Patients and family attitudes about clinical and research sharing of electronic clinical data.

PURPOSE: To access the attitudes of service users about the sharing of health records for research and to foster collaboration between municipal health services and the specialist health services in Norway. METHODS: Members (n ≈ 2000) of the Norwegian mental health service users' organizations (SUO's), ADHD Norway, the Autism Association and the Tourette Association, representing Central Norway, participated in the study, (N = 108, 5.4% response rate). Descriptive statistics were used to evaluate distributions of responses to the questionnaire. RESULTS: Service users reported being aware that municipal health services collaborate with the specialist health service (62%), with mental health care in the specialist health service (57%), and child and adolescent psychiatric services (61%). A large proportion of individuals were aware of the benefits of sharing their health records (93%), have trust in the use of data by health authorities (81%), and were willing to share records to benefit fellow patients (84%). Personal experience (69%) and impressions from mainstream media (55%) had the most influential impact on users' views of the Health Platform, an electronic health communication system. A majority of users had a negative perception of the Health Platform, even though some expect it to become a valuable tool in the future (50%). CONCLUSIONS: Service users are aware of and positive about benefiting others by sharing health records. They trust the health authorities, however, have negative attitudes about the Health Platform, apparently based on personal experiences and media influence. However, service users can see the potential usefulness of the Health Platform in the future.

A review of information sources and analysis methods for data driven decision aids in child and adolescent mental health services.

OBJECTIVE: Clinical data analysis relies on effective methods and appropriate data. Recognizing distinctive clinical services and service functions may lead to improved decision-making. Our first objective is to categorize analytical methods, data sources, and algorithms used in current research on information analysis and decision support in child and adolescent mental health services (CAMHS). Our secondary objective is to identify the potential for data analysis in different clinical services and functions in which data-driven decision aids can be useful. MATERIALS AND METHODS: We searched related studies in Science Direct and PubMed from 2018 to 2023(Jun), and also in ACM (Association for Computing Machinery) Digital Library, DBLP (Database systems and Logic Programming), and Google Scholar from 2018 to 2021. We have reviewed 39 studies and extracted types of analytical methods, information content, and information sources for decision-making. RESULTS: In order to compare studies, we developed a framework for characterizing health services, functions, and data features. Most data sets in reviewed studies were small, with a median of 1,176 patients and 46,503 record entries. Structured data was used for all studies except two that used textual clinical notes. Most studies used supervised classification and regression. Service and situation-specific data analysis dominated among the studies, only two studies used temporal, or process features from the patient data. This paper presents and summarizes the utility, but not quality, of the studies according to the care situations and care providers to identify service functions where data-driven decision aids may be relevant. CONCLUSIONS: Frameworks identifying services, functions, and care processes are necessary for characterizing and comparing electronic health record (EHR) data analysis studies. The majority of studies use features related to diagnosis and assessment and correspondingly have utility for intervention planning and follow-up. Profiling the disease severity of referred patients is also an important application area.

Economic evidence of clinical decision support systems in mental health: A systematic literature review.

Mental health conditions are among the highest disease burden on society, affecting approximately 20% of children and adolescents at any point in time, with depression and anxiety being the leading causes of disability globally. To improve treatment outcomes, healthcare organizations turned to clinical decision support systems (CDSSs) that offer patient-specific diagnoses and recommendations. However, the economic impact of CDSS is limited, especially in child and adolescent mental health. This systematic literature review examined the economic impacts of CDSS implemented in mental health services. We planned to follow PRISMA reporting guidelines and found only one paper to describe health and economic outcomes. A randomized, controlled trial of 336 participants found that 60% of the intervention group and 32% of the control group achieved symptom reduction, i.e. a 50% decrease as per the Symptom Checklist-90-Revised (SCL-90-R), a method to evaluate psychological problems and identify symptoms. Analysis of the incremental cost-effectiveness ratio found that for every 1% of patients with a successful treatment result, it added €57 per year. There are not enough studies to draw conclusions about the cost-effectiveness in a mental health context. More studies on economic evaluations of the viability of CDSS within mental healthcare have the potential to contribute to patients and the larger society.

