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BACKGROUND: A wealth of clinically relevant information is only obtainable within unstructured clinical narratives, leading to great interest in clinical natural language processing (NLP). While a multitude of approaches to NLP exist, current algorithm development approaches have limitations that can slow the development process. These limitations are exacerbated when the task is emergent, as is the case currently for NLP extraction of signs and symptoms of COVID-19 and postacute sequelae of SARS-CoV-2 infection (PASC). OBJECTIVE: This study aims to highlight the current limitations of existing NLP algorithm development approaches that are exacerbated by NLP tasks surrounding emergent clinical concepts and to illustrate our approach to addressing these issues through the use case of developing an NLP system for the signs and symptoms of COVID-19 and PASC. METHODS: We used 2 preexisting studies on PASC as a baseline to determine a set of concepts that should be extracted by NLP. This concept list was then used in conjunction with the Unified Medical Language System to autonomously generate an expanded lexicon to weakly annotate a training set, which was then reviewed by a human expert to generate a fine-tuned NLP algorithm. The annotations from a fully human-annotated test set were then compared with NLP results from the fine-tuned algorithm. The NLP algorithm was then deployed to 10 additional sites that were also running our NLP infrastructure. Of these 10 sites, 5 were used to conduct a federated evaluation of the NLP algorithm. RESULTS: An NLP algorithm consisting of 12,234 unique normalized text strings corresponding to 2366 unique concepts was developed to extract COVID-19 or PASC signs and symptoms. An unweighted mean dictionary coverage of 77.8% was found for the 5 sites. CONCLUSIONS: The evolutionary and time-critical nature of the PASC NLP task significantly complicates existing approaches to NLP algorithm development. In this work, we present a hybrid approach using the Open Health Natural Language Processing Toolkit aimed at addressing these needs with a dictionary-based weak labeling step that minimizes the need for additional expert annotation while still preserving the fine-tuning capabilities of expert involvement.

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Trisomy 18 syndrome, also known as Edwards syndrome, is the second most common autosomal chromosome syndrome after Down syndrome. Trisomy 18 is a serious medical disorder due to the increased occurrence of structural defects, the high neonatal and infant mortality, and the disabilities observed in older children. Interventions, including cardiac surgery, remain controversial, and the traditional approach is to pursue pure comfort care. While the medical challenges have been well-characterized, there are scant data on the parental views and perspective of the lived experience of rearing a child with trisomy 18. Knowledge of the parental viewpoints can help clinicians guide families through decision-making. Our aim was to identify parents' perspectives by analyzing a series of narratives. In this qualitative study, we collected 46 parent narratives at the 2015 and 2016 conferences of the Support Organization for Trisomy 18 & 13 (SOFT). The participants were asked to "Tell us a story about your experience." Inductive content analysis and close reading were used to identify themes from the stories. Dedoose, a web-based application to analyze qualitative data, was used to code themes more systematically. Of the identified themes, the most common included Impact of trisomy 18 diagnosis and Surpassing expectations. Other themes included Support from professionals, A child, not a diagnosis, and Trust/lack of trust. We examined the voice and the perspectives of the parents in their challenges in caring for their children with this life-limiting condition. The exploration of the themes can ideally guide clinicians in their approach to the counseling and care of the child in a shared decision-making approach.

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Storytelling-an ancient way for humans to share individual experiences with others-has been found to induce neural alignment among listeners. In exploring the dynamic fluctuations in listener-listener (LL) coupling throughout stories, we uncover a significant correlation between LL coupling and lagged speaker-listener (lag-SL) coupling over time. Using the analogy of neural pattern (dis)similarity as distances between participants, we term this phenomenon the "herding effect." Like a shepherd guiding a group of sheep, the more closely listeners mirror the speaker's preceding brain activity patterns (higher lag-SL similarity), the more tightly they cluster together (higher LL similarity). This herding effect is particularly pronounced in brain regions where neural alignment among listeners tracks with moment-by-moment behavioral ratings of narrative content engagement. By integrating LL and SL neural coupling, this study reveals a dynamic, multi-brain functional network between the speaker and the audience, with the unfolding narrative content playing a mediating role in network configuration.

