Comparison of methods for auto-coding causation of injury narratives

Manually reading free-text narratives in large databases to identify the cause of an injury can be very time consuming and recently, there has been much work in automating this process. In particular, the variations of the naïve Bayes model have been used to successfully auto-code free text narratives describing the event/exposure leading to the injury of a workers' compensation claim. This paper compares the naïve Bayes model with an alternative logistic model and found that this new model outperformed the naïve Bayesian model. Further modest improvements were found through the addition of sequences of keywords in the models as opposed to consideration of only single keywords. The programs and weights used in this paper are available upon request to researchers without a training set wishing to automatically assign event codes to large data-sets of text narratives. The utility of sharing this program was tested on an outside set of injury narratives provided by the Bureau of Labor Statistics with promising results.

Development and evaluation of a Naïve Bayesian model for coding causation of workers' compensation claims

INTRODUCTION

Tracking and trending rates of injuries and illnesses classified as musculoskeletal disorders caused by ergonomic risk factors such as overexertion and repetitive motion (MSDs) and slips, trips, or falls (STFs) in different industry sectors is of high interest to many researchers. Unfortunately, identifying the cause of injuries and illnesses in large datasets such as workers' compensation systems often requires reading and coding the free form accident text narrative for potentially millions of records.

METHOD

To alleviate the need for manual coding, this paper describes and evaluates a computer auto-coding algorithm that demonstrated the ability to code millions of claims quickly and accurately by learning from a set of previously manually coded claims.

CONCLUSIONS

The auto-coding program was able to code claims as a musculoskeletal disorders, STF or other with approximately 90% accuracy.

IMPACT ON INDUSTRY

The program developed and discussed in this paper provides an accurate and efficient method for identifying the causation of workers' compensation claims as a STF or MSD in a large database based on the unstructured text narrative and resulting injury diagnoses. The program coded thousands of claims in minutes. The method described in this paper can be used by researchers and practitioners to relieve the manual burden of reading and identifying the causation of claims as a STF or MSD. Furthermore, the method can be easily generalized to code/classify other unstructured text narratives.

Effect of fluoxetine on regional cerebral metabolism in autistic spectrum disorders: a pilot study

The regional metabolic effects of fluoxetine were examined in patients with autism spectrum disorders. Six adult patients with DSM-IV and Autism Diagnostic Interview (ADI) diagnoses of autism (n = 5) and Asperger's syndrome (n = 1), entered a 16-wk placebo-controlled cross-over trial of fluoxetine. The patients received (18)F-deoxyglucose positron emission tomography with co-registered magnetic resonance imaging at baseline and at the end of the period of fluoxetine administration. After treatment, the patients showed significant improvement on the scores of the Yale--Brown Obsessive--Compulsive Scale -- Obsessions subscale and the Hamilton Anxiety Scale; Clinical Global Impressions -- Autism scores showed 3 of the patients much improved and 3 unchanged. Relative metabolic rates were significantly higher in the right frontal lobe following fluoxetine, especially in the anterior cingulate gyrus and the orbitofrontal cortex. Patients with higher metabolic rates in the medial frontal region and anterior cingulate when unmedicated were more likely to respond favourably to fluoxetine. These results are consistent with those in depression indicating that higher cingulate gyrus metabolic rates at baseline predict SRI response.

Early thermal experience has different effects on growth and muscle fibre recruitment in spring- and autumn-running Atlantic salmon populations

The consequence of early thermal experience for subsequent growth patterns was investigated in Atlantic salmon (Salmo salar L.). Spring- and autumn-running salmon were caught in upland (Baddoch) and lowland (Sheeoch) tributaries of the River Dee, Aberdeenshire, Scotland, respectively, on the final stages of their spawning migrations. The eggs were incubated at the simulated natural temperature regime of each stream, which was on average 2.8 degrees C lower for the Baddoch. The offspring, representing 11 families per population, were transferred at first feeding to constant environmental conditions (12–14 degrees C; 16h:8h light:dark photoperiod) and reared in replicate tanks. Salmon of both populations were longer and heavier at 6 and 12 weeks in fish initially reared under the cooler Baddoch regime. Length frequency distributions became bimodal after 18 weeks, and only the upper growth mode was studied. Modelling of length distributions at 40 weeks revealed significantly different patterns of muscle growth according to initial temperature regime, but only for the Sheeoch salmon. In fish of Sheeoch origin, significantly more white muscle fibres were recruited per mm(2) increase in myotomal cross-sectional area at Sheeoch than at Baddoch temperatures (P<0.01). After 40 weeks, the density of white fibres was 10.4 % higher in fish initially reared at the Sheeoch (533+/−6 mm(−2)) than at the Baddoch (483+/−5 mm(−2)) thermal regimes (means +/− s.e.m., 16 fish per group; P<0.001). Muscle satellite cells were identified using an antibody to c-met. At 24 weeks, the density of muscle satellite cells was 29 % higher in Sheeoch salmon reared to first feeding at the temperature of their natal stream than at cooler Baddoch temperatures (P<0.01). In contrast, the number and size distributions of white muscle fibres in the myotomes of Baddoch salmon were independent of early thermal experience.

