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Competing Interests: Disclosure: The authors declare that they have nothing to disclose.

Clinical documentation in electronic health records contains crucial narratives and details about patients and their care. Natural language processing (NLP) can unlock the information conveyed in clinical notes and reports, and thus plays a critical role in real-world studies. The NLP Working Group at the Observational Health Data Sciences and Informatics (OHDSI) consortium was established to develop methods and tools to promote the use of textual data and NLP in real-world observational studies. In this paper, we describe a framework for representing and utilizing textual data in real-world evidence generation, including representations of information from clinical text in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM), the workflow and tools that were developed to extract, transform and load (ETL) data from clinical notes into tables in OMOP CDM, as well as current applications and specific use cases of the proposed OHDSI NLP solution at large consortia and individual institutions with English textual data. Challenges faced and lessons learned during the process are also discussed to provide valuable insights for researchers who are planning to implement NLP solutions in real-world studies., Competing Interests: Declaration of Competing Interest Dr. Hua Xu and The University of Texas Health Science Center at Houston have research related financial interests at Melax Technologies Inc. Dr. Xiaoyan Wang has related financial interests at Sema4 Mount Sinai Genomics Inc., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To determine whether phosphodiesterase-5 inhibitor documentation is associated with biochemical relapse-free and overall survival of patients with prostate cancer treated with radical prostatectomy., Materials and Methods: We undertook a retrospective cohort analysis of 3,100 patients with prostate cancer treated with radical prostatectomy between 2003 and 2015. The patients were categorized as a phosphodiesterase- 5- inhibitor user or non-user. The biochemical relapse-free and overall survival at 5-years and 10-years were determined., Results: Of the patients, 1,372 reported phosphodiesterase-5 inhibitor documentation, and 1,728 did not. The biochemical recurrence-free survival for non-users at 5- and 10-years follow-up was 87.6% and 85.3%, respectively, and the overall survival at these time intervals was 97.9% and 94.5%. The biochemical recurrence-free survival for phosphodiesterase-5 inhibitor users was 94.3% and 93.2% at 5- and 10-years follow-up, respectively, and overall survival was 99.2% and 95.8% at these intervals. The hazard ratio for biochemical recurrence-free survival was 0.44 (CI 0.34-0.56) and for overall survival was 0.65 (CI 0.45-0.94). On the multivariate analysis, phosphodiesterase-5 inhibitor documentation was associated with a lower risk of biochemical recurrence and death when corrected for the other variables. Age at surgery and Gleason scores >8 was associated with a higher risk of death. Higher pathological stage, higher Gleason score, presence of lymph node metastases, and nonwhite race were associated with a higher risk of recurrence., Conclusion: This retrospective analysis revealed a significant association of postoperative phosphodiesterase-5 inhibitor documentation with biochemical recurrence-free- and overall survival in patients with localized prostate cancer treated with radical prostatectomy. Larger scale studies are warranted to investigate the clinical significance of this association., Competing Interests: Conflict of interest No authors have any conflicts of interest with subjects in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Multiple studies have investigated the role of statins in prostate cancer (CaP), the leading cause of cancer related death in men. Retrospective cohort studies investigating the correlation between statin use and biochemical recurrence free (BCRF) survival in men with CaP have been inconclusive., Objectives: In the largest reported surgical cohort to date, we investigated the effect of statin therapy on BCRF and overall survival in patients with CaP who have undergone radical prostatectomy (RP)., Patients and Methods: We performed a retrospective analysis of men (n = 3,088) participating in the NCI funded Specialized Program of Research Excellence (SPORE) in CaP at Northwestern University (NM) in Chicago, Illinois. Patients were treated with RP between 2002 and 2015. Patients in the statin users group received treatment within 2 years prior to or subsequent to RP. Wilcoxon rank-sum and Fisher's exact tests were used to compare age, race, Gleason score, clinical staging, and pathological stage between statin users and nonstatin users., Results: The analysis identified 1,222 statin users and 1,865 nonusers (mean age 71 years, 92% Caucasian). After a median follow-up time of 49.0 months, the 5-year BCRF survival rate was 93.3% (95% confidence interval [CI]: 91.9-94.8%) among statin users and 88.6% (95% CI: 87.1%-90%) among nonusers (log-rank P< 0.001). After 10 years, the progression-free survival (PFS) was 91.7% (95% CI: 90.1%-93.3%) among statin users and 86.5% (95% CI: 84.4%-88.2%) among nonusers (log-rank P< 0.001)., Conclusions: Extended follow-up data in this large surgical cohort show statin use improves BCRF but not overall survival in RP patients., (Copyright © 2020. Published by Elsevier Inc.)

Observational research in cancer requires substantially more detail than most other therapeutic areas. Cancer conditions are defined through histology, affected anatomical structures, staging and grading, and biomarkers, and are treated with complex therapies. Here, we show a new cancer module as part of the OMOP CDM, allowing manual and automated abstraction and standardized analytics. We tested the model in EHR and registry data against a number of typical use cases.

