Extracting Complementary and Integrative Health Approaches in Electronic Health Records

Complementary and Integrative Health (CIH) has gained increasing popularity in the past decades. While the evidence bases to support them are growing, there is still a gap in understanding their effects and potential adverse events using real-world data. The overall goal of this study is to represent information pertinent to both psychological and physical CIH approaches (specifically, using examples of music therapy, chiropractic, and aquatic exercise in this study) in an electronic health record (EHR) system. We also aim to evaluate the ability of existing natural language processing (NLP) systems to identify CIH approaches. A total of 300 notes were randomly selected and manually annotated. Annotations were made for status, symptom, and frequency of each approach. This set of annotations was used as a gold standard to evaluate the performance of NLP systems used in this study (specifically BioMedICUS, MetaMap, and cTAKES) for extracting CIH concepts. Venn diagram was used to investigate the consistency of medical records searching by Current Procedural Terminology (CPT) codes and CIH approaches keywords in SQL. Since CPT codes usually do not have specific mentions of CIH approaches, the Venn diagram had less overlap with those found in clinical notes for all three CIH therapies. The three NLP systems achieved 0.41 in average lenient match F1-score in all three CIH approaches, respectively. BioMedICUS achieved the best performance in aquatic exercise with an F1-score of 0.66. This study contributes to the overall representation of CIH in clinical note and lays a foundation for using EHR for clinical research for CIH approaches.

Annotating Music Therapy, Chiropractic and Aquatic Exercise Using Electronic Health Record

Complementary and Integrative Health (CIH) has gained increasing popularity in the past decades. The overall goal of this study is to represent information pertinent to music therapy, chiropractic and aquatic exercise in an EHR system. A total of 300 clinical notes were randomly selected and manually annotated. Annotations were made for status, symptom and frequency of each approach. This set of annotations was used as a gold standard to evaluate performance of NLP systems used in this study (specifically BioMedICUS, MetaMap and cTAKES) for extracting CIH concepts. Three NLP systems achieved an average lenient match F1-score of 0.50 in all three CIH approaches. BioMedICUS achieved the best performance in music therapy with an F1-score of 0.73. This study is a pilot to investigate CIH representation in clinical note and lays a foundation for using EHR for clinical research for CIH approaches.

Predictors of Post-Acute Sequelae of COVID-19 Development and Rehabilitation: A Retrospective Study

Objective

To examine the frequency of postacute sequelae of SARS-CoV-2 (PASC) and the factors associated with rehabilitation utilization in a large adult population with PASC.

Design

Retrospective study.

Setting

Midwest hospital health system.

Participants

19,792 patients with COVID-19 from March 10, 2020, to January 17, 2021.

Intervention

Not applicable.

Main Outcome Measures

Descriptive analyses were conducted across the entire cohort along with an adult subgroup analysis. A logistic regression was performed to assess factors associated with PASC development and rehabilitation utilization.

Results

In an analysis of 19,792 patients, the frequency of PASC was 42.8% in the adult population. Patients with PASC compared with those without had a higher utilization of rehabilitation services (8.6% vs 3.8%, P<.001). Risk factors for rehabilitation utilization in patients with PASC included younger age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-1.00; P=.01). In addition to several comorbidities and demographics factors, risk factors for rehabilitation utilization solely in the inpatient population included male sex (OR, 1.24; 95% CI, 1.02-1.50; P=.03) with patients on angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers 3 months prior to COVID-19 infections having a decreased risk of needing rehabilitation (OR, 0.80; 95% CI, 0.64-0.99; P=.04).

Conclusions

Patients with PASC had higher rehabilitation utilization. We identified several clinical and demographic factors associated with the development of PASC and rehabilitation utilization.

