Combining deep neural networks, a rule-based expert system and targeted manual coding for ICD-10 coding causes of death of French death certificates from 2018 to 2019.

OBJECTIVE: For ICD-10 coding causes of death in France in 2018 and 2019, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team focused on certificates with a special public health interest and those for which DNNs have a low confidence index. METHODS: Supervised seq-to-seq DNNs are trained on previously coded data to ICD-10 code multiple causes and underlying causes of death. The DNNs are then used to target death certificates to be sent to the coding team and to predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign for 2018 and 2019 combines three modes of coding and a loop of interaction between the three. FINDINGS: In this campaign, 62% of the certificates are automatically batch coded by the expert system, 3% by the coding team, and the remainder by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 93.4% for ICD-10 coding of the underlying cause (95.6% at the European shortlist level). Some limitations (risks of under- or overestimation) appear for certain ICD categories, with the advantage of being quantifiable. CONCLUSION: The combination of the three coding methods illustrates how artificial intelligence, automated and human codings are mutually enriching. Quantified limitations on some chapters of ICD codes encourage an increase in the volume of certificates sent for manual coding from 2021 onward.

The Virtual Geriatric Assessment Interdisciplinary Team Project: Interprofessional Geriatric Training Against the Backdrop of COVID-19.

Interprofessional geriatric education programs enhance trainees' knowledge of older adults, and the valuable contributions health and social care practitioners make to their well-being when specialists work collaboratively. In response to the 2020 COVID-19 pandemic restrictions, in-person geriatric interprofessional education (IPE) programs were redesigned for virtual delivery. Nineteen virtual programs were held between September 2020 and December 2022. Of the 369 health and social care trainees who participated, 67.2% completed both pre- and post-program surveys. Survey instruments included the Interprofessional Collaborative Competency Attainment Survey (ICASS), which measures perceptions associated with patient-centered, team-based, collaborative care. Significant differences were obtained across ICASS domains, including communication, conflict management/resolution, and team functioning, suggesting that virtual programs may enhance attitudes and perceived abilities for interprofessional collaborative practice. Furthermore, participants' perceived understanding of older adult needs improved, as did their interest in geriatrics. Results illustrate that virtual geriatric interprofessional (IP) programs may be viable alternatives to in-person opportunities.

Family ASL: An Early Start to Equitable Education for Deaf Children.

Deaf and hard of hearing (DHH) children experience systematic barriers to equitable education due to intentional or unintentional ableist views that can lead to a general lack of awareness about the value of natural sign languages, and insufficient resources supporting sign language development. Furthermore, an imbalance of information in favor of spoken languages often stems from a phonocentric perspective that views signing as an inferior form of communication that also hinders development of spoken language. To the contrary, research demonstrates that early adoption of a natural sign language confers critical protection from the risks of language deprivation without endangering spoken language development. In this position paper, we draw attention to deep societal biases about language in information presented to parents of DHH children, against early exposure to a natural sign language. We outline actions that parents and professionals can adopt to maximize DHH children's chances for on-time language development.

Deaf and Hearing American Sign Language-English Bilinguals: Typical Bilingual Language Development.

Some studies have concluded that sign language hinders spoken language development for deaf and hard-of-hearing (DHH) children even though sign language exposure could protect DHH children from experiencing language deprivation. Furthermore, this research has rarely considered the bilingualism of children learning a signed and a spoken language. Here we compare spoken English development in 2-6-year-old deaf and hearing American Sign Language-English bilingual children to each other and to monolingual English speakers in a comparison database. Age predicted bilinguals' language scores on all measures, whereas hearing status was only significant for one measure. Both bilingual groups tended to score below monolinguals. Deaf bilinguals' scores differed more from monolinguals, potentially because of later age of and less total exposure to English, and/or to hearing through a cochlear implant. Overall, these results are consistent with typical early bilingual language development. Research and practice must treat signing-speaking children as bilinguals and consider the bilingual language development literature.

Reactive surveillance of suicides during the COVID-19 pandemic in France, 2020 to March 2022.

