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Introduction: Asthma, a frequent chronic respiratory disease, poses a public health problem due to its frequency, its impact on patients' lives and its significant direct and indirect costs. Despite all the published recommendations and the availability of increasingly effective therapies, many asthmatics remain poorly monitored, treated and controlled. This is due to several factors, including the association with comorbidities. The aim of this study was to determine the relationship between anxiety, asthma and its control. Patients and Methods: A descriptive cross-sectional study with an analytical aim spread over one year (July 2016-July 2017). Were included in the study all asthmatics whose age was higher than 16 years randomly recruited at the consultation of the pneumophthisiology service of the CHU of Tizi-Ouzou (Algeria). Results: According to the ACT criteria on 300 asthma patients, only 6.3% were controlled, 51.3% had partial control and 42.3% were uncontrolled. The factors negatively influencing asthma control were female gender (p=0.01) and anxiety (p= 0.0004). Factors associated with anxiety were female gender (p=0.001) and heart disease (p=0.00004). Conclusion: Our study highlighted the relationship between asthma and anxiety, which has a negative impact on asthma control. [ABSTRACT FROM AUTHOR]

Background and Aim: There is a worldwide controversy about the choice of microbial flora for use as process hygiene indicators. This study aimed to evaluate the pertinence of using either coliforms or Enterobacteriaceae (EB) as process hygiene indicators in the pasteurized milk production line. Two flora families and total flora were used as bacterial indicators in some stages of pasteurized milk production line to identify the origin of post-pasteurization contamination and compare the results obtained for each flora. In addition, the bacteriological profile of isolated coliforms and EB was developed. Materials and Methods: One thousand and two hundred samples of pasteurized cow milk and surfaces (pipes and tank) at various processing stages were taken from two dairies in the northern region of Algeria. The total microbial flora (TF), total coliforms (TC), thermotolerant coliforms, and EB were enumerated, following the recommendations of ISO 4833:2006, ISO 4832:2006, and ISO 21528-2:2017 methods, respectively. The bacteriological profile was determined using the API 20E and 10S tests (bioMérieux, France). Furthermore, the cleaning efficiency and disinfection protocol of surfaces were evaluated using contact agar slides 1 (Liofilchem™, Italy). Results: Enumeration of the different indicators shows that the highest contamination rate is recorded by the total flora in the two units, 3.28 and 3.78 log CFU/mL, respectively. EB (–0.60 log CFU/mL) at post-pasteurization stage in Unit 1 and coliforms (0.44 log CFU/mL) at the pasteurized packaged milk stage in Unit 2 are the least significant germ families. The lowest compliance rates of bacterial contamination were reported for total flora (82-85%) at the three sampled sites in Unit 2. In comparison, the highest was reported in Unit 1 (99.8%) and 2 (98%) by the EB indicator. Assessing the surface cleaning and disinfection protocol compliance shows that the tank records the highest non-compliance rates for EB and TF (4% and 3%) in Unit 2. EB are represented in both units by various species. Acinetobacter baumannii in Unit 1 and Enterobacter cloacae in Unit 2 are the common species of the three indicator families. Acinetobacter and Enterobacter in Unit 1, Escherichia, Citrobacter, Enterobacter, Klebsiella, and Hafnia in Unit 2 are the most time persistent bacterial genera along the production line. Stenotrophomonas, Serratia, Salmonella, Enterobacter, and Escherichia are common genera in both units. Conclusion: The results obtained show no difference in the use of EB or TC as hygiene indicators. However, if the objective is to identify the species of bacterial populations, using EBs are the most appropriate.

