Integrating speculation detection and deep learning to extract lung cancer diagnosis from clinical notes

Despite efforts to develop models for extracting medical concepts from clinical notes, there are still some challenges in particular to be able to relate concepts to dates. The high number of clinical notes written for each single patient, the use of negation, speculation, and different date formats cause ambiguity that has to be solved to reconstruct the patient’s natural history. In this paper, we concentrate on extracting from clinical narratives the cancer diagnosis and relating it to the diagnosis date. To address this challenge, a hybrid approach that combines deep learning-based and rule-based methods is proposed. The approach integrates three steps: (i) lung cancer named entity recognition, (ii) negation and speculation detection, and (iii) relating the cancer diagnosis to a valid date. In particular, we apply the proposed approach to extract the lung cancer diagnosis and its diagnosis date from clinical narratives written in Spanish. Results obtained show an F-score of 90% in the named entity recognition task, and a 89% F-score in the task of relating the cancer diagnosis to the diagnosis date. Our findings suggest that speculation detection is together with negation detection a key component to properly extract cancer diagnosis from clinical notesThis work is supported by the EU Horizon 2020 innovation program under grant agreement No. 780495, project BigMedilytics (Big Data for Medical Analytics). It has been also supported by Fundación AECC and Instituto de Salud Carlos III (grant AC19/00034), under the frame of ERA-NET PerMe

Understanding quality of life through Sen's capability framework : an application to people living with HIV/AIDS

It is nearly 30 years ago that the Acquired Immune Deficiency Syndrome (AIDS) epidemic officially started. In 2008 an estimated total of 33.4 million people lived worldwide with Human Immunodeficiency Virus (HIV), the virus that causes AIDS. Despite the fact that there is still no cure or vaccine for the HIV virus, important progress has been achieved in treatment for people living with HIV/AIDS (PLWHA) since the mid-1990s, when Highly-Active Antiretroviral Therapy (HAART) was introduced. HAART has proved successful in reducing AIDS-related morbidity and mortality and, therefore, prolonging the life expectancy of PLWHA. In Western democracies such as Australia, HIV/AIDS is considered as a chronic disease that can be managed by most people with the help of regular medical monitoring, adherence to treatment, and access to medical care. The substantial clinical changes observed since the introduction of HAART open a series of important questions regarding the quality of life of PLWHA. The current quality of life research on PLWHA consist primarily of health related quality of life studies (HRQOL), which investigate the subjective perceptions of PLWHA regarding the impact of their health status, disease, impairment, disability, or treatment primarily on their physical, mental/cognitive, and social functioning. This type of study has received several criticisms, for example the fact of confusing quality of life with perceived health. Another important limit of HRQOL studies is that they focus on PLWHA as patients or clinical cases, rather than as social actors with individual, social and economic rights experiencing freedoms and constraints to fulfil valued social roles and achieve desired social statuses. Lack of research on the experiences of PLWHA as social actors is regrettable because it would offer social scientists and social policy makers relevant information to identify health and social inequalities among PLWHA and to generate a broader and more insightful understanding of their quality of life. This thesis sets out to address these latter questions by introducing a complementary approach to the investigation of the quality of life of PLWHA known as the 'capability framework', which was founded by the economist and philosopher, Amartya Sen. This framework suggests that quality of life should be measured by focusing on people's capabilities, namely their real opportunities to lead the life that have reason to value. The thesis introduces the capability framework by discussing it in the wider debate around the concept of quality of life. It addresses the operationalisation of its core concept, capabilities, founding it in Sen's epistemological perspective, 'positional objectivity', which is interpreted as a constructivist approach. This is expanded by placing it in a more inclusive and developed constructivist framework, the phenomenological sociology of Alfred Schutz, which requires exploring and making explicit the model of social actor that underpins the operationalisation and measurement of any social science concept. Consequently, the psychological and sociological literature that has investigated the phenomenon of opportunities is reviewed to identify the cognitive, emotional, and meaning-making processes that underpin people's perception of opportunities. These analyses led to the development ofa threefold model of the main components of people's perception of opportunities and a fourfold model of experiences of opportunities. Both models are empirically tested through a mixed method investigation based on a concurrent nested strategy. The quantitative analysis operationalised the models through a secondary data analysis of the HIV Futures V Survey, an Australian nationwide survey of various clinical and social aspects of the lives of PLWHA. The qualitative analysis explored the factors affecting the perception of opportunities in 29 PLWHA of different socio economic background. The relevance of the results of both analyses to understand the quality of life of PLWHA is discussed against alternative measures and conceptualisations of quality of life