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Despite the emerging evidence base to support the therapeutic potential of creative writing and poetry for a variety of mental health problems, the therapeutic potential of poetry for people who have experienced psychosis remains poorly understood. The paper argues that by considering psychosis as meaningful poetics, this epistemological shift has the potential to foster curious inquiry and increase opportunities for meaningful dialogue. The paper introduces and explores the concept of the 'poetic wavelength', building on the previously established notion of the psychotic wavelength, which proposes that others need to 'tune in' to what is being communicated through psychosis. The concept of the poetic wavelength suggests that the reading and writing of poetry may support this process of 'tuning in' both for those experiencing psychosis and those working therapeutically with them.

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BACKGROUND: It has been advocated that the development of medical school curricula must be informed by students, doctors in training, educators, employers, other health and social care professionals and patients, families and carers. Patients are widely employed to teach clinical and interpersonal skills, and while recognised as crucial in health education, they have mostly been offered a passive role. We assessed the impact of patients contributing personal illness narratives in the master curriculum of allied health care professionals on students' learning experiences. METHODS: We designed a module (Patient and Society) for a master's degree programme in Health Sciences at the University of Southern Denmark in collaboration with six patients. The patients contributed to the teaching by sharing and discussing their personal illness narrative. At the end of the module, as part of the exam, we asked the students to reflect on the patients' contribution to the module and how this affected their learning experiences. The 500-word exam responses of 29 students were analysed, in collaboration with six patients, using thematic analysis. RESULTS: Including patients' illness narratives lifted students' academic learning, and their personal and professional development. The stories brought theoretical concepts to life; it helped the students to obtain, retain, and apply academic knowledge. Actively and uninterrupted listening to patients' illness experiences promoted empathy and critical reflection on clinical practice. Faced with the impact of a disease on a person's life, seeing the healthcare system through a patient's lens made students reflect critically on the medical positivist model ruling the health care system focused on just fixing the medical problem with very little room for the illness experience. CONCLUSION: Our analyses support previous findings indicating that patient narratives are a powerful tool to achieve academic and professional development. Working with patients in health education has the potential to work towards a more inclusive epistemological stance in the health care system and health research.

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Background: Physicians understand that certain personal attributes are essential in medical leaders, but they often do not know what actions are expected of them as leaders or what they should do to be more effective leaders. Purpose: We sought to compile, through interviews with senior leaders at an academic institution, real leadership scenarios for a series of case-based examples to be used during group mentoring sessions for aspiring medical leaders. Methods: We conducted one-to-one interviews using open-ended questions with 11 current and emeritus chairpersons or chiefs of major departments or divisions at our academic medical center. Questions were designed to elicit anecdotes and examples of actions that demonstrate effective and ineffective leadership. Responses were analyzed with qualitative techniques to generate topics of leadership behaviors, which then were compiled into a collection of illustrative examples. Results: The leaders interviewed discussed challenges they encountered in daily routines and described how they addressed certain dilemmas. Topics included making decisions without complete information, winning over reluctant administrators, building alliances with peers, involving subordinates in initiatives, and using knowledge to defend one's position. Actions requiring interpersonal skills also were discussed, including varying modes of communication, avoiding adversity, displaying gratitude toward subordinates, and safeguarding one's professional image. The leaders' insights and recommendations were compiled into a themed collection of topics to be used during group mentoring sessions to enhance leadership skills. Conclusions: This qualitative study suggests that the wisdom and experience of senior leaders may be gleaned for a collection of case-based topics that could complement other formal training programs for aspiring medical leaders.

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This article explores the emergence of molecular approaches in German genetic research during the 1958-1968 decade as a period of contingency and alternative possibilities. We introduce "Narratives of Contingency" as an analytical framework to examine how scientists construct a specific narrative - linking past experiences with expectations of future conditions - in order to outline and navigate pathway-decisions in the present. We apply this framework to Hans-Jörg Rheinberger's developmental model of molecular genetics and illustrate how the stages he identifies - the direction of the field, institutional developments, and epistemological demarcations - were already central themes in the comparative practices underlying narratives of contingency in this early period. Narratives of contingency can thus serve as a systematic framework for analyzing the processes through which new scientific fields, institutions, and epistemic horizons emerge, and possibly also for identifying historically plausible fork moments or alternative pathways not taken.