The structural and dielectric properties of iron and bismuth co-substituted BaTiO3 ceramic with the formula: B0.95Bi0.05Ti1-xFexO3 for x=0.00 to 1.00, synthesis with solid state route, were characterized. The X-ray diffraction results show a tetragonal phase for x=0.00. While for x=0.40 to 0.80 we observed a coexistence of tree phase tetragonal, hexagonal and pseudo-cubic. And at x=1.00 only the pseudo-cubic phase is present and the other phase disappeared. The Raman results indicate the existence of tetragonal band for x≤0.40, and an appearance of characteristic bands of Fe3+ ions for more than 0.40 of Fe content. The SEM micrographs show an increase in grain size with the increase of Fe content and it reaches a maximum at x=0.40. And the Mossbauer spectroscopy indicates that our samples is paramagnetic at room temperature and that the Fe is oxidized under Fe3+ with no existence of Fe2+ and Fe4+ ions. The temperature dependence of dielectric permittivity was investigated in the frequency range from 20 Hz to 2MHz. The results show three dielectric relaxation phase transitions from a rhombohedral ferroelectric to orthorhombic ferroelectric (TR-O) then to a tetragonal ferroelectric phase (at TO-T), and finally to cubic paraelectric at the Curie temperature (TC). In addition, the temperature of phase transition shifted to the lower temperature with the increase of Fe content for all the phase transitions. And the maximum of dielectric permittivity increases for TR-O while for TT-O and Tm phases transitions, it reaches a maximum at x=0.60 and x=0.80 respectively and then decreases.

Study Design: A 5-year longitudinal, retrospective, cohort study., Objectives: Develop a prediction model based on electronic health record (EHR) data to identify veterans with spinal cord injury/diseases (SCI/D) at highest risk for new pressure injuries (PIs)., Setting: Structured (coded) and text EHR data, for veterans with SCI/D treated in a VHA SCI/D Center between October 1, 2008, and September 30, 2013., Methods: A total of 4709 veterans were available for analysis after randomly selecting 175 to act as a validation (gold standard) sample. Machine learning models were created using ten-fold cross validation and three techniques: (1) two-step logistic regression; (2) regression model employing adaptive LASSO; (3) and gradient boosting. Models based on each method were compared using area under the receiver-operating curve (AUC) analysis., Results: The AUC value for the gradient boosting model was 0.62 (95% CI = 0.54-0.70), for the logistic regression model it was 0.67 (95% CI = 0.59-0.75), and for the adaptive LASSO model it was 0.72 (95% CI = 0.65-80). Based on these results, the adaptive LASSO model was chosen for interpretation. The strongest predictors of new PI cases were having fewer total days in the hospital in the year before the annual exam, higher vs. lower weight and most severe vs. less severe grade of injury based on the American Spinal Cord Injury Association (ASIA) Impairment Scale., Conclusions: While the analyses resulted in a potentially useful predictive model, clinical implications were limited because modifiable risk factors were absent in the models., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Complementary and integrative health (CIH) approaches have been recommended in national and international clinical guidelines for chronic pain management. We set out to determine whether exposure to CIH approaches is associated with pain care quality (PCQ) in the Veterans Health Administration (VHA) primary care setting. Methods: We followed a cohort of 62,721 Veterans with newly diagnosed musculoskeletal disorders between October 2016 and September 2017 over 1-year. PCQ scores were derived from primary care progress notes using natural language processing. CIH exposure was defined as documentation of acupuncture, chiropractic or massage therapies by providers. Propensity scores (PSs) were used to match one control for each Veteran with CIH exposure. Generalized estimating equations were used to examine associations between CIH exposure and PCQ scores, accounting for potential selection and confounding bias. Results: CIH was documented for 14,114 (22.5%) Veterans over 16,015 primary care clinic visits during the follow-up period. The CIH exposure group and the 1:1 PS-matched control group achieved superior balance on all measured baseline covariates, with standardized differences ranging from 0.000 to 0.045. CIH exposure was associated with an adjusted rate ratio (aRR) of 1.147 (95% confidence interval [CI]: 1.142, 1.151) on PCQ total score (mean: 8.36). Sensitivity analyses using an alternative PCQ scoring algorithm (aRR: 1.155; 95% CI: 1.150-1.160) and redefining CIH exposure by chiropractic alone (aRR: 1.118; 95% CI: 1.110-1.126) derived consistent results. Discussion : Our data suggest that incorporating CIH approaches may reflect higher overall quality of care for patients with musculoskeletal pain seen in primary care settings, supporting VHA initiatives and the Declaration of Astana to build comprehensive, sustainable primary care capacity for pain management. Future investigation is warranted to better understand whether and to what degree the observed association may reflect the therapeutic benefits patients actually received or other factors such as empowering provider-patient education and communication about these approaches.

