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  1. This was sent to the lab team for discussion and we decided that the INF-y response tests should be modeled in IS.
  2. Craig said there are NO other variables to capture the units and dosing concentrations for the test agents that are added to the samples. In fact, this is a gap in the CDISC model that we lack variables (or a domain) to help mapping in vitro drug/non-drug exposure data. The EX/EC and AG domains are used for mapping in vivo drug and non-drug agents exposure data (respectively). These domains have variables for mapping dosing concentrations and units, but we can't use them for in vitro exposure data. Craig said he would pre-coordinate the concentrations and units of the added agents into the ISCNAGT (test condition agent) variable, see the texts in red in the above example.
    • This is a problem because a single CDISC variable should be designed for a single meaning and a single purpose. The Test Condition Agent variable is used for the name/identity of the added study/control drugs or other materials. I think we would be breaking rules to also include the concentration and unit in this variable as well.
  3. While brain storming Stefan's use-case, I remembered that in the MS domain, there are MSAGENT (Agent Name), MSCONC (Agent Concentration), MSCONCU (Agent Concentration Units) variables that were added back in SDTMIG v3.2 to represent the study and control drugs used for microbial resistance testing. The 3 variables, MSAGENT, MSCONC, and MSCONCU are used to map the name of the study/control drugs, their concentrations and units respectively. Basically, for these MS tests, you dump antibiotics study drugs, likely an antibiotic (at varying concentrations) on a plate to see if the bacteria would be resistant or susceptible for the drug by measuring a few specific outputs. Below is an a MS example from IG3.4 to show how the 3 variables are used together with the MSTESTs:

After "After E. faecalis was identified in the subject sample, drug susceptibility testing was performed at each of the labs using both the sponsor's investigational drug and amoxicillin. Because an identified organism is the subject of the test, the NHOID variable is populated with "ENTEROCOCCUS FAECALIS". Between the 2 labs (MSNAM), a total of 3 susceptibility testing methods were used: epsilometer, disk diffusion, and macro broth dilution (MSMETHOD). Epsilometer and disk diffusion both use agar diffusion methods, in which an agar plate is inoculated with the microorganism of interest and either a strip (epsilometer) or discs (disk diffusion) containing various concentrations of the drug are placed on the agar plate. The epsilometer test method provides both a  minimum inhibitory concentration (MSTESTCD = "MIC"), the  lowest concentration of a drug  that inhibits the growth of a microorganism, and a qualitative interpretation (MSTESTCD = "MICROSUS") such as susceptible, intermediate, or resistant. The disk diffusion test method provides the diameter of the zone of inhibition (MSTESTCD = "DIAZOINH") and a qualitative interpretation such as susceptible, intermediate, or resistant (MSTESTCD = " MICROSUS" ). The quantitative and qualitative results are grouped together using MSGRPID.

The third method, macro broth dilution, was used to test the specimen at a predefined drug concentration of each of the drugs. When the drug and amount are a predefined part of the test, the variable MSAGENT is populated with the with the name of the drug being used in the susceptibility test. The variables MSCONC and MSCONCU represent the concentration and units of the drug being used."

Dataset wrap
titlems.xpt
Namems
Rowcaps
Rows 1-4:Show the minimum inhibitory concentration and the interpretation result reported from Central Lab ABC from a sample that was tested for susceptibility to the sponsor drug and amoxicillin, using an epsilometer test method.
Rows 5-6:Show that Local Lab XYZ found that the sample was susceptible to the sponsor drug at a concentration of 0.5 ug/dL and resistant to amoxicillin at a concentration of 0.5 ug/dL.
Rows 7-10:Show the diameter of the zone of inhibition and the interpretation result reported from Local Lab XYZ from a sample that was tested for susceptibility to the sponsor drug and amoxicillin using a disk diffusion test method.
Dataset2
RowSTUDYIDDOMAINUSUBJIDNHOIDMSGRPIDMSSEQMSREFIDMSLNKGRPMSTESTCDMSTESTMSAGENTMSCONCMSCONCUMSORRESMSORRESUMSSTRESCMSSTRESNMSSTRESUMSNAMMSMETHODMSDTC
1ABCMSABC-001-002ENTEROCOCCUS FAECALIS11SPEC011MICMinimum Inhibitory ConcentrationSponsor Drug

