A combined Fuzzy and Naive Bayesian strategy can be used to assign event codes to injury narratives.

BACKGROUND: Bayesian methods show promise for classifying injury narratives from large administrative datasets into cause groups. This study examined a combined approach where two Bayesian models (Fuzzy and Naïve) were used to either classify a narrative or select it for manual review. METHODS: Injury narratives were extracted from claims filed with a worker's compensation insurance provider between January 2002 and December 2004. Narratives were separated into a training set (n=11,000) and prediction set (n=3,000). Expert coders assigned two-digit Bureau of Labor Statistics Occupational Injury and Illness Classification event codes to each narrative. Fuzzy and Naïve Bayesian models were developed using manually classified cases in the training set. Two semi-automatic machine coding strategies were evaluated. The first strategy assigned cases for manual review if the Fuzzy and Naïve models disagreed on the classification. The second strategy selected additional cases for manual review from the Agree dataset using prediction strength to reach a level of 50% computer coding and 50% manual coding. RESULTS: When agreement alone was used as the filtering strategy, the majority were coded by the computer (n=1,928, 64%) leaving 36% for manual review. The overall combined (human plus computer) sensitivity was 0.90 and positive predictive value (PPV) was >0.90 for 11 of 18 2-digit event categories. Implementing the 2nd strategy improved results with an overall sensitivity of 0.95 and PPV >0.90 for 17 of 18 categories. CONCLUSIONS: A combined Naïve-Fuzzy Bayesian approach can classify some narratives with high accuracy and identify others most beneficial for manual review, reducing the burden on human coders.

Bayesian methods: a useful tool for classifying injury narratives into cause groups.

To compare two Bayesian methods (Fuzzy and Naïve) for classifying injury narratives in large administrative databases into event cause groups, a dataset of 14 000 narratives was randomly extracted from claims filed with a worker's compensation insurance provider. Two expert coders assigned one-digit and two-digit Bureau of Labor Statistics (BLS) Occupational Injury and Illness Classification event codes to each narrative. The narratives were separated into a training set of 11 000 cases and a prediction set of 3000 cases. The training set was used to develop two Bayesian classifiers that assigned BLS codes to narratives. Each model was then evaluated for the prediction set. Both models performed well and tended to predict one-digit BLS codes more accurately than two-digit codes. The overall sensitivity of the Fuzzy method was, respectively, 78% and 64% for one-digit and two-digit codes, specificity was 93% and 95%, and positive predictive value (PPV) was 78% and 65%. The Naïve method showed similar accuracy: a sensitivity of 80% and 70%, specificity of 96% and 97%, and PPV of 80% and 70%. For large administrative databases, Bayesian methods show significant promise as a means of classifying injury narratives into cause groups. Overall, Naïve Bayes provided slightly more accurate predictions than Fuzzy Bayes.

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.

OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. METHODS: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.

Welding related occupational eye injuries: a narrative analysis.

OBJECTIVE: To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury. METHODS: Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed. RESULTS: During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%). CONCLUSIONS: Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.

Using narrative text and coded data to develop hazard scenarios for occupational injury interventions.

OBJECTIVE: To determine whether narrative text in safety reports contains sufficient information regarding contributing factors and precipitating mechanisms to prioritize occupational back injury prevention strategies.Design, setting, subjects, and MAIN OUTCOME MEASURES: Nine essential data elements were identified in narratives and coded sections of safety reports for each of 94 cases of back injuries to United States Army truck drivers reported to the United States Army Safety Center between 1987 and 1997. The essential elements of each case were used to reconstruct standardized event sequences. A taxonomy of the event sequences was then developed to identify common hazard scenarios and opportunities for primary interventions. RESULTS: Coded data typically only identified five data elements (broad activity, task, event/exposure, nature of injury, and outcomes) while narratives provided additional elements (contributing factor, precipitating mechanism, primary source) essential for developing our taxonomy. Three hazard scenarios were associated with back injuries among Army truck drivers accounting for 83% of cases: struck by/against events during motor vehicle crashes; falls resulting from slips/trips or loss of balance; and overexertion from lifting activities. CONCLUSIONS: Coded data from safety investigations lacked sufficient information to thoroughly characterize the injury event. However, the combination of existing narrative text (similar to that collected by many injury surveillance systems) and coded data enabled us to develop a more complete taxonomy of injury event characteristics and identify common hazard scenarios. This study demonstrates that narrative text can provide the additional information on contributing factors and precipitating mechanisms needed to target prevention strategies.

