Use Of Multiple Codes Research Articles

The Intrarater and Interrater Reliability of the OMT Classification Among Physicians With a Different Background.

The Oberg-Manske-Tonkin (OMT) classification established excellent reliability scores in several validation studies. However, one study published in 2022 found much lower scores in a subanalysis of their sample when very simple anomalies were excluded. Our study assessed the reliability of the OMT among physicians with a different background, all involved in congenital hand anomaly care, and analyzed codes with less agreement. Time required for classification was recorded to give an indication on its usability. One hundred digital cases were classified twice with a minimal 1-month time interval, with the use of the 2020 version of the OMT. Two pediatric hand surgeons, 2 rehabilitation specialists, and 2 plastic surgery residents participated in this reliability analysis. The use of multiple codes was allowed. The intra- and interrater reliability was assessed for all 15 possible rater couples by calculating percentage of agreement. Cohen's kappa was calculated along with a 95% confidence interval. For the analysis of individual codes with less agreement, we calculated positive agreement with the use of a summed agreement table. Time necessary for classification was documented in seconds. The inter- and intrarater agreement was moderate with a mean Cohen's kappa of 0.45 and 0.60 retrospectively. On average, 39 seconds per case were necessary for the first and 24 seconds for the second rating. Background did not influence the level of agreement. Lowest agreement levels (ie, lowest positive agreement) were observed with all the arthrogryposis multiplex congenita subgroups, the "other" subgroups of isolated congenital contractures, syndromic syndactyly, and synpolydactyly. Codes commonly used interchangeably were symbrachydactyly and transverse deficiency and the distinction between these anomalies of only the hand or the entire upper limb; symbrachydactyly and brachydactyly; and camptodactyly and distal arthrogryposis. Our study showed a moderate reliability, emphasizing the complexity of this heterogeneous patient population. Despite its imperfections, the OMT remains the best and most versatile classification tool at hand. Its main purpose may lie in contributing to a universal language for research. I.

Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health Insurance, 2016-2021: Introduction of the P04.14 ICD-10-CM Code.

The opioid epidemic has led to a surge in diagnoses of neonatal opioid withdrawal syndrome (NOWS). Many states track the incidence of NOWS by using the P96.1 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code for "neonatal withdrawal symptoms from maternal use of drugs of addiction." In October 2018, an ICD-10-CM code for neonatal opioid exposure (P04.14) was introduced. This code can be used when an infant is exposed to opioids in utero but does not have clinically significant withdrawal symptoms. We analyzed the effect of the P04.14 code on the incidence rate of NOWS (P96.1) and "other" neonatal drug exposure diagnoses (P04.49). We used private health insurance data collected for infants in the United States from the first quarter of 2016 through the third quarter of 2021 to describe incidence rates for each code over time and examine absolute and percentage changes before and after the introduction of code P04.14. The exclusive use of code P96.1 declined from an incidence rate per 1000 births of 1.08 in 2016-2018 to 0.70 in 2019-2021, a -35.7% (95% CI, -47.6% to -23.8%) reduction. Use of code P04.49 only declined from an incidence rate of 2.34 in 2016-2018 to 1.64 in 2019-2021, a -30.0% (95% CI, -36.4% to -23.7%) reduction. Use of multiple codes during the course of treatment increased from an average incidence per 1000 births of 0.56 in 2016-2018 to 0.79 in 2019-2021, a 45.5% (95% CI, 24.8%-66.1%) increase. The introduction of ICD-10-CM code P04.14 altered the use of other neonatal opioid exposure codes. The use of multiple codes increased, indicating that some ambiguity may exist about which ICD-10-CM code is most appropriate for a given set of symptoms.

Affordances and Common Grounds in Buyer-Seller Interactions

This study examines the interactions between buyers and sellers in the market setting using the common ground theoretical framework. From the existing literature, it is observed that no research work has examined the above subject matter in the Igbo language using the above mentioned theoretical framework. This is the lacuna in the literature that this study intends to address. The specific objective is to explore the interactions between presuppositions, stages of understanding an utterance and reception strategies in buyer-seller interactions during haggling. Ten interactions were recorded and three of them were sampled in this study. The data were analyzed using the common ground theory. The findings of the study reveal that both the seller and buyer often have the generic structure of buyer-seller interactions in their subconscious, which they put into practice when they engage in market discourse. Also, the buyers and sellers update their personal or emergent common ground as they negotiate meaning during interactions. Furthermore, as the result of the common ground shared by the buyer and the seller, they interpret every utterance based on the affordances of a speech event in a market setting where a buyer is under no obligation to buy after haggling nor is the seller obligated to sell. It also discovers that presupposition is at the heart of grounding because at every interactive turn, a speaker believes that the addressee understands his/ her intentions. The researcher recommends further research on the pragmatic implications for the use of multiple codes during buyer-seller interactions in Igbo land.