Dromedary camels are an important source of food and income in many countries. However, it has been largely overlooked that they can also transmit antibiotic-resistant bacteria. The aim of this study was to identify the Staphylococcaceae bacteria composition of the nasal flora in dromedary camels and evaluate the presence of methicillin-resistant Mammaliicoccus (MRM) and methicillin-resistant Staphylococcus (MRS) in dromedary camels in Algeria. Nasal swabs were collected from 46 camels from seven farms located in two different regions of Algeria (M'sila and Ouargla). We used non-selective media to determine the nasal flora, and antibiotic-supplemented media to isolate MRS and MRM. The staphylococcal isolates were identified using an Autoflex Biotyper Mass Spectrometer (MALDI-TOF MS). The mecA and mecC genes were detected by PCR. Methicillin-resistant strains were further analysed by long-read whole genome sequencing (WGS). Thirteen known Staphylococcus and Mammaliicoccus species were identified in the nasal flora, of which half (49.2%) were coagulase-positive staphylococci. The results showed that four out of seven farms were positive for MRS and/or MRM, with a total of 16 isolates from 13 dromedary camels. The predominant species were M. lentus , S. epidermidis , and S. aureus . Three methicillin-resistant S. aureus (MRSA) were found to be ST6 and spa type t304. Among methicillin-resistant S. epidermidis (MRSE), ST61 was the predominant ST identified. Phylogenetic analysis showed clonal relatedness among M. lentus strains, while S. epidermidis strains were not closely related. Resistance genes were detected, including mecA , mecC , ermB , tet (K), and blaZ . An SCC mec type VIII element was found in a methicillin-resistant S. hominis (MRSH) belonging to the ST1 strain. An SCC mec - mecC hybrid element was detected in M. lentus , similar to what was previously detected in M. sciuri . This study highlights that dromedary camels may be a reservoir for MRS and MRM, and that they contain a specific set of SCC mec elements. This emphasizes the need for further research in this ecological niche from a One Health perspective.

Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain during primary care visits in the Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD = 2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR = 1.006, 95%CI 1.002-1.010, P = .007). Depression, alcohol use disorder, other substance use disorder, schizophrenia, and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care. PERSPECTIVE: This study used a natural language processing approach to analyze medical records to determine whether mental health conditions are associated with indicators of pain care quality as documented by primary care clinicians. Findings suggest that presence of a diagnosed mental health condition is not associated with lower quality pain care., (Published by Elsevier Inc.)

Abstract: The lack of a reliable approach to assess quality of pain care hinders quality improvement initiatives. Rule-based natural language processing algorithms were used to extract pain care quality (PCQ) indicators from documents of Veterans Health Administration primary care providers for veterans diagnosed within the past year with musculoskeletal disorders with moderate-to-severe pain intensity across 2 time periods 2013 to 2014 (fiscal year [FY] 2013) and 2017 to 2018 (FY 2017). Patterns of documentation of PCQ indicators for 64,444 veterans and 124,408 unique visits (FY 2013) and 63,427 veterans and 146,507 visits (FY 2017) are described. The most commonly documented PCQ indicators in each cohort were presence of pain, etiology or source, and site of pain (greater than 90% of progress notes), while least commonly documented were sensation, what makes pain better or worse, and pain's impact on function (documented in fewer than 50%). A PCQ indicator score (maximum = 12) was calculated for each visit in FY 2013 (mean = 7.8, SD = 1.9) and FY 2017 (mean = 8.3, SD = 2.3) by adding one point for every indicator documented. Standardized Cronbach alpha for total PCQ scores was 0.74 in the most recent data (FY 2017). The mean PCQ indicator scores across patient characteristics and types of healthcare facilities were highly stable. Estimates of the frequency of documentation of PCQ indicators have face validity and encourage further evaluation of the reliability, validity, and utility of the measure. A reliable measure of PCQ fills an important scientific knowledge and practice gap., (Copyright © 2021 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Affective characteristics are associated with depression severity, course, and prognosis. Patients' affect captured by clinicians during sessions may provide a rich source of information that more naturally aligns with the depression course and patient-desired depression outcomes., Objective: In this paper, we propose an information extraction vocabulary used to pilot the feasibility and reliability of identifying clinician-recorded patient affective states in clinical notes from electronic health records., Methods: Affect and mood were annotated in 147 clinical notes of 109 patients by 2 independent coders across 3 pilots. Intercoder discrepancies were settled by a third coder. This reference annotation set was used to test a proof-of-concept natural language processing (NLP) system using a named entity recognition approach., Results: Concepts were frequently addressed in templated format and free text in clinical notes. Annotated data demonstrated that affective characteristics were identified in 87.8% (129/147) of the notes, while mood was identified in 97.3% (143/147) of the notes. The intercoder reliability was consistently good across the pilots (interannotator agreement [IAA] >70%). The final NLP system showed good reliability with the final reference annotation set (mood IAA=85.8%; affect IAA=80.9%)., Conclusions: Affect and mood can be reliably identified in clinician reports and are good targets for NLP. We discuss several next steps to expand on this proof of concept and the value of this research for depression clinical research., (©Vanessa Panaite, Andrew R Devendorf, Dezon Finch, Lina Bouayad, Stephen L Luther, Susan K Schultz. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.05.2022.)

