Development of a 3-Step theory of suicide ontology to facilitate 3ST factor extraction from clinical progress notes.

OBJECTIVE: Suicide risk prediction algorithms at the Veterans Health Administration (VHA) do not include predictors based on the 3-Step Theory of suicide (3ST), which builds on hopelessness, psychological pain, connectedness, and capacity for suicide. These four factors are not available from structured fields in VHA electronic health records, but they are found in unstructured clinical text. An ontology and controlled vocabulary that maps psychosocial and behavioral terms to these factors does not exist. The objectives of this study were 1) to develop an ontology with a controlled vocabulary of terms that map onto classes that represent the 3ST factors as identified within electronic clinical progress notes, and 2) to determine the accuracy of automated extractions based on terms in the controlled vocabulary. METHODS: A team of four annotators did linguistic annotation of 30,000 clinical progress notes from 231 Veterans in VHA electronic health records who attempted suicide or who died by suicide for terms relating to the 3ST factors. Annotation involved manually assigning a label to words or phrases that indicated presence or absence of the factor (polarity). These words and phrases were entered into a controlled vocabulary that was then used by our computational system to tag 14 million clinical progress notes from Veterans who attempted or died by suicide after 2013. Tagged text was extracted and machine-labelled for presence or absence of the 3ST factors. Accuracy of these machine-labels was determined for 1000 randomly selected extractions for each factor against a ground truth created by our annotators. RESULTS: Linguistic annotation identified 8486 terms that related to 33 subclasses across the four factors and polarities. Precision of machine-labeled extractions ranged from 0.73 to 1.00 for most factor-polarity combinations, whereas recall was somewhat lower 0.65-0.91. CONCLUSION: The ontology that was developed consists of classes that represent each of the four 3ST factors, subclasses, relationships, and terms that map onto those classes which are stored in a controlled vocabulary (https://bioportal.bioontology.org/ontologies/THREE-ST). The use case that we present shows how scores based on clinical notes tagged for terms in the controlled vocabulary capture meaningful change in the 3ST factors during weeks preceding a suicidal event.

Deaf Teachers' Reflections on Chinese Literacy.

Using grounded theory, the researcher posed this question in this qualitative study: What childhood literacy-learning and current literacy-teaching experiences have influenced Chinese Deaf teachers' views on literacy learning? Responses were obtained from Deaf teachers by means of videotaped interviews about their literacy-learning and literacy-teaching experiences. When the interviews, which were conducted in Chinese Sign Language (CSL) glossed to written Chinese and English, were analyzed, six themes emerged. Extracted core categories provide the unique context for a "boomerang effect" related to language and literacy through a bilingual path to literacy. Recommendations for future research using bilingual theory and practice are discussed.

Epilogue: Chinese Literacy From a Deaf Lens.

To promote dialogue among literacy researchers from East and West along the "'Silk Road' to literacy" for Chinese d/Deaf and hard of hearing (d/Dhh) students (Andrews et al., 2021), this epilogue to an American Annals of the Deaf special issue on language development and literacy learning of d/Dhh students in Chinese communities poses questions and provides reflections from the perspective of the Chinese Deaf lens on the ideas in the six articles that make up the special issue. This perspective reframes literacy instruction toward an asset-based model that emphasizes visual sensory strengths, sign-to-print mapping strategies, and Deaf cultural capital. This special issue includes a tribute (Q. Wang et al., 2021) to the authors' late colleague Dr. Ye (Angel) Wang, who encouraged collaborative work with deaf and hearing literacy researchers employing different paradigms of literacy instruction.