Background The Centers for Disease Control and Prevention's Surveillance of Congenital Heart Defects Across the Lifespan project uses large clinical and administrative databases at sites throughout the United States to understand population‐based congenital heart defect (CHD) epidemiology and outcomes. These individual databases are also relied upon for accurate coding of CHD to estimate population prevalence. Methods and Results This validation project assessed a sample of 774 cases from 4 surveillance sites to determine the positive predictive value (PPV) for identifying a true CHD case and classifying CHD anatomic group accurately based on 57 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Chi‐square tests assessed differences in PPV by CHD severity and age. Overall, PPV was 76.36% (591/774 [95% CI, 73.20–79.31]) for all sites and all CHD‐related ICD‐9‐CM codes. Of patients with a code for complex CHD, 89.85% (177/197 [95% CI, 84.76–93.69]) had CHD; corresponding PPV estimates were 86.73% (170/196 [95% CI, 81.17–91.15]) for shunt, 82.99% (161/194 [95% CI, 76.95–87.99]) for valve, and 44.39% (83/187 [95% CI, 84.76–93.69]) for “Other” CHD anatomic group ( X 2 =142.16, P <0.0001). ICD‐9‐CM codes had higher PPVs for having CHD in the 3 younger age groups compared with those >64 years of age, ( X 2 =4.23, P <0.0001). Conclusions While CHD ICD‐9‐CM codes had acceptable PPV (86.54%) (508/587 [95% CI, 83.51–89.20]) for identifying whether a patient has CHD when excluding patients with ICD‐9‐CM codes for “Other” CHD and code 745.5, further evaluation and algorithm development may help inform and improve accurate identification of CHD in data sets across the CHD ICD‐9‐CM code groups.
Linguistic communication requires understanding of words in relation to their context. Among various aspects of context, one that has received relatively little attention until recently is the speakers themselves. We asked whether comprehenders’ online language comprehension is affected by the perceived reliability with which a speaker formulates pragmatically well-formed utterances. In two eye-tracking experiments, we conceptually replicated and extended a seminal work by Grodner and Sedivy (2011). A between-participant manipulation was used to control reliability with which a speaker follows implicit pragmatic conventions (e.g., using a scalar adjective in accordance with contextual contrast). Experiment 1 replicated Grodner and Sedivy’s finding that contrastive inference in response to scalar adjectives was suspended when both the spoken input and the instructions provided evidence of the speaker’s (un)reliability: For speech from the reliable speaker, comprehenders exhibited the early fixations attributable to a contextually-situated, contrastive interpretation of a scalar adjective. In contrast, for speech from the unreliable speaker, comprehenders did not exhibit such early fixations. Experiment 2 provided novel evidence of the reliability effect in the absence of explicit instructions. In both experiments, the effects emerged in the earliest expected time window given the stimuli sentence structure. The results suggest that real-time interpretations of spoken language are optimized in the context of a speaker identity, characteristics of which are extrapolated across utterances.
Background Spina bifida is the most common neural tube defect. It has been associated with increased mortality, disability, and may require lifelong medical care. Higher‐level lesions have been shown to be associated with increased mortality in infants with spina bifida. Methods A study was conducted using data from infants with myelomeningocele and related spina bifida reported to the New York State Birth Defects Registry for birth years 2008 through 2017. Descriptive statistics were conducted. Cox regression was used to calculate adjusted hazard ratios for mortality by age one, by lesion level. Hazard ratios were adjusted for birthweight and maternal race/ethnicity. Results Overall survival at age one was 90.7%. Cervical‐level lesions had an increased risk of mortality compared to lumbar‐level lesions (HR 8.32; 95% CI: 2.56, 27.05). No statistically significant associations were found for sacral‐level lesions compared to lumbar‐level lesions. Conclusion These results suggest that infants with cervical‐level spina bifida have a higher risk of death by age one than those with other lesion levels.
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