Inductive identification of functional status information and establishing a gold standard corpus: a case study on the mobility domain

The importance of functional status information (FSI) has become increasingly evident in recent years [1, 2]. However, implementation, application, and normalization of FSI in health care and Electronic Health Records (EHRs) have been largely underexplored. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) [3] is considered to be the international standard for describing and coding function and health states. Nevertheless, the ICF provides only a limited vocabulary for recognizing FSI descriptions, since its purpose is to organize concepts related to functioning rather than to provide a comprehensive terminology or a complete set of relations between concepts. While the free text portion of EHRs might provide a more complete picture of health status, treatment, and progress, current Natural Language Processing (NLP) methods largely focus on extracting medical conditions (e.g. diagnoses and symptoms, etc.). The absence of a standardized functional terminology and incompleteness of the ICF as a vocabulary source makes it challenging to build a NLP system to extract FSI from EHR free text. Our work takes the first step towards extraction of FSI from free text by systematically identifying the structure of FSI related to Mobility, a key domain of the ICF and an important domain in the determination of work disability. Our interdisciplinary research group inductively evaluated examples extracted from over 1,200 Physical Therapy (PT) notes from the Clinical Center of the National Institutes of Health (NIH). This extensive work resulted in a nested entity structure comprised of 2 entities, 3 sub-entities, 8 attributes, and 21 attribute values. Furthermore, we have manually curated the first gold standard corpus of 200 double-annotated and 50 triple-annotated PT notes. Our inter-annotator agreement (IAA) averages 97% F1-score on partial textual span matching and from 0.4 to 0.9 Siegel & Castellan's kappa on attribute value matching. Such a rich semantic corpus of Mobility FSI is valuable and a promising resource for future statistical learning. Our method is also adaptable to other domains of the ICF

SARS-CoV-2 infection among hospitalised pregnant women and impact of different viral strains on COVID-19 severity in Italy: a national prospective population-based cohort study

OBJECTIVE: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN: National population-based prospective cohort study. SETTING: A total of 315 Italian maternity hospitals. SAMPLE: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes

Recovery of Biomass Fly Ash and HDPE in Innovative Synthetic Lightweight Aggregates for Sustainable Geotechnical Applications

Sustainable development principles aim to re-utilize wastes to reduce their impact on the environment. In this context, the present contribution shows preliminary results on the preparation of innovative synthetic lightweight aggregates, starting from biomass-derived fly ash and high-density polyethylene (HDPE), to be used in geotechnical applications. The present work focuses on the manufacturing process of aggregate blends (including the selection of the right proportions of the two components) as well as on the relative determination of (i) physical–chemical properties (i.e., chemical composition, morphological analysis, mineral leachability, water absorption, specific gravity, grain size distribution); (ii) permeability features and (iii) mechanical properties (one-dimensional compression and shear strength behavior). The results, gathered from the new synthetic lightweight aggregates and compared with the corresponding ones obtained in a previous study conducted on natural and synthetic lightweight aggregates, appear promising for a potential utilization in geotechnical engineering