Challenges in Interpreting Norwegian Child and Adolescent Mental Health Records.

The Electronic Health Record system BUPdata served Norwegian Child and Adolescent Mental Health Services (CAMHS) for over 35 years and is still an important source of information for understanding clinical practice. Secondary usage of clinical data enables learning and service quality improvement. We present some insights from explorative data analysis for interpreting the records of patients referred for hyperkinetic disorders. The major challenges were data preparation, pre-analysis, imputation, and validation. We summarize the main characteristics, spot anomalies, and detect errors. The results include observations about the patient referral diversity based on 12 different variables. We modeled the activities in an individual episode of care, described our clinical observations among data, and discussed the challenges of data analysis.

Usability of the IDDEAS prototype in child and adolescent mental health services: A qualitative study for clinical decision support system development.

Introduction: Child and adolescent mental health services (CAMHS) clinical decision support system (CDSS) provides clinicians with real-time support as they assess and treat patients. CDSS can integrate diverse clinical data for identifying child and adolescent mental health needs earlier and more comprehensively. Individualized Digital Decision Assist System (IDDEAS) has the potential to improve quality of care with enhanced efficiency and effectiveness. Methods: We examined IDDEAS usability and functionality in a prototype for attention deficit hyperactivity disorder (ADHD), using a user-centered design process and qualitative methods with child and adolescent psychiatrists and clinical psychologists. Participants were recruited from Norwegian CAMHS and were randomly assigned patient case vignettes for clinical evaluation, with and without IDDEAS. Semi-structured interviews were conducted as one part of testing the usability of the prototype following a five-question interview guide. All interviews were recorded, transcribed, and analyzed following qualitative content analysis. Results: Participants were the first 20 individuals from the larger IDDEAS prototype usability study. Seven participants explicitly stated a need for integration with the patient electronic health record system. Three participants commended the step-by-step guidance as potentially helpful for novice clinicians. One participant did not like the aesthetics of the IDDEAS at this stage. All participants were pleased about the display of the patient information along with guidelines and suggested that wider guideline coverage will make IDDEAS much more useful. Overall, participants emphasized the importance of maintaining the clinician as the decision-maker in the clinical process, and the overall potential utility of IDDEAS within Norwegian CAMHS. Conclusion: Child and adolescent mental health services psychiatrists and psychologists expressed strong support for the IDDEAS clinical decision support system if better integrated in daily workflow. Further usability assessments and identification of additional IDDEAS requirements are necessary. A fully functioning, integrated version of IDDEAS has the potential to be an important support for clinicians in the early identification of risks for youth mental disorders and contribute to improved assessment and treatment of children and adolescents.

Success Factors of an Early EHR System for Child and Adolescent Mental Health: Lessons Learned for Future Practice Data-Driven Decision Aids.

This paper recounts the successful BUPdata, a discontinued electronic health record (EHR) system for Child and Adolescent Mental Health Services (CAMHS) in Norway. It was developed and owned by the national association for CAMHS and fulfilled needs for collaborative care, practice insight, and service management. It aimed to unify the requirements of government, administration, clinicians, patients, and researchers alike, with the goal of providing uniform quality of care nationally. When CAMHS became integrated with specialist healthcare, BUPdata was replaced with more a general EHR system offering far less functionality and insight into CAMHS practice. We have studied BUPdata, and interviewed stakeholders in order to develop decision aids based on practice data analysis and give clinicians and patients insight into successful local practice, collaboration patterns, and overview of local resources.

Attitudes of Mental Health Service Users Toward Storage and Use of Electronic Health Records.