THU0239 DYNAMIC TEMPORAL CHANGES IN CLINICAL DISEASE ACTIVITY AND GUT MICROBIOTA REPRESENTATION OF A PATHOBIONT LINKED TO LUPUS NEPHRITIS

Background:

From a cross-sectional cohort, we have identified a candidate human gut anaerobic pathobiont,Ruminococcus gnavus(RG) of the familyLachnospiraceaethat was linked to active Lupus nephritis (LN)(1). Based on 16S rRNA amplicon analysis, LN patients displayed increased fecal RG abundance, concordant with serum IgG anti-RG antibody responses that appeared intertwined with anti-dsDNA responses implicated in renal pathogenesis. Indeed, monocolonization of germ-free mice is reported to result in generalized inflammation and expansions of Th17 cells. However, RG at low levels are also prevalent in healthy adults, and the temporal dynamics of RG representation within Lupus microbiota ecosystems have not been investigated. Also, genomic sequences of few RG strains have been reported, and these vary greatly in genome structure, gene representation and sequence, which may have broad implications for adaptation to a host with systemic inflammation and/or factors that contribute to immune activation in a susceptible host.

Objectives:

To investigate the relationships betweenin vivoRG expansions and disease activity that often wax and wane overtime, we initiated longitudinal studies in Lupus patients and controls. As representation of RG strains alone might alter pathogenic potential, we also sought to characterize RG strains from active LN patients.

Methods:

From our cohort, patients were characterized for demographics, clinical disease activity, and serologies including standard autoantibody and complement levels, and anti-bacterial responses of interest. High throughput 16S rRNA amplicon libraries from fecal samples were analyzed using QIIME 2 and DADA2 (1). Also, individual RG colonies were isolated and subjected to whole genome sequencing. Species and strains were then assigned in part based on multi-locus sequence typing and reference guided genomic assemblies.

Results:

16S rRNA analysis of 34 samples, at 2-4 timepoints from 14 SLE patients, documented highly conserved patterns of gut community representation overtime in 10/14 patients, based in part on unsupervised hierarchical cluster analysis. Notably, independent of vacillations in clinical disease activity of up to 8 SLEDAI points, conserved microbiome phylogenetic abundance/composition was documented at a family level, and the level of amplicon sequence variants that approximate identification of individual species. In pilot studies, from two active lupus nephritis patients hundreds of fecal bacterial colonies were isolated, with initial assignments by 16S rRNA sequence. From highly redundant whole genome sequence analysis, these Lupus-patient fecal colonies were found to distribute into only four distinct RG strains, which differed from reported strains.

Conclusion:

Our findings suggest that many Lupus patients have little or no detectable perturbations in representation of theLachnospiraceaefamily or abundance of RG species overtime. Moreover, this seeming microbiota stability was documented even in patients with dramatic changes in disease activity. However, these approaches are inadequate to detect shifts between RG strains. In pilot studies we have isolated and characterized the genomes of four unique RG strains from active LN patients, which include variations in gene content and sequence that may have implications for the host-commensal relationship and immune activation. Broadening of these studies to larger number of SLE patients and healthy subjects, with metagenomic surveys of strain representation in genomic shotgun libraries are currently in progress, in coordination with murine colonization testing for immune modulatory properties of individual strains.

References:

[1]Azzouzet al.Ann Rheum Dis2019 78(7):947-56

Disclosure of Interests: :

Gregg Silverman Consultant of: Work with industry is unrelated to the topic in this abstract, Doua Azzouz: None declared, Ze Chen: None declared, Jing Deng: None declared, Zhi Li: None declared, David Fenyo: None declared, Alexander Alekseyenko: None declared

