4,339 research outputs found

    A Framework (SOCRATex) for Hierarchical Annotation of Unstructured Electronic Health Records and Integration Into a Standardized Medical Database: Development and Usability Study

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    Background: Although electronic health records (EHRs) have been widely used in secondary assessments, clinical documents are relatively less utilized owing to the lack of standardized clinical text frameworks across different institutions. Objective: This study aimed to develop a framework for processing unstructured clinical documents of EHRs and integration with standardized structured data. Methods: We developed a framework known as Staged Optimization of Curation, Regularization, and Annotation of clinical text (SOCRATex). SOCRATex has the following four aspects: (1) extracting clinical notes for the target population and preprocessing the data, (2) defining the annotation schema with a hierarchical structure, (3) performing document-level hierarchical annotation using the annotation schema, and (4) indexing annotations for a search engine system. To test the usability of the proposed framework, proof-of-concept studies were performed on EHRs. We defined three distinctive patient groups and extracted their clinical documents (ie, pathology reports, radiology reports, and admission notes). The documents were annotated and integrated into the Observational Medical Outcomes Partnership (OMOP)-common data model (CDM) database. The annotations were used for creating Cox proportional hazard models with different settings of clinical analyses to measure (1) all-cause mortality, (2) thyroid cancer recurrence, and (3) 30-day hospital readmission. Results: Overall, 1055 clinical documents of 953 patients were extracted and annotated using the defined annotation schemas. The generated annotations were indexed into an unstructured textual data repository. Using the annotations of pathology reports, we identified that node metastasis and lymphovascular tumor invasion were associated with all-cause mortality among colon and rectum cancer patients (both P=.02). The other analyses involving measuring thyroid cancer recurrence using radiology reports and 30-day hospital readmission using admission notes in depressive disorder patients also showed results consistent with previous findings. Conclusions: We propose a framework for hierarchical annotation of textual data and integration into a standardized OMOP-CDM medical database. The proof-of-concept studies demonstrated that our framework can effectively process and integrate diverse clinical documents with standardized structured data for clinical research.ope

    Literary Advice or Literally Advice? A comparative analysis of memoirs and self-help manuals as therapeutic devices for mental illnesses

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    Å bruke litteratur som verktĂžy for Ă„ forbedre seg selv har Ăžkt betraktelig i lĂžpet av det siste Ă„rhundre. Overalt hvor man ser, finner man litterĂŠre verk med Ăžnske om Ă„ forbedre aspekter med livet. En sjanger som har bemerket seg spesielt pĂ„ dette omrĂ„det er selvhjelpssjangeren, som angivelig har et steg-for-steg-svar pĂ„ nĂŠrmest alt. Samtidig som denne sjangeren har utviklet seg, har ogsĂ„ sĂžkelyset pĂ„ mental helse Ăžkt betraktelig. Et utfall av dette er at selvhjelpssangeren tilbyr lesere raske kurer pĂ„ ulike mentale sykdommer. Til tross for gode tilbud, stiller jeg spĂžrsmĂ„l til at en slik monologisk guide kan ha enkle lĂžsninger pĂ„ kompliserte mentale sykdommer, og foreslĂ„r at man heller kan utforske memoarer som et godt alternativ til selvhjelpsbĂžker. Gjennom teorier hovedsakelig av Mikhail M. Bakthin, Marielle MacĂ©, Wolfgang Iser og J. Hillis Miller, finner jeg at forstĂ„else av litteratur, diskurs og tilnĂŠrminger til litterĂŠre verk er avgjĂžrende for leserens utfall. Memoarer kan fremme et dialogisk samspill mellom tekst og leser, og forfattere av memoarer inviterer leseren til Ă„ ta del i leseprosessen og finne ut selv hva de Ăžnsker Ă„ fĂ„ ut av teksten. Denne avhandlingen gjennomfĂžrer en analyse av selvhjelpsboken The Depression Cure av Stephen L. Ilardi og memoarene Prozac Nation av Elizabeth Wurtzel og Girl, Interrupted av Susanna Kaysen. Ved Ă„ lese disse litterĂŠre verkene som terapeutisk litteratur, Ăžnsker jeg Ă„ fremme leserens rolle i lesningen og se pĂ„ hvilke muligheter forfatteren og teksten legger til rette for.Engelsk mastergradsoppgaveENG350MAHF-ENGMAHF-LÆF

