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Tahmasbi F, Toni E, Javanmard Z, Kheradbin N, Nasiri S, Sadoughi F. An overview of reviews on digital health interventions during COVID- 19 era: insights and lessons for future pandemics. Arch Public Health 2025; 83:129. [PMID: 40346715 PMCID: PMC12063330 DOI: 10.1186/s13690-025-01590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 03/30/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND The COVID- 19 pandemic has significantly impacted global health, underscoring the crucial role of digital health solutions. The World Health Organization's Classification of Digital Interventions, Services, and Applications in Health (CDISAH) provides a framework for categorizing these technologies. This study aims to analyze the adoption and trends of digital health interventions during the COVID- 19 pandemic, mapping them to the CDISAH framework to identify the most and least utilized interventions and technologies. METHODS This overview-of-reviews study was conducted from 1 st January 2020 to 30 th December 2023, focusing on systematic reviews and meta-analyses retrieved from the Cochrane Database of Systematic Reviews, PubMed, Scopus, Web of Science, IEEE Xplore, and ProQuest. Additionally, gray literature was identified through searches on the Google Scholar platform and reviewing the citations and reference lists of the included studies. The findings were qualitatively mapped to the CDISAH framework. RESULTS A total of 64 review articles were analyzed. A content analysis of the included studies identified 292 codes related to healthcare providers, 257 codes related to data services, 88 codes related to individuals, and 43 codes related to health management and support personnel. The results revealed that the most frequent interventions were associated with telemedicine and data management subcategories, while gaps were identified in areas such as individual-based data reporting during the pandemic, highlighting the need for individuals to take a more active role in managing their own health in preparation for future crises. CONCLUSIONS This study identifies both the strengths and weaknesses of the current digital health landscape. It emphasizes the transformative impact of digital health technologies during the COVID- 19 pandemic and provides a roadmap for future improvements in digital health interventions. By providing a comprehensive overview of digital health during this period, the study underscores the importance of implementing robust digital health strategies within the healthcare system to address existing gaps, leverage strengths, and enhance preparedness and resilience in future public health crises.
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Affiliation(s)
- Foziye Tahmasbi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Esmaeel Toni
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zohreh Javanmard
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Kheradbin
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg
| | - Somayeh Nasiri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Ozawa T, Chubachi S, Namkoong H, Nemoto S, Ikegami R, Asakura T, Tanaka H, Lee H, Fukushima T, Azekawa S, Otake S, Nakagawara K, Watase M, Masaki K, Kamata H, Harada N, Ueda T, Ueda S, Ishiguro T, Arimura K, Saito F, Yoshiyama T, Nakano Y, Muto Y, Suzuki Y, Edahiro R, Murakami K, Sato Y, Okada Y, Koike R, Ishii M, Hasegawa N, Kitagawa Y, Tokunaga K, Kimura A, Miyano S, Ogawa S, Kanai T, Fukunaga K, Imoto S. Predicting coronavirus disease 2019 severity using explainable artificial intelligence techniques. Sci Rep 2025; 15:9459. [PMID: 40108236 PMCID: PMC11923144 DOI: 10.1038/s41598-025-85733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 01/06/2025] [Indexed: 03/22/2025] Open
Abstract
Predictive models for determining coronavirus disease 2019 (COVID-19) severity have been established; however, the complexity of the interactions among factors limits the use of conventional statistical methods. This study aimed to establish a simple and accurate predictive model for COVID-19 severity using an explainable machine learning approach. A total of 3,301 patients ≥ 18 years diagnosed with COVID-19 between February 2020 and October 2022 were included. The discovery cohort comprised patients whose disease onset fell before October 1, 2020 (N = 1,023), and the validation cohort comprised the remaining patients (N = 2,278). Pointwise linear and logistic regression models were used to extract 41 features. Reinforcement learning was used to generate a simple model with high predictive accuracy. The primary evaluation was the area under the receiver operating characteristic curve (AUC). The predictive model achieved an AUC of ≥ 0.905 using four features: serum albumin levels, lactate dehydrogenase levels, age, and neutrophil count. The highest AUC value was 0.906 (sensitivity, 0.842; specificity, 0.811) in the discovery cohort and 0.861 (sensitivity, 0.804; specificity, 0.675) in the validation cohort. Simple and well-structured predictive models were established, which may aid in patient management and the selection of therapeutic interventions.
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Affiliation(s)
- Takuya Ozawa
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shota Nemoto
- Industrial and Digital Business Unit, Hitachi, Ltd, Tokyo, Japan
| | - Ryo Ikegami
- Industrial and Digital Business Unit, Hitachi, Ltd, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Faculty of Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Soichiro Ueda
- JCHO (Japan Community Health Care Organization, Internal Medicine, Saitama Medical Center, Saitama, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Ken Arimura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan
| | | | - Yasushi Nakano
- Department of Internal Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan
| | - Yoshikazu Muto
- Department of Infectious Diseases, Tosei General Hospital, Aichi, Japan
| | - Yusuke Suzuki
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Ryuya Edahiro
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yasunori Sato
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Ryuji Koike
- Health Science Research and Development Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project (Toyama), National Center for Global Health and Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-0071, Japan.
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Rong R, Gu Z, Lai H, Nelson TL, Keller T, Walker C, Jin KW, Chen C, Navar AM, Velasco F, Peterson ED, Xiao G, Yang DM, Xie Y. A deep learning model for clinical outcome prediction using longitudinal inpatient electronic health records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.21.25320916. [PMID: 39974062 PMCID: PMC11838940 DOI: 10.1101/2025.01.21.25320916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Objective Recent advances in deep learning show significant potential in analyzing continuous monitoring electronic health records (EHR) data for clinical outcome prediction. We aim to develop a Transformer-based, Encounter-level Clinical Outcome (TECO) model to predict mortality in the intensive care unit (ICU) using inpatient EHR data. Materials and Methods TECO was developed using multiple baseline and time-dependent clinical variables from 2579 hospitalized COVID-19 patients to predict ICU mortality, and was validated externally in an ARDS cohort (n=2799) and a sepsis cohort (n=6622) from the Medical Information Mart for Intensive Care (MIMIC)-IV. Model performance was evaluated based on area under the receiver operating characteristic (AUC) and compared with Epic Deterioration Index (EDI), random forest (RF), and extreme gradient boosting (XGBoost). Results In the COVID-19 development dataset, TECO achieved higher AUC (0.89-0.97) across various time intervals compared to EDI (0.86-0.95), RF (0.87-0.96), and XGBoost (0.88-0.96). In the two MIMIC testing datasets (EDI not available), TECO yielded higher AUC (0.65-0.76) than RF (0.57-0.73) and XGBoost (0.57-0.73). In addition, TECO was able to identify clinically interpretable features that were correlated with the outcome. Discussion TECO outperformed proprietary metrics and conventional machine learning models in predicting ICU mortality among COVID-19 and non-COVID-19 patients. Conclusions TECO demonstrates a strong capability for predicting ICU mortality using continuous monitoring data. While further validation is needed, TECO has the potential to serve as a powerful early warning tool across various diseases in inpatient settings.