AIMS: Mitigation actions during the COVID-19 pandemic may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from 2020 to March 2022 in France. METHODS: Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either a Tenth revision of the International Classification of Diseases (ICD-10) code for 'intentional self-harm' or for 'external cause of undetermined intent' as the underlying cause. The number of suicide deaths from January 2020 to March 2022 was then compared with the expected number estimated using a generalized additive model. The difference and the ratio between the observed and expected number of suicide deaths were calculated on the three lockdown periods and for periods between lockdowns and after the third one. The analysis was stratified by age group and gender. RESULTS: The free-text algorithm demonstrated high performances. From January 2020 to mid-2021, suicide mortality declined during France's three lockdowns, particularly in men. During the periods between and after the two first lockdowns, suicide mortality remained comparable to the expected values, except for men over 85 years old and in 65-84 year-old age group, where a small number of excess deaths was observed in the weeks following the end of first lockdown, and for men aged 45-64 years old, where the decline continued after the second lockdown ended. After the third lockdown until March 2022, an increase in suicide mortality was observed in 18-24 year-old age group for both genders and in men aged 65-84 years old, while a decrease was observed in the 25-44 year-old age group. CONCLUSIONS: This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic and a substantial decline during lockdown periods, something already observed in other countries. The increase in suicide mortality observed in 18-24 year-old age group and in men aged 65-84 years old from mid-2021 to March 2022 suggests a prolonged impact of COVID-19 on mental health, also described on self-harm hospitalizations and emergency department's attendances in France. Further studies are required to explain the factors for this change. Reactive monitoring of suicide mortality needs to be continued since mental health consequences and the increase in suicide mortality may be continued in the future with the international context.

Socialisation Agents' Use(fulness) for Older Consumers Learning ICT.

This research investigates the socialisation agents older consumers use to learn about information and communication technologies (ICT). We surveyed 871 older consumers in Victoria, Australia, about whom they would most likely turn to for advice (i.e., their preferred socialisation agents) if they needed help using or fixing an ICT device. They were asked to identify the most and second most likely source of advice. Participants were also asked to assess the usefulness of the advice received from their preferred agents and to estimate their level of ICT knowledge. The findings reveal that older consumers tend to rely on younger family members. Still, the agency they receive from non-familial sources is essential when preparing for a digital consumer role. Surprisingly, ICT knowledge is determined by the socialisation agency received by older adults' second advice option-which is less likely to be their own adult children. This research expands current knowledge about how older consumers perceive various ICT socialisation agents. Consumer socialisation theory suggests that socialisation agents impact how consumers function in the marketplace. Although the first choice of socialisation agent may be perceived as beneficial for older adults, the advice given does not relate to marketplace functioning regarding improved ICT knowledge.

Sleep Traits, Night Shift Work and Lung Cancer Risk among Women: Results from a Population-Based Case-Control Study in France (The WELCA Study).

Circadian rhythm disruption due to night shift work and/or sleep disorders is associated with negative health outcomes including cancer. There is only scant evidence of an association with lung cancer, unlike breast and prostate cancer. We explore the role of sleep disorders and night shift work in lung cancer risk among women in a population-based case-control study, including 716 lung cancer cases and 758 controls. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) associated with sleep duration per day (<7 h, 7−7.9 h, ≥8 h), a summary index of sleep disorders, chronotype, and night shift work exposure metrics. When compared to women with an average sleep duration of 7−7.9 h per day, the OR was 1.39 (95% CI 1.04−1.86) in long sleepers (≥8 h) and 1.16 (95% CI 0.86−1.56) in short sleepers (<7 h). Overall, lung cancer was not associated with the sleep disorder index, nor with night shift work, regardless of the duration of night work or the frequency of night shifts. However, elevated OR associated with the sleep disorder index were found in the subgroup of current smokers. The U-shaped association of lung cancer with sleep duration was more particularly pronounced among women who worked at night ≥5 years. Our findings suggested that sleep patterns are associated with lung cancer risk in women with a potential modifying effect by night shift work duration or tobacco smoking.

Phonological development in American Sign Language-signing children: Insights from pseudosign repetition tasks.