EXPERIMENTAL ATTEMPTS TO INCREASE THE BLOOD SUPPLY TO THE DOG'S HEART BY MEANS OF CORONARY SINUS OCCLUSION

Sudden occlusion of the left anterior descending branch approximately 2 cm. below the ostium of the left circumflex coronary artery in the dog's heart produces a mortality rate of approximately 50 per cent. In dogs weighing approximately 15 kilos surviving more than 24 hours (average 1 week), an infarction is produced which almost invariably measures 5 x 5 cm. on surface. Following coronary sinus obturation such secondary sudden occlusion of the left anterior descending branch is followed either by no infarction or by a reduction in the size of the infarct. The success of the procedure, quite apart from the mortality rate, depends upon the completeness of the coronary sinus obturation. On the other hand, sudden and complete coronary sinus obturation by itself is associated with a high operative mortality and apparently does not affect the mortality rate following subsequent sudden left anterior descending branch occlusion. Partial persistent obturation of the coronary sinus, however, is in itself associated with a low operative mortality. Furthermore, its experimental production in dogs appears to lower the mortality rate following subsequent sudden occlusion of the left anterior descending branch and to diminish the extent of the infarction. In the introduction to this report it was pointed out that there are three important desiderata to the problem of improving the coronary circulation in the human heart. The findings herein reported fulfill these requisites to an encouraging degree. It has been shown that following the outlined procedures, a functional increase in the blood supply to the heart can be produced in a significant proportion of experimental animals, this varying with the nature of the experimental procedure. The manipulation is simple, can be performed in the dog within approximately 20 minutes, and does not lead to appreciable pericardial adhesions. Increase in the nutrition of the myocardium is noted 1 week after the experimental procedure. Although no experiments employing sudden left anterior descending coronary branch occlusion were carried out sooner than 1 week, there is available anatomic evidence that within possibly 24 hours after coronary sinus occlusion a dilatation of the vascular bed occurs. In subsequent experiments attempts will be made to determine whether this early vascular dilatation is adequate to compensate for subsequent sudden left anterior descending branch occlusion. A discussion is given of the results following various coronary sinus occlusion procedures in which it is indicated that it is desirable to produce a partial or gradual occlusion in order to lower the mortality rate both of the initial procedure as well as of the subsequent sudden arterial occlusion. Experiments thus far reported on cardiopexy operations are lacking in evidence that they are associated with appreciable improvement in the vascular nutrition of the myocardium.

A randomized trial of stenting with or without balloon predilation for the treatment of coronary artery disease

BACKGROUND

Stent placement has historically been preceded by predilation of the target lesion with percutaneous transluminal coronary angioplasty. Direct stent implantation, without predilation, has the potential to have a favorable impact on procedure cost by reducing the number of devices used, contrast administered, and procedure time.

METHODS AND RESULTS

We conducted a prospective randomized trial to compare the economic outcome of stenting with or without predilation. Inclusion criteria included intention to treat a single lesion with a coronary stent in a vessel with a reference diameter >2.4 mm. Exclusion criteria included total occlusions, culprit lesion within a saphenous vein graft, lesion length >25 mm, patients within 48 hours of an acute myocardial infarction, and patients unable to be treated with aspirin and clopidogrel. From September 1999 to March 2000, 77 patients were randomized to direct stent implantation (n = 37) or balloon-facilitated stenting (n = 40). Stent placement was successful in all patients. Crossover to predilation was required in 2 patients in the direct stent group because of inability to deliver the stent. Compared with balloon-facilitated stenting, direct stenting used fewer catheter devices (1.4 +/- 0.7 vs 2.5 +/- 0.8, P <.001), less contrast (92.7 +/- 43.1 mL vs 117.4 +/- 61.0 mL, P =.04), and less fluoroscopy time (7.5 +/- 3.9 minutes vs 11.6 +/- 8.3 minutes, P =.006). No difference in procedural complications or predischarge outcome was found. No difference in major adverse cardiovascular events was found at 6-month follow-up.

CONCLUSION

Direct stenting is a safe and successful procedure that reduces the number of devices used, fluoroscopy time, and contrast administration.