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Affiliation(s)
- Ruichen Rong
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Zifan Gu
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Hongyin Lai
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | | | | | | | - Kevin W. Jin
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Catherine Chen
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ann Marie Navar
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Eric D. Peterson
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
- Department of Bioinformatics, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Donghan M. Yang
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Yang Xie
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
- Department of Bioinformatics, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
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Gawande MS, Zade N, Kumar P, Gundewar S, Weerarathna IN, Verma P. The role of artificial intelligence in pandemic responses: from epidemiological modeling to vaccine development. MOLECULAR BIOMEDICINE 2025; 6:1. [PMID: 39747786 PMCID: PMC11695538 DOI: 10.1186/s43556-024-00238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 11/26/2024] [Accepted: 12/02/2024] [Indexed: 01/04/2025] Open
Abstract
Integrating Artificial Intelligence (AI) across numerous disciplines has transformed the worldwide landscape of pandemic response. This review investigates the multidimensional role of AI in the pandemic, which arises as a global health crisis, and its role in preparedness and responses, ranging from enhanced epidemiological modelling to the acceleration of vaccine development. The confluence of AI technologies has guided us in a new era of data-driven decision-making, revolutionizing our ability to anticipate, mitigate, and treat infectious illnesses. The review begins by discussing the impact of a pandemic on emerging countries worldwide, elaborating on the critical significance of AI in epidemiological modelling, bringing data-driven decision-making, and enabling forecasting, mitigation and response to the pandemic. In epidemiology, AI-driven epidemiological models like SIR (Susceptible-Infectious-Recovered) and SIS (Susceptible-Infectious-Susceptible) are applied to predict the spread of disease, preventing outbreaks and optimising vaccine distribution. The review also demonstrates how Machine Learning (ML) algorithms and predictive analytics improve our knowledge of disease propagation patterns. The collaborative aspect of AI in vaccine discovery and clinical trials of various vaccines is emphasised, focusing on constructing AI-powered surveillance networks. Conclusively, the review presents a comprehensive assessment of how AI impacts epidemiological modelling, builds AI-enabled dynamic models by collaborating ML and Deep Learning (DL) techniques, and develops and implements vaccines and clinical trials. The review also focuses on screening, forecasting, contact tracing and monitoring the virus-causing pandemic. It advocates for sustained research, real-world implications, ethical application and strategic integration of AI technologies to strengthen our collective ability to face and alleviate the effects of global health issues.
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Affiliation(s)
- Mayur Suresh Gawande
- Department of Artificial Intelligence and Data Science, Faculty of Engineering and Technology, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Nikita Zade
- Department of Artificial Intelligence and Data Science, Faculty of Engineering and Technology, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Praveen Kumar
- Department of Computer Science and Medical Engineering, Faculty of Engineering and Technology, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Sawangi (Meghe), Wardha, Maharashtra, 442001, India.
| | - Swapnil Gundewar
- Department of Artificial Intelligence and Machine Learning, Faculty of Engineering and Technology, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, Maharashtra, 442001, India
| | - Induni Nayodhara Weerarathna
- Department of Biomedical Sciences, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, Maharashtra, 442001, India
| | - Prateek Verma
- Department of Artificial Intelligence and Machine Learning, Faculty of Engineering and Technology, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, Maharashtra, 442001, India
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Ceylan B, Olmuşçelik O, Karaalioğlu B, Ceylan Ş, Şahin M, Aydın S, Yılmaz E, Dumlu R, Kapmaz M, Çiçek Y, Kansu A, Duger M, Mert A. Predicting Severe Respiratory Failure in Patients with COVID-19: A Machine Learning Approach. J Clin Med 2024; 13:7386. [PMID: 39685844 DOI: 10.3390/jcm13237386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/23/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: Studies attempting to predict the development of severe respiratory failure in patients with a COVID-19 infection using machine learning algorithms have yielded different results due to differences in variable selection. We aimed to predict the development of severe respiratory failure, defined as the need for high-flow oxygen support, continuous positive airway pressure, or mechanical ventilation, in patients with COVID-19, using machine learning algorithms to identify the most important variables in achieving this prediction. Methods: This retrospective, cross-sectional study included COVID-19 patients with mild respiratory failure (mostly receiving oxygen through a mask or nasal cannula). We used XGBoost, support vector machines, multi-layer perceptron, k-nearest neighbor, random forests, decision trees, logistic regression, and naïve Bayes methods to accurately predict severe respiratory failure in these patients. Results: A total of 320 patients (62.1% male; average age, 54.67 ± 15.82 years) were included in this study. During the follow-ups of these cases, 114 patients (35.6%) required high-level oxygen support, 67 (20.9%) required intensive care unit admission, and 43 (13.4%) died. The machine learning algorithms with the highest accuracy values were XGBoost, support vector machines, k-nearest neighbor, logistic regression, and multi-layer perceptron (0.7395, 0.7395, 0.7291, 0.7187, and 0.75, respectively). The method that obtained the highest ROC-AUC value was logistic regression (ROC-AUC = 0.7274). The best predictors of severe respiratory failure were a low lymphocyte count, a high computed tomography score in the right and left upper lung zones, an elevated neutrophil count, a small decrease in CRP levels on the third day of admission, a high Charlson comorbidity index score, and a high serum procalcitonin level. Conclusions: The development of severe respiratory failure in patients with COVID-19 could be successfully predicted using machine learning methods, especially logistic regression, and the best predictors of severe respiratory failure were the lymphocyte count and the degree of upper lung zone involvement.
