Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department

BACKGROUND: Falls among older adults are both a common reason for presentation to the emergency department, and a major source of morbidity and mortality. It is critical to identify fall patients quickly and reliably during, and immediately after, emergency department encounters in order to deliver appropriate care and referrals. Unfortunately, falls are difficult to identify without manual chart review, a time intensive process infeasible for many applications including surveillance and quality reporting. Here we describe a pragmatic NLP approach to automating fall identification. METHODS: In this single center retrospective review, 500 emergency department provider notes from older adult patients (age 65 and older) were randomly selected for analysis. A simple, rules-based NLP algorithm for fall identification was developed and evaluated on a development set of 1084 notes, then compared with identification by consensus of trained abstractors blinded to NLP results. RESULTS: The NLP pipeline demonstrated a recall (sensitivity) of 95.8%, specificity of 97.4%, precision of 92.0%, and F1 score of 0.939 for identifying fall events within emergency physician visit notes, as compared to gold standard manual abstraction by human coders. CONCLUSIONS: Our pragmatic NLP algorithm was able to identify falls in ED notes with excellent precision and recall, comparable to that of more labor-intensive manual abstraction. This finding offers promise not just for improving research methods, but as a potential for identifying patients for targeted interventions, quality measure development and epidemiologic surveillance

Neural EGFL-Like 1 Is a Downstream Regulator of Runt-Related Transcription Factor 2 in Chondrogenic Differentiation and Maturation

Recent studies indicate that neural EGFL-like 1 (Nell-1), a secretive extracellular matrix molecule, is involved in chondrogenic differentiation. Herein, we demonstrated that Nell-1 serves as a key downstream target of runt-related transcription factor 2 (Runx2), a central regulator of chondrogenesis. Unlike in osteoblast lineage cells where Nell-1 and Runx2 demonstrate mutual regulation, further studies in chondrocytes revealed that Runx2 tightly regulates the expression of Nell-1; however, Nell-1 does not alter the expression of Runx2. More important, Nell-1 administration partially restored Runx2 deficiency–induced impairment of chondrocyte differentiation and maturation in vitro, ex vivo, and in vivo. Mechanistically, although the expression of Nell-1 is highly reliant on Runx2, the prochondrogenic function of Nell-1 persisted in Runx2−/− scenarios. The biopotency of Nell-1 is independent of the nuclear import and DNA binding functions of Runx2 during chondrogenesis. Nell-1 is a key functional mediator of chondrogenesis, thus opening up new possibilities for the application of Nell-1 in cartilage regeneration. © 2017 American Society for Investigative Patholog

The first clinical data of the SAPIEN 3 aortic valve in the treatment of aortic stenosis in China

BackgroundData on outcomes following transcatheter aortic valve replacement with SAPIEN 3 in China is limited as it was approved by the National Medical Products since 2020. The present study was designed to collect clinical data on the SAPIEN 3 aortic valve in Chinese patients with bicuspid aortic valve and tricuspid aortic valve stenosis.MethodsWe analyzed the patient characteristics, procedural features and procedural outcomes of the first 438 patients (223 for bicuspid aortic valve and 215 tricuspid aortic valve) from 21 provinces in 74 sites treated with the SAPIEN 3 valve system for transcatheter aortic valve replacement between September 2020 and May 2022.ResultsProcedural mortality was 0.7%. 5 cases during the operation were converted to surgery. Among 438 cases, permanent pacemaker implantation was performed in a total of 12 cases (2.7%). The patient had severe leaflet calcification of the aortic valve, with moderate and severe calcification reaching 39.7% and 35.2% respectively. The size of the implanted valves was predominantly 26 mm and 23 mm, reaching 42.5% and 39.5% respectively. The incidence of moderate or severe perivalvular leak in the postoperative period was 0.5%, with a predominance of 90/10 and 80/20 valve deployment height. There was a significant difference in the deployment height of the valve between bicuspid aortic valve and tricuspid aortic valve, with the bicuspid aortic valve having a more deployment height of 90/10. Annulus size in bicuspid aortic valve group was significantly larger than tricuspid aortic valve group. Valve sizing for oversized, within size, and undersized were different between bicuspid aortic valve and tricuspid aortic valve.ConclusionsProcedural success rates were high, with similar and good results for bicuspid aortic valve and tricuspid aortic valve, low perivalvular leak for both valve types, and low permanent pacemaker implantation rates for both valve types. Annulus size, valve sizing and coronary artery height were significantly different in the BAV and TAV group