Undergraduate environmental health education: preparing for the future

Attendees indicated that the workshop was beneficial and that the opportunity to communicate with faculty representing 23 programs accredited by EHAC and nine programs not accredited by EHAC was extremely useful. There was general agreement on a number of points: There is a need for undergraduate environmental health programs to collaborate on matters related to distance learning. Topics related to women, gender, diversity, ethics, and international environmental health should be incorporated into the environmental health curriculum. There are no major problems with current EHAC curricular guidelines, but the guidelines should be evaluated on a regular basis. Field experience or internship is an essential component in the academic preparation of undergraduate environmental health students. There is a significant need for increased funding for undergraduate environmental health programs. There is a need to increase the visibility and recognition of environmental health programs. There is a need to solidify ties with traditional partners and to establish new linkages at the local, regional, and national levels in the government, community, and private sector. It is essential that undergraduate faculty communicate with each other on matters relating to the preparation of environment health practitioners. There is a need for an association of undergraduate academic programs to provide leadership and a focal point for identification and resolution of issues common to all. The establishment of an association was viewed as the most practical and effective way to address these issues and to pursue related opportunities.

Immunological responses to oxidized LDL

Considerable evidence now points to an important role for the immune system in experimental models of atherosclerosis. We have reviewed the growing body of evidence that oxidation of LDL generates a wide variety of neoself determinants that lead to cellular and humoral immune responses. In particular, we have demonstrated that at least some of the oxidation-specific epitopes generated on the oxidized LDL particle, such as oxidized phospholipid epitopes, are also generated on apoptotic cells and are also present on the surface of some bacteria. Many of these same epitopes serve as important ligands mediating the binding and clearance of oxidatively damaged lipoprotein particles and apoptotic cells, and the innate immune response to these epitopes can be seen as a concerted response to effect their removal. In addition, other epitopes of OxLDL also undoubtedly play a role in the immune activation that characterizes the progressive atherosclerotic plaque. It will be of great importance to define the importance of the role of these responses and to understand which are beneficial and which deleterious. Such information could lead one day to novel therapeutic approaches to inhibit atherogenesis that take advantage of the ability to manipulate the immune response.

Assessing the efficacy of three dentifrices in the treatment of dentinal hypersensitivity

A multicenter clinical trial conducted by the authors compared the desensitizing efficacy of a new 5 percent potassium nitrate: 0.243 percent sodium fluoride dentifrice along with two clinically proven, commercially available desensitizing dentifrices to a placebo dentifrice. Sensitivity to cold air and tactile stimulation, along with patients' subjective assessments, were evaluated to assess the dentinal desensitizing efficacy of the test dentifrices. Results demonstrated that after four weeks, participants who used the new dentifrice formulation experienced significant decreases in dentinal sensitivity compared to the placebo group for all measured indexes.

Automating data collection, analysis & documentation for medical research

The personal computer (PC) has evolved into a powerful, cost-effective computing platform capable of performing many tasks associated with the management of scientific, clinical, or other information. These activities include: Control of an instrument by the PC; Data acquisition from an experiment or subject; Analysis of the data that the computer has collected; Presentation of the analyzed data in a form that makes it useful; Long term storage of data. Until recently, these tasks required the user to be familiar with a high level programming language (HLL) in order to fulfill these assignments. Arcane text based programs whose logic is often difficult to follow is gradually being replaced by visual programming using a terminology based on icons where ideas familiar to scientists and medical practitioners rely on graphic symbols rather than textual language to describe programming actions.

Desensitizing effect of a potassium chloride dentifrice

Sensodyne F is a potassium chloride (KCl) and sodium monofluorphosphate (MFP) containing dentifrice currently marketed in the United Kingdom and Germany was compared to a KCl only dentifrice and to a placebo dentifrice for effectiveness in alleviating dentin hypersensitivity. This 3-cell, randomized, double-blind, parallel clinical study utilized 62 subjects for an 8-week duration of product use. The degree of hypersensitivity of the affected teeth was assessed by tactile stimulation, cold air stimulation and overall subjective patient response. The results from these three methods of assessment indicated that a KCl containing dentifrice either alone or in combination with sodium MFP were significantly more effective than the placebo dentifrice in reducing dentin hypersensitivity. The therapeutic response to the KCl dentifrices as measured by air sensitivity and tactile sensitivity was statistically significant when compared to the placebo dentifrice within 4 weeks of use. Significant improvement was seen for all parameters at the conclusion of the 8-week clinical study period. Plaque reduction was significantly reduced at 8 weeks. The results indicate that KCl is an efficacious molecule in reducing dentin hypersensitivity when used either alone or in combination with sodium MFP as measured by improved overall patient comfort.