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Affiliation(s)
- Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Oktay Olmuşçelik
- Department of Internal Medicine, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Banu Karaalioğlu
- Department of Radiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Şule Ceylan
- Department of Nuclear Medicine, University of Health Science, Gaziosmanpaşa Training ve Research Hospital, Istanbul 34668, Türkyie
| | - Meyha Şahin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Selda Aydın
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Ezgi Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Rıdvan Dumlu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Mahir Kapmaz
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Yeliz Çiçek
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Abdullah Kansu
- Department of Chest Diseases, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Mustafa Duger
- Department of Chest Diseases, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
| | - Ali Mert
- Department of Internal Medicine, Medical Faculty, Istanbul Medipol University, Istanbul 34214, Türkyie
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Yan Y, Si Z, Chun C, Chao-Qun P, Ke M, Dong Z, Li W. Multiphase MRI-Based Radiomics for Predicting Histological Grade of Hepatocellular Carcinoma. J Magn Reson Imaging 2024; 60:2117-2127. [PMID: 38344854 DOI: 10.1002/jmri.29289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a highly heterogeneous cancer. Accurate preoperative prediction of histological grade holds potential for improving clinical management and disease prognostication. PURPOSE To evaluate the performance of a radiomics signature based on multiphase MRI in assessing histological grade in solitary HCC. STUDY TYPE Retrospective. SUBJECTS A total of 405 patients with histopathologically confirmed solitary HCC and with liver gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI within 1 month of surgery. FIELD STRENGTH/SEQUENCE Contrast-enhanced T1-weighted spoiled gradient echo sequence (LAVA) at 1.5 or 3.0 T. ASSESSMENT Tumors were graded (low/high) according to results of histopathology. Basic clinical characteristics (including age, gender, serum alpha-fetoprotein (AFP) level, history of hepatitis B, and cirrhosis) were collected and tumor size measured. Radiomics features were extracted from Gd-EOB-DTPA-enhanced MRI data. Three feature selection strategies were employed sequentially to identify the optimal features: SelectFromModel (SFM), SelectPercentile (SP), and recursive feature elimination with cross-validation (RFECV). Probabilities of five single-phase radiomics-based models were averaged to generate a radiomics signature. A combined model was built by combining the radiomics signature and clinical predictors. STATISTICAL TESTS Pearson χ2 test/Fisher exact test, Wilcoxon rank sum test, interclass correlation coefficient (ICC), univariable/multivariable logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), DeLong test, calibration curve, Brier score, decision curve, Kaplan-Meier curve, and log-rank test. A P-value <0.05 was considered statistically significant. RESULTS High-grade HCCs were present in 33.8% of cases. AFP levels (odds ratio [OR] 1.89) and tumor size (>5 cm; OR 2.33) were significantly associated with HCC grade. The combined model had excellent performance in assessing HCC grade in the test dataset (AUC: 0.801), and demonstrated satisfactory calibration and clinical utility. DATA CONCLUSION A model that combined a radiomics signature derived from preoperative multiphase Gd-EOB-DTPA-enhanced MRI and clinical predictors showed good performance in assessing HCC grade. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Yang Yan
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Zhang Si
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Cui Chun
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Pen Chao-Qun
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Mu Ke
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Zhang Dong
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Wen Li
- Department of Radiology, XinQiao Hospital, Army Medical University, Chongqing, China
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7
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Chen X, Chen Q, Liu Y, Qiu Y, Lv L, Zhang Z, Yin X, Shu F. Radiomics models to predict bone marrow metastasis of neuroblastoma using CT. CANCER INNOVATION 2024; 3:e135. [PMID: 38948899 PMCID: PMC11212276 DOI: 10.1002/cai2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Bone marrow is the leading site for metastasis from neuroblastoma and affects the prognosis of patients with neuroblastoma. However, the accurate diagnosis of bone marrow metastasis is limited by the high spatial and temporal heterogeneity of neuroblastoma. Radiomics analysis has been applied in various cancers to build accurate diagnostic models but has not yet been applied to bone marrow metastasis of neuroblastoma. METHODS We retrospectively collected information from 187 patients pathologically diagnosed with neuroblastoma and divided them into training and validation sets in a ratio of 7:3. A total of 2632 radiomics features were retrieved from venous and arterial phases of contrast-enhanced computed tomography (CT), and nine machine learning approaches were used to build radiomics models, including multilayer perceptron (MLP), extreme gradient boosting, and random forest. We also constructed radiomics-clinical models that combined radiomics features with clinical predictors such as age, gender, ascites, and lymph gland metastasis. The performance of the models was evaluated with receiver operating characteristics (ROC) curves, calibration curves, and risk decile plots. RESULTS The MLP radiomics model yielded an area under the ROC curve (AUC) of 0.97 (95% confidence interval [CI]: 0.95-0.99) on the training set and 0.90 (95% CI: 0.82-0.95) on the validation set. The radiomics-clinical model using an MLP yielded an AUC of 0.93 (95% CI: 0.89-0.96) on the training set and 0.91 (95% CI: 0.85-0.97) on the validation set. CONCLUSIONS MLP-based radiomics and radiomics-clinical models can precisely predict bone marrow metastasis in patients with neuroblastoma.
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Affiliation(s)
- Xiong Chen
- Department of Paediatric Urology, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
- Department of Paediatric Surgery, Guangzhou Institute of PaediatricsGuangzhou Medical UniversityGuangzhouChina
| | - Qinchang Chen
- Department of Pediatric Cardiology, Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Structural Heart DiseaseGuangzhouChina
| | - Yuanfang Liu
- Department of Radiology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Ya Qiu
- Department of Radiologythe First People's Hospital of Kashi PrefectureKashiChina
| | - Lin Lv
- Medical SchoolSun Yat‐sen UniversityGuangzhouChina
| | - Zhengtao Zhang
- Department of Paediatric Urology, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
- Department of Paediatric Surgery, Guangzhou Institute of PaediatricsGuangzhou Medical UniversityGuangzhouChina
| | - Xuntao Yin
- Department of RadiologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Fangpeng Shu
- Department of Paediatric Urology, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
- Department of Paediatric Surgery, Guangzhou Institute of PaediatricsGuangzhou Medical UniversityGuangzhouChina
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Bhagat N, Mackey O, Wilcox A. Large Language Models for Efficient Medical Information Extraction. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:509-514. [PMID: 38827084 PMCID: PMC11141860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Extracting valuable insights from unstructured clinical narrative reports is a challenging yet crucial task in the healthcare domain as it allows healthcare workers to treat patients more efficiently and improves the overall standard of care. We employ ChatGPT, a Large language model (LLM), and compare its performance to manual reviewers. The review focuses on four key conditions: family history of heart disease, depression, heavy smoking, and cancer. The evaluation of a diverse sample of History and Physical (H&P) Notes, demonstrates ChatGPT's remarkable capabilities. Notably, it exhibits exemplary results in sensitivity for depression and heavy smokers and specificity for cancer. We identify areas for improvement as well, particularly in capturing nuanced semantic information related to family history of heart disease and cancer. With further investigation, ChatGPT holds substantial potential for advancements in medical information extraction.
