Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study

ObjectiveTo develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing.Data SourceWith respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated system''s electronic portal. Sociodemographic, clinical, and utilization data were obtained via questionnaire and electronic health records.Study DesignRetrospective study used natural language processing and machine learning to generate five unique “Literacy Profiles” by employing various sets of linguistic indices: Flesch‐Kincaid (LP_FK); basic indices of writing complexity, including lexical diversity (LP_LD) and writing quality (LP_WQ); and advanced indices related to syntactic complexity, lexical sophistication, and diversity, modeled from self‐reported (LP_SR), and expert‐rated (LP_Exp) health literacy. We first determined the performance of each literacy profile relative to self‐reported and expert‐rated health literacy to discriminate between high and low health literacy and then assessed Literacy Profiles’ relationships with known correlates of health literacy, such as patient sociodemographics and a range of health‐related outcomes, including ratings of physician communication, medication adherence, diabetes control, comorbidities, and utilization.Principal FindingsLP_SR and LP_Exp performed best in discriminating between high and low self‐reported (C‐statistics: 0.86 and 0.58, respectively) and expert‐rated health literacy (C‐statistics: 0.71 and 0.87, respectively) and were significantly associated with educational attainment, race/ethnicity, Consumer Assessment of Provider and Systems (CAHPS) scores, adherence, glycemia, comorbidities, and emergency department visits.ConclusionsSince health literacy is a potentially remediable explanatory factor in health care disparities, the development of automated health literacy indicators represents a significant accomplishment with broad clinical and population health applications. Health systems could apply literacy profiles to efficiently determine whether quality of care and outcomes vary by patient health literacy; identify at‐risk populations for targeting tailored health communications and self‐management support interventions; and inform clinicians to promote improvements in individual‐level care.     

Translating clinical and patient-reported data to tailored shared decision reports with predictive analytics for knee and hip arthritis

Quality of Life Research - New informatics tools can transform evidence-based information to individualized predictive reports to serve shared decisions in clinic. We developed a web-based system...     

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne,Australia

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.     

Negative modulation of nitric oxide production by neurotensin as a putative mechanism of the diuretic action of SR 48692 in rats

1. We investigated the effect of the non-peptide neurotensin (NT) antagonist SR 48692 on renal function in rats and the involvement of nitric oxide (NO) in the diuretic action of this compound.
2. In fed animals, SR 48692 dose-dependently (0.5 to 12.5 mg kg⁻¹, p.o., 0.03 to 1 mg kg⁻¹, i.p. and 0.1 to 1 μg/rat, i.c.v.) increased urine output and urinary excretion of Na⁺, K⁺ and Cl⁻ and reduced urine osmolality. The diuretic activity was also evident in water-deprived, fasted animals and in fasted, water-loaded rats.
3. NT (0.1 μg/rat, i.c.v.) had no effect on urine output in fed rats, but reduced the diuretic action of SR 48692 (1 μg/rat, i.c.v.). The opposite result was obtained in fasted, water-loaded animals: NT dose-dependently (0.01 and 0.1 μg/rat, i.c.v.) inhibited diuresis and this effect was significantly inhibited by i.c.v. SR 48692. In this experimental condition, SR 48692 did not further increase the on-going diuresis.
4. The NO synthesis inhibitor N^ω-nitro-L-arginine methyl ester (L-NAME; 30 mg kg⁻¹, i.p.) alone had no effect on urine output in fed rats but prevented the diuretic action of i.c.v. or i.p. SR 48692; L-arginine (1 g kg⁻¹, i.p.) but not D-arginine (1 g kg⁻¹, i.p.) restored the SR 48692-dependent increase in diuresis. L-NAME had no effect on furosemide-stimulated diuresis.
5. Systemically administered L-NAME or i.c.v. NT in fasted, water-loaded rats significantly reduced water diuresis but this effect was no longer seen in animals given i.p. L-arginine. Rats receiving i.c.v. NT, whose diuresis was significantly reduced, also excreted less nitrates and nitrites in urine.
6. Increased diuresis after central or systemic administration of SR 48692 to fed rats was paralleled by increased urinary excretion of nitrates and nitrites, this being consistent with peripheral enhancement of NO production after NT-receptor blockade by SR 48692. The increase in diuresis after furosemide also involved an increase of nitrates and nitrites in urine, but this effect was about half that attained with an equipotent diuretic dose of SR 48692.
7. In fed rats, the NO donor isosorbide-dinitrate, reduced systolic blood pressure (unlike SR 48692 which did not affect blood pressure) but also dose-dependently (1 and 5 mg kg⁻¹, i.p.) stimulated urine output.
8. The overall effects of SR 48692 strongly support a link between the actions of endogenous NT, AVP and peripheral NO production in the modulation of renal excretion of water, Na⁺, K⁺ and Cl⁻.

