Just in time crisis response: suicide alert system for telemedicine psychotherapy settings.

AbstractObjective: To design a Natural Language Processing (NLP) algorithm capable of detecting suicide content from patients' written communication to their therapists, to support rapid response and clinical decision making in telehealth settings. Method: A training dataset of therapy transcripts for 1,864 patients was established by detecting patient content endorsing suicidality using a proxy-model anchored on therapists' suicide prevention interventions; human expert raters then assessed the level of suicide risk endorsed by patients identified by the proxy-model (i.e., no risk, risk factors, ideation, method, or plan). A bag-of-words classification model was then iteratively built using the annotations from the expert raters to detect suicide risk level in 85,216 labeled patients' sentences from the training dataset. Results: The final NLP model identified risk-related content from non-risk content with good accuracy (AUC = 82.78). Conclusions: Risk for suicide could be reliably identified by the NLP algorithm. The risk detection model could assist telehealth clinicians in providing crisis resources in a timely manner. This modeling approach could also be applied to other psychotherapy research tasks to assist in the understanding of how the psychotherapy process unfolds for each patient and therapist.

Self-reported dietary adherence, disease-specific symptoms, and quality of life are associated with healthcare provider follow-up in celiac disease.

BACKGROUND: The only treatment for celiac disease (CeD) is a lifelong gluten-free diet (GFD). The restrictive nature of the GFD makes adherence a challenge. As an integral part of CeD management, multiple professional organizations recommend regular follow-up with a healthcare provider (HCP). Many CeD patients also participate in patient advocacy groups (PAGs) for education and support. Previous work found that follow-up of CeD patients is highly variable. Here we investigated the self-reported factors associated with HCP follow-up among individuals diagnosed with CeD who participate in a PAG. METHODS: We conducted a survey of members of Beyond Celiac (a PAG), collecting responses from 1832 U.S. adults ages 19-65 who reported having CeD. The survey queried HCP follow-up related to CeD and included validated instruments for dietary adherence (CDAT), disease-specific symptoms (CSI), and quality of life (CD-QOL). RESULTS: Overall, 27% of respondents diagnosed with CeD at least five years ago reported that they had not visited an HCP about CeD in the last five years. The most frequent reason for not visiting an HCP was "doing fine on my own" (47.6%). Using multiple logistic regression, we identified significant associations between whether a respondent reported visiting an HCP about CeD in the last five years and the scores for all three validated instruments. In particular, as disease-specific symptoms and quality of life worsened, the probability of having visited an HCP increased. Conversely, as dietary adherence worsened, the probability decreased. CONCLUSIONS: Our results suggest that many individuals with CeD manage their disease without ongoing support from an HCP. Our results thus emphasize the need for greater access to high quality CeD care, and highlight an opportunity for PAGs to bring together patients and HCPs to improve management of CeD.

Framework for managing mycotoxin risks in the food industry.

We propose a methodological framework for managing mycotoxin risks in the food processing industry. Mycotoxin contamination is a well-known threat to public health that has economic significance for the food processing industry; it is imperative to address mycotoxin risks holistically, at all points in the procurement, processing, and distribution pipeline, by tracking the relevant data, adopting best practices, and providing suitable adaptive controls. The proposed framework includes (i) an information and data repository, (ii) a collaborative infrastructure with analysis and simulation tools, (iii) standardized testing and acceptance sampling procedures, and (iv) processes that link the risk assessments and testing results to the sourcing, production, and product release steps. The implementation of suitable acceptance sampling protocols for mycotoxin testing is considered in some detail.