Rheumatoid factor and immune networks

Rheumatoid factors represent a normal component of the immune network. The autoantibodies promote complement fixation and clearance of immune complexes. They amplify the avidity of polyclonally induced IgG. Genes related to the primary structure of rheumatoid-factor light chains are widely distributed in the human population and have been conserved during the evolution and dispersion of the species. Products of these genes may be detected with anti-idiotypic antibodies against synthetic peptides corresponding to individual hypervariable regions on rheumatoid-factor light chains. Such anti-peptide antibodies provide unique reagents for analyzing the genetics of immunoglobulins in outbred populations. Precursors of rheumatoid factor are abundant among immature B lymphocytes. Some of these cells may tend to localize to mucosal surfaces, where they are stimulated directly by pathogenic microorganisms with polyclonal B cell-activating properties. Synthesis of rheumatoid factor regularly accompanies all secondary immune responses but is usually transient. Production of the autoantibody is T-cell dependent. The T cells may recognize antigen in an IgG-antigen immune complex that is processed and presented by B-cell precursors of rheumatoid factor. Rheumatoid factor-associated light-chain idiotypes are rare in serum IgG and on IgG myeloma proteins. They are common among monoclonal IgM proteins and on the surface of the malignant B cells from patients with chronic lymphatic leukemia. The rheumatoid factors that are produced by patients with mixed cryoglobulinemia, or primary Sjogren's syndrome can share idiotypic antigens with monoclonal rheumatoid factors. Rheumatoid factor synthesis in the diseases may reflect an abnormal proliferation of B-cells that is not antigen-driven and that can degenerate into malignancy. The rheumatoid factors in patients with rheumatoid arthritis are diverse and almost certainly represent the outcome of antigen-induced, T cell-dependent mechanisms. The antigens that drive the T cells have not been identified but could represent exogenous microorganisms, self components, or idiotypic antigens that fortuitously interact with rheumatoid factors.

Computer based instruments for laboratory environments

The personal computer is viewed as an all-purpose laboratory instrument and work station. Popular architectures are examined with regard to advantages and limitations, and applications discussed in terms of "stand alone" environments, situations requiring passive interfaces, and those employing intelligent configurations. A new hardware/software architecture is presented which is highly modular, and which supports rapid instrumental reconfiguration, high throughput (information capacity), and ease of use.

Binocular summation on fused annular backgrounds

A paradigm has been proposed to test the hypothesis that binocular fusion results in simple summation, S, of monocular photopic luminances: S = delta LBM(L)/delta LB(2L) = 1, where delta LBM and delta LB are threshold luminances for a monocular and a binocular increment, appearing on a fused background of luminance L or 2L, respectively. This prediction was tested psychophysically, with background size as parameter. Thresholds were measured for a brief (20 ms) foveal flash centered on a luminous disk encircled by a massive black annulus serving as a fusion lock. The flash was presented binocularly, or monocularly, at 30 and 60 cd m-2 background luminances. The diameter of the disk was varied from 3 min to 40 min visual angle. The size of the flash was constant (6 min diameter), except for the smallest disk (3 min diameter). All thresholds varied as a function of background size (the known 'sensitization effect'). The summation index S did not vary with background size. A mean value S = 0.9 was found; this is consistent with the notion that summation of the order of 90% occurs during binocular fusion. We surmise that even a weak monocular test flash makes fusion less than perfect.