Phenotypic plasticity of early myogenesis and satellite cell numbers in atlantic salmon spawning in upland and lowland tributaries of a river system

Early myogenesis was studied in the offspring of Atlantic salmon (Salmo salar L.) spawning in a lowland (Sheeoch) and an upland (Baddoch) tributary of the River Dee System, Aberdeenshire, Scotland. Eggs from each population were incubated at the simulated natural thermal regimes of each stream, which was on average 2.8 degrees C cooler for the Baddoch than for the Sheeoch. Relationships between muscle cellularity variables, the density of myonuclei and responses to temperature were investigated using multivariate statistical techniques. These revealed highly significant temperature effects (P<0.001) at hatch (H) and first feeding (FF) and significant interactions between population and temperature (P<0.001), indicating that Baddoch and Sheeoch salmon responded differently to the two temperature regimes. The total cross-sectional area of white muscle (WF.ta) at the adipose fin was relatively independent of temperature at hatch and first feeding in the Sheeoch population. In contrast, for alevins of Baddoch origin, WF.ta was 18.9% (H) and 30.5% (FF) higher in fish incubated at Baddoch than at Sheeoch temperatures. At hatch, there were 15.6% more white muscle fibres (WF.no) at the cooler incubation temperature in fish of Sheeoch origin and 6.0% more in fish of Baddoch origin. However, by first feeding, the difference in WF.no between temperatures had narrowed to 7.2% in the Sheeoch fish and increased to 17.4% in the Baddoch population. In contrast, at hatch, the density of myonuclei was 59.8% higher at the warmer incubation temperature in the Sheeoch population and 23.5% higher in the Baddoch population, but differences were less evident at first feeding. In Baddoch fish, 22.5% of the total muscle nuclei were actively dividing at first feeding, as assessed by staining for proliferating cell nuclear antigen (PCNA). Of the PCNA-positive nuclei, 78% were present in cells that stained for the c-met tyrosine kinase receptor, a marker of satellite cells and their division products. The proportion of c-met-positive cells staining for individual myogenic regulatory factors was 72.4% for the myogenic transcription factor MyoD, 76.3% for the myogenic transcription factor Myf-5, 62.1% for myogenin and 48.7% for the myogenic transcription factor Myf-6. For the Sheeoch population, there were 26.5% more c-met-expressing (P<0.01) and 23.2% more myogenic-regulatory-factor-expressing (P<0.05) cells at Sheeoch than at Baddoch temperatures. In contrast, incubation temperature had no significant effects on satellite cell density in the Baddoch population.

An epilepsy care package: the nurse specialist's role

Deficiencies in existing primary care for people with epilepsy are well-recognized in the United Kingdom and include a lack of structure and an inability to meet the patients' needs for information and support to cope with their epilepsy. The introduction of clinics set up by nurse specialists within family practice in a few United Kingdom cities has met with a high degree of acceptability and satisfaction from patients. A package of care was developed to support epilepsy management in the community in the United Kingdom. It includes provision of advice and information, counseling, and interdisciplinary liaison. Nurse specialists with a sound training in epilepsy can adopt a proactive role and effectively deliver this package.

Feasibility and effects of nurse run clinics for patients with epilepsy in general practice: randomised controlled trial. Epilepsy Care Evaluation Group

OBJECTIVE

To test the feasibility and effect of nurse run epilepsy clinics in primary care.

DESIGN

A randomised controlled trial of nurse run clinics versus "usual care."

SETTING

Six general practices in the South Thames region.

SUBJECTS

251 patients aged over 15 years who were taking anti-epileptic drugs or had a diagnosis of epilepsy and an attack in the past two years who met specified inclusion criteria and had responded to a questionnaire.

MAIN OUTCOME MEASURES

Questionnaire responses and recording of key variables extracted from the clinical records before and after the intervention.

RESULTS

127 patients were randomised to a nurse run clinic, of whom 106 (83%) attended. The nurse wrote 28 letters to the general practitioners suggesting changes in epilepsy management. For this intervention group compared with the usual care group there was a highly significant improvement in the level of advice recorded as having been given on drug compliance, adverse drug effects, driving, alcohol intake, and self help groups.

CONCLUSIONS

Nurse run clinics for patients with epilepsy were feasible and well attended. Such clinics can significantly improve the level of advice and drug management recorded.