Introduction: Asthma, a frequent chronic respiratory disease, poses a public health problem due to its frequency, its impact on patients' lives and its significant direct and indirect costs. Despite all the published recommendations and the availability of increasingly effective therapies, many asthmatics remain poorly monitored, treated and controlled. This is due to several factors, including the association with comorbidities. The aim of this study was to determine the relationship between anxiety, asthma and its control., Patients and Methods: A descriptive cross-sectional study with an analytical aim spread over one year (July 2016-July 2017). Were included in the study all asthmatics whose age was higher than 16 years randomly recruited at the consultation of the pneumophthisiology service of the CHU of Tizi-Ouzou (Algeria)., Results: According to the ACT criteria on 300 asthma patients, only 6.3% were controlled, 51.3% had partial control and 42.3% were uncontrolled. The factors negatively influencing asthma control were female gender (p=0.01) and anxiety (p= 0.0004). Factors associated with anxiety were female gender (p=0.001) and heart disease (p=0.00004)., Conclusion: Our study highlighted the relationship between asthma and anxiety, which has a negative impact on asthma control., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (DL-PCBs) in fish samples have been investigated in many previous studies. However, the available data regarding this issue in low- and middle-income countries are very scarce, and no study has been performed in Algeria yet. Therefore, this work aimed to determine the levels of PCDD/Fs and DL-PCBs in swordfish (Xiphias gladius) caught in three regions of the Algerian coasts, and the health risk associated with these contaminants was assessed. The PCDD/Fs and DL-PCBs were analyzed in 37 fish samples from Algiers, Bejaia, and Oran using the DR-CALUX bioassay method. The overall mean (and standard deviation) of PCDD/Fs and DL-PCBs concentrations in swordfish from Algiers, Bejaia, and Oran were 0.19 (0.13), 0.27 (0.24), and 0.08 (0.05) pg TEQ g -1 wet weight (ww), respectively, which were lower than the national and European regulatory limits. Daily and weekly intake values of PCDD/F and DL-PCB were higher for the samples from Bejaia (0.45 and 3.15 pg TEQ kg -1 body weight (bw) per day and week, respectively) and for the samples from Algiers (0.31 and 2.17 pg TEQ kg -1 bw per day and week, respectively), which were higher than the tolerable weekly intake of 2 pg TEQ kg -1 bw per week recently established by the European Food Safety Authority. Overall, our findings indicate that swordfish consumption poses a risk to the Algerian consumer.

In this study, the levels of arsenic (As), cadmium (Cd) and lead (Pb) have been determined in the flesh of two species of fish, sardine ( Sardina pilchardus ) and swordfish ( Xiphias gladius ) fished in the Algerian coast. Quantification of As, Cd and Pb was carried out using an ICP-MS method and the results were compared with the thresholds set by national and international regulatory bodies. In a further step, the risk to consumers was assessed using estimated daily intake (EDI), target hazard quotient (THQ) and hazard index (HI).The average concentration of As and Pb was higher in sardine (1.82; 0.10 mg kg -1 w.w., respectively), than in swordfish (1.10 mg kg -1 w.w.; not determined), whereas the concentration recorded for Cd was the same for both species (0.01 mg kg -1 w.w.). These concentrations are below maximum limits set in regulations. The THQs and HI were widely below 1. The consumption of these fish does not pose risk to the consumers.