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Theory is a critical component of the biological research process, and complements observational and experimental approaches. However, most biologists receive little training on how to frame a theoretical question and, thus, how to evaluate when theory has successfully answered the research question. Here, we develop a guide with six verbal framings for theoretical models in biology. These correspond to different personas one might adopt as a theorist: 'Advocate', 'Explainer', 'Instigator', 'Mediator', 'Semantician' and 'Tinkerer'. These personas are drawn from combinations of two starting points (pattern or mechanism) and three foci (novelty, robustness or conflict). We illustrate each of these framings with examples of specific theoretical questions, by drawing on recent theoretical papers in the fields of ecology and evolutionary biology. We show how the same research topic can be approached from slightly different perspectives, using different framings. We show how clarifying a model's framing can debunk common misconceptions of theory: that simplifying assumptions are bad, more detail is always better, models show anything you want and modelling requires substantial maths knowledge. Finally, we provide a roadmap that researchers new to theoretical research can use to identify a framing to serve as a blueprint for their own theoretical research projects.

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Disabled women with significant impairments (DWSI) are not adequately recognised within feminist disability studies. They face stigma, carnal taboos, and systemic exclusion from economies of desire and sexuality. Their voices are seldom heard, and their stories, when captured, are whitewashed. There is an urgent need for these women to gain voice and visibility as a unique category within the political spectrum of women with disabilities so that their unique challenges can be identified and their rights restored. In-depth research aimed at spotlighting their unique challenges and vulnerabilities using 'raw narratives' as a novel method, exposed their tabooed and otherwise censored embodied experiences. This paper presents a candid case study of one such woman in India using narrative inquiry and autoethnography. Carol Thomas' notion of 'impairment effects' and Margrit Shildrick's concept of 'embodied precarity' are used to highlight how impairment effects, coupled with inadequate care infrastructure in India, force disabled women with significant impairments into chronic states of dependency and precarity, leading to an internalised loss of self-worth and agency. The wider use of raw narratives as a lens to probe unspoken elements of human experience and further study of DWSI as a community could enrich feminist disability studies.

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BACKGROUND: The recent crises of bushfires, floods, and the COVID-19 pandemic on the southeast coast of Australia were unprecedented in their extent and intensity. Few studies have investigated responses to cumulative disasters in First Nations communities, despite acknowledgement that these crises disproportionately impact First Nations people. This study was conducted by Aboriginal and non-Aboriginal researchers in partnership with Waminda, South Coast Women's Health and Wellbeing Aboriginal Corporation, an Aboriginal Community Controlled Health Organisation (ACCHO). It investigated the collective experiences of people affected by cumulative disasters to identify the practices that support healing, and recovery for Aboriginal communities. The study addresses a knowledge gap of how Waminda, designs, manages and delivers responses to address complex health and social issues in the context of cumulative disasters. METHODS: Underpinned by practice theory this study employed Indigenous-informed, narrative inquiry. Culturally-appropriate, multiple interpretive methods were used to collect data including: observations; yarns with Aboriginal community members, yarns with Waminda practitioners, management and board members; interviews-to-the-double, visual images and documentation. The data were collated and analysed using the phases of reflexive thematic analysis. RESULTS: The paper articulates a suite of culturally safe and place-based practices that enhance social, emotional and spiritual well-being following cumulative disasters. These practice bundles include: adopting a Country-centred conception of local communities; being community-led; viewing care as a collective, relational, sociomaterial accomplishment and having fluid boundaries. These practice bundles 'hang together' through organising practices including the Waminda Model of Care, staff wellbeing framework and emergency management plan which orient action and manage risks. The paper demonstrates the need for disaster responses to be community-led and culturally situated. ACCHOs are shown to play a crucial role, and their local responses to immediate community needs are grounded in contextual knowledge and use existing resources rather than relying on mainstream system-wide interventions. CONCLUSIONS: The paper suggests crafting responses that focus on assisting communities (re)gain their sense of belonging, hope for the future, control over their lives and their capacities to care for and to be cared for by Country, are key to both enhancing healing, health and well-being and harnessing the strengths of communities.