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Affiliation(s)
- Navya Bhagat
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Olivia Mackey
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Adam Wilcox
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, MO
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Kuziemsky CE, Chrimes D, Minshall S, Mannerow M, Lau F. AI Quality Standards in Health Care: Rapid Umbrella Review. J Med Internet Res 2024; 26:e54705. [PMID: 38776538 PMCID: PMC11153979 DOI: 10.2196/54705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND In recent years, there has been an upwelling of artificial intelligence (AI) studies in the health care literature. During this period, there has been an increasing number of proposed standards to evaluate the quality of health care AI studies. OBJECTIVE This rapid umbrella review examines the use of AI quality standards in a sample of health care AI systematic review articles published over a 36-month period. METHODS We used a modified version of the Joanna Briggs Institute umbrella review method. Our rapid approach was informed by the practical guide by Tricco and colleagues for conducting rapid reviews. Our search was focused on the MEDLINE database supplemented with Google Scholar. The inclusion criteria were English-language systematic reviews regardless of review type, with mention of AI and health in the abstract, published during a 36-month period. For the synthesis, we summarized the AI quality standards used and issues noted in these reviews drawing on a set of published health care AI standards, harmonized the terms used, and offered guidance to improve the quality of future health care AI studies. RESULTS We selected 33 review articles published between 2020 and 2022 in our synthesis. The reviews covered a wide range of objectives, topics, settings, designs, and results. Over 60 AI approaches across different domains were identified with varying levels of detail spanning different AI life cycle stages, making comparisons difficult. Health care AI quality standards were applied in only 39% (13/33) of the reviews and in 14% (25/178) of the original studies from the reviews examined, mostly to appraise their methodological or reporting quality. Only a handful mentioned the transparency, explainability, trustworthiness, ethics, and privacy aspects. A total of 23 AI quality standard-related issues were identified in the reviews. There was a recognized need to standardize the planning, conduct, and reporting of health care AI studies and address their broader societal, ethical, and regulatory implications. CONCLUSIONS Despite the growing number of AI standards to assess the quality of health care AI studies, they are seldom applied in practice. With increasing desire to adopt AI in different health topics, domains, and settings, practitioners and researchers must stay abreast of and adapt to the evolving landscape of health care AI quality standards and apply these standards to improve the quality of their AI studies.
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Affiliation(s)
| | - Dillon Chrimes
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Simon Minshall
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | | | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
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10
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Chagas OJ, Gonçalves FAR, Nagatomo PP, Buccheri R, Pereira-Chioccola VL, Del Negro GMB, Benard G. Predictive models-assisted diagnosis of AIDS-associated Pneumocystis jirovecii pneumonia in the emergency room, based on clinical, laboratory, and radiological data. Sci Rep 2024; 14:11247. [PMID: 38755293 PMCID: PMC11099134 DOI: 10.1038/s41598-024-61174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
We assessed predictive models (PMs) for diagnosing Pneumocystis jirovecii pneumonia (PCP) in AIDS patients seen in the emergency room (ER), aiming to guide empirical treatment decisions. Data from suspected PCP cases among AIDS patients were gathered prospectively at a reference hospital's ER, with diagnoses later confirmed through sputum PCR analysis. We compared clinical, laboratory, and radiological data between PCP and non-PCP groups, using the Boruta algorithm to confirm significant differences. We evaluated ten PMs tailored for various ERs resource levels to diagnose PCP. Four scenarios were created, two based on X-ray findings (diffuse interstitial infiltrate) and two on CT scans ("ground-glass"), incorporating mandatory variables: lactate dehydrogenase, O2sat, C-reactive protein, respiratory rate (> 24 bpm), and dry cough. We also assessed HIV viral load and CD4 cell count. Among the 86 patients in the study, each model considered either 6 or 8 parameters, depending on the scenario. Many models performed well, with accuracy, precision, recall, and AUC scores > 0.8. Notably, nearest neighbor and naïve Bayes excelled (scores > 0.9) in specific scenarios. Surprisingly, HIV viral load and CD4 cell count did not improve model performance. In conclusion, ER-based PMs using readily available data can significantly aid PCP treatment decisions in AIDS patients.
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Affiliation(s)
- Oscar José Chagas
- Laboratório de Micologia Médica (LIM53), Instituto de Medicina Tropical (IMT), Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Fabio Augusto Rodrigues Gonçalves
- Laboratório de Medicina Laboratorial (LIM03), Hospital das Clínicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Priscila Paiva Nagatomo
- Laboratório de Micologia Médica (LIM53), Instituto de Medicina Tropical (IMT), Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renata Buccheri
- Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil
- Vitalant Research Institute, San Francisco, CA, USA
| | - Vera Lucia Pereira-Chioccola
- Laboratório de Biologia Molecular de Parasitas e Fungos do Centro de Parasitologia e Micologia, Instituto Adolfo Lutz, São Paulo, SP, Brazil
| | - Gilda Maria Barbaro Del Negro
- Laboratório de Micologia Médica (LIM53), Instituto de Medicina Tropical (IMT), Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gil Benard
- Laboratório de Micologia Médica (LIM53), Instituto de Medicina Tropical (IMT), Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
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11
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Zhang Z, Tang L, Guo Y, Guo X, Pan Z, Ji X, Gao C. Development of Biomarkers and Prognosis Model of Mortality Risk in Patients with COVID-19. J Inflamm Res 2024; 17:2445-2457. [PMID: 38681069 PMCID: PMC11048291 DOI: 10.2147/jir.s449497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
Background As of 30 April 2023, the COVID-19 pandemic has resulted in over 6.9 million deaths worldwide. The virus continues to spread and mutate, leading to continuously evolving pathological and physiological processes. It is imperative to reevaluate predictive factors for identifying the risk of early disease progression. Methods A retrospective study was conducted on a cohort of 1379 COVID-19 patients who were discharged from Xin Hua Hospital affiliated with Shanghai Jiao Tong University School of Medicine between 15 December 2022 and 15 February 2023. Patient symptoms, comorbidities, demographics, vital signs, and laboratory test results were systematically documented. The dataset was split into testing and training sets, and 15 different machine learning algorithms were employed to construct prediction models. These models were assessed for accuracy and area under the receiver operating characteristic curve (AUROC), and the best-performing model was selected for further analysis. Results AUROC for models generated by 15 machine learning algorithms all exceeded 90%, and the accuracy of 10 of them also surpassed 90%. Light Gradient Boosting model emerged as the optimal choice, with accuracy of 0.928 ± 0.0006 and an AUROC of 0.976 ± 0.0028. Notably, the factors with the greatest impact on in-hospital mortality were growth stimulation expressed gene 2 (ST2,19.3%), interleukin-8 (IL-8,17.2%), interleukin-6 (IL-6,6.4%), age (6.1%), NT-proBNP (5.1%), interleukin-2 receptor (IL-2R, 5%), troponin I (TNI,4.6%), congestive heart failure (3.3%) in Light Gradient Boosting model. Conclusion ST-2, IL-8, IL-6, NT-proBNP, IL-2R, TNI, age and congestive heart failure were significant predictors of in-hospital mortality among COVID-19 patients.