Analysis of synonymous codon usage in Hepatitis A virus

<p>Abstract</p> <p>Background</p> <p>Hepatitis A virus is the causative agent of type A viral hepatitis, which causes occasional acute hepatitis. Nevertheless, little information about synonymous codon usage pattern of HAV genome in the process of its evolution is available. In this study, the key genetic determinants of codon usage in HAV were examined.</p> <p>Results</p> <p>The overall extent of codon usage bias in HAV is high in <it>Picornaviridae</it>. And the patterns of synonymous codon usage are quite different in HAV genomes from different location. The base composition is closely correlated with codon usage bias. Furthermore, the most important determinant that results in such a high codon bias in HAV is mutation pressure rather than natural selection.</p> <p>Conclusions</p> <p>HAV presents a higher codon usage bias than other members of <it>Picornaviridae</it>. Compositional constraint is a significant element that influences the variation of synonymous codon usage in HAV genome. Besides, mutation pressure is supposed to be the major factor shaping the hyperendemic codon usage pattern of HAV.</p

Hierarchical layered titanate microspherulite: formation by electrochemical spark discharge spallation and application in aqueous pollutant treatment

An ultrafast and template-free method to synthesize three-dimensional (3D) hierarchical layered titanate microspherulite (TMS) particles with high surface area is reported. The synthesis makes use of an electrochemical spark discharge spallation (ESDS) process, during which a fast anodic reaction on the titanium surface creates a layer of titanium dioxide that instantly breaks down by the applied electrical field into the solution in the form of titanium oxide particles. The spalled particles readily react with the heated NaOH electrolyte to form the titanate particles. A typical as-prepared TMS with a diameter of 0.4 similar to 1.5 mu m is synthesized by ESDS of Ti foils in 10 M NaOH solution under an applied current density of 0.5 A cm(-2), leading to a reaction yield of approximately 0.10 similar to 0.15 g per square centimetre of exposed Ti foil within 20 min. After hydrogen ion exchange, the surface area can reach as high as similar to 406 m(2) g(-1). On the Ti surface, a crystalline rutile TiO2 nanosheet structure is formed, which is attributed to the local exothermic heat caused by the spark discharge. A formation mechanism of the TMS is discussed based on field emission scanning electron microscopy (FESEM), a transmission electron microscopy (TEM) study and Raman scattering spectroscopy analysis. The as-prepared TMS shows excellent adsorption performance compared with a titanate micro-particle (TMP), nanowire (TNW) and nanotube (TNT) when methylene blue (MB) and Pb-II ions are used as representative organic and inorganic pollutants. The mechanism of adsorption has also been discussed.National Research Foundation of Singapore Government [MEWR651/06/160

Reform of Japan's Land Planning and Implications to China

This paper first briefly summarized the current state of exploration and construction of China's land space planning. Then, it analyzed Japan's land planning reform, studied its spatial planning process and explored relevant reform paths to obtain relevant experience. Through analyzing and summarizing the experience in the exploration of Japan's land space planning in combination with China's specific national conditions, it is intended to draw implications for China's land space planning in the new era, in order to provide references for the future operation of related actual projects of land planning and exploration of related strategic theories

Discussions about Gardening Craft of Japanese Gardens and Implications for China

Japanese gardens were developed under the influence of China. In the process of development, the Japanese gardens studied the modern Western gardening craft, and developed unique gardening craft with local regional characteristics and national style in accordance with local conditions. This paper analyzed Japanese gardens through the development of Japanese gardens, the development process, the types of gardens and gardening elements, the characteristics of garden design and the implications for modern and contemporary Chinese garden design. In addition, through an in-depth understanding of Japanese gardens and exploring their intrinsic value, this paper summarized their development experience, in the hope of applying them into the future garden landscape design