The emergence of children's causal explanations and theories: evidence from everyday conversation.

This research examines the content of explanations that 4 English-speaking children gave or asked for in everyday conversations recorded from 2 1/2 to 5 years of age. Analyses of nearly 5,000 codable explanations (identified by markers like why or because) focused on the entity targeted for explanation (e.g., person, animal, object), the explanatory mode of causal reasoning (e.g., psychological, physical), and interrelations between these elements. Children's explanations focused on varied entities (animals, objects, and persons) and incorporated diverse modes (psychological, physical, social-conventional, and even biological reasoning). Children's pairings of entities with explanatory modes suggest appropriately constrained yet flexible causal reasoning. These data are consistent with the hypothesis that young children draw on several complementary causal-explanatory theories to make sense of real-life events.

Meta-analysis of theory-of-mind development: the truth about false belief.

Research on theory of mind increasingly encompasses apparently contradictory findings. In particular, in initial studies, older preschoolers consistently passed false-belief tasks-a so-called "definitive" test of mental-state understanding-whereas younger children systematically erred. More recent studies, however, have found evidence of false-belief understanding in 3-year-olds or have demonstrated conditions that improve children's performance. A meta-analysis was conducted (N = 178 separate studies) to address the empirical inconsistencies and theoretical controversies. When organized into a systematic set of factors that vary across studies, false-belief results cluster systematically with the exception of only a few outliers. A combined model that included age, country of origin, and four task factors (e.g., whether the task objects were transformed in order to deceive the protagonist or not) yielded a multiple R of .74 and an R2 of .55; thus, the model accounts for 55% of the variance in false-belief performance. Moreover, false-belief performance showed a consistent developmental pattern, even across various countries and various task manipulations: preschoolers went from below-chance performance to above-chance performance. The findings are inconsistent with early competence proposals that claim that developmental changes are due to tasks artifacts, and thus disappear in simpler, revised false-belief tasks; and are, instead, consistent with theoretical accounts that propose that understanding of belief, and, relatedly, understanding of mind, exhibit genuine conceptual change in the preschool years.

Theory of mind and conceptual change.

We agree with the commentaries by Scholl and Leslie, and also by Moses, that the meta-analytic findings do not definitively rule out early competence accounts. But they do make extant versions of such accounts increasingly unlikely. In particular, the meta-analytic findings argue against executive function expression accounts, including the Theory-of-Mind Mechanism/Selection Processor account advocated by Scholl and Leslie. Specifically, Scholl and Leslie articulate two explicit predictions of their account: that task manipulations that attenuate inhibitory demands should differentially advantage older children, and that theory-of-mind developments should occur with consistent timetables. Both of these specific predictions are clearly contradicted, not supported, by the meta-analytic findings.

Thinking about the past: early knowledge about links between prior experience, thinking, and emotion.

In two studies the authors investigated the situations where 3- to 7-year-olds and adults (N = 152) will connect a person's current feelings to the past, especially to thinking or being reminded about a prior experience. Study 1 presented stories featuring a target character who felt sad, mad, or happy after an event in the past and who many days later felt that same negative or positive emotion upon seeing a cue related to the prior incident. For some story endings, the character's emotion upon seeing the cue matched, or was congruent, with the current situation, whereas for others, the emotion mismatched the present circumstances. Participants were asked to explain the cause of each character's current feelings. As a further comparison, children and adults listened to behavior cuing stories and provided explanations for characters' present actions. Study 2 presented emotional scenarios that varied by emotion-situation fit (whether the character's emotion matched the current situation), person-person fit (whether the character's emotion matched another person's), and past history information (whether information about the character's past was known). Results showed that although there were several significant developments with increasing age, even most 3-year-olds demonstrated some knowledge about connections between past events and present emotions and between thinking and feeling. Indeed, children 5 years and younger revealed strikingly cogent understanding about historical-mental influences in certain situations, especially where they had to explain why a person, who had experienced a negative event in the past, was currently feeling sad or mad in a positive situation. These findings help underwrite a more general account of the development of children's coherent understandings of life history, mind, and emotion.

Surveillance of work-related carpal tunnel syndrome in Massachusetts, 1992-1997: a report from the Massachusetts Sentinel Event Notification System for Occupational Risks (SENSOR).

