A Natural Language Processing and Machine Learning Approach to Identification of Incidental Radiology Findings in Trauma Patients Discharged from the Emergency Department.

STUDY OBJECTIVE: Patients undergoing diagnostic imaging studies in the emergency department (ED) commonly have incidental findings, which may represent unrecognized serious medical conditions, including cancer. Recognition of incidental findings frequently relies on manual review of textual radiology reports and can be overlooked in a busy clinical environment. Our study aimed to develop and validate a supervised machine learning model using natural language processing to automate the recognition of incidental findings in radiology reports of patients discharged from the ED. METHODS: We performed a retrospective analysis of computed tomography (CT) reports from trauma patients discharged home across an integrated health system in 2019. Two independent annotators manually labeled CT reports for the presence of an incidental finding as a reference standard. We used regular expressions to derive and validate a random forest model using open-source and machine learning software. Final model performance was assessed across different ED types. RESULTS: The study CT reports were divided into derivation (690 reports) and validation (282 reports) sets, with a prevalence of incidental findings of 22.3%, and 22.7%, respectively. The random forest model had an area under the curve of 0.88 (95% confidence interval [CI], 0.84 to 0.92) on the derivation set and 0.92 (95% CI, 0.88 to 0.96) on the validation set. The final model was found to have a sensitivity of 92.2%, a specificity of 79.4%, and a negative predictive value of 97.2%. Similarly, strong model performance was found when stratified to a dedicated trauma center, high-volume, and low-volume community EDs. CONCLUSION: Machine learning and natural language processing can classify incidental findings in CT reports of ED patients with high sensitivity and high negative predictive value across a broad range of ED settings. These findings suggest the utility of natural language processing in automating the review of free-text reports to identify incidental findings and may facilitate interventions to improve timely follow-up.

Torres Irribarra's Perspective on Measurement: a Commentary.

David Torres Irribarra's new book (2021), A Pragmatic Perspective of Measurement describes the most prominent definitions of measurement, which tend to focus on the properties of score scales, and offers a new definition of measurement based on the philosophy of Pragmatism. Torres Irribarra gives the purpose or goal of measurement a central role in his model, and treats measurements as tools for achieving these goals. His emphasis on particular relevant variables and on the intended use of measures of these variable to achieve a specific goals is akin to validity theory as practiced in educational and psychological measurement. The traditional definitions of measurement focus on abstract scaling models that can be applied equally well to a range of variables, but in practice, the uses of data in the social sciences do not usually require strong scaling assumptions. Torres Irribarra's definition requires that we attend to the specific interpretations and uses of the measures.

The Natural History of Initial Antipsychotic Treatment Among Men Admitted to a State Prison.

OBJECTIVE: This study examined the natural history of antipsychotic medication treatment for men with a psychotic disorder who entered the North Carolina prison system in 2016-2017. METHODS: The authors used prison records to identify individuals with a psychotic illness who were prescribed an index antipsychotic medication on prison entry (N=245). Data were analyzed to determine persistence of antipsychotic therapy and potential associations with treatment discontinuation. RESULTS: About 28% of the patients had stopped their antipsychotic medication by day 50; the median time until stopping was 248 days (95% confidence interval=147-355). Younger patients and those not continuing a preincarceration medication regimen discontinued treatment sooner than their respective counterparts. CONCLUSIONS: The early weeks of incarceration are a period of increased risk for antipsychotic discontinuation, particularly among younger individuals and those prescribed a new medication. These findings may help guide prison systems in implementing interventions that reduce antipsychotic treatment interruptions.

Historical Note: Lessons Learned from Developing the First Semi-Defined Medium for Culture of One-Cell Rabbit Embryos to Expanding Blastocysts.

In a review written in 1987 entitled "Pioneering mammalian embryo culture," John Biggers (The mammalian preimplantation embryo: regulation of growth and differentiation in vitro, Plenum Press, New York, 1987) summarized the history of early preimplantation embryo culture as follows "The culture of early mammalian embryos has been studied predominantly in two species: the rabbit and the mouse. Up to 1949, the rabbit was used almost exclusively, with media composed of ill-defined biological fluids. After this time, techniques for the culture of preimplantation mouse embryos rapidly developed using simple, defined media with relatively few components… In the 1960s, there was renewed interest in the culture of early rabbit embryos and a marked difference in the nutritional requirements of the two species was found." This chapter describes the history of the development of the semi-defined medium that stimulated this "renewed interest" referred to above and includes some of the initial difficulties in getting the work published. The phrase "semi-defined medium" is understood here to mean a defined medium (all of whose components are chemically known) supplemented with an undefined component such as albumin.

Culture of Preimplantation Rabbit Embryos.

It is surprising that so little attention is currently given to in vitro culture of preimplantation rabbit embryos, even though the rabbit is the only laboratory animal in which there is very considerable embryo growth before implantation, resulting in a 300-fold increase in protein content of embryonic cells during the preimplantation period and the formation of more than a 100,000 cells in the blastocyst. This growth pattern explains why blastocyst formation in vitro has an absolute requirement for amino acids, and vitamins, particularly inositol, are esssential for blastocyst growth. A semi-defined medium supplemented with 1.5% BSA (variously known as BSM II or modified F10) was developed at Cornell University at the end of the 1960s and allowed the systematic investigation of the requirements for development of 1-cell rabbit embryos to blastocysts. However, the requirements for in vitro blastocyst growth comparable to in vivo growth still remain an unsolved problem. Citrate, often found as a contaminant in serum albumin, may have an essential role in rabbit blastocyst growth, which would fit in with its role in the development of serum-free media for culture of various types of mammalian cells.A comprehensive account of the methodology is given to enable a researcher with experience culturing embryos of a different species to work on the rabbit embryo. This account covers medium preparation, hormonal stimulation of superovulation, natural breeding/artificial insemination, and collection of embryos of different stages from 1-cell to blastocyst either after euthanasia or under anesthesia. Peculiarities of the rabbit embryo such as the presence of the mucoprotein coat and its effects on behavior of cultured and transferred embryos are described. Suggestions are made for future avenues of research.

A community-based aquatic exercise program to improve endurance and mobility in adults with mild to moderate intellectual disability.

The purpose of this study was to investigate the impact of a community-based aquatic exercise program on physical performance among adults with mild to moderate intellectual disability (ID). Twenty-two community-dwelling adults with mild to moderate ID volunteered to participate in this study. Participants completed an 8-week aquatic exercise program (2 days/wk, 1 hr/session). Measures of physical performance, which were assessed prior to and following the completion of the aquatic exercise program, included the timed-up-and-go test, 6-min walk test, 30-sec chair stand test, 10-m timed walk test, hand grip strength, and the static plank test. When comparing participants' measures of physical performance prior to and following the 8-week aquatic exercise program, improvements were seen in all measures, but the change in scores for the 6-min walk test, 30-sec chair stand test, and the static plank test achieved statistical significance (P<0.05). An 8-week group aquatic exercise program for adults with ID may promote improvements in endurance and balance/mobility.