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Affiliation(s)
- Zhishuo Zhang
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lujia Tang
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yiran Guo
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xin Guo
- School of Information Science and Technology, Sanda University, Shanghai, Pudong District, 201209, China
| | - Zhiying Pan
- School of Information Science and Technology, Sanda University, Shanghai, Pudong District, 201209, China
| | - Xiaojing Ji
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Chengjin Gao
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
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Tariq MU, Ismail SB. AI-powered COVID-19 forecasting: a comprehensive comparison of advanced deep learning methods. Osong Public Health Res Perspect 2024; 15:115-136. [PMID: 38621765 PMCID: PMC11082441 DOI: 10.24171/j.phrp.2023.0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic continues to pose significant challenges to the public health sector, including that of the United Arab Emirates (UAE). The objective of this study was to assess the efficiency and accuracy of various deep-learning models in forecasting COVID-19 cases within the UAE, thereby aiding the nation's public health authorities in informed decision-making. METHODS This study utilized a comprehensive dataset encompassing confirmed COVID-19 cases, demographic statistics, and socioeconomic indicators. Several advanced deep learning models, including long short-term memory (LSTM), bidirectional LSTM, convolutional neural network (CNN), CNN-LSTM, multilayer perceptron, and recurrent neural network (RNN) models, were trained and evaluated. Bayesian optimization was also implemented to fine-tune these models. RESULTS The evaluation framework revealed that each model exhibited different levels of predictive accuracy and precision. Specifically, the RNN model outperformed the other architectures even without optimization. Comprehensive predictive and perspective analytics were conducted to scrutinize the COVID-19 dataset. CONCLUSION This study transcends academic boundaries by offering critical insights that enable public health authorities in the UAE to deploy targeted data-driven interventions. The RNN model, which was identified as the most reliable and accurate for this specific context, can significantly influence public health decisions. Moreover, the broader implications of this research validate the capability of deep learning techniques in handling complex datasets, thus offering the transformative potential for predictive accuracy in the public health and healthcare sectors.
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Affiliation(s)
- Muhammad Usman Tariq
- Marketing, Operations, and Information System, Abu Dhabi University, Abu Dhabi, United Arab Emirates
- Faculty of Computer Science and Information Technology, Univesiti Tun Hussien Onn Malaysia, Parit Raja, Malaysia
| | - Shuhaida Binti Ismail
- Faculty of Computer Science and Information Technology, Univesiti Tun Hussien Onn Malaysia, Parit Raja, Malaysia
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Ramón A, Bas A, Herrero S, Blasco P, Suárez M, Mateo J. Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach. J Clin Med 2024; 13:1837. [PMID: 38610602 PMCID: PMC11013017 DOI: 10.3390/jcm13071837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Despite advancements in vaccination, early treatments, and understanding of SARS-CoV-2, its impact remains significant worldwide. Many patients require intensive care due to severe COVID-19. Remdesivir, a key treatment option among viral RNA polymerase inhibitors, lacks comprehensive studies on factors associated with its effectiveness. Methods: We conducted a retrospective study in 2022, analyzing data from 252 hospitalized COVID-19 patients treated with remdesivir. Six machine learning algorithms were compared to predict factors influencing remdesivir's clinical benefits regarding mortality and hospital stay. Results: The extreme gradient boost (XGB) method showed the highest accuracy for both mortality (95.45%) and hospital stay (94.24%). Factors associated with worse outcomes in terms of mortality included limitations in life support, ventilatory support needs, lymphopenia, low albumin and hemoglobin levels, flu and/or coinfection, and cough. For hospital stay, factors included vaccine doses, lung density, pulmonary radiological status, comorbidities, oxygen therapy, troponin, lactate dehydrogenase levels, and asthenia. Conclusions: These findings underscore XGB's effectiveness in accurately categorizing COVID-19 patients undergoing remdesivir treatment.
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Affiliation(s)
- Antonio Ramón
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Andrés Bas
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
| | - Santiago Herrero
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
| | - Pilar Blasco
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Miguel Suárez
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Department of Gastroenterology, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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14
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Tariq MU, Ismail SB. Deep learning in public health: Comparative predictive models for COVID-19 case forecasting. PLoS One 2024; 19:e0294289. [PMID: 38483948 PMCID: PMC10939212 DOI: 10.1371/journal.pone.0294289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 03/17/2024] Open
Abstract
The COVID-19 pandemic has had a significant impact on both the United Arab Emirates (UAE) and Malaysia, emphasizing the importance of developing accurate and reliable forecasting mechanisms to guide public health responses and policies. In this study, we compared several cutting-edge deep learning models, including Long Short-Term Memory (LSTM), bidirectional LSTM, Convolutional Neural Networks (CNN), hybrid CNN-LSTM, Multilayer Perceptron's, and Recurrent Neural Networks (RNN), to project COVID-19 cases in the aforementioned regions. These models were calibrated and evaluated using a comprehensive dataset that includes confirmed case counts, demographic data, and relevant socioeconomic factors. To enhance the performance of these models, Bayesian optimization techniques were employed. Subsequently, the models were re-evaluated to compare their effectiveness. Analytic approaches, both predictive and retrospective in nature, were used to interpret the data. Our primary objective was to determine the most effective model for predicting COVID-19 cases in the United Arab Emirates (UAE) and Malaysia. The findings indicate that the selected deep learning algorithms were proficient in forecasting COVID-19 cases, although their efficacy varied across different models. After a thorough evaluation, the model architectures most suitable for the specific conditions in the UAE and Malaysia were identified. Our study contributes significantly to the ongoing efforts to combat the COVID-19 pandemic, providing crucial insights into the application of sophisticated deep learning algorithms for the precise and timely forecasting of COVID-19 cases. These insights hold substantial value for shaping public health strategies, enabling authorities to develop targeted and evidence-based interventions to manage the virus spread and its impact on the populations of the UAE and Malaysia. The study confirms the usefulness of deep learning methodologies in efficiently processing complex datasets and generating reliable projections, a skill of great importance in healthcare and professional settings.
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Affiliation(s)
- Muhammad Usman Tariq
- Abu Dhabi University, Abu Dhabi, United Arab Emirates
- Universiti Tun Hussein Onn Malaysia (UTHM), Parit Raja, Malaysia
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15
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Moyano-Fernández C, Rueda J, Delgado J, Ausín T. May Artificial Intelligence take health and sustainability on a honeymoon? Towards green technologies for multidimensional health and environmental justice. Glob Bioeth 2024; 35:2322208. [PMID: 38476503 PMCID: PMC10930144 DOI: 10.1080/11287462.2024.2322208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. Highlights Using AI in medicine and epidemiology has some benefits in the short term.AI usage may cause social inequalities and environmental damage in the long term.Health justice should be rethought from the One Health perspective.Going beyond anthropocentric and myopic cost-benefit analysis would expand health justice to include an environmental dimension.Greening AI would help to reconcile public and global health measures.