Developing Drinking-Water Quality Regulations and Standards

This document provides practical guidance to support the development or revision of customized national or subnational drinking-water quality regulations and standards.The principles and guidance presented are broadly applicable across countries and contexts, including more resource-limited settings. Supporting examples from both lower- and higher-income countries are included.Drinking-water quality regulations and standards developed or revised in accordance with this guidance will reflect the best practices identified in the WHO Guidelines for Drinking-water Quality to most effectively protect public health. Moreover, the regulations and standards will consider local needs, priorities and capacities to ensure that they are realistic and appropriate. Topics covered include:Guiding principlesGetting startedSelecting parameters and parameter limitsSetting out compliance monitoring requirement

Functioning and quality of life in Dutch oldest old with diverse levels of dependency

Background: Frequently, a questionnaire like the EQ-5D is applied to investigate elderly health-related quality of life (HRQoL), but current literature suggests that inputs that go beyond these traditional health aspects might be of importance. The capability approach is a different method, which integrates several non-health-related factors to define the well-being of the oldest old. Objective: We propose to investigate the differences in oldest old functionings and quality of life (QoL), given different levels of dependency, using both a utility-based (EQ-5D+C) and capability-based (Currently Achieved Functioning) questionnaire. Methods: We interviewed 99 Dutch elderly, living in the Groningen, Veendam, and Hoogeveen areas. The average age of the elderly was 80 years, who were living independently, still looking after themselves; living semi-dependently with moderate care; or living in a nursing home requiring consistent care. Results: The utility score for the dependent group is the lowest of all three groups, across the diseases investigated in this study. The respective average utility scores calculated for the dependent, semi-dependent, and independent subgroups were 0.56 (SD +/- 0.10); 0.84 (SD +/- 0.11), and 0.69 (SD +/- 0.13). Mobility and pain were reported to be the major domains where problems appeared across the three groups. Additionally, dependent elderly experience deficits in the role and control functionings while the other two subgroups experience deficits in pleasure and security. Conclusion: The results suggest that it is important to take note of the achievability of functionings and HRQoL, in addition to care dependency, to obtain QoL and well-being outcomes of the oldest old

Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research

© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd Background: Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. Objective: To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale)

Artificial Intelligence in Radiation Therapy

Artificial intelligence (AI) has great potential to transform the clinical workflow of radiotherapy. Since the introduction of deep neural networks, many AI-based methods have been proposed to address challenges in different aspects of radiotherapy. Commercial vendors have started to release AI-based tools that can be readily integrated to the established clinical workflow. To show the recent progress in AI-aided radiotherapy, we have reviewed AI-based studies in five major aspects of radiotherapy including image reconstruction, image registration, image segmentation, image synthesis, and automatic treatment planning. In each section, we summarized and categorized the recently published methods, followed by a discussion of the challenges, concerns, and future development. Given the rapid development of AI-aided radiotherapy, the efficiency and effectiveness of radiotherapy in the future could be substantially improved through intelligent automation of various aspects of radiotherapy

Communication practices that encourage and constrain shared decision making in health-care encounters: systematic review of conversation analytic research

Background: Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters.Objective: To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM.Search strategy: We searched nine electronic databases (last search November 2016) and our own and other academics’ collections.Inclusion criteria: Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion)was present and where the data and analysis focused on health/illness-related decision making.Data extraction and synthesis: We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively.Results: Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs’ responses to patients’ resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs’ practices may constrain or encourage this participation.Conclusions: Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision’s rationale)