0.25ug/dL0.250.25ug/dLCENTRAL LAB ABCEPSILOMETER2005-06-19T08:00
2ABCMSABC-001-002ENTEROCOCCUS FAECALIS12SPEC011MICROSUSMicrobial SusceptibilitySponsor Drug

SUSCEPTIBLE
SUSCEPTIBLE

CENTRAL LAB ABCEPSILOMETER2005-06-19T08:00
3ABCMSABC-001-002ENTEROCOCCUS FAECALIS23SPEC011MICMinimum Inhibitory ConcentrationAmoxicillin

1ug/dL11ug/dLCENTRAL LAB ABCEPSILOMETER2005-06-19T08:00
4ABCMSABC-001-002ENTEROCOCCUS FAECALIS24SPEC011MICROSUSMicrobial SusceptibilityAmoxicillin

RESISTANT
RESISTANT

CENTRAL LAB ABCEPSILOMETER2005-06-19T08:00
5ABCMSABC-001-002ENTEROCOCCUS FAECALIS
5SPEC012MICROSUSMicrobial SusceptibilitySponsor Drug0.5ug/dLSUSCEPTIBLE
SUSCEPTIBLE

LOCAL LAB XYZMACRO BROTH DILUTION2005-06-19T08:00
6ABCMSABC-001-002ENTEROCOCCUS FAECALIS
6SPEC012MICROSUSMicrobial SusceptibilityAmoxicillin0.5ug/dLRESISTANT
RESISTANT

LOCAL LAB XYZMACRO BROTH DILUTION2005-06-19T08:00
7ABCMSABC-001-002ENTEROCOCCUS FAECALIS37SPEC012DIAZOINHDiameter of the Zone of InhibitionSponsor Drug

23mm2323mmLOCAL LAB XYZDISK DIFFUSION2005-06-26T08:00
8ABCMSABC-001-002ENTEROCOCCUS FAECALIS38SPEC012MICROSUSMicrobial SusceptibilitySponsor Drug

SUSCEPTIBLE
SUSCEPTIBLE

LOCAL LAB XYZDISK DIFFUSION2005-06-26T08:00
9ABCMSABC-001-002ENTEROCOCCUS FAECALIS49SPEC012DIAZOINHDiameter of the Zone of InhibitionAmoxicillin

25mm
25mmLOCAL LAB XYZDISK DIFFUSION2005-06-26T08:00
10ABCMSABC-001-002ENTEROCOCCUS FAECALIS410SPEC012MICROSUSMicrobial SusceptibilityAmoxicillin

RESISTANT
RESISTANT

LOCAL LAB XYZDISK DIFFUSION2005-06-26T08:00

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I want to run this by the team to see if we can take advantage of the existing standard variables? Are Do we also duplicating variables who have "duplicate variables" in different domains that serve the same purpose?

  1. Are we using the Test Condition Agent (ISCNDAGT) variable the same as the Agent Name (MSAGENT)? Do we use them for the same purpose?
    • They both are used to map the name of the thing/entity (e.g. study/control drug, stimulating test materials like TB antigens, etc) that are added to a sample to "induce" a response.
    • The "induced" response can be stimulating stimulatory (in immune response) or inhibitory (in bacterial resistance response).
  2. If yes, do we need to merge these two variables? Seeing as we are making changes for IG4.0, this might be worth considering, and will need multiple team's review and approval.
    • This also means there would be one less standard variable out there (as people complain that there are too many new variables in IG3.4). 
  3. SeparatelyAs a separate conversation, can we extend the use of the standard variables --CONC (Agent Concentration), --CONCU (Agent Concentration Units) to the other specimen-based domains? For mapping concentration and unit of the in vitro exposure agents? There are now use-cases needing these variables in IS, MS and CP, at least. Right now --CONC and --CONCU are limited to MS only. They also only qualify --AGENT.
    • This way we can take advantage of existing standard variables, instead of creating new ones.
    • This also means we don't need to tell users to pre-coordinate unit and dosing concentration of the exposure agent into the same variable - which would be breaking rules.

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