In this study, we conducted a pseudosign (nonce sign) repetition task with 22 children (mean age: 6;04) acquiring American Sign Language (ASL) as a first language (L1) from deaf parents. Thirty-nine pseudosigns with varying complexity were developed and organized into eight categories depending on number of hands, number of simultaneous movement types, and number of movement sequences. Pseudosigns also varied in handshape complexity. The children's performance on the ASL pseudosign task improved with age, displaying relatively accurate (re)production of location and orientation, but much less accurate handshape and movement, a finding in line with real sign productions for both L1 and L2 signers. Handshapes with higher complexity were correlated with lower accuracy in the handshape parameter. We found main effects of sequential and simultaneous movement combinations on overall performance. Items with no movement sequence were produced with higher overall accuracy than those with a movement sequence. Items with two simultaneous movement types or a single movement type were produced with higher overall accuracy than those with three simultaneous movement types. Finally, number of hands did not affect the overall accuracy. Remarkably, movement sequences impose processing constraints on signing children whereas complex hands (two hands) and two simultaneous movement types do not significantly lower accuracy, indicating a capacity for processing multiple simultaneous components in signs. Spoken languages, in contrast, manifest greater complexity in temporal length. Hearing children's pseudoword repetition still displays high levels of accuracy on disyllabic words, with complexity effects affecting only longer multisyllabic words. We conclude that the pseudosign repetition task is an informative tool for studies of signing children's phonological development and that sheds light on potential modality effects for phonological development.

Co-Creating ICT Risk Strategies with Older Australians: A Workshop Model.

As digital inclusion becomes a growing indicator of wellbeing in later life, the ability to understand older adults' preferences for information and communication technologies (ICTs) and develop strategies to support their digital literacy is critical. The barriers older adults face include their perceived ICT risks and capacity to learn. Complexities, including ICT environmental stressors and societal norms, may require concerted engagement with older adults to achieve higher digital literacy competencies. This article describes the results of a series of co-design workshops to develop strategies for increased ICT competencies and reduced perceived risks among older adults. Engaging older Australians in three in-person workshops (each workshop consisting of 15 people), this study adapted the "Scenario Personarrative Method" to illustrate the experiences of people with technology and rich pictures of the strategies seniors employ. Through the enrichment of low-to-high-digital-literacy personas and mapping workshop participant responses to several scenarios, the workshops contextualized the different opportunities and barriers seniors may face, offering a useful approach toward collaborative strategy development. We argued that in using co-designed persona methods, scholars can develop more nuance in generating ICT risk strategies that are built with and for older adults. By allowing risks to be contextualized through this approach, we illustrated the novelty of adapting the Scenario Personarrative Method to provide insights into perceived barriers and to build skills, motivations, and strategies toward enhancing digital literacy.

Lessons to be Learned from Bimodal Bilingualism.

This article presents a selective overview of topics related to the language experience of early bimodal bilinguals - individuals who are raised from an early age using two languages from two different modalities, typically spoken (or written) and signed. We show that deaf and hearing bimodal bilinguals may display patterns of bilingualism that are similar to unimodal bilinguals in some ways, such as the use of both languages in a single situation or even a single utterance. Nevertheless, there are also differences between bimodal and unimodal bilinguals, and differences among different subgroups of bimodal bilinguals, given large variation in relative access to the dominant and minority language(s) in their environment and their differential experiences in schooling and interactions with potential interlocutors. Moreover, we review studies discussing potential advantages of the sign modality and advantages of bilingualism in this population. We hope to highlight the importance of considering children's overall language experience, including the age(s) at which they are exposed to each of their languages, the richness of their experiences with each of the languages, and the ways that the language-learning experience may contribute to the child's linguistic and cognitive development.

Signed languages - Unique and ordinary: A commentary on.

In this commentary on the article by Kidd and Garcia, we point out that research on natural signed languages is an important component of the goal of broadening the database of knowledge about how languages are acquired. While signed languages do display some modality effects, they also have many similarities to spoken languages, both in function and in form. Thus, research on signed languages and their acquisition is important for a fuller understanding of the diversity of languages. Since signed languages are often learned in contexts other than those of typical input, it is also important to document the effects of input variation; we also see it as critical that input be provided as early as possible from models as fluent as possible. Finally, we call for removing existing barriers to training and education for would-be researchers, especially those interested in working on signed languages. Importantly, we advocate for the recognition of signed languages, for signed language research, and for the empowerment of community members to lead this research.

Promoting healthy eating in the community sport setting: a scoping review.

