Welcome to the Front Row: A Plea for Equal Access to God in Orthodox Jewish Culture

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From these prayers, 42 contained signs of religious struggle, whereas did not indicate religious struggle. Overall, interrater reliability was. In addition, the annotators produced an overall agreement of The most successful classifier had an AROC of 0. Different methods were used to tune the classifier, and the entire results can be found in Table 2.

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The list of top features is detailed in Table 3. Figure 1 depicts the full receiving operating characteristic ROC curve. AROC for different classifiers in determining whether written prayers contain religious struggle. Techniques include wrapper method and information foraging IF. Probabilities and P -values of top features occurring in a prayer of both classes. The gray line is the area under a receiving operating characteristic curve for a baseline random classifier. A second analysis was performed, in which the total prayers were annotated, of which were obtained from site 1 and of which were obtained from site 2.

For this analysis, a combination of 1 to 4 annotators both from the United States and United Kingdom annotated each prayer. In addition, the annotators achieved an overall agreement of The purpose of this analysis was to test whether there was a significant difference in language that would require different classifiers for different cultures. Figure 2 depicts the full ROC curve.

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We present an exploratory attempt to use NLP to identify the spiritual struggle written in the prayer books of a pediatric academic medical center. The classifier can identify religious struggle by examining patterns of words and phrases within the corpus of texts. In addition, the classification algorithm used can be applied across data sets with different prayers and cultures because the classifier with just American prayers and annotators performed comparably as the classifier with both British and American prayers and annotators.

Consequently, the classifier can provide additional decision support to chaplains in identifying persons with religious struggle. Prayers across 2 English-speaking cultures as having expressions of religious struggle could be identified. This suggests that although there may be geographically unique expressions of religious struggle, there are also some expressions that are sufficiently common as to make the use of the classifier possible across regions. These results also suggest that it is feasible to train persons who are not board-certified chaplains to recognize expressions of religious struggle.

It may therefore be possible to have prayers in chapel notebooks read in a cost-efficient manner by someone trained to use the ontology to recognize expressions of religious struggle and who is not a board-certified chaplain.

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To determine whether the context in which gendered pronouns occurred might provide a different perspective, a further review of randomly selected prayers was undertaken by the senior author DHG. It could also reflect a finding that is statistically significant and yet not clinically meaningful. Because these self personal pronouns were demonstrated to be some of the most distinguishing features in the classifier, they might indicate the negative emotional state contained within prayers that have religious struggle, suggesting a need for further analysis.

The study has limitations that we acknowledge and accept for an exploratory study.

The classifier was built around prayers and 7 annotators from 2 different contexts. The restraints of time and the availability of the annotators meant that only 1 annotator annotated British prayers in the supplementary analysis. As a result, more false-negatives and false-positives could have occurred than intended. However, with relatively stable interannotator agreement, much deviation was not expected and the chance of a type I error or type II error was low.

Another potential limitation arises from the concern over the privacy of health information. This has led some institutions to discourage prayer writers from using surnames or patient room numbers, which would be helpful or necessary to correctly identify a prayer writer for follow-up. This concern need not be irremediable: Instructions at the top of each notebook page or on a bookstand could indicate that prayers are being reviewed and that a member of a chaplaincy department may follow up.

This is little different in principle for similar notations that prayers may be read aloud during public worship in the chapel space. The lack of need of oversight of this or similar studies stems from the very public nature of the prayer books, the voluntary surrender of some privacy that is made in choosing to write a prayer, and the degree of self-disclosure writers choose to make. One study has even noted that some prayer writers appear to write what is in effect a plea for others to read and lift up their person in prayer.

However, it is the religious struggle of the prayer writer that is of primary clinical interest to the chaplain, which may or may not be directly related to the health status or religious struggle of the patient or the person being prayed about. Prayers written in a pediatric hospital may differ in significant ways from those written in adult hospitals. It is also impossible to definitively obtain demographic data about the prayer writers. More women than men attend religious services in the United States, 52 and it may well be that most of the prayer writers were women.

Nevertheless, important conclusions can be drawn. The classifier can discriminate between prayers with or without religious struggle. Potential future research directions should focus on preparing for the next pilot phase of development. This translational research is needed to address the limitations mentioned above. These include, first, increasing the number of prayers included to strengthen the classifier, as well as give more evidence regarding the interannotator reliability across the cultures of the United States and the United Kingdom.

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Second is identifying and operationalizing a means of linking a prayer with an identifiable person while maintaining an appropriate level of privacy. After overcoming the translational barriers, the algorithm may be implemented by making it available to medical centers or publishable to be used conveniently and with regional data if our current presented data show drastic contrast to the region. The issue of religious struggle occurring more frequently when a woman is the subject of prayer in a hospital notebook bears further exploration.

Another intriguing use for the classifier and this methodology lies outside the medical scope: The current state of foreign affairs for the United States increasingly deals with potential persons who might become radicalized. The machine learning algorithm of religious struggle might be useful to identify potential persons at risk of radicalization at a faster or even more reliable rate, using social media outlets eg, Facebook and Twitter.

Peer Review: Four peer reviewers contributed to the peer review report. Author Contributions: DHG conceived and designed the experiments. DHG and PN collected study data. JG and PN provided annotations for data. JG wrote the first draft of the manuscript. PN reviewed the manuscript for intellectual content. All authors reviewed and approved the final manuscript. Disclosures and Ethics: As a requirement of publication, author s have provided to the publisher signed confirmation of compliance with legal and ethical obligations including, but not limited to, the following: authorship and contributorship, conflicts of interest, privacy and confidentiality, and where applicable protection of human and animal research subjects.

The authors have read and confirmed their agreement with the ICMJE authorship and conflict of interest criteria. The authors have also confirmed that this article is unique and not under consideration or published in any other publication, and that they have permission from rights holders to reproduce any copyrighted material.

Any disclosures are made in this section. The external blind peer reviewers report no conflicts of interest.

National Center for Biotechnology Information , U. Journal List Biomed Inform Insights v. Biomed Inform Insights. Published online Feb 8. Author information Article notes Copyright and License information Disclaimer. Email: gro. Received Aug 5; Accepted Oct Abstract Religious or spiritual struggles are clinically important to health care chaplains because they are related to poorer health outcomes, involving both mental and physical health problems.

Keywords: Prayer, chaplaincy, natural language processing, machine learning, spiritual struggle. Procedure Following the process by Pestian et al, 28 an ontology for this study was developed by a quasi-Delphi consensus-building process. Table 1. Chaplain-generated ontology of expressions of religious struggle. Open in a separate window. Machine learning classifier The task of building a machine learning model to classify text can be separated into 5 parts: 1 transcribing the text, 2 preprocessing of the transcribed text, 3 extraction of features unique word or phrase found in any of the prayers , 4 selection of those features that most differentiate the text between 2 separate classes, and 5 optimization of the classifier.

Results The main analysis was conducted on American prayers, which were only annotated by American members in the study 2 board-certified chaplains and 1 layperson. Table 2. Table 3. Figure 1. Figure 2. Discussion We present an exploratory attempt to use NLP to identify the spiritual struggle written in the prayer books of a pediatric academic medical center.

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Footnotes Peer Review: Four peer reviewers contributed to the peer review report. References 1.

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Oman D, Thoresen CE. Is Christianity real for you? Most Christians talk a good game, but there are the odd ones that do try and help where possible. You can do that the same as anyone else. There are wolves in church and church is a place to get away from that. I would rather stay home in quite peace. The Sabbath Day is to be kept Holy.

I am sure I will be held accountable for this. The Devil and his minions are all about.