Aim: The objectives of this study were to assess the prevalence of Staphylococcus aureus in raw milk in Algerian dairies, to study the effect of seasons on the contamination of milk and the susceptibility of isolated strains to antibiotics, and to estimate the risk on the health consumer., Materials and Methods: The ISO method 6888-1 (1) was used for Staphylococcus screening. Antimicrobial susceptibility to the 11most used antibiotics in veterinary medicine was assessed using the disk diffusion assay., Results: The overall prevalence was 31.56% (95/301); 34.84% (85/244) from raw milk collectors cisterns (MCC), 22.73% (5/22) from mixing tank milk before pasteurization, and 14.29% (5/35) from pasteurized tank milk (p<0.05). A significant difference (p<0.001) of contamination on MCC was observed between dairies without season influence (p≥0.05). It was observed that 49.47% of S. aureus isolates were resistant to penicillin, 5.26% to tetracycline, 4.21% to erythromycin, 3.15% to neomycin, 2.10% to cefoxitin, 2.10% to clindamycin, and 1.05% to ofloxacin. No resistance was observed for vancomycin, gentamicin, chloramphenicol, and trimethoprim-sulfamethoxazole., Conclusion: A high prevalence of S. aureus from MCC was observed without significant effect of season. The pasteurization does not ensure the elimination of bacteria in all samples. Half of the isolates were resistant to penicillin. These findings emphasize the importance of S. aureus control in Algerian milk industry at different levels to improve public health.

Aim: The present study was conducted to evaluate the capacity of Listeria monocytogenes (L.m), Listeria innocua (L.i), and Escherichia coli to form biofilms on polystyrene support under different parameters by performing crystal violet (CV) staining technique., Materials and Methods: Different suspensions were prepared with single strains and with multiple combinations of strains including two serogroups of L.m ( IIa and IIb ), L.i, and E. coli strains at different microbial load. Selected strains and combinations were grown in biofilms for 6 days attached to polystyrene microplates under aerobic and microaerophilic conditions. The evaluation of the power of adhesion and biofilm formation was determined by CV staining followed by the measurement of optical density at 24 h, 72 h, and 6 days incubation time with and without renewal of the culture medium., Results: All the strains tested, presented more or less adhesion power depending on the variation of the studied parameters as well as the ability to form multispecies biofilms. Their development is more important by renewing the culture medium and increasing the initial load of bacteria. The ability to adhere and form biofilms differs from one serogroup to another within the same species. In bacterial combination, strains and species of bacteria adopt different behaviors., Conclusion: The ability to form biofilms is a key factor in the persistence of tested strains in the environment. Our study showed that L.m, L.i, and E. coli could adhere to polystyrene and form biofilms under different conditions. More researches are necessary to understand the mechanisms of biofilm formation and the influence of different parameters in their development.

Aim: This study aimed to evaluate mercury (Hg), cadmium (Cd), and lead (Pb) levels in 70 samples of sardine ( Sardina pilchardus ) and 30 samples of swordfish ( Xiphias gladius ) fished in the Algerian coasts., Materials and Methods: After the mineralization of the fish samples through the pressure digestion, the analyses were carried out by inductively coupled plasma atomic emission spectroscopy., Results: Mean concentrations of Hg, Cd, and Pb in sardine were 0.62, 0.55, and 2.13 mg/kg wet weight, respectively, while in swordfish, the concentrations were 0.56, 0.57, and 3.9 mg/kg wet weight, respectively. These results exceeded the Algerian and European legislation threshold values, whereas Hg's concentration in swordfish remained close to and did not exceed the recommended thresholds (0.56 mg/kg wet weight)., Conclusion: This fish may represent a hazard for consumers in Algeria. Systematic and periodic controls of heavy metals in fish are recommended, and risk assessment is needed to protect the consumer.