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Affiliation(s)
| | - Jon Rueda
- FiloLab Scientific Unit of Excellence, University of Granada, Granada, Spain
| | - Janet Delgado
- Department of Philosophy 1, Faculty of Philosophy, University of Granada, Granada, Spain
| | - Txetxu Ausín
- Institute of Philosophy, Spanish National Research Council, Madrid, Spain
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Talimtzi P, Ntolkeras A, Kostopoulos G, Bougioukas KI, Pagkalidou E, Ouranidis A, Pataka A, Haidich AB. The reporting completeness and transparency of systematic reviews of prognostic prediction models for COVID-19 was poor: a methodological overview of systematic reviews. J Clin Epidemiol 2024; 167:111264. [PMID: 38266742 DOI: 10.1016/j.jclinepi.2024.111264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To conduct a methodological overview of reviews to evaluate the reporting completeness and transparency of systematic reviews (SRs) of prognostic prediction models (PPMs) for COVID-19. STUDY DESIGN AND SETTING MEDLINE, Scopus, Cochrane Database of Systematic Reviews, and Epistemonikos (epistemonikos.org) were searched for SRs of PPMs for COVID-19 until December 31, 2022. The risk of bias in systematic reviews tool was used to assess the risk of bias. The protocol for this overview was uploaded in the Open Science Framework (https://osf.io/7y94c). RESULTS Ten SRs were retrieved; none of them synthesized the results in a meta-analysis. For most of the studies, there was absence of a predefined protocol and missing information on study selection, data collection process, and reporting of primary studies and models included, while only one SR had its data publicly available. In addition, for the majority of the SRs, the overall risk of bias was judged as being high. The overall corrected covered area was 6.3% showing a small amount of overlapping among the SRs. CONCLUSION The reporting completeness and transparency of SRs of PPMs for COVID-19 was poor. Guidance is urgently required, with increased awareness and education of minimum reporting standards and quality criteria. Specific focus is needed in predefined protocol, information on study selection and data collection process, and in the reporting of findings to improve the quality of SRs of PPMs for COVID-19.
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Affiliation(s)
- Persefoni Talimtzi
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Antonios Ntolkeras
- School of Biology, Aristotle University of Thessaloniki, University Campus, 54636, Thessaloniki, Greece
| | | | - Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Eirini Pagkalidou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Andreas Ouranidis
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Athanasia Pataka
- Department of Respiratory Deficiency, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece.
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Helenason J, Ekström C, Falk M, Papachristou P. Exploring the feasibility of an artificial intelligence based clinical decision support system for cutaneous melanoma detection in primary care - a mixed method study. Scand J Prim Health Care 2024; 42:51-60. [PMID: 37982736 PMCID: PMC10851794 DOI: 10.1080/02813432.2023.2283190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
Objective: Skin examination to detect cutaneous melanomas is commonly performed in primary care. In recent years, clinical decision support systems (CDSS) based on artificial intelligence (AI) have been introduced within several diagnostic fields.Setting: This study employs a variety of qualitative and quantitative methodologies to investigate the feasibility of an AI-based CDSS to detect cutaneous melanoma in primary care.Subjects and Design: Fifteen primary care physicians (PCPs) underwent near-live simulations using the CDSS on a simulated patient, and subsequent individual semi-structured interviews were explored with a hybrid thematic analysis approach. Additionally, twenty-five PCPs performed a reader study (diagnostic assessment on the basis of image interpretation) of 18 dermoscopic images, both with and without help from AI, investigating the value of adding AI support to a PCPs decision. Perceived instrument usability was rated on the System Usability Scale (SUS).Results: From the interviews, the importance of trust in the CDSS emerged as a central concern. Scientific evidence supporting sufficient diagnostic accuracy of the CDSS was expressed as an important factor that could increase trust. Access to AI decision support when evaluating dermoscopic images proved valuable as it formally increased the physician's diagnostic accuracy. A mean SUS score of 84.8, corresponding to 'good' usability, was measured.Conclusion: AI-based CDSS might play an important future role in cutaneous melanoma diagnostics, provided sufficient evidence of diagnostic accuracy and usability supporting its trustworthiness among the users.
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Affiliation(s)
| | | | - Magnus Falk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Panagiotis Papachristou
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Ashique S, Mishra N, Mohanto S, Garg A, Taghizadeh-Hesary F, Gowda BJ, Chellappan DK. Application of artificial intelligence (AI) to control COVID-19 pandemic: Current status and future prospects. Heliyon 2024; 10:e25754. [PMID: 38370192 PMCID: PMC10869876 DOI: 10.1016/j.heliyon.2024.e25754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on the everyday livelihood of people has been monumental and unparalleled. Although the pandemic has vastly affected the global healthcare system, it has also been a platform to promote and develop pioneering applications based on autonomic artificial intelligence (AI) technology with therapeutic significance in combating the pandemic. Artificial intelligence has successfully demonstrated that it can reduce the probability of human-to-human infectivity of the virus through evaluation, analysis, and triangulation of existing data on the infectivity and spread of the virus. This review talks about the applications and significance of modern robotic and automated systems that may assist in spreading a pandemic. In addition, this study discusses intelligent wearable devices and how they could be helpful throughout the COVID-19 pandemic.
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Affiliation(s)
- Sumel Ashique
- Department of Pharmaceutical Sciences, Bengal College of Pharmaceutical Sciences & Research, Durgapur, 713212, West Bengal, India
| | - Neeraj Mishra
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Gwalior, 474005, Madhya Pradesh, India
| | - Sourav Mohanto
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, 575018, India
| | - Ashish Garg
- Guru Ramdas Khalsa Institute of Science and Technology, Pharmacy, Jabalpur, M.P, 483001, India
| | - Farzad Taghizadeh-Hesary
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Clinical Oncology Department, Iran University of Medical Sciences, Tehran, Iran
| | - B.H. Jaswanth Gowda
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, 575018, India
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, BT9 7BL, UK
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur, 57000, Malaysia
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Wei S, Lin S, Wenjing Z, Shaoxia S, Yuejie Y, Yujie H, Shu Z, Zhong L, Ti L. The prediction of influenza-like illness using national influenza surveillance data and Baidu query data. BMC Public Health 2024; 24:513. [PMID: 38369456 PMCID: PMC10875817 DOI: 10.1186/s12889-024-17978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Seasonal influenza and other respiratory tract infections are serious public health problems that need to be further addressed and investigated. Internet search data are recognized as a valuable source for forecasting influenza or other respiratory tract infection epidemics. However, the selection of internet search data and the application of forecasting methods are important for improving forecasting accuracy. The aim of the present study was to forecast influenza epidemics based on the long short-term memory neural network (LSTM) method, Baidu search index data, and the influenza-like-illness (ILI) rate. METHODS The official weekly ILI% data for northern and southern mainland China were obtained from the Chinese Influenza Center from 2018 to 2021. Based on the Baidu Index, search indices related to influenza infection over the corresponding time period were obtained. Pearson correlation analysis was performed to explore the association between influenza-related search queries and the ILI% of southern and northern mainland China. The LSTM model was used to forecast the influenza epidemic within the same week and at lags of 1-4 weeks. The model performance was assessed by evaluation metrics, including the mean square error (MSE), root mean square error (RMSE) and mean absolute error (MAE). RESULTS In total, 24 search queries in northern mainland China and 7 search queries in southern mainland China were found to be correlated and were used to construct the LSTM model, which included the same week and a lag of 1-4 weeks. The LSTM model showed that ILI% + mask with one lag week and ILI% + influenza name were good prediction modules, with reduced RMSE predictions of 16.75% and 4.20%, respectively, compared with the estimated ILI% for northern and southern mainland China. CONCLUSIONS The results illuminate the feasibility of using an internet search index as a complementary data source for influenza forecasting and the efficiency of using the LSTM model to forecast influenza epidemics.