    Examining Depressive Symptoms Over Time in Women with Coronary Heart Disease

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    Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported. Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores. This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on depressive symptoms in women with CHD examined by instrument, and presents results of a 3-month feasibility study examining women’s depressive symptoms. The purpose of the study was to evaluate participant enrollment, data collection, preliminary quantitative trends, and qualitative surveys for qualitative data collection. Participant recruitment by individuals other than the P.I. was generally poor and attrition was problematic (16.7 – 28%). Prevalence of mean depression screening scores ≄ cutoff values averaged 30% at baseline, 26% at month 2, and 25% at month 3. Trends in symptom severity over the course of the study reflected trends in somatic symptoms and distress but not cognitive symptoms. Current depression was strongly correlated with fatigue and sleep as well as younger age, comorbid diabetes, a history of anxiety, and acute coronary syndrome symptoms. It was less strongly correlated with a history of depression and cardiac rehabilitation attendance. No correlation was found between current depression and employment status. Qualitative survey uptake was poor and the original survey was too restrictive, requiring modification. This dissertation clarifies our understanding of the concept of depression in women with CHD and summarizes the longitudinal descriptive literature on depression in women with CHD. The dissertation study enhances our understanding of depressive symptoms experienced in this population, gives some important preliminary data on use of the PROMIS Depression 8b instrument in this population, highlights the importance of screening for depressive symptoms in this population, and emphasizes the ongoing need for CHD studies which examine and report data by gender