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Background: This study investigates the discourse on anxiety management strategies within the TikTok platform, analyzing a substantial dataset of 45,639 comments collected over a year.Aims: The primary aim is to explore the various strategies users employ to manage anxiety, focusing on how these strategies are discussed and shared on TikTok.Methods: A mixed-method approach was utilized, combining Latent Dirichlet Allocation (LDA) for topic modeling with qualitative analysis. This methodology allowed for the identification of nine distinct topics, which were further grouped into three main categories: Self-Empowerment and Coping Strategies, Community Support and Social Connectivity, and Recognizing and Navigating Triggers.Results: The analysis revealed a diverse range of strategies users employ to manage anxiety, spanning personal coping mechanisms, social support networks, and the recognition and mitigation of triggers. These findings underscore TikTok's role as a dynamic space for sharing, exploring, and validating experiences related to anxiety management.Conclusions: TikTok offers unique opportunities for identity construction and community support amidst the challenges of anxiety. However, the study acknowledges limitations, such as potential biases in keyword-based data collection and the complexity of capturing multimodal discourse on the platform. The conclusion emphasizes the need for further refinement of digital mental health platforms, calling for sophisticated algorithmic solutions to enhance user support and content relevance.

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PURPOSE: The study aimed to understand how bilingual children with typical language development (TLD) and those with developmental language disorder (DLD) use frequent word co-occurrences in their narratives. METHOD: We studied the change over time in the word co-occurrences used by 30 Spanish-English bilingual children with and without DLD (experimental group). An additional normative group consisted of 98 TLD Spanish-English bilingual first graders. Children narrated two Spanish and two English stories in kindergarten and first grade. Employing a Python program on the transcribed narratives, we extracted all adjacent two-word and three-word co-occurrences. From the normative group, the 90 most frequently occurring two-word and 90 most frequently occurring three-word co-occurrences were extracted. The type and tokens of word co-occurrences each child in the experimental group produced out of the 180 identified word co-occurrences were analysed. RESULT: Overall, children at first grade produced more word co-occurrences types than in kindergarten. Children with DLD used fewer types of word co-occurrences but produced them as often as than their TLD peers. Children with DLD increased their word co-occurrences from kindergarten to first grade at the same rate although at a lower frequency. Children in both groups produced similar types and tokens of word co-occurrences in both Spanish and English, except tokens of two word co-occurrences. Children produced two word co-occurrences more often in English than in their Spanish narratives. CONCLUSION: The results shed light on children with DLD's deficits in production of word co-occurrences, indirectly reflecting possible deficits in statistical pattern detection.

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BACKGROUND: The dramatic reconfigurations of work-family roles and social boundaries resulting from the social restrictions imposed during the Covid-19 pandemic led working mums to look for online sites as spaces of emotional support and regulation where they could vent their emotions, share their concerns and griefs, and seek advice. They also became interactional spaces where mums' relevant identities were reassessed and enacted as they aimed to balance work-family roles and improve their wellbeing. The paper explores how working mums discursively negotiated their multiple identities in an online support forum during times of global struggle, how these identity constructions reflect the domains of Work-Family Conflict (WFC) and how working mums perceived these identities are related to their mental health. METHODS: 127 posts of Chilean working mums published in a public online support forum for working mums collected during the first half of 2020 were analysed in three phases. The first one involved a thematic analysis to identify themes and subthemes related to working mums' identity construction in the data. The second phase involved conducting a narrative analysis of working mums' microstorias in order to identify a master narrative crafted by these working mums, and contesting and conforming ideologies of motherhood, among others. Finally, the third phase involved a fine-grained discourse analysis of the most representative extracts illustrating working mums' identity negotiation. RESULTS: The sociolinguistic analysis showed that working mums' discourses displayed three themes of self-reflection, namely, diminishing self-care, reassessing their self, and enhancing self through self-care. Identity-related sub-themes for each main theme are discussed and discursively analysed. Two main points are emphasised: (1) the identity that was most salient in working mums' discourse was their personal identity (rather than work-family roles and identities), and (2) microstorias allowed working mums to challenge the hegemonic power of dominant discourses around their identities and their work-family roles. CONCLUSIONS: The study shows that a sociolinguistic approach to the exploration of working mums' identity negotiation is useful to highlight the ways in which mums contest binary assumptions of work-family roles and the need to reconsider working mums' life domains so that they reflect working mums' actual identity needs and lived experiences. Future lines of research are outlined.