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Affiliation(s)
- Su Wei
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, Shandong, 250014, People's Republic of China.
| | - Sun Lin
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China
| | - Zhao Wenjing
- Dezhou Center for Disease Control and Prevention, Dezhou, Shandong, 253000, People's Republic of China
| | - Song Shaoxia
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China
| | - Yang Yuejie
- China Institute of Water Resources and Hydropower Research, Beijing, 100038, People's Republic of China
| | - He Yujie
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China
| | - Zhang Shu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China
| | - Li Zhong
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China
| | - Liu Ti
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong University Institution for Prevention Medicine, Jinan, Shandong, 250014, People's Republic of China.
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20
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Kolasa K, Admassu B, Hołownia-Voloskova M, Kędzior KJ, Poirrier JE, Perni S. Systematic reviews of machine learning in healthcare: a literature review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:63-115. [PMID: 37955147 DOI: 10.1080/14737167.2023.2279107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The increasing availability of data and computing power has made machine learning (ML) a viable approach to faster, more efficient healthcare delivery. METHODS A systematic literature review (SLR) of published SLRs evaluating ML applications in healthcare settings published between1 January 2010 and 27 March 2023 was conducted. RESULTS In total 220 SLRs covering 10,462 ML algorithms were reviewed. The main application of AI in medicine related to the clinical prediction and disease prognosis in oncology and neurology with the use of imaging data. Accuracy, specificity, and sensitivity were provided in 56%, 28%, and 25% SLRs respectively. Internal and external validation was reported in 53% and less than 1% of the cases respectively. The most common modeling approach was neural networks (2,454 ML algorithms), followed by support vector machine and random forest/decision trees (1,578 and 1,522 ML algorithms, respectively). EXPERT OPINION The review indicated considerable reporting gaps in terms of the ML's performance, both internal and external validation. Greater accessibility to healthcare data for developers can ensure the faster adoption of ML algorithms into clinical practice.
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Affiliation(s)
- Katarzyna Kolasa
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | - Bisrat Admassu
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
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21
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Thakur D, Gera T, Bhardwaj V, AlZubi AA, Ali F, Singh J. An enhanced diabetes prediction amidst COVID-19 using ensemble models. Front Public Health 2023; 11:1331517. [PMID: 38155892 PMCID: PMC10754515 DOI: 10.3389/fpubh.2023.1331517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
In the contemporary landscape of healthcare, the early and accurate prediction of diabetes has garnered paramount importance, especially in the wake of the COVID-19 pandemic where individuals with diabetes exhibit increased vulnerability. This research embarked on a mission to enhance diabetes prediction by employing state-of-the-art machine learning techniques. Initial evaluations highlighted the Support Vector Machines (SVM) classifier as a promising candidate with an accuracy of 76.62%. To further optimize predictions, the study delved into advanced feature engineering techniques, generating interaction and polynomial features that unearthed hidden patterns in the data. Subsequent correlation analyses, visualized through heatmaps, revealed significant correlations, especially with attributes like Glucose. By integrating the strengths of Decision Trees, Gradient Boosting, and SVM in an ensemble model, we achieved an accuracy of 93.2%, showcasing the potential of harmonizing diverse algorithms. This research offers a robust blueprint for diabetes prediction, holding profound implications for early diagnosis, personalized treatments, and preventive care in the context of global health challenges and with the goal of increasing life expectancy.
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Affiliation(s)
- Deepak Thakur
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
| | - Tanya Gera
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
| | - Vivek Bhardwaj
- Department of Computer Science and Engineering, Manipal University Jaipur, Jaipur, Rajasthan
| | - Ahmad Ali AlZubi
- Department of Computer Science, Community College, King Saud University, Riyadh, Saudi Arabia
| | - Farman Ali
- Department of Computer Science and Engineering, School of Convergence, College of Computing and Informatics, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaiteg Singh
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
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22
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Zarkogianni K, Dervakos E, Filandrianos G, Ganitidis T, Gkatzou V, Sakagianni A, Raghavendra R, Max Nikias CL, Stamou G, Nikita KS. The smarty4covid dataset and knowledge base as a framework for interpretable physiological audio data analysis. Sci Data 2023; 10:770. [PMID: 37932314 PMCID: PMC10628219 DOI: 10.1038/s41597-023-02646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023] Open
Abstract
Harnessing the power of Artificial Intelligence (AI) and m-health towards detecting new bio-markers indicative of the onset and progress of respiratory abnormalities/conditions has greatly attracted the scientific and research interest especially during COVID-19 pandemic. The smarty4covid dataset contains audio signals of cough (4,676), regular breathing (4,665), deep breathing (4,695) and voice (4,291) as recorded by means of mobile devices following a crowd-sourcing approach. Other self reported information is also included (e.g. COVID-19 virus tests), thus providing a comprehensive dataset for the development of COVID-19 risk detection models. The smarty4covid dataset is released in the form of a web-ontology language (OWL) knowledge base enabling data consolidation from other relevant datasets, complex queries and reasoning. It has been utilized towards the development of models able to: (i) extract clinically informative respiratory indicators from regular breathing records, and (ii) identify cough, breath and voice segments in crowd-sourced audio recordings. A new framework utilizing the smarty4covid OWL knowledge base towards generating counterfactual explanations in opaque AI-based COVID-19 risk detection models is proposed and validated.
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Affiliation(s)
- Konstantia Zarkogianni
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece.
- Maastricht University, Faculty of Science and Engineering, Department of Advanced Computing Sciences, Maastricht, 6200 MD, Netherlands.