BACKGROUND: This surveillance study was undertaken to target efforts to prevent work-related carpal tunnel syndrome (WR-CTS) and to assess physician case-reports as a source of surveillance data. METHODS: Physician case-reports and workers' compensation disability claims were used to document patterns of WR-CTS in Massachusetts from March 1992 to June 1997 by age, gender, industry, occupation, and calendar year. Characteristics of cases identified through the two data sources were compared. RESULTS: 4,836 cases of WR-CTS were ascertained; 6% were identified by both data sources. Whereas the two sets of cases were similar with respect to age and occupation categories, physician-reported cases were more likely male and employed in manufacturing. The number of compensation claims filed by women declined over time, and a substantial number of cases under age 25 years were identified. Manufacturing workers had the highest rates; the highest numbers of cases were employed in hospitals, grocery stores, and the insurance industry. Several technical/administrative support occupations likely to use video display terminals had both high rates and frequencies. CONCLUSION: WR-CTS is a significant public health problem. Physician reports are useful in understanding problem magnitude and targeting specific establishments for intervention but are currently of limited use in targeting specific industries and occupations.

Young children's understanding of perception, desire, and emotion.

Very young children seem to know that people experience several mental states: desires, perceptions, emotions. In three studies, we investigated 2- and young 3-year-olds' judgments and communications about how these states connect together in people's lives and minds. Two experimental studies with 56 participants demonstrated young children's understanding of at least one set of connections: In appropriate circumstances, a person's perception of desirable or undesirable objects leads to related emotional experiences. A complementary investigation of four young children's everyday conversations demonstrated their awareness of and expression of several additional connections between people's desires, perceptions, and emotions.

Acquisition of mental state language in Mandarin- and Cantonese-speaking children.

Children's theory of mind appears to develop from a focus on desire to a focus on belief. However, it is not clear (a) whether this pattern is universal and (b) whether it could also be explained by linguistic and sociocultural factors. This study examined mental state language in 10 Mandarin-speaking (21-27 months) and 8 Cantonese-speaking (18-44 months) toddlers. The results suggest a pattern of theory-of-mind development similar to that in English, with early use of desire terms followed by other mental state references. However, the Chinese-speaking children used desire terms much earlier, and the use of terms for thinking was very infrequent, even for Mandarin-speaking adults. This finding suggests a consistency in the overall sequence, but variation in the timing of beginning and end points, in children's theory-of-mind development across cultures.

FDG-PET and MRI in temporal lobe epilepsy: relationship to febrile seizures, hippocampal sclerosis and outcome.

OBJECTIVE: To correlate the volumetric head magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan findings with the history, intracarotid amobarbital procedure, pathology, and outcome in patients with medically refractory temporal lobe epilepsy. MATERIAL AND METHODS: Thirty-eight patients with temporal lobe epilepsy treated surgically following a comprehensive presurgical evaluation. Follow-up ranged from 12 to 44 months. RESULTS: Volumetric MRI showed ipsilateral hippocampal atrophy in 29 (76%), and PET scan showed ipsilateral temporal hypometabolism (PET-TH) in 31 (81.5%) of patients. Eighty-three percent of those patients with hippocampal sclerosis on MRI (MRI-HS) had ipsilateral PET-TH. Sixty-six percent of patients with MRI-HS had a history of prolonged febrile convulsions or a childhood febrile illness accompanied by convulsions, and 77% of patients with MRI-HS had pathologically proven hippocampal sclerosis (HS). Ninety percent became seizure free or had rare seizures. CONCLUSION: FDG-PET scans and head MRIs were complementary; 95% of patients had either MRI-HS or temporal hypometabolism. MRI-HS correlated with a history of febrile seizures and pathologically demonstrated hippocampal sclerosis. Ninety-three percent of patients had focal functional deficits on the epileptogenic side. Concordance between PET temporal hypometabolism and MRI-HS correlated with better outcome.

Culture, variation, and levels of analysis in folk psychologies: comment on Lillard (1998)

Not only do folk psychologies differ for adults in different cultures, but naive psychological conceptions begin early in life and develop. Understanding cultural variation requires understanding these beginnings and developments as well as considering naive psychological conceptions at several different levels of analysis.

Explaining human movements and actions: children's understanding of the limits of psychological explanation.