    ìŁŒìš” ìš°ìšž 임애의 음성 êž°ë°˜ 분석: 연속적읞 발화의 음햄적 ëł€í™”ë„Œ ì€‘ì‹ŹìœŒëĄœ

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    í•™ìœ„ë…ŒëŹž(ë°•ì‚Ź) -- 서욞대학ꔐ대학원 : ìœ”í•©êłŒí•™êž°ìˆ ëŒ€í•™ì› ìœ”í•©êłŒí•™ë¶€(ë””ì§€í„žì •ëłŽìœ”í•©ì „êł”), 2023. 2. ìŽê”ê”Ź.Major depressive disorder (commonly referred to as depression) is a common disorder that affects 3.8% of the world's population. Depression stems from various causes, such as genetics, aging, social factors, and abnormalities in the neurotransmitter system; thus, early detection and monitoring are essential. The human voice is considered a representative biomarker for observing depression; accordingly, several studies have developed an automatic depression diagnosis system based on speech. However, constructing a speech corpus is a challenge, studies focus on adults under 60 years of age, and there are insufficient medical hypotheses based on the clinical findings of psychiatrists, limiting the evolution of the medical diagnostic tool. Moreover, the effect of taking antipsychotic drugs on speech characteristics during the treatment phase is overlooked. Thus, this thesis studies a speech-based automatic depression diagnosis system at the semantic level (sentence). First, to analyze depression among the elderly whose emotional changes do not adequately reflect speech characteristics, it developed the mood-induced sentence to build the elderly depression speech corpus and designed an automatic depression diagnosis system for the elderly. Second, it constructed an extrapyramidal symptom speech corpus to investigate the extrapyramidal symptoms, a typical side effect that can appear from an antipsychotic drug overdose. Accordingly, there is a strong correlation between the antipsychotic dose and speech characteristics. The study paved the way for a comprehensive examination of the automatic diagnosis system for depression.ìŁŒìš” ìš°ìšž ìž„ì•  슉 흔히 ìš°ìšžìŠìŽëŒêł  ìŒì»Źì–Žì§€ëŠ” Ʞ분 임애는 전 ì„žêł„ìž 쀑 3.8%에 달하는 ì‚ŹëžŒë“€ìŽ êČȘ은바 있는 맀우 흔한 ì§ˆëł‘ìŽë‹€. 유전, 녾화, ì‚ŹíšŒì  요읞, 신êČœì „ë‹ŹëŹŒì§ˆ ìČŽêł„ì˜ 읎상등 닀양한 ì›ìžìœŒëĄœ 발생하는 우욞슝은 ìĄ°êž° 발êČŹ 및 음상 생활에서의 êŽ€ëŠŹê°€ 맀우 ì€‘ìš”í•˜ë‹€êł  할 수 있닀. 읞간의 음성은 우욞슝을 ꎀ찰하Ʞ에 대표적읞 ë°”ìŽì˜€ë§ˆì»€ëĄœ ì—ŹêČšì ž 왔윌며, 음성 데읎터넌 êž°ë°˜ìœŒëĄœí•œ 자동 우욞슝 진닚 시슀템 개발을 위한 ì—ŹëŸŹ ì—°ê”Źë“€ìŽ 진행되얎 왔닀. ê·žëŸŹë‚˜ 음성 말뭉ìč˜ ê”Źì¶•ì˜ ì–Žë €ì›€êłŒ 60ì„ž 읎하의 성읞듀에êȌ 쎈점읎 맞추얎진 ì—°ê”Ź, ì •ì‹ êłŒ ì˜ì‚Źë“€ì˜ 임상 소êČŹì„ ë°”íƒ•ìœŒëĄœí•œ 의학적 가섀 섀정의 ëŻžíĄë“±ì˜ í•œêł„ì ì„ ê°€ì§€êł  있윌며, 읎는 ì˜ëŁŒ 진닚 êž°ê”ŹëĄœ 발전하는데 í•œêł„ì ìŽëŒêł  할 수 있닀. 또한, 항정신성 ì•œëŹŒì˜ ëł”ìš©ìŽ 음성 íŠč징에 믞ìč  ìˆ˜ 있는 영햄 또한 ê°„êłŒë˜êł  있닀. ëłž ë…ŒëŹžì—ì„œëŠ” 위의 í•œêł„ì ë“€ì„ ëłŽì™„í•˜êž° 위한 ì˜ëŻžëĄ ì  수쀀 (ëŹžìž„ 닚위)에서의 음성 êž°ë°˜ 자동 우욞슝 진닚에 대한 ì—°ê”Źë„Œ ì‹œí–‰í•˜êł ìž 한닀. ìš°ì„ ì ìœŒëĄœ 감정의 ëł€í™”ê°€ 음성 íŠč징을 잘 반영되지 않는 녞읞잔의 우욞슝 분석을 위핎 감정 발화 ëŹžìž„ì„ ê°œë°œí•˜ì—Ź 녞읞 우욞슝 음성 말뭉ìč˜ë„Œ ê”Źì¶•í•˜êł , ëŹžìž„ 닚위에서의 ꎀ찰을 톔핎 녞읞 우욞슝 ꔰ에서 감정 ëŹžìž„ 발화가 믞ìč˜ëŠ” ì˜í–„êłŒ 감정 전읎넌 확읞할 수 있었윌며, 녞읞잔의 자동 우욞슝 진닚 시슀템을 ì„€êł„í•˜ì˜€ë‹€. ì”œìą…ì ìœŒëĄœ í•­ì •ì‹ ëł‘ ì•œëŹŒì˜ êłŒëł”ìš©ìœŒëĄœ 나타날 수 있는 대표적읞 부작용읞 추ìČŽì™žëĄœ 슝상을 ìĄ°ì‚Źí•˜êž° 위핎 추ìČŽì™žëĄœ 슝상 음성 말뭉ìč˜ë„Œ ê”Źì¶•í•˜ì˜€êł , í•­ì •ì‹ ëł‘ ì•œëŹŒì˜ ëł”ìš©ëŸ‰êłŒ 음성 íŠč징간의 ìƒêŽ€êŽ€êł„ë„Œ ë¶„ì„í•˜ì—Ź 우욞슝의 ìč˜ëŁŒ êłŒì •ì—ì„œ í•­ì •ì‹ ëł‘ ì•œëŹŒìŽ 음성에 믞ìč  ìˆ˜ 있는 영햄에 대핎서 ìĄ°ì‚Źí•˜ì˜€ë‹€. 