A teachers' guide to teaching medical interviewing

Success in teaching a course in medical interviewing requires competence on the part of instructors, who also need training, and have to provide a structured approach. Problems encountered by course coordinators at the Department of Family Medicine, University of Miami School of Medicine, Miami, Florida have been: (1) a shortage of skilled teachers; (2) inadequate motivation of instructors for teaching the course; (3) differences in content, teacher's style, and outcomes from small groups; and (4) ambiguities in structure or guidelines provided for teachers. The development of a teacher's guide, giving specific objectives and step-by-step methods for teaching significantly improved teacher satisfaction and commitment to the course, as well as student learning.

Maximum incisal biting force in denture wearers as influenced by adequacy of denture-bearing tissues and the use of an adhesive

Maximum incisal biting force was measured in 21 subjects by gnathodynamometry. Biting force was directly related to the quality of the denture support tissues. Biting force was increased and denture dislodgements reduced, especially in those with unsatisfactory support tissues, by the use of a test adhesive.

Clinical evaluation of a new treatment for dentinal hypersensitivity

The effectiveness of potassium nitrate (5%, delivered in a low abrasive toothpaste vehicle) as a daily home treatment of dentinal hypersensitivity was evaluated in a 4-week, double-blind, parallel, comparative study of 27 subjects with the condition. Hypersensitivity levels in affected teeth were assessed by two quantifying methods--electrical stimulus and cold air stimulus--and by a subjective recall procedure. The results from these three methods of assessment indicate that potassium nitrate desensitizes hypersensitive teeth to a significant degree. The therapeutic response (decline in dentinal hypersensitivity) to potassium nitrate was evident within 1 week and increased continuously for the length of the study period. Sensitivity threshold of teeth adjudged to be normally sensitive were not altered by treatment with potassium nitrate, nor did the agent exert any discernable effects on oral tissues.

Fluctuations of visibility during dichoptic viewing: Preliminary report

Detection rates were determined for multiple flashes (20-msec duration, 7.5 arc min dia) presented foveally to one eye while the other eye had either a uniform target (the "monocular" condition), a congruent grating (fusion), or an orthogonal grating (rivalry). Average detection rates were highest in the monocular condition, and they were about the same in fusion and rivalry. In all conditions, the typical error (some 70% of all errors) was one stimulus missed out of several simultaneously presented. It was concluded that sensitivity fluctuates over the fovea, even in the absence of contours in the other eye. In two observers, the ratio of detection rates for the two eyes was about the same for all conditions; in two other observers, this ratio decreased (eye dominance increased) in fusion, and especially in rivalry, relative to the monocular condition. The question is raised whether a common link exists between spontaneous fluctuations of sensitivity and those induced by dichoptic contours.

An evaluation of two methods for the quantitation of dentinal hypersensitivity

In a well-controlled, double-blind, parallel study design using burnishing with 33% sodium fluoride paste and "sham" burnishing with a placebo paste, both a cold air stimulus method and an electrical stimulus method can discriminate between levels of dentinal hypersensitivity. Correlation between the scores obtained by the methods was significant. The electrical stimulus method discriminated between the sodium fluoride and placebo effects to a greater degree than did the cold air method. Use of these methods should broaden the scientific foundation and rationale for evaluating the condition of dentinal hypersensitivity and the agents designed for treatment of persons with this condition.

Aspects of intensity of affective constructs in depressed patients

Two groups, 10 subjects in each, one consisting of depressed patients and the others normal controls, ranked photographs of faces for two sets of six constructs. One set consisted of the critical constructs of the Bannister and Fransella grid test, while the other set of constructs were all related to affect. The depressed patients showed a higher intensity score for affective constructs than did the normal subjects. There was no difference for critical constructs. The affective intensity score decreased on two further retestings for the depressed group; for the normal group they remained reasonably constant. These results may shed light on the reorganization in construing aspects of affect which occurs with depression and its remission.

Solid-state animal detection system: its application to open field activity and freezing behavior

A detection system is described which is capable of monitoring animal movements without apparent effect upon the behavior of test animals. Data demonstrate its successful application in measuring either open field activity or freezing behavior in several species of animals. The system can be constructed at low cost and has proven to be both sensitive and reliable.