Human actions and movements can be caused by psychological states (e.g. beliefs and desires), physical forces (e.g. gravity) and biological processes (e.g. reflexes). In three studies we explored young children's understanding of the causes of human movements in order to examine their ability to differentiate and coordinate psychological, physical and biological reasoning to account for the activities of one single entity--a human being. In Study 1, 4-year-olds explained characters' voluntary actions, mistakes, physically-caused and biologically-caused behaviors and movements. Children gave psychological explanations for the intended actions and mistakes, but biological and physical explanations for the biologically-caused and physically-caused movements. Studies 2 and 3 extended the investigation to younger children (3-year-olds), encompassed a greater variety of items, and used several converging methods in order to examine children's judgments and explanations. Consistently, 3- and 4-year-olds gave appropriately different responses and explanations to the different item types. These findings show that far from viewing people in strictly psychological terms, young children evidence multiple causal-explanatory construals of human behavior. We discuss the implications of these findings for children's everyday psychological, physical, and biological theories. One implication of the findings is that young children do not assume a match between entities and theories (persons-psychology, objects-physics). If they do not, this raises the question of what information they use to decide which explanatory system fits which events.

Comparative study of interictal PET and ictal SPECT in complex partial seizures.

OBJECTIVE: To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluoro-deoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). MATERIAL AND METHODS: Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total = 67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of focal hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. RESULTS: Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (chi 2y = 0.18, DF = 1, P = 0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. CONCLUSION: Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

Practical operation of a biaxial goniometer at the wrist joint.

The objectives of this study were (a) to determine errors in wrist angle measurements from a commercially available biaxial electrogoniometer and (b) to develop a calibration routine in order to correct for these errors. Goniometric measurements were collected simultaneously with true angular data using a fixture that allowed wrist movement in one plane while restricting motion in the orthogonal plane. These data were collected in two sets of trials: flexion/extension with radial/ulnar deviation restricted, and radial/ulnar deviation with flexion/extension restricted. During these trials, we studied discrete 30 degrees increments of forearm rotation. The results showed the expected cross talk and zero drift errors during forearm rotation. The application of mathematical equations that describe the effect of goniometer twist resulted in significant error reduction for most forearm rotations. The calibration technique employs both a slope and a displacement transformation to improve the accuracy of angular data. The calibration technique may be used on data collected in the field if forearm rotation is measured simultaneously with the goniometer data.

Preschoolers' understanding of the link between thinking and feeling: cognitive cuing and emotional change.

In 3 studies we investigated 3- through 6-year-olds' knowledge of thinking and feeling by examining their understanding of how emotions can change when memories of past sad events are cued by objects in the current environment. In Study 1, 48 4-, 5-, and 6-year-olds were presented with 4 illustrated stories in which focal characters experience minor sad events. Later, each story character encounters a visual cue that is related to one of his or her previous sad experiences. Children were told that the character felt sad, and they were asked to explain why. Study 1 suggested considerable competence as well as substantial development in the years between 4 and 6 in the understanding of the influence of mental activity on emotions. Studies 2 and 3 more systematically explored preschoolers' understanding of cognitive cuing and emotional change with different types of situations and cues. Across these 2 studies, 108 3-, 4-, and 5-year-olds listened to illustrated stories that featured story characters who each experienced a sad event and who were later exposed to a related cue. Children were not only asked to explain why the characters suddenly felt sad, but in some stories, they were also asked to predict and explain how another character, who was never at the past sad event, would feel. Results of Studies 2 and 3 showed an initial understanding of cognitive cuing and emotion in some children as young as 3, replicated and extended the evidence for significant developmental changes in that understanding during the preschool years, and revealed that the strength and consistency of preschoolers' knowledge of cognitive cuing and emotion was affected by whether cues were the same, or only similar to, parts of the earlier events.

Young children's understanding of thought bubbles and of thoughts.

In a series of 4 studies, we explored preschoolers' understanding of thought bubbles. Very few 3-year-olds or 4-year-olds we tested knew what a thought-bubble depiction was without instruction. But, if simply told that the thought bubble "shows what someone is thinking," the vast majority of 3-year-olds and 4-year-olds easily understood the devices as depicting thoughts generally and individual thought contents specifically. In total, these children used thought-bubble depictions to ascertain the contents of characters' thoughts in a variety of situations; appropriately distinguished such depictions from mere associated actions or objects; described thought bubbles in the language of mental states; judged that persons' thoughts in these depictions were subjective in the sense of person-specific (and hence 2 people can have different thoughts about the same state of affairs); and judged that thought-bubble thoughts (a) were representational in the sense of depicting or showing some other state of affairs, (b) were mental and thus showed intangible, private, internal thoughts unlike real pictures or photographs, and (c) can be false, that is, can depict a person's misrepresentation of some state of affairs. We discuss the implications of these findings for young children's understanding of thoughts and thought bubbles, for their learning and comprehension of pictorial conventions, and for the use of thought bubbles to assess children's early understanding of mind.