Community sport organizations promote beneficial health outcomes such as social connection and physical activity, yet they can also facilitate the consumption of unhealthy food and beverages. To provide a foundation for future research and to inform intervention efforts in this context, this scoping review summarizes existing knowledge of the factors that contribute to unhealthy food and beverage consumption in the community sport setting and explores the interventions to promote healthier choices. Using a qualitative process aligned with the nature of our aims, 228 articles were initially identified and subjected to a systemized appraisal, resulting in 45 articles pertinent to the review. The findings identify that the two key factors contributing to unhealthy food choices are the limited availability of healthy options within the sport setting and the presence of unhealthy food and beverage sponsorship. These factors contribute to the normalization of unhealthy eating in this context and health promotion interventions have had limited success. Barriers to change primarily stem from the revenue implications of removing unhealthy food sponsors, lack of organizational capabilities and resources, and consumer preference for unhealthy options. Public health practitioners seeking to intervene in this setting should consider adopting practices used in other settings outside of the sport environment, including the use of technology, the role of peers and mentors and the co-production of impactful material. Community sport plays a vital role in delivering health benefits but must do more to stem its facilitation of a potentially unhealthy consumptive environment.

Acquisition of Sign Languages.

Natural sign languages of deaf communities are acquired on the same time scale as that of spoken languages if children have access to fluent signers providing input from birth. Infants are sensitive to linguistic information provided visually, and early milestones show many parallels. The modality may affect various areas of language acquisition; such effects include the form of signs (sign phonology), the potential advantage presented by visual iconicity, and the use of spatial locations to represent referents, locations, and movement events. Unfortunately, the vast majority of deaf children do not receive accessible linguistic input in infancy, and these children experience language deprivation. Negative effects on language are observed when first-language acquisition is delayed. For those who eventually begin to learn a sign language, earlier input is associated with better language and academic outcomes. Further research is especially needed with a broader diversity of participants.

Risk of lung cancer among women in relation to lifetime history of tobacco smoking: a population-based case-control study in France (the WELCA study).

BACKGROUND: This study aims to provide new insights on the role of smoking patterns and cigarette dependence in female lung cancer, and to examine differences by histological subtype. METHODS: We conducted a population-based case-control study in the great Paris area among women including 716 incident cases diagnosed between 2014 and 2017 and 757 age-matched controls. Detailed data on smoking history was collected during in-person interviews to assess intensity and duration of tobacco smoking, time since cessation, smoking habits (depth of smoke inhalation, use of filter, type of tobacco, and type of cigarettes) and Fagerström test for cigarette dependence. The comprehensive smoking index (CSI), a score modelling the combined effects of intensity, duration and time since quitting smoking was determined for each subject. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and their confidence intervals (95%CI) of lung cancer associated with smoking variables. RESULTS: Lung cancer risk increased linearly with intensity and duration of tobacco smoking while it decreased with time since cessation, to reach the risk in never-smokers after 20 years of abstinence. The combined effect of intensity and duration of tobacco smoking was more than multiplicative (p-interaction 0.012). The OR in the highest vs the lowest quartile of CSI was 12.64 (95%CI 8.50; 18.80) (p-trend < 0.001). The risk of small cell or squamous cell carcinomas increased with the CSI more sharply than the risk of adenocarcinomas. Deep smoke inhalation, dark vs blond tobacco, conventional vs light cigarettes, and unfiltered vs filtered cigarettes, as well as having mixed smoking habits, were found to be independent risk factors. Having high cigarette addiction behaviours also increased the risk after adjusting for CSI. CONCLUSION: This study provides additional insights on the effects of tobacco smoking patterns on lung cancer risk among women.

Code-blending with depicting signs.

Bimodal bilinguals sometimes use code-blending, simultaneous production of (parts of) an utterance in both speech and sign. We ask what spoken language material is blended with entity and handling depicting signs (DS), representations of action that combine discrete components with iconic depictions of aspects of a referenced event in a gradient, analog manner. We test a semantic approach that DS may involve a demonstration, involving a predicate which obligatorily includes a modificational demonstrational component, and adopt a syntactic analysis which crucially distinguishes between entity and handling DS. Given the model of bilingualism we use, we expect both DS can be produced with speech that occurs in the verbal structure, along with vocal gestures, but speech that includes a subject is only expected to be blended with handling DS, not entity. The data we report from three Codas, native bimodal bilinguals, from the United States and one from Brazil conform with this prediction.

Biochemically Tracked Variability of Blood Plasma Thawed-State Exposure Times in a Multisite Collection Study.