Objective: Develop an approach, One-class-at-a-time, for triaging psychiatric patients using machine learning on textual patient records. Our approach aims to automate the triaging process and reduce expert effort while providing high classification reliability., Materials and Methods: The One-class-at-a-time approach is a multistage cascading classification technique that achieves higher triage classification accuracy compared to traditional multiclass classifiers through 1) classifying one class at a time (or stage), and 2) identification and application of the highest accuracy classifier at each stage. The approach was evaluated using a unique dataset of 433 psychiatric patient records with a triage class label provided by "I2B2 challenge," a recent competition in the medical informatics community., Results: The One-class-at-a-time cascading classifier outperformed state-of-the-art classification techniques with overall classification accuracy of 77% among 4 classes, exceeding accuracies of existing multiclass classifiers. The approach also enabled highly accurate classification of individual classes-the severe and mild with 85% accuracy, moderate with 64% accuracy, and absent with 60% accuracy., Discussion: The triaging of psychiatric cases is a challenging problem due to the lack of clear guidelines and protocols. Our work presents a machine learning approach using psychiatric records for triaging patients based on their severity condition., Conclusion: The One-class-at-a-time cascading classifier can be used as a decision aid to reduce triaging effort of physicians and nurses, while providing a unique opportunity to involve experts at each stage to reduce false positive and further improve the system's accuracy.

Aim: Sources of contamination, prevalence, and antimicrobial susceptibility of thermophilic Campylobacter isolated from turkey samples were determined., Materials and Methods: A total of 300 samples were collected from 3 farms (fecal droppings) and 4 poultry slaughterhouses (neck skins and ceca) located in the middle area of Algeria (Algiers, Boumerdès, and Bouira). After detection, an antibiogram was realized only for slaughterhouses samples., Results: Samples from cecum (90.0%, 90/100; 95% confidence interval (CI)=84.1-95.9%), fecal dropping (68.0%, 68/100; 95% CI=58.9-77.1%), and neck skin (55.0%, 55/100; 95% CI=45.2-64.8%) were positive for thermophilic Campylobacter (p<0.05). Contamination rate of turkey carcasses was higher in modern slaughterhouse (96.7%) than in traditional slaughterhouses (37.1%) (p<0.05). Isolated strains were resistant to nalidixic acid (NA) (87.5%), tetracycline (TE) (81.3%), ciprofloxacin (CIP) (75.0%), ampicillin (AM) (65.6%), and erythromycin (25.0%) (p<0.05). 96.9% (124/128) of the isolates were multiresistant and 18 drug resistance patterns were registered. The predominant one (43.0%) was AM, NA, CIP, and TE., Conclusions: Potential sources of contamination of this fastidious bacterium were noticed in farms and slaughterhouses. Modern slaughterhouse allowed contamination of turkey carcasses more than a traditional slaughterhouse. However, the scalding step could not represent a source of contamination. The most tested strains exhibited resistance to erythromycin and/or CIP. It is worrisome because these molecules are considered as first-choice antibiotics for human campylobacteriosis.

Pain is a significant public health problem, affecting millions of people in the USA. Evidence has highlighted that patients with chronic pain often suffer from deficits in pain care quality (PCQ) including pain assessment, treatment, and reassessment. Currently, there is no intelligent and reliable approach to identify PCQ indicators inelectronic health records (EHR). Hereby, we used unstructured text narratives in the EHR to derive pain assessment in clinical notes for patients with chronic pain. Our dataset includes patients with documented pain intensity rating ratings > = 4 and initial musculoskeletal diagnoses (MSD) captured by (ICD-9-CM codes) in fiscal year 2011 and a minimal 1 year of follow-up (follow-up period is 3-yr maximum); with complete data on key demographic variables. A total of 92 patients with 1058 notes was used. First, we manually annotated qualifiers and descriptors of pain assessment using the annotation schema that we previously developed. Second, we developed a reliable classifier for indicators of pain assessment in clinical note. Based on our annotation schema, we found variations in documenting the subclasses of pain assessment. In positive notes, providers mostly documented assessment of pain site (67%) and intensity of pain (57%), followed by persistence (32%). In only 27% of positive notes, did providers document a presumed etiology for the pain complaint or diagnosis. Documentation of patients' reports of factors that aggravate pain was only present in 11% of positive notes. Random forest classifier achieved the best performance labeling clinical notes with pain assessment information, compared to other classifiers; 94, 95, 94, and 94% was observed in terms of accuracy, PPV, F1-score, and AUC, respectively. Despite the wide spectrum of research that utilizes machine learning in many clinical applications, none explored using these methods for pain assessment research. In addition, previous studies using large datasets to detect and analyze characteristics of patients with various types of pain have relied exclusively on billing and coded data as the main source of information. This study, in contrast, harnessed unstructured narrative text data from the EHR to detect pain assessment clinical notes. We developed a Random forest classifier to identify clinical notes with pain assessment information. Compared to other classifiers, ours achieved the best results in most of the reported metrics. Graphical abstract Framework for detecting pain assessment in clinical notes.

