers but has a high potential for adverse incidents. A successful POCT service needs good clinical governance and a comprehensive quality management system. In New Zealand, Medsafe regulates medical devices including POCT devices in accordance with the Medicines Act 1981. A number of regulations impact on the use of devices but none address analytical and clinical performance. In 2015 PHARMAC will assume responsibility for management of medical devices. We propose a governance framework that optimises patient safety and maximises benefit from this indispensable technology. This is the first of two articles; the second will address point-of-care governance at healthcare provider level.

Osteoblastic MG-63 cell differentiation, contraction, and mRNA expression in stress-relaxed 3D collagen I gels.

To investigate the molecular aspects of osteoblastic interactions with a type I collagen matrix, human osteoblast-like MG-63 cells were cultured in three-dimensional (3D) collagen I gels. MG-63 cells in collagen gels expressed higher osteocalcin mRNA levels than cells in monolayer (2D) on polystyrene surfaces. Gel contraction was assessed via releasing the collagen gels from attachment following 24 h incubation in serum free, TGF-beta1-treated, or 1,25-(OH)(2)D(3)-treated media. 10 ng/ml of TGF-beta1 was optimal for enhancing contraction and led to decreased osteocalcin mRNA levels. In contrast, 50 nM 1,25-(OH)(2)D(3) led to increased osteocalcin mRNA levels, but did not affect contraction. Furthermore, the effect of contraction on gene expression was examined by releasing a subset of gels after 24 h and assessing mRNA levels by RT-PCR. Contracting gels exhibited temporally regulated differential increases in MMP-1, MMP-3, and alpha(2) integrin mRNA levels at specific time points post release. Cytochalasin D treatment immediately following release of gels inhibited contraction in a dose-dependent manner as well as prevented upregulation of MMP-1, MMP-3, and alpha2 integrin mRNA levels in contracting gels. These results suggest that osteoblastic cells generate internal loads that may affect specific gene expression, and these changes can be altered in the presence of biomediators.