Validation of Electronic Health Record Phenotyping of Bipolar Disorder Cases and Controls

Objective: The study was designed to validate use of elec-tronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. Method: EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype di- agnoses was calculated against diagnoses from direct semi- structured interviews of 190 patients by trained clinicians blind to EHR diagnosis. Results: The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR- classified control subject received a diagnosis of bipolar dis- order on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based clas- sifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. Conclusions: Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.

Personal Exposure to Grass Pollen: Relating Inhaled Dose to Background Concentration

Background Very few studies on human exposure to allergenic pollen have been conducted using direct methods, with background concentrations measured at city center monitoring stations typically taken as a proxy for exposure despite the inhomogeneous nature of atmospheric pollen concentrations. A 2003 World Health Organization report highlighted the need for an improved understanding of the relation between monitoring station data and actual exposure. Objective To investigate the relation between grass pollen dose and background concentrations measured at a monitoring station, to assess the fidelity of monitoring station data as a qualitative proxy for dose, and to evaluate the ratio of dose rate to background concentration. Methods Grass pollen dose data were collected in Aarhus, Denmark, in an area where grass pollen sources were prevalent, using Nasal Air Samplers. Sample collection lasted for approximately 25 to 30 minutes and was performed at 2-hour intervals from noon to midevening under moderate exercise by 2 individuals. Results A median ratio of dose rate to background concentration of 0.018 was recorded, with higher ratio values frequently occurring at 12 to 2 pm, the time of day when grass species likely to be present in the area are expected to flower. From 4 to 8 pm, dose rate and background concentration data were found to be strongly and significantly correlated (rs = 0.81). Averaged dose rate and background concentration data showed opposing temporal trends. Conclusion Where local emissions are not a factor, background concentration data constitute a good quantitative proxy for inhaled dose. The present ratio of dose rate to background concentration may aid the study of dose–response relations.

Relative Efficiencies of the Burkard 7-Day, Rotorod and Burkard Personal Samplers for Poaceae and Urticaceae Pollen under Field Conditions

Introduction: In aerobiological studies it is often necessary to compare concentration data recorded with different models of sampling instrument. Sampler efficiency typically varies from device to device, and depends on the target aerosol and local atmospheric conditions. To account for these differences inter-sampler correction factors may be applied, however for many pollen samplers and pollen taxa such correction factors do not exist and cannot be derived from existing published work. Materials and methods: In this study the relative efficiencies of the Burkard 7-Day Recording Volumetric Spore Trap, the Sampling Technologies Rotorod Model 20 and the Burkard Personal Volumetric Air Sampler were evaluated for Urticaceae and Poaceae pollen under field conditions, and the influence of wind speed and relative humidity on these efficiency relationships was assessed. Data for the two pollen taxa were collected during 2010 and 2011-12 respectively. Results: The three devices were found to record significantly different concentrations for both pollen taxa, with the exception of the 7-Day and Rotorod samplers for Poaceae pollen. Under the range of conditions present during the study wind speed was found to only have a significant impact on inter-sampler relationships involving the vertically orientated Burkard Personal sampler, whilst no interaction between relative efficiency and relative humidity was observed. Conclusions: Data collected with the three models of sampler should only be compared once the appropriate correction has been made, with wind speed taken into account where appropriate.