OBJECTIVE: Electronic health records (EHRs) are used for both clinical practice and research. Because mental health service users' views are underrepresented in perspectives on EHR use, the authors examined service users' awareness, attitudes, and opinions about EHR data storage and sharing. METHODS: A mixed-methods, cross-sectional design was used to examine attitudes of 253 Norwegian mental health service users who were recruited online to complete a quantitative and qualitative (free-text) survey about EHR utilization. RESULTS: Most participants were aware that EHRs were stored (95%) and shared (58%). Most thought that patients benefited from EHR storage (84%), trusted authorities with EHR sharing (71%), were willing to share their EHRs to help others (75%), felt they benefited from EHR sharing (75%), and thought EHR sharing was ethical for health care and research (71%). Fewer were aware of EHR sharing for research (36%), and 62% were aware that shared data were anonymized. Of the participants, 69% recognized privacy risks associated with sharing. Lack of transparency and skepticism about anonymization and misuse of EHR data were concerns and perceived risks. Mental health service users thought that EHRs should be shared for policy development (81%), education and training (85%), improving care quality (89%), research (91%), and clinical decision support (81%). CONCLUSIONS: Participants were aware of and supported EHR sharing for research and clinical care. They supported sharing to help others and were willing to fully participate in clinical care and research, as well as to share EHR information for their own care, research, and the care of others.

Using neural networks to support high-quality evidence mapping.

BACKGROUND: The Living Evidence Map Project at the Norwegian Institute of Public Health (NIPH) gives an updated overview of research results and publications. As part of NIPH's mandate to inform evidence-based infection prevention, control and treatment, a large group of experts are continously monitoring, assessing, coding and summarising new COVID-19 publications. Screening tools, coding practice and workflow are incrementally improved, but remain largely manual. RESULTS: This paper describes how deep learning methods have been employed to learn classification and coding from the steadily growing NIPH COVID-19 dashboard data, so as to aid manual classification, screening and preprocessing of the rapidly growing influx of new papers on the subject. Our main objective is to make manual screening scalable through semi-automation, while ensuring high-quality Evidence Map content. CONCLUSIONS: We report early results on classifying publication topic and type from titles and abstracts, showing that even simple neural network architectures and text representations can yield acceptable performance.

Meristematic Connectome: A Cellular Coordinator of Plant Responses to Environmental Signals?

Mechanical stress in tree roots induces the production of reaction wood (RW) and the formation of new branch roots, both functioning to avoid anchorage failure and limb damage. The vascular cambium (VC) is the factor responsible for the onset of these responses as shown by their occurrence when all primary tissues and the root tips are removed. The data presented confirm that the VC is able to evaluate both the direction and magnitude of the mechanical forces experienced before coordinating the most fitting responses along the root axis whenever and wherever these are necessary. The coordination of these responses requires intense crosstalk between meristematic cells of the VC which may be very distant from the place where the mechanical stress is first detected. Signaling could be facilitated through plasmodesmata between meristematic cells. The mechanism of RW production also seems to be well conserved in the stem and this fact suggests that the VC could behave as a single structure spread along the plant body axis as a means to control the relationship between the plant and its environment. The observation that there are numerous morphological and functional similarities between different meristems and that some important regulatory mechanisms of meristem activity, such as homeostasis, are common to several meristems, supports the hypothesis that not only the VC but all apical, primary and secondary meristems present in the plant body behave as a single interconnected structure. We propose to name this structure "meristematic connectome" given the possibility that the sequence of meristems from root apex to shoot apex could represent a pluricellular network that facilitates long-distance signaling in the plant body. The possibility that the "meristematic connectome" could act as a single structure active in adjusting the plant body to its surrounding environment throughout the life of a plant is now proposed.

Testing an individualized digital decision assist system for the diagnosis and management of mental and behavior disorders in children and adolescents.