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Few studies have investigated parent's experiences with racism in the neonatal intensive care unit (NICU). Our objective was to explore how parents perceive their interactions with NICU staff and if/how racism in the NICU was experienced. Parents of infants receiving care in an urban NICU completed fixed choice surveys regarding their experiences and demographics, with 6 open-ended questions to elaborate on their fixed-choice responses. Using a constant comparative method informed by Constructivist Grounded Theory, we identified 3 main themes from the comments provided by 97 respondents: Care and harm coexisting, racism often manifesting as neglectful care, and the power differential is most impactful during times of parent advocacy. Parents spoke positively regarding their experiences and also reported disparate treatment attributed to their racial/ethnic identity. Racism was experienced by inappropriate comments and apathy toward parent requests, occurring during intimate interactions between staff and parents. Descriptions of parental advocacy efforts highlighted the lack of power they held in relation to the NICU staff. We recommend strengthening the focus on equity and mitigating power imbalances in the NICU.

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The increasing volume of unstructured textual data in healthcare, particularly in nursing care reports, presents both challenges and opportunities for enhancing patient care and operational efficiency. This study explores the application of Latent Dirichlet Allocation (LDA) topic modeling to analyze free-text nursing narratives from inpatient stays in three different clinics, aiming to uncover the latent thematic structures within. Utilizing the R programming environment and the visualization tool LDAvis, we identified three main themes: "Patient Well-being," "Patient Mobility and Care Activities," and "Treatment and Pain Management," the latter combining two closely related but initially distinct topics due to their overlapping content. Our findings demonstrate the potential of LDA topic modeling in extracting meaningful insights from nursing narratives, which could inform patient care strategies and healthcare practices. However, the study also highlights significant challenges associated with the method, including the sensitivity to parameter settings, the lack of updates for key software packages, and concerns about reproducibility. These issues highlight the need for meticulous parameter validation and the exploration of alternative text analysis methodologies for future research. By addressing these methodological challenges and emphasizing the importance of comparative method analysis, this study contributes to the advancement of text analytics in healthcare. It opens avenues for further research aimed at developing more robust, efficient, and accessible tools for analyzing free-text data, thereby enhancing the ability of healthcare professionals to use unstructured data to improve decision making and patient outcomes.

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Background: The assessment of language deficits can be valuable in the early clinical diagnosis of neurodegenerative disorders, including Alzheimer's disease (AD). Objective: The present study aims to explore whether language markers at the macrostructural level could assist with the placement of an individual across the dementia continuum employing production data from structured narratives. Methods: We administered a Picture Sequence Narrative Discourse Task to 170 speakers of Greek: young healthy controls (yHC), cognitively intact healthy elders (eHC), elder participants with subjective cognitive impairment (SCI), with mild cognitive impairment (MCI), and with AD dementia at the mild/moderate stages. Structural MRIs, medical history, neurological examination, and neuropsychological/cognitive screening determined the status of each speaker to appropriately groupthem. Results: The data analysis revealed that the Macrostructure Index, Irrelevant Info, and Narration Density markers can track cognitive decline and AD (p < 0.001; Macrostructural Index: eHC versus AD Sensitivity 93.8%, Specificity 74.4%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%; Narration Density: eHC versus AD Sensitivity 90.6%, Specificity 71.8%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%). Moreover, Narrative Complexity was significantly affected for subjects with AD, Irrelevant Info increased in the narrations of speakers with MCI and AD, while Narration Length did not appear to indubitably differentiate between the cognitively intact groups and the clinical ones. Conclusions: Narrative Macrostructure Indices provide valuable information on the language profile of speakers with(out) intact cognition revealing subtle early signs of cognitive decline and AD suggesting that the inclusion of language-based assessment tools would facilitate the clinical process.

