\u3ci\u3eMedicine Meets Virtual Reality 21\u3c/i\u3e

Editors: James D. Westwood, Susan W. Westwood, Li Felländer-Tsai, Cali M. Fidopiastis, Randy S. Haluck, Richard A. Robb, Steven Senger, Kirby G. Vosburgh. Chapter, Varying the Speed of Perceived Self-Motion Affects Postural Control During Locomotion, co-authored by Joshua Pickhinke, Jung Hung Chien, Mukul Mukherjee, UNO faculty and staff members. Virtual reality environments have been used to show the importance of perception of self-motion in controlling posture and gait. In this study, the authors used a virtual reality environment to investigate whether varying optical flow speed had any effect on postural control during locomotion. Healthy young adult participants walked under two conditions, with optical flow matching their preferred walking speed, and with a randomly varying optic flow speed compared to their preferred walking speed. Exposure to the varying optic flow increased the variability in their postural control as measured by area of COP when compared with the matched speed condition. If perception of self-motion becomes less predictable, postural control during locomotion becomes more variable and possibly riskier.https://digitalcommons.unomaha.edu/facultybooks/1261/thumbnail.jp

TPM: Cloud-Based Tele PTSD Monitor Using Multi-Dimensional Information

An automated system that can remotely and non-intrusively screen individuals at high risk for Post-Traumatic Stress Disorder (PTSD) and monitor their progress during treatment would be desired by many Veterans Affairs (VAs) as well as other PTSD treatment and research organizations. In this paper, we present an automated, cloud-based Tele-PTSD Monitor (TPM) system based on the fusion of multiple sources of information. The TPM system can be hosted in a cloud environment and accessed through landline or cell phones, or on the Internet through a web portal or mobile application (app)

A Voice-Based Automated System for PTSD Screening and Monitoring

Comprehensive evaluation of PTSD includes diagnostic interviews, self-report testing, and physiological reactivity measures. It is often difficult and costly to diagnose PTSD due to patient access and the variability in symptoms presented. Additionally, potential patients are often reluctant to seek help due to the stigma associated with the disorder. A voice-based automated system that is able to remotely screen individuals at high risk for PTSD and monitor their symptoms during treatment has the potential to make great strides in alleviating the barriers to cost effective PTSD assessment and progress monitoring. In this paper we present a voice-based automated Tele-PTSD Monitor (TPM) system currently in development, designed to remotely screen, and provide assistance to clinicians in diagnosing PTSD. The TPM system can be accessed via a Public Switched Telephone Network (PSTN) or the Internet. The acquired voice data is then sent to a secure server to invoke the PTSD Scoring Engine (PTSD-SE) where a PTSD mental health score is computed. If the score exceeds a predefined threshold, the system will notify clinicians (via email or short message service) for confirmation and/or an appropriate follow-up assessment and intervention. The TPM system requires only voice input and performs computer-based automated PTSD scoring, resulting in low cost and easy field-deployment. The concept of the TPM system was supported using a limited dataset with an average detection accuracy of up to 95.88%

The hospital microbiome project: meeting report for the UK science and innovation network UK-USA workshop ‘beating the superbugs: hospital microbiome studies for tackling antimicrobial resistance’, October 14th 2013

The UK Science and Innovation Network UK-USA workshop ‘Beating the Superbugs: Hospital Microbiome Studies for tackling Antimicrobial Resistance’ was held on October 14th 2013 at the UK Department of Health, London. The workshop was designed to promote US-UK collaboration on hospital microbiome studies to add a new facet to our collective understanding of antimicrobial resistance. The assembled researchers debated the importance of the hospital microbial community in transmission of disease and as a reservoir for antimicrobial resistance genes, and discussed methodologies, hypotheses, and priorities. A number of complementary approaches were explored, although the importance of the built environment microbiome in disease transmission was not universally accepted. Current whole genome epidemiological methods are being pioneered in the UK and the benefits of moving to community analysis are not necessarily obvious to the pioneers; however, rapid progress in other areas of microbiology suggest to some researchers that hospital microbiome studies will be exceptionally fruitful even in the short term. Collaborative studies will recombine different strengths to tackle the international problems of antimicrobial resistance and hospital and healthcare associated infections

Sticky Stories: Joe Orton, Queer History, Queer Dramaturgy

This paper investigates the resonances of Orton’s work for contemporary queer audiences. By presenting potential reasons for the rise and fall in popularity and visibility of Orton’s work for queer and gay audiences through the 1980s and 1990s, this paper looks to the queer context in which Joe Orton’s work developed in order to explore the queer social history into which it fits.  This sense of queer history is linked to contemporary notions of queer theorising about temporalities and queer dramaturgy, which offers potentially novel ways of engaging with Orton’s work queerly without twisting it to fit a ‘neat’ reading, in part because such readings tend to ‘smooth out’ the more difficult elements of the work.  In particular, the paper explores the theatrical form of farce, often articulated as conservative, in relation to queer positions, which are quite the opposite.  In so doing, the paper, by way of queer temporalities and work on queer dramaturgies, sketches out a reading strategy that does not ignore Orton’s more difficult or stickier elements, in particular his treatment of women and race

STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies.

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

A systematic review classifies sources of bias and variation in diagnostic test accuracy studies

Objective To classify the sources of bias and variation and to provide an updated summary of the evidence of the effects of each source of bias and variation. Study Design and Setting We conducted a systematic review of studies of any design with the main objective of addressing bias or variation in the results of diagnostic accuracy studies. We searched MEDLINE, EMBASE, BIOSIS, the Cochrane Methodology Register, and Database of Abstracts of Reviews of Effects (DARE) from 2001 to October 2011. Citation searches based on three key papers were conducted, and studies from our previous review (search to 2001) were eligible. One reviewer extracted data on the study design, objective, sources of bias and/or variation, and results. A second reviewer checked the extraction. Results We summarized the number of studies providing evidence of an effect arising from each source of bias and variation on the estimates of sensitivity, specificity, and overall accuracy. Conclusions We found consistent evidence for the effects of case-control design, observer variability, availability of clinical information, reference standard, partial and differential verification bias, demographic features, and disease prevalence and severity. Effects were generally stronger for sensitivity than for specificity. Evidence for other sources of bias and variation was limited. © 2013 Elsevier Inc. All rights reserved