Use of ontology structure and Bayesian models to aid the crowdsourcing of ICD-11 sanctioning rules

The International Classification of Diseases (ICD) is the de facto standard international classification for mortality reporting and for many epidemiological, clinical, and financial use cases. The next version of ICD, ICD-11, will be submitted for approval by the World Health Assembly in 2018. Unlike previous versions of ICD, where coders mostly select single codes from pre-enumerated disease and disorder codes, ICD-11 coding will allow extensive use of multiple codes to give more detailed disease descriptions. For example, “severe malignant neoplasms of left breast” may be coded using the combination of a “stem code” (e.g., code for malignant neoplasms of breast) with a variety of “extension codes” (e.g., codes for laterality and severity). The use of multiple codes (a process called post-coordination), while avoiding the pitfall of having to pre-enumerate vast number of possible disease and qualifier combinations, risks the creation of meaningless expressions that combine stem codes with inappropriate qualifiers. To prevent that from happening, “sanctioning rules” that define legal combinations are necessary. In this work, we developed a crowdsourcing method for obtaining sanctioning rules for the post-coordination of concepts in ICD-11. Our method utilized the hierarchical structures in the domain to improve the accuracy of the sanctioning rules and to lower the crowdsourcing cost. We used Bayesian networks to model crowd workers’ skills, the accuracy of their responses, and our confidence in the acquired sanctioning rules. We applied reinforcement learning to develop an agent that constantly adjusted the confidence cutoffs during the crowdsourcing process to maximize the overall quality of sanctioning rules under a fixed budget. Finally, we performed formative evaluations using a skin-disease branch of the draft ICD-11 and demonstrated that the crowd-sourced sanctioning rules replicated those defined by an expert dermatologist with high precision and recall. This work demonstrated that a crowdsourcing approach could offer a reasonably efficient method for generating a first draft of sanctioning rules that subject matter experts could verify and edit, thus relieving them of the tedium and cost of formulating the initial set of rules.

A multicode approach for high data rate UWB system design

This contribution provides a very high data rate UWB system design based on direct sequence spreading. In order to attain >500 Mbps for short range communication, two classical solutions are feasible: either use very short spreading sequences or very large bandwidth. These classical strategies increase intersymbol interference. In contrast, our approach consists in allocating multiple long codes to each user. Long codes allow to cope with channel impairments while the use of multiple codes maintains very high bit rates. With such high data rates the receiver obviously has to be simple by requiring a low complexity digital processing. This paper shows that the proposed strategy is compatible with simple receivers. In fact, even if the amount of interference increases, joint usage of very long codes and simple linear receiver can result in high data rate, high performance UWB system. This assertion is substantiated through comparisons with existing UWB solutions.

Code Switching and Language Leveling: Use of Multiple Codes in a Severn Ojibwe Community

Introduction. The northernmost dialect of Ojibwe, often designated Severn Ojibwe by scholars,1 is spoken in some seventeen northwestern Ontario and northeastern Manitoba villages situated along the drainage system of the Severn and Winisk rivers. This dialect has long been an enigma to historians and linguists. Linguistically, Severn Ojibwe differs in a number of important lexical, phonological, and grammatical respects from its closest Ojibwe neighbor, the Northwestern dialect (following the terminology of Rhodes and Todd 1981), spoken directly to the south. To the north, east, and west of the Severn area lie several dialects of another Algonquian language, Cree. Many of the features that distinguish Severn from other Ojibwe dialects are quite similar to Cree, though these same features often show the clear reflexes of Ojibwe phonological development which indicate that they cannot be recent borrowings from Cree.2 Close scrutiny of the codes used in the Severn Ojibwe community of Lynx Lake, one of the remote and seemingly isolated village located in this broad expanse of the subarctic taiga, provides a great deal of information about social relationships among the Severn people, Cree populations, and the Euro-Canadian matrix culture. Within this community of some three hundred people, one finds two subdialects of Severn Ojibwe, three dialects of Cree (Swampy, Plains, and Moose), and at least two varieties of English regularly employed as linguistic resources. Most code-switching research has involved groups living in industrialized societies where two or more speech communities exhibit extensive, daily contact. In the majority of these studies, the languages involved are