The integrity of blood plasma/serum (P/S) specimens can be impacted by preanalytical handling and storage conditions that result in thawed-state exposures (> -30°C). We recently reported a simple dilute-and-shoot, intact-protein liquid chromatography/mass spectrometry (LC/MS) assay called ΔS-Cys-Albumin that quantifies cumulative exposure of P/S to thawed conditions based on the change in relative abundance of the oxidized (S-cysteinylated) proteoform of albumin (S-Cys-Albumin) in the native sample to that of an aliquot of the sample intentionally driven to its maximum oxidation state. Herein, we evaluated the effect of prestorage delay and initial storage temperature on sample integrity by applying the ΔS-Cys-Albumin assay to a set of plasma samples (n = 413) collected under a single clinical study but from 12 different collection sites. Major differences (p < 0.0001) were observed between different groups of samples with modestly inconsistent initial handling conditions (i.e., initial processing of whole blood to plasma and placement at -80°C completed in under 3 hours, 3-13 hours, and over 17 hours). ΔS-Cys-Albumin was significantly inversely correlated with delay time at 4°C before centrifugation and total delay before final storage at -80°C (p < 0.0001). Samples from two collection sites had much lower ΔS-Cys-Albumin values relative to samples from other sites, in accordance with the fact that they were stored at -20°C for an average of 7.6 months before shipment to the central repository for final storage at -80°C. Based on the rate law for S-Cys-Albumin formation in plasma ex vivo, the average time that each plasma specimen had been exposed to the equivalent of room temperature (23°C) was back calculated from the measured ΔS-Cys-Albumin values. A survey of clinical analytes in P/S whose measured concentrations are sensitive to the initial handling/storage conditions documented in this study is provided and the ramifications of the plasma integrity findings from this multisite clinical study are discussed.

Person vs. locative agreement: Evidence from late learners and language emergence.

Sign languages are frequently described as having three verb classes. One, 'agreeing' verbs, indicates the person/number of its subject and object by modification of the beginning and ending locations of the verb. The second, 'spatial' verbs, makes a similar appearing modification of verb movement to represent the source and goal locations of the theme of a verb of motion. The third class, 'plain' verbs, is characterized as having neither of these types of modulations. A number of researchers have proposed accounts that collapse all of these types, or the person-agreeing and spatial verbs. Here we present evidence from late learners of American Sign Language and from the emergence of new sign languages that person agreement and locative agreement have a different status in these conditions, and we claim their analysis should be kept distinct, at least in certain ways.

Morphological Accuracy in the Speech of Bimodal Bilingual Children with CIs.

Sign language use in the (re)habilitation of children with cochlear implants (CIs) remains a controversial issue. Concerns that signing impedes spoken language development are based on research comparing children exposed to spoken and signed language (bilinguals) to children exposed only to speech (monolinguals), although abundant research demonstrates that bilinguals and monolinguals differ in language development. We control for bilingualism effects by comparing bimodal bilingual (signing-speaking) children with CIs (BB-CI) to those with typical hearing (BB-TH). Each child had at least one Deaf parent and was exposed to ASL from birth. The BB-THs were exposed to English from birth by hearing family members, while the BB-CIs began English exposure after cochlear implantation around 22-months-of-age. Elicited speech samples were analyzed for accuracy of English grammatical morpheme production. Although there was a trend toward lower overall accuracy in the BB-CIs, this seemed driven by increased omission of the plural -s, suggesting an exaggerated role of perceptual salience in this group. Errors of commission were rare in both groups. Because both groups were bimodal bilinguals, trends toward group differences were likely caused by delayed exposure to spoken language or hearing through a CI, rather than sign language exposure.

Executive Function in Deaf Children: Auditory Access and Language Access.

Purpose: Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions. Method: We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF. Results: Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant. Conclusions: These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.

Auditory access, language access, and implicit sequence learning in deaf children.

Developmental psychology plays a central role in shaping evidence-based best practices for prelingually deaf children. The Auditory Scaffolding Hypothesis (Conway et al., 2009) asserts that a lack of auditory stimulation in deaf children leads to impoverished implicit sequence learning abilities, measured via an artificial grammar learning (AGL) task. However, prior research is confounded by a lack of both auditory and language input. The current study examines implicit learning in deaf children who were (Deaf native signers) or were not (oral cochlear implant users) exposed to language from birth, and in hearing children, using both AGL and Serial Reaction Time (SRT) tasks. Neither deaf nor hearing children across the three groups show evidence of implicit learning on the AGL task, but all three groups show robust implicit learning on the SRT task. These findings argue against the Auditory Scaffolding Hypothesis, and suggest that implicit sequence learning may be resilient to both auditory and language deprivation, within the tested limits. A video abstract of this article can be viewed at: https://youtu.be/EeqfQqlVHLI [Correction added on 07 August 2017, after first online publication: The video abstract link was added.].