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Introduction: Labor consolidation is not a sufficient criterion to abandon the need for the qualification and requalification of professionals, especially in the field of education, which must respond to the uncertainties of society in the light of trends and advances incorporated in pedagogical research. Methods: The present qualitative study analyzes the training demands of social education professionals from their own perspective, using their own stories in a semi-structured interview format conducted with), key informants from governmental and non-governmental organizations in southeastern Spain, specifically from the autonomous community of the region of Murcia. Results: According to the results, the most frequent and significant formative limitations are those referred to in the field of social policies, legislative training, administrative processing, specialized work in specific sectors or collectives, and mediation. Similarly, the results reveal fashion themes (mental health, gender) and reiteration of non-exclusive conditioners of social education. These are extrapolable to other areas, such as the increasing bureaucracy and complexity in the proceedings as common places in the reflection of professionals with their own initiative and commitment to their own updating that is associated with a reflective criticism of their own professionalization. Discussion: The diverse range of responses and subjects, as indicated by the numerous descriptors needed for the categorization and their respective percentages, leads us to conclude that ongoing professional training does not encourage excessive specialization. Instead, it necessitates offering a broad range of training adjusted to the versatility of situations.

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In the last two decades, there has been an explosion of scholarship in the phenomenology of health and illness of great practical significance for clinicians and the allied health professions. 'Healing' has been distinguished from medical 'cure' insofar as it involves a process of existential re-integration even in the face of ongoing illness and incapacity. This article goes further than much existing literature in the field: it examines ways in which illness can trigger for some 'transformational healing'-that is, not simply a return to previous functioning, but positive alterations that open one's life to enhanced fulfilment, authenticity and/or connection. Using philosophical resources and 'pathographies', first-person accounts of illness and healing, we examine six forms, often interconnected, of transformational healing. These involve, in turn: vulnerability, intimacy, resilience, presence, gratitude and transcendence In placing a spotlight on ways in which serious illness, injury and disability can inform positive transformations, we are not minimising the suffering often associated with such conditions. Nonetheless, many individuals experience life-enhancements despite, or even because of, the effects of suffering which can reveal personal strengths, deepened intimacy with others and heightened appreciation of life. The possibility of transformational healing, while far from a universal experience, has personal, philosophical and clinical significance not to be overlooked.

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Cognitive economics is an emerging interdisciplinary field that uses the tools of cognitive science to study economic and social decision-making. Although most strains of cognitive economics share commitments to bridging levels of analysis (cognitive, behavioral, and systems) and embracing interdisciplinary approaches, we review a newer strand of cognitive economic thinking with a further commitment: conceptualizing minds and markets each as complex adaptive systems. We describe three ongoing research programs that strive toward these goals: (i) studying narratives as a cognitive and social representation used to guide decision-making; (ii) building cognitively informed agent-based models; and (iii) understanding markets as an extended mind - the Market Mind Hypothesis - analyzed using the concepts, methods, and tools of Coordination Dynamics.

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Our study focuses on exploring the embodied experiences of genetic inheritance within and between bodies. Drawing on insights from studies on embodied experiences and family risk we examine how interviewees perceive their vulnerability, negotiate family narratives, genetic inheritance, and the transmission of genetic knowledge within families. To answer these questions, we conducted an interpretative phenomenological analysis, based on 10 in-depth interviews with patients with thrombophilia diagnosis and venous thromboembolic disease, in Hungary. Three Experiential Themes were identified: The body as a repository of risk (1), Family heritage (2), and The borderline of thrombophilia-liminality (3). Our study has found that patients living with thrombophilia interpret their bodies as repositories of genetic risk. It seems that an important aspect of adapting to thrombophilia is the creation of genetically vulnerable identities. Alongside the new identity(ies), living with risk can induce newly discovered forms of familial responsibility, within the common identification experience of family history and succession. Based on our research, we see that individuals living with thrombophilia experience the liminality of borderlands. In some cases, however, the space between health and illness represents a dynamic permeability for people with thrombophilia, which can be triggered by medical uncertainty in addition to individual experiences and life events.