BACKGROUND: Nearly half of all mental health disorders develop prior to the age of 15. Early assessments, diagnosis, and treatment are critical to shortening single episodes of care, reducing possible comorbidity and long-term disability. In Norway, approximately 20% of all children and adolescents are experiencing mental health problems. To address this, health officials in Norway have called for the integration of innovative approaches. A clinical decision support system (CDSS) is an innovative, computer-based program that provides health professionals with clinical decision support as they care for patients. CDSS use standardized clinical guidelines and big data to provide guidance and recommendations to clinicians in real-time. IDDEAS (Individualised Digital DEcision Assist System) is a CDSS for diagnosis and treatment of child and adolescent mental health disorders. The aim of IDDEAS is to enhance quality, competency, and efficiency in child and adolescent mental health services (CAMHS). METHODS/DESIGN: IDDEAS is a mixed-methods innovation and research project, which consists of four stages: 1) Assessment of Needs and Preparation of IDDEAS; 2) The Development of IDDEAS CDSS Model; 3) The Evaluation of the IDDEAS CDSS; and, 4) Implementation & Dissemination. Both qualitative and quantitative methods will be used for the evaluation of IDDEAS CDSS model. Child and adolescent psychologists and psychiatrists (n = 30) will evaluate the IDDEAS` usability, acceptability and relevance for diagnosis and treatment of attention-deficit/hyperactivity disorder. DISCUSSION: The IDDEAS CDSS model is the first guidelines and data-driven CDSS to improve efficiency of diagnosis and treatment of child and adolescent mental health disorders in Norway. Ultimately, IDDEAS will help to improve patient health outcomes and prevent long-term adverse outcomes by providing each patient with evidence-based, customized clinical care. TRIAL REGISTRATION: ISRCTN, ISRCTN12094788. Ongoing study, registered prospectively 8 April 2020 https://doi.org/10.1186/ISRCTN12094788.

Local, Early, and Precise: Designing a Clinical Decision Support System for Child and Adolescent Mental Health Services.

Mental health disorders often develop during childhood and adolescence, causing long term and debilitating impacts at individual and societal levels. Local, early, and precise assessment and evidence-based treatment are key to achieve positive mental health outcomes and to avoid long-term care. Technological advancements, such as computerized Clinical Decision Support Systems (CDSSs), can support practitioners in providing evidence-based care. While previous studies have found CDSS implementation helps to improve aspects of medical care, evidence is limited on its use for child and adolescent mental health care. This paper presents challenges and opportunities for adapting CDSS design and implementation to child and adolescent mental health services (CAMHS). To highlight the complexity of incorporating CDSSs within local CAMHS, we have structured the paper around four components to consider before designing and implementing the CDSS: supporting collaboration among multiple stakeholders involved in care; optimally using health data; accounting for comorbidities; and addressing the temporality of patient care. The proposed perspective is presented within the context of the child and adolescent mental health services in Norway and an ongoing Norwegian innovative research project, the Individualized Digital DEcision Assist System (IDDEAS), for child and adolescent mental health disorders. Attention deficit hyperactivity disorder (ADHD) among children and adolescents serves as the case example. The integration of IDDEAS in Norway intends to yield significantly improved outcomes for children and adolescents with enduring mental health disorders, and ultimately serve as an educational opportunity for future international approaches to such CDSS design and implementation.

Regulatory networks controlling the development of the root system and the formation of lateral roots: a comparative analysis of the roles of pericycle and vascular cambium.

Background: The production of a new lateral root from parental root primary tissues has been investigated extensively, and the most important regulatory mechanisms are now well known. A first regulatory mechanism is based on the synthesis of small peptides which interact ectopically with membrane receptors to elicit a modulation of transcription factor target genes. A second mechanism involves a complex cross-talk between plant hormones. It is known that lateral roots are formed even in parental root portions characterized by the presence of secondary tissues, but there is not yet agreement about the putative tissue source providing the cells competent to become founder cells of a new root primordium. Scope: We suggest models of possible regulatory mechanisms for inducing specific root vascular cambium (VC) stem cells to abandon their activity in the production of xylem and phloem elements and to start instead the construction of a new lateral root primordium. Considering the ontogenic nature of the VC, the models which we suggest are the result of a comparative review of mechanisms known to control the activity of stem cells in the root apical meristem, procambium and VC. Stem cells in the root meristems can inherit various competences to play different roles, and their fate could be decided in response to cross-talk between endogenous and exogenous signals. Conclusions: We have found a high degree of relatedness among the regulatory mechanisms controlling the various root meristems. This fact suggests that competence to form new lateral roots can be inherited by some stem cells of the VC lineage. This kind of competence could be represented by a sensitivity of specific stem cells to factors such as those presented in our models.