Vertebrates utilize six extraocular muscles that attach to a tough, protective sclera to rotate the eye. The goal of the study was to describe the maximum tetanic forces, as well as the torques produced by the six extraocular muscles of the piked dogfish Squalus acanthias to understand the forces exerted on the eye. The lateral rectus extraocular muscle of Squalus acanthias was determined to be parallel fibered with the muscle fibers bundled into discrete fascicles. The extraocular muscles attach to the sclera by muscular insertions. The total tensile forces generated by the extraocular muscles ranged from 1.18 N to 2.21 N. The torques of the extraocular muscles ranged from 0.39 N to 2.34 N. The torques were greatest in the principal direction of movement for each specific muscle. The lateral rectus produced the greatest total tensile force, as well as the greatest torque force component, while the medial rectus produced the second greatest. This is likely due to the constant rotational movement of the eye anteriorly and posteriorly to stabilize the visual image, as well as increase the effective visual field during swimming. Rotational forces in dimensions other than the primary direction of movement may contribute to motion in directions other than the principal direction during multi-muscle contraction that occurs in the vertebrate eye. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. Anat Rec, 302:837-844, 2019. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)

Background: We developed a cardiac SPECT system (X-ACT) with low dose volume CT transmission-based attenuation correction (AC). Three solid-state detectors are configured to form a triple-head system for emission scans and reconfigured to form a 69-cm field-of-view detector arc for transmission scans. A near mono-energetic transmission line source is produced from the collimated fluorescence x-ray emitted from a lead target when the target is illuminated by a narrow polychromatic x-ray beam from an x-ray tube. Transmission scans can be completed in 1 min with insignificant patient dose (deep dose equivalent <5 muSv)., Methods: We used phantom studies to evaluate (1) the accuracy of the reconstructed attenuation maps, (2) the effect of AC on image uniformity, and (3) the effect of AC on defect contrast (DC). The phantoms we used included an ACR phantom, an anthropomorphic phantom with a uniform cardiac insert, and an anthropomorphic phantom with two defects in the cardiac insert., Results: The reconstructed attenuation coefficient of water at 140 keV was .150 +/- .003/cm in the uniform region of the ACR phantom, .151 +/- .003/cm and .151 +/- .002/cm in the liver and cardiac regions of the anthropomorphic phantom. The ACR phantom images with AC showed correction of the bowing effect due to attenuation in the images without AC (NC). The 17-segment scores of the images of the uniform cardiac insert were 78.3 +/- 6.5 before and 87.9 +/- 3.3 after AC (average +/- standard deviation). The inferior-to-anterior wall ratio and the septal-to-lateral wall ratio were .99 and 1.16 before and 1.02 and 1.00 after AC. The DC of the two defects was .528 and .156 before and .628 and .173 after AC., Conclusion: The X-ACT system generated accurate attenuation maps with 1-minute transmission scans. AC improved image quality and uniformity over NC.

Background: In cardiac SPECT perfusion imaging, motion correction of the data is critical to the minimization of motion introduced artifacts in the reconstructed images. Software-based (data-driven) motion correction techniques are the most convenient and economical approaches to fulfill this purpose. However, the accuracy is significantly affected by how the data complexities, such as activity overlap, non-uniform tissue attenuation, and noise are handled., Methods: We developed STASYS, a new, fully automatic technique, for motion detection and correction in cardiac SPECT. We evaluated the performance of STASYS by comparing its effectiveness of motion correcting patient studies with the current industry standard software (Cedars-Sinai MoCo) through blind readings by two readers independently., Results: For 204 patient studies from multiple clinical sites, the first reader identified (1) 69 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 86.9% and MoCo 72.5%; and (2) 20 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 80.0% and MoCo 60.0%. The second reader identified (1) 84 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 82.2% and MoCo 76.2%; and (2) 34 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 58.9% and MoCo 50.0%., Conclusions: We developed a fully automatic software-based motion correction technique, STASYS, for cardiac SPECT. Clinical studies showed that STASYS was effective and corrected a larger percent of cardiac SPECT studies than the current industrial standard software.

Purpose: To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis., Methods and Results: Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent "burst-bolus" technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients., Conclusions: Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.

Visiting hours play an integral role in the intensive care unit (ICU) for both patients and health care providers. Family members offer support and comfort to patients during critical illnesses. Nurses, however, often view visiting hours as intrusive and time consuming. The issue of restricted versus open visiting hours continues in many ICUs, and the advantages and disadvantages of both types of visitation must be weighed before selecting the visiting hours appropriate for the institution.

Thirty male mice from three inbred strains (C57BL/10J, BALB/cJ, C3H/2Ibg) were assigned to infantile handling or control conditions. At sixty days of age, all animals were tested in a two-choice situation for selection of 10% ethanol vs. water. Consumption from both drinking tubes was recorded for 15 days and selection ratios for alcohol per total fluid volume were calculated. C57 mice demonstrated increased preference for alcohol as a result of early handling. The BALB strain, known for low preference for alcohol, showed increased preference for alcohol as well. C3H mice evinced a biphasic effect of early handling, showing an initially greater acceptance of alcohol as compared to controls, followed by decreased selection.