| | - Edmund Dervakos
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
| | - George Filandrianos
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
| | - Theofanis Ganitidis
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
| | - Vasiliki Gkatzou
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
| | - Aikaterini Sakagianni
- Sismanoglion General Hospital, Department of Intensive Care Unit, Athens, 15126, Greece
| | - Raghu Raghavendra
- University of Southern California, Viterbi School of Engineering, Los Angeles, 90089, USA
| | - C L Max Nikias
- University of Southern California, Viterbi School of Engineering, Los Angeles, 90089, USA
| | - Giorgos Stamou
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
| | - Konstantina S Nikita
- National Technical University of Athens, School of Electrical and Computer Engineering, Athens, 157 80, Greece
- University of Southern California, Viterbi School of Engineering, Los Angeles, 90089, USA
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23
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Casillas N, Ramón A, Torres AM, Blasco P, Mateo J. Predictive Model for Mortality in Severe COVID-19 Patients across the Six Pandemic Waves. Viruses 2023; 15:2184. [PMID: 38005862 PMCID: PMC10675561 DOI: 10.3390/v15112184] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The impact of SARS-CoV-2 infection remains substantial on a global scale, despite widespread vaccination efforts, early therapeutic interventions, and an enhanced understanding of the disease's underlying mechanisms. At the same time, a significant number of patients continue to develop severe COVID-19, necessitating admission to intensive care units (ICUs). This study aimed to provide evidence concerning the most influential predictors of mortality among critically ill patients with severe COVID-19, employing machine learning (ML) techniques. To accomplish this, we conducted a retrospective multicenter investigation involving 684 patients with severe COVID-19, spanning from 1 June 2020 to 31 March 2023, wherein we scrutinized sociodemographic, clinical, and analytical data. These data were extracted from electronic health records. Out of the six supervised ML methods scrutinized, the extreme gradient boosting (XGB) method exhibited the highest balanced accuracy at 96.61%. The variables that exerted the greatest influence on mortality prediction encompassed ferritin, fibrinogen, D-dimer, platelet count, C-reactive protein (CRP), prothrombin time (PT), invasive mechanical ventilation (IMV), PaFi (PaO2/FiO2), lactate dehydrogenase (LDH), lymphocyte levels, activated partial thromboplastin time (aPTT), body mass index (BMI), creatinine, and age. These findings underscore XGB as a robust candidate for accurately classifying patients with COVID-19.
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Affiliation(s)
- Nazaret Casillas
- Department of Internal Medicine, Hospital Virgen De La Luz, 16002 Cuenca, Spain
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Antonio Ramón
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Ana María Torres
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Pilar Blasco
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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24
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Chimbunde E, Sigwadhi LN, Tamuzi JL, Okango EL, Daramola O, Ngah VD, Nyasulu PS. Machine learning algorithms for predicting determinants of COVID-19 mortality in South Africa. Front Artif Intell 2023; 6:1171256. [PMID: 37899965 PMCID: PMC10600470 DOI: 10.3389/frai.2023.1171256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/15/2023] [Indexed: 10/31/2023] Open
Abstract
Background COVID-19 has strained healthcare resources, necessitating efficient prognostication to triage patients effectively. This study quantified COVID-19 risk factors and predicted COVID-19 intensive care unit (ICU) mortality in South Africa based on machine learning algorithms. Methods Data for this study were obtained from 392 COVID-19 ICU patients enrolled between 26 March 2020 and 10 February 2021. We used an artificial neural network (ANN) and random forest (RF) to predict mortality among ICU patients and a semi-parametric logistic regression with nine covariates, including a grouping variable based on K-means clustering. Further evaluation of the algorithms was performed using sensitivity, accuracy, specificity, and Cohen's K statistics. Results From the semi-parametric logistic regression and ANN variable importance, age, gender, cluster, presence of severe symptoms, being on the ventilator, and comorbidities of asthma significantly contributed to ICU death. In particular, the odds of mortality were six times higher among asthmatic patients than non-asthmatic patients. In univariable and multivariate regression, advanced age, PF1 and 2, FiO2, severe symptoms, asthma, oxygen saturation, and cluster 4 were strongly predictive of mortality. The RF model revealed that intubation status, age, cluster, diabetes, and hypertension were the top five significant predictors of mortality. The ANN performed well with an accuracy of 71%, a precision of 83%, an F1 score of 100%, Matthew's correlation coefficient (MCC) score of 100%, and a recall of 88%. In addition, Cohen's k-value of 0.75 verified the most extreme discriminative power of the ANN. In comparison, the RF model provided a 76% recall, an 87% precision, and a 65% MCC. Conclusion Based on the findings, we can conclude that both ANN and RF can predict COVID-19 mortality in the ICU with accuracy. The proposed models accurately predict the prognosis of COVID-19 patients after diagnosis. The models can be used to prioritize COVID-19 patients with a high mortality risk in resource-constrained ICUs.
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Affiliation(s)
- Emmanuel Chimbunde
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lovemore N. Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacques L. Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Olawande Daramola
- Department of Information Technology, Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Veranyuy D. Ngah
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S. Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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25
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Sandhu SS, Gorji HT, Tavakolian P, Tavakolian K, Akhbardeh A. Medical Imaging Applications of Federated Learning. Diagnostics (Basel) 2023; 13:3140. [PMID: 37835883 PMCID: PMC10572559 DOI: 10.3390/diagnostics13193140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Since its introduction in 2016, researchers have applied the idea of Federated Learning (FL) to several domains ranging from edge computing to banking. The technique's inherent security benefits, privacy-preserving capabilities, ease of scalability, and ability to transcend data biases have motivated researchers to use this tool on healthcare datasets. While several reviews exist detailing FL and its applications, this review focuses solely on the different applications of FL to medical imaging datasets, grouping applications by diseases, modality, and/or part of the body. This Systematic Literature review was conducted by querying and consolidating results from ArXiv, IEEE Xplorer, and PubMed. Furthermore, we provide a detailed description of FL architecture, models, descriptions of the performance achieved by FL models, and how results compare with traditional Machine Learning (ML) models. Additionally, we discuss the security benefits, highlighting two primary forms of privacy-preserving techniques, including homomorphic encryption and differential privacy. Finally, we provide some background information and context regarding where the contributions lie. The background information is organized into the following categories: architecture/setup type, data-related topics, security, and learning types. While progress has been made within the field of FL and medical imaging, much room for improvement and understanding remains, with an emphasis on security and data issues remaining the primary concerns for researchers. Therefore, improvements are constantly pushing the field forward. Finally, we highlighted the challenges in deploying FL in medical imaging applications and provided recommendations for future directions.
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Affiliation(s)
- Sukhveer Singh Sandhu
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND 58202, USA; (H.T.G.); (P.T.)
| | - Hamed Taheri Gorji
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND 58202, USA; (H.T.G.); (P.T.)
- SafetySpect Inc., 4200 James Ray Dr., Grand Forks, ND 58202, USA
| | - Pantea Tavakolian
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND 58202, USA; (H.T.G.); (P.T.)
| | - Kouhyar Tavakolian
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND 58202, USA; (H.T.G.); (P.T.)
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26
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Tariq MU, Ismail SB, Babar M, Ahmad A. Harnessing the power of AI: Advanced deep learning models optimization for accurate SARS-CoV-2 forecasting. PLoS One 2023; 18:e0287755. [PMID: 37471397 PMCID: PMC10359009 DOI: 10.1371/journal.pone.0287755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
The pandemic has significantly affected many countries including the USA, UK, Asia, the Middle East and Africa region, and many other countries. Similarly, it has substantially affected Malaysia, making it crucial to develop efficient and precise forecasting tools for guiding public health policies and approaches. Our study is based on advanced deep-learning models to predict the SARS-CoV-2 cases. We evaluate the performance of Long Short-Term Memory (LSTM), Bi-directional LSTM, Convolutional Neural Networks (CNN), CNN-LSTM, Multilayer Perceptron, Gated Recurrent Unit (GRU), and Recurrent Neural