Winnerless competition in clustered balanced networks: inhibitory assemblies do the trick.

Balanced networks are a frequently employed basic model for neuronal networks in the mammalian neocortex. Large numbers of excitatory and inhibitory neurons are recurrently connected so that the numerous positive and negative inputs that each neuron receives cancel out on average. Neuronal firing is therefore driven by fluctuations in the input and resembles the irregular and asynchronous activity observed in cortical in vivo data. Recently, the balanced network model has been extended to accommodate clusters of strongly interconnected excitatory neurons in order to explain persistent activity in working memory-related tasks. This clustered topology introduces multistability and winnerless competition between attractors and can capture the high trial-to-trial variability and its reduction during stimulation that has been found experimentally. In this prospect article, we review the mean field description of balanced networks of binary neurons and apply the theory to clustered networks. We show that the stable fixed points of networks with clustered excitatory connectivity tend quickly towards firing rate saturation, which is generally inconsistent with experimental data. To remedy this shortcoming, we then present a novel perspective on networks with locally balanced clusters of both excitatory and inhibitory neuron populations. This approach allows for true multistability and moderate firing rates in activated clusters over a wide range of parameters. Our findings are supported by mean field theory and numerical network simulations. Finally, we discuss possible applications of the concept of joint excitatory and inhibitory clustering in future cortical network modelling studies.

A user-friendly technical set-up for infrared photography of forensic findings.

Infrared photography is interesting for a use in forensic science and forensic medicine since it reveals findings that normally are almost invisible to the human eye. Originally, infrared photography has been made possible by the placement of an infrared light transmission filter screwed in front of the camera objective lens. However, this set-up is associated with many drawbacks such as the loss of the autofocus function, the need of an external infrared source, and long exposure times which make the use of a tripod necessary. These limitations prevented up to now the routine application of infrared photography in forensics. In this study the use of a professional modification inside the digital camera body was evaluated regarding camera handling and image quality. This permanent modification consisted of the replacement of the in-built infrared blocking filter by an infrared transmission filter of 700nm and 830nm, respectively. The application of this camera set-up for the photo-documentation of forensically relevant post-mortem findings was investigated in examples of trace evidence such as gunshot residues on the skin, in external findings, e.g. hematomas, as well as in an exemplary internal finding, i.e., Wischnewski spots in a putrefied stomach. The application of scattered light created by indirect flashlight yielded a more uniform illumination of the object, and the use of the 700nm filter resulted in better pictures than the 830nm filter. Compared to pictures taken under visible light, infrared photographs generally yielded better contrast. This allowed for discerning more details and revealed findings which were not visible otherwise, such as imprints on a fabric and tattoos in mummified skin. The permanent modification of a digital camera by building in a 700nm infrared transmission filter resulted in a user-friendly and efficient set-up which qualified for the use in daily forensic routine. Main advantages were a clear picture in the viewfinder, an auto-focus usable over the whole range of infrared light, and the possibility of using short shutter speeds which allows taking infrared pictures free-hand. The proposed set-up with a modification of the camera allows a user-friendly application of infrared photography in post-mortem settings.

[The problem of highlights in forensic photography]. / Zur Problematik der Glanzlichtbildung bei der Fotodokumentation im Obduktionssaal.

A problem of forensic photography, especially when using direct flashlight, is the appearance of highlights on wet or shiny surfaces because of light reflections. Highlights can cause considerable difficulties if they interfere with relevant findings, because in a flare image information is reduced. Forensic literature describes several procedures to prevent the formation of highlights, which we compared to each other using flashlight in order to find the most effective and practicable method for reducing reflections. First, bounce flash photography can completely prevent flashlight flares on shiny surfaces such as putrefied bodies. Second, powdering such surfaces with rice powder can eliminate disruptive flares even when using direct flashlight but causes visible artefacts when using higher magnifications. As our study showed, bounce flash photography is an easy way to reduce highlights on photographs without the application of complex techniques or methods that may even alter relevant findings.

[Photodocumentation during autopsy]. / Fotodokumentation im Obduktionssaal--Untersuchungen zur Hintergrundgestaltung.