읎넌 톔핎 ìŁŒìš” ìš°ìšž 임애의 영역에 대한 íŹêŽ„ì ìž ì—°ê”Źë„Œ 진행하였닀.Chapter 1 Introduction 1 1.1 Research Motivations 3 1.1.1 Bridging the Gap Between Clinical View and Engineering 3 1.1.2 Limitations of Conventional Depressed Speech Corpora 4 1.1.3 Lack of Studies on Depression Among the Elderly 4 1.1.4 Depression Analysis on Semantic Level 6 1.1.5 How Antipsychotic Drug Affects the Human Voice? 7 1.2 Thesis objectives 9 1.3 Outline of the thesis 10 Chapter 2 Theoretical Background 13 2.1 Clinical View of Major Depressive Disorder 13 2.1.1 Types of Depression 14 2.1.2 Major Causes of Depression 15 2.1.3 Symptoms of Depression 17 2.1.4 Diagnosis of Depression 17 2.2 Objective Diagnostic Markers of Depression 19 2.3 Speech in Mental Disorder 19 2.4 Speech Production and Depression 21 2.5 Automatic Depression Diagnostic System 23 2.5.1 Acoustic Feature Representation 24 2.5.2 Classification / Prediction 27 Chapter 3 Developing Sentences for New Depressed Speech Corpus 31 3.1 Introduction 31 3.2 Building Depressed Speech Corpus 32 3.2.1 Elements of Speech Corpus Production 32 3.2.2 Conventional Depressed Speech Corpora 35 3.2.3 Factors Affecting Depressed Speech Characteristics 39 3.3 Motivations 40 3.3.1 Limitations of Conventional Depressed Speech Corpora 40 3.3.2 Attitude of Subjects to Depression: Masked Depression 43 3.3.3 Emotions in Reading 45 3.3.4 Objectives of this Chapter 45 3.4 Proposed Methods 46 3.4.1 Selection of Words 46 3.4.2 Structure of Sentence 47 3.5 Results 49 3.5.1 Mood-Inducing Sentences (MIS) 49 3.5.2 Neutral Sentences for Extrapyramidal Symptom Analysis 49 3.6 Summary 51 Chapter 4 Screening Depression in The Elderly 52 4.1 Introduction 52 4.2 Korean Elderly Depressive Speech Corpus 55 4.2.1 Participants 55 4.2.2 Recording Procedure 57 4.2.3 Recording Specification 58 4.3 Proposed Methods 59 4.3.1 Voice-based Screening Algorithm for Depression 59 4.3.2 Extraction of Acoustic Features 59 4.3.3 Feature Selection System and Distance Computation 62 4.3.4 Classification and Statistical Analyses 63 4.4 Results 65 4.5 Discussion 69 4.6 Summary 74 Chapter 5 Correlation Analysis of Antipsychotic Dose and Speech Characteristics 75 5.1 Introduction 75 5.2 Korean Extrapyramidal Symptoms Speech Corpus 78 5.2.1 Participants 78 5.2.2 Recording Process 79 5.2.3 Extrapyramidal Symptoms Annotation and Equivalent Dose Calculations 80 5.3 Proposed Methods 81 5.3.1 Acoustic Feature Extraction 81 5.3.2 Speech Characteristics Analysis recording to Eq.dose 83 5.4 Results 83 5.5 Discussion 87 5.6 Summary 90 Chapter 6 Conclusions and Future Work 91 6.1 Conclusions 91 6.2 Future work 95 Bibliography 97 쎈 록 121박