     

Characterization of ultrastructural and contractile activation properties of crustacean (Cherax destructor) muscle fibres during claw regeneration and moulting

Summary Long-(SL>6m) and short-sarcomere (SL<4m) fibres were isolated from the claw muscle of the yabby (Cherax destructor) during limb regeneration and at different stages of the moult cycle. Long-sarcomere fibres were more susceptible to the changes resulting from the moult-induced atrophy compared with the short-sarcomere fibres. Signs of atrophy included fibre erosion, loss of myosin filaments, a reduction in the diameter of myosin filaments and changes associated with the Z line. The intracellular structure of the fibres, however, remained intact in both fibre types. Fibres taken immediately prior to ecdysis could not be fully activated with Ca²⁺ or Sr²⁺ without breaking. In contrast fibres taken within 4 h after ecdysis could develop and maintain full force when activated by Ca²⁺ or Sr²⁺. The results suggest that loss of myofibrillar proteins via the moult-induced atrophy and/or events associated with fibre elongation may occur in the period just prior to ecdysis and that these changes may be responsible for the fibres inability to function during the premoult stage. Results from this study showed that short-sarcomere fibres add sarcomeres by at least two different mechanisms (1) transverse sarcomere splitting and (2) Z line splitting. Long-sarcomere fibres appear to be elongated by mechanism (s) other than those used by short-sarcomere fibres which possibly involve large electron dense structures which are positioned between the myofibrils and within the A and I bands. Results from the regenerating chelae limb bud showed that sarcomeres form from separate units comprising myosin filaments and actin filaments anchored into Z lines respectively. These sub-sarcomeric units then join together to form sarcomeres. Myofibril formation is aided by electron dense regions which are closely associated with the membrane system. These fibres although short in length and still within the non-functional limb bud could be activated by Ca²⁺ and Sr²⁺ suggesting that full fibre function exists before the chelae become functional. Regenerating muscle fibres consisted predominately of fibres with short-sarcomeres.     

The prospects of a harm reduction approach among indigenous people in Canada

A harm reduction approach to alcohol and substance abuse is becoming increasingly popular as an alternative to prohibitionist and abstentionist policies. It is seen as particularly valuable for some high-risk populations, such as injection drug users and street youth. A strong argument can be made that Aboriginal communities in Ontario, Canada, and probably across the country, are appropriate environments for a harm reduction approach. Aboriginal people are at extremely elevated risk for accident, illness and death. At the same time, alcohol use is a predominant factor in many of these outcomes, and elevates many of the risks associated with Aboriginal life. Isolated, remote reserve communities in northern Ontario present additional risks of extremely poor living conditions and extreme weather conditions. Prohibition and abstinence are currently the main approaches to alcohol and substance abuse in many of these communities, while the role of alcohol in morbidity, mortality and other social problems remains high. There are positive indications that the feasibility of harm reduction strategies could be broached in some communities. It is concluded that the obstacles are significant but a community-by-community approach is a strong feature of harm reduction, and may increase its prospects for piloting strategies in individual communities.     

Anomalous kinetic visual fields found in family members of patients with a confirmed diagnosis of Gilles de la Tourette syndrome.

Three visual manifestations of Gilles de la Tourette syndrome (TS), a neuropsychiatric disorder, have been previously reported. In this paper we report anomalies in the measured kinetic paracentral visual field of TS patients and their family members. We found that 96% of TS patients exhibited paracentral kinetic visual field defects (nasal and temporal steps, enlargement, "ringing," and/or baring of the blind spot). Ninety-three percent of fathers of TS children and, surprisingly, about 80% of mothers exhibit these characteristic visual field anomalies. Sample data and examples of family studies are reported.