Photography during autopsy is an important part of forensic imaging and essential for the documentation of autopsy findings. A forensic photograph mainly serves the purpose of providing evidence and should be authentic. But aesthetic artwork may improve both the attractiveness and acceptance of autopsies and thus help to increase the autopsy rate. Different materials were compared to each other as photographic backdrop, particularly with regard to reflection and contrast, stability of exposure measurement and monitoring of colour fidelity. The photofoil 9010 Dove Grey proved to be a material of outstanding quality. In practical application, the foil was scratch-resistant and easy to clean. Furthermore, backdrop boards with a gap, e.g. for head and neck, allow special perspectives without a distracting background.

Water uptake along the length of grapevine fine roots: developmental anatomy, tissue-specific aquaporin expression, and pathways of water transport.

To better understand water uptake patterns in root systems of woody perennial crops, we detailed the developmental anatomy and hydraulic physiology along the length of grapevine (Vitis berlandieri × Vitis rupestris) fine roots from the tip to secondary growth zones. Our characterization included the localization of suberized structures and aquaporin gene expression and the determination of hydraulic conductivity (Lpr) and aquaporin protein activity (via chemical inhibition) in different root zones under both osmotic and hydrostatic pressure gradients. Tissue-specific messenger RNA levels of the plasma membrane aquaporin isogenes (VvPIPs) were quantified using laser-capture microdissection and quantitative polymerase chain reaction. Our results highlight dramatic changes in structure and function along the length of grapevine fine roots. Although the root tip lacked suberization altogether, a suberized exodermis and endodermis developed in the maturation zone, which gave way to the secondary growth zone containing a multilayer suberized periderm. Longitudinally, VvPIP isogenes exhibited strong peaks of expression in the root tip that decreased precipitously along the root length in a pattern similar to Arabidopsis (Arabidopsis thaliana) roots. In the radial orientation, expression was always greatest in interior tissues (i.e. stele, endodermis, and/or vascular tissues) for all root zones. High Lpr and aquaporin protein activity were associated with peak VvPIP expression levels in the root tip. This suggests that aquaporins play a limited role in controlling water uptake in secondary growth zones, which contradicts existing theoretical predictions. Despite having significantly lower Lpr, woody roots can constitute the vast majority of the root system surface area in mature vines and thus provide for significant water uptake potential.

Plant root research: the past, the present and the future.

This special issue is dedicated to root biologists past and present who have been exploring all aspects of root structure and function with an extensive publication record going over 100 years. The content of the Special Issue on Root Biology covers a wide scale of contributions, spanning interactions of roots with microorganisms in the rhizosphere, the anatomy of root cells and tissues, the subcellular components of root cells, and aspects of metal accumulation and stresses on root function and structure. We have organized the papers into three topic categories: (1) root ecology, interactions with microbes, root architecture and the rhizosphere; (2) experimental root biology, root structure and physiology; and (3) applications of new technology to study root biology. Finally, we will speculate on root research for the future.

Listen, You are Writing! Speeding up Online Spelling with a Dynamic Auditory BCI.

Representing an intuitive spelling interface for brain-computer interfaces (BCI) in the auditory domain is not straight-forward. In consequence, all existing approaches based on event-related potentials (ERP) rely at least partially on a visual representation of the interface. This online study introduces an auditory spelling interface that eliminates the necessity for such a visualization. In up to two sessions, a group of healthy subjects (N = 21) was asked to use a text entry application, utilizing the spatial cues of the AMUSE paradigm (Auditory Multi-class Spatial ERP). The speller relies on the auditory sense both for stimulation and the core feedback. Without prior BCI experience, 76% of the participants were able to write a full sentence during the first session. By exploiting the advantages of a newly introduced dynamic stopping method, a maximum writing speed of 1.41 char/min (7.55 bits/min) could be reached during the second session (average: 0.94 char/min, 5.26 bits/min). For the first time, the presented work shows that an auditory BCI can reach performances similar to state-of-the-art visual BCIs based on covert attention. These results represent an important step toward a purely auditory BCI.