Towards an evaluation of the effectiveness of an epilepsy nurse in primary care

This paper reports on early results of an investigation of the effectiveness of a specialist epilepsy nurse in primary care. Based on before-and-after interviews with sub-samples of adults with epilepsy, these results suggest that not only are expectations of the usefulness of epilepsy nurse interventions high, but also that these expectations are not disappointed in practice. Particular areas where epilepsy nurses may be able to complement and enhance medical approaches to treatment and care are identified.

Epilepsy monitoring and advice recorded: general practitioners' views, current practice and patients' preferences

BACKGROUND

Epilepsy is a common condition that is managed at the interface between primary and secondary care.

AIM

A study aimed to describe general practitioners' criteria for aspects of optimal epilepsy care and their estimates of current levels of care achieved; to compare these estimates with clinical data extracted from their patients' medical records; and to compare general practitioners' estimates and recorded data with information provided by the patients themselves.

METHOD

Thirty seven general practitioners from six practices in the south Thames region were sent a questionnaire enquiring about current practice with regard to general practitioner and specialist monitoring of patients with epilepsy and provision of advice, and about their criteria for the optimum levels of aspects of epilepsy care. Of patients aged over 15 years in the study practices, 0.6% were found to have active epilepsy; 283 of these 326 patients were sent a questionnaire enquiring about their epilepsy, the service and advice provided, and whether they required more information. Responses to the general practitioners' questionnaire and to the patients' questionnaire were compared and also compared with information extracted from the patients' medical records.

RESULTS

Ninety five per cent of the general practitioners responded. Of 255 patient questionnaires (90%) returned, 251 could be analysed. Of 247 patients, 168 (68%) reported having had no seizure in the previous six months. Forty of 241 patients (17%) had a regular arrangement to see their general practitioner regarding their epilepsy. Of 191 patients who expressed a preference, 116 (61%) reported preferring to receive their epilepsy care mainly from their general practitioner. General practitioners reported that ideally patients should be monitored in primary care every six months (the median recorded frequency was 14 months) and that there should be a record of advice given to all patients on driving, adverse effects of antiepileptic drugs, and self-help groups. Advice was recorded in patients' records as having been given on driving (46% of records), adverse effects of antiepileptic drugs (9%), and self-help groups (3%); 82 of 237 patients (35%) reported not receiving enough advice.

CONCLUSION

Patients generally preferred to receive their epilepsy care in general practice. Monitoring and provision of advice were less than optimal from both the general practitioners' and the patients' point of view. New resources and skills will be necessary to bridge this perceived gap. Specially trained nurses may have a role in this monitoring and advice provision.

Extraocular muscle forces in alert monkey

We describe an extraocular muscle (EOM) force transducer that provides low-noise signals from an alert animal for several months, is implanted without disinserting the muscle, and is well-tolerated by the body, and present results obtained with the device. The transducer can be used to study orbital statics and dynamics, and oculomotor control signals undiminished by orbital low-pass filtering and antagonistic pairing of muscles. It may provide an index of effective EOM innervation, useful in studies of orbital tissue healing and plasticity, and oculomotor (OM) signal adaptation. During horizontal saccades transducers implanted in the lateral rectus (LR) and medial rectus (MR) of a monkey trained to fixate revealed an agonist muscle tension waveform corresponding to the "pulse-slide-step" pattern of saccadic innervation, and an antagonist waveform that was similar within a scale factor. We never observed transient increases in antagonist force at the ends of saccades (active braking) or at the beginnings. Onset of saccadic force in LR preceded that in MR by 1.6 msec for abducting saccades, and lagged that in MR by 1.1 msec for adducting saccades. During vertical saccades, transient force changes were found in LR and MR, which were likely due, at least in part, to globe translation. LR and MR forces during fixation tended to be largest with the eye about 10 degrees in elevation, and smallest in depression, indicating that effective total innervation was a function of vertical gaze, or that there was variation in the elastic component of muscle force related to orbital geometry, with LR and MR innervation independent of vertical gaze. An exponential decrease in fixation force, having a time constant of about 10 days, was observed after implantation. This may have reflected adaptive muscle lengthening or post-surgical healing.

Molecular and cytogenetic analysis of a familial microdeletion of Xq

Cytogenetic analysis of a male infant referred for poor neurological development and failure to thrive showed a microdeletion of the X chromosome, his karyotype being 46,Y,del(X)(pter----q21.1:: q21.2----qter). His mother and grandmother were also found to carry the deletion. DNA probes were used to define the deletion molecularly and it was shown to span intervals 2 to 6 of Cremers et al, a portion of Xq that contains the TCD gene and genes whose absence is associated with deafness and mental retardation. RFLP analysis together with X inactivation studies using the probe M27 beta verified the carrier status of the female relatives and showed non-random X inactivation in the heterozygous females.