Background: A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels., Objective: The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice., Methods: We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content., Results: We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation., Conclusions: Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR system use, and costs associated with PHR data storage and analytics., (©Lina Bouayad, Anna Ialynytchev, Balaji Padmanabhan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.11.2017.)

Background: Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population., Objective: The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran's electronic health record (EHR)., Methods: This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determined if these were found in structured data or unstructured form in narrative clinical notes for FY 2009-2013. These data are from the VHA enterprise Corporate Data Warehouse that is derived from the EHR structured (ie, coded in database/table) or narrative (ie, text in clinical notes) data for FY 2009-2013., Results: This study is ongoing and final results are expected in 2017. Thus far, the expert panel reviewed the initial list of risk factors extracted from the literature; the panel recommended additions and omissions and provided insights about the format in which the documentation of the risk factors might exist in the EHR. This list was then iteratively refined through review and discussed with individual experts in the field. The cohort for the study was then identified, and all structured, unstructured, and semistructured data were extracted. Annotation schemas were developed, samples of documents were extracted, and annotations are ongoing. Operational definitions of structured data elements have been created and steps to create an analytic dataset are underway., Conclusions: To our knowledge, this is the largest cohort employed to identify PrU risk factors in the United States. It also represents the first time natural language processing and statistical text mining will be used to expand the number of variables available for analysis. A major strength of this quantitative study is that all VHA SCI centers were included in the analysis, reducing potential for selection bias and providing increased power for complex statistical analyses. This longitudinal study will eventually result in a risk prediction tool to assess PrU risk that is reliable and valid, and that is sensitive to this vulnerable population., Competing Interests: Conflicts of Interest: None declared., (©Stephen L Luther, Susan S Thomason, Sunil Sabharwal, Dezon K Finch, James McCart, Peter Toyinbo, Lina Bouayad, Michael E Matheny, Glenn T Gobbel, Gail Powell-Cope. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 19.01.2017.)

Pain is a significant public health problem, affecting an estimated 100 million Americans. Evidence has highlighted that patients with chronic pain often suffer from deficits in pain care quality (PCQ). Efforts to improve PCQ hinge on the identification of reliable PCQ indicators such as pain assessment. In this study, we developed a classifier that leverages narratives in clinical notes to derive indicators of pain assessment for patients with chronic pain.

Products from three broiler abattoirs were sampled for Listeria species to evaluate the changes in the prevalence and contamination rates at two stages of processing. Sampling was performed at the evisceration stage and at the end of processing after packaging and refrigerating at 4°C for 24 h. A total of 212 samples were collected; 52 were from abattoir A, and 80 samples each were collected from abattoirs B and C. Among all samples, 99 (46.7%) tested positive for Listeria, including L. monocytogenes 19 (8.9%), L. innocua 69 (32.5%), L. grayi 10 (4.7%), and L. welshimeri 1 (0.5%). The L. monocytogenes contamination rate varied from 5% to 11.5% in the 3 abattoirs. L. innocua was the most common species identified and was found in 8.8% of the samples from abattoir A and 33.7% of the samples from both abattoirs B and C. Twenty-six of the L. monocytogenes isolates obtained from positive samples were subjected to serotyping by multiplex polymerase chain reaction and characterization by the pulsed-field gel electrophoresis (PFGE) method using two cutting enzymes, ApaI and AscI. Three molecular serogroups were identified: IIa, IIb, and IVb. Serogroup IIa was common to all abattoirs, and serogroups IIb and IVb were found only in abattoir C. The 10 different obtained PFGE profiles were grouped into 7 clusters; some of these clusters were common to the 3 abattoirs, and others were specific to the abattoirs in which they were identified. This study revealed a high prevalence of Listeria spp., particularly L. monocytogenes, in raw broilers. This high incidence presents a risk to consumers due to the potential occurrence of cross-contamination with other foods in domestic refrigerators and the ability of these microorganisms to survive in undercooked products.