    Autonomy and autonomy disturbances in self-development and psychopathology: research on motivation, attachment, and clinical process

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    Self-determination theory (SDT) maintains that the adequate support and satisfaction of individuals' psychological needs for autonomy, competence, and relatedness promotes the gradual unfolding of individuals' integrative tendencies, as manifested through intrinsic motivation, internalization, identity development, and integrative emotion regulation. At the same time, the thwarting of these same psychological needs and the resultant need frustration is presumed to evoke or amplify a variety of psychopathologies, many of which involve autonomy disturbances. We begin by defining what autonomy involves and how socializing agents, particularly parents, can provide a nurturing (i.e., need-supportive) environment, and we review research within the SDT literature that has shed light on various integrative tendencies and how caregivers facilitate them. In the second part of this chapter, we detail how many forms of psychopathology involve autonomy disturbances and are associated with a history of psychological need thwarting. We especially focus on internally controlling regulation in internalizing disorders; impairments of internalization in conduct disorders and antisocial behavior; and fragmented self-functioning in borderline and dissociative disorders. The role of autonomy support as an ameliorative factor in treatment settings is then discussed among other translational issues. Finally we highlight some implications of recognizing the important role of basic psychological needs for both growth-related and pathology-related processes

    The biopsychosocial model and hypothyroidism

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    This paper comments on the role and emergence of the biopsychosocial model in modern medical literature and health care settings. The evolution of the biopsychosocial model and its close association with modern pain theory is also examined. This paper seeks to discuss the place of this model with respect to the management of hypothyroidism. This discussion represents a forerunner to a randomised control trial that will seek to investigate the effect of a biopsychosocial-based treatment regime on hypothyroidism

    Fatherhood and mental illness: a review of key issues

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    Researchers have traditionally paid little attention to the intersections between men’s mental illness and family life. Recently, however, this has been changing. This paper provides practitioners and policy-makers with a broad overview of some of the key issues identified in the growing literature on paternal mental illness. Key messages Compared to many other life stages, the transition to fatherhood and the early years of childrearing are periods in which men are at a substantially increased risk of experiencing psychological distress. The children of men with a mental illness are more likely than other children to experience internalising (i.e., emotional) and externalising (i.e., behavioural) problems, as well as to be diagnosed with a mental illness themselves. Parenting behaviour is one of the mechanisms by which parental mental illness may translate into problem outcomes in children. Fathers with a mental illness are more likely than other fathers to show low levels of parental engagement, warmth and appropriate monitoring. The scarce qualitative literature exploring fathers\u27 experiences of mental illness suggests that fatherhood is central to the image many men have of themselves - their experience of mental illness and their paternal identity are inextricably linked. Stigma is a significant source of suffering for many people with mental health concerns. Fathers with a mental illness can be subject to unique forms of stigma, which can influence their perceptions and experiences in a number of ways. Psychiatric and welfare service providers in Australia and internationally have often struggled to effectively engage fathers, either failing to see men as members of a family unit, or failing to offer services tailored to their specific needs

    Multimodal Machine Learning for Automated ICD Coding

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    This study presents a multimodal machine learning model to predict ICD-10 diagnostic codes. We developed separate machine learning models that can handle data from different modalities, including unstructured text, semi-structured text and structured tabular data. We further employed an ensemble method to integrate all modality-specific models to generate ICD-10 codes. Key evidence was also extracted to make our prediction more convincing and explainable. We used the Medical Information Mart for Intensive Care III (MIMIC -III) dataset to validate our approach. For ICD code prediction, our best-performing model (micro-F1 = 0.7633, micro-AUC = 0.9541) significantly outperforms other baseline models including TF-IDF (micro-F1 = 0.6721, micro-AUC = 0.7879) and Text-CNN model (micro-F1 = 0.6569, micro-AUC = 0.9235). For interpretability, our approach achieves a Jaccard Similarity Coefficient (JSC) of 0.1806 on text data and 0.3105 on tabular data, where well-trained physicians achieve 0.2780 and 0.5002 respectively.Comment: Machine Learning for Healthcare 201
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