Extraocular muscle sideslip and orbital geometry in monkeys

The belly of each extraocular muscle is elastically coupled to both the globe and orbit. The dependence of muscle planes on gaze angle must be determined experimentally. In monkeys, radio-opaque markers were implanted along the upper and lower margins of a lateral rectus. A scleral search coil was implanted in the other eye. With the eye in various gaze positions, X-ray images were made to show the LR in the lateral view. We found that as the eye rotates vertically over 50 deg (+/- 25 deg), the point of tangency of the LR with the globe slips an average of 5.1 mm vertically with respect to the globe, allowing this point--and so the muscle plane--to remain approximately fixed relative to the orbit. The results of quantitative orbital dissections are presented in support of the sideslip calculations.

Sequence comparison of alleles of the fourth component of complement (C4) and sex-limited protein (Slp)

cDNA clones specific for the fourth component of complement (C4) and its androgen-regulated isotype, sex-limited protein (Slp), have been isolated from two mouse haplotypes (H-2d and H-2w7) that show differential C4 activity and differential regulation of Slp. Clones were first isolated using a cDNA probe enriched by subtractive hybridization. Subsequent screening has resulted in cDNAs spanning the entire C4d mRNA, as well as much of C4w7, Slpw7 and a short region of Slpd. The cDNAs for C4 and Slp show extensive sequence homology, but can be distinguished using oligonucleotide probes synthesized to regions of greatest sequence divergence. Sequence differences between C4 and Slp indicate structurally important features of C4 that have been altered in Slp such that Slp is unable to participate in the complement pathway. Of the few nucleotide differences between C4d and C4w7, a single base change resulting in one less glycosylation site in the C4w7 alpha chain could account for its 4-fold reduced hemolytic efficiency. Sequence comparison of multiple alleles of C4 and Slp indicates that possible gene conversion events occurred in the H-2w7 strain that has multiple Slp genes.

Eccentric visual acuity in patients with macular disease

A series of cards each containing a two dimensional array of identical Snellen "E's" was used to determine best eccentric visual acuity in patients with macular disease having Snellen visual acuity of 20/70 or worse. Each "full field E" card simultaneously presents the same letter to foveal and parafoveal areas. This test can therefore determine quickly if potentially useful vision is present in any area of the central visual field. In our study of 37 eyes, 70% demonstrated potential visual acuity at least two times better than visual acuity measured by conventional methods, and 20% demonstrated at least a fourfold improvement. This suggests that most patients with macular disease do not spontaneously employ their best remaining area of retina for fixation.

The effect of exogenous DNA insertion at a chromosomal region containing rDNA

We have previously shown that exogenous DNA may be incorporated into host cell chromosomes following DNA-mediated gene transfer (transformation). Discrete chromosomal changes often accompany the integration event. In this study, the effect of integration of DNA that codes for human growth hormone into a region containing ribosomal DNA in rat chromosomes was investigated. The results show that insertion of exogenous DNA results in the inactivation of the ribosomal DNA and a partial deletion of ribosomal DNA sequences.

Altering genotype and phenotype by DNA-mediated gene transfer

Transformation, or DNA-mediated gene transfer, permits the introduction of new genetic information into a cell and frequently results in a change in phenotype. The transforming DNA is ultimately integrated into a recipient cell chromosome. No unique chromosomal locations are apparent, different lines contain the transforming DNA on different chromosomes. Expression of transformed genes frequently results in the synthesis of new polypeptide products which restore appropriate mutant cells to the wild-type phenotype. Thus transformation provides an in vivo assay for the functional role of DNA sequence organization about specific genes. Transforming genes coding for selectable functions, such as adenine phosphoribosyltransferase or thymidine kinase, have now been isolated by utilizing transformation in concert with molecular cloning. Finally, transformation may provide a general approach to the analysis of complex heritable phenotypes by permitting the distinction between phenotypic changes without concomitant changes in DNA and functional genetic rearrangements.

Salt-losing syndrome in 2 infants with defective 18-dehydrogenation in aldosterone biosynthesis

Two infants presented with a salt-losing syndrome, the presenting features of which were subtle. One case appeared to be transient. Deficient production of aldosterone was shown by plasma renin activity and plasma aldosterone profile. Gas chromatography-mass spectrometry of urine indicated a defect in 18-dehydrogenation of 18-hydroxycorticosterone. Treatment with salt supplements and 9alpha-fludrocortisone reversed the salt-losing state and in one case treatment was later stopped. Although the disease may appear transient, the biochemical defect is persistent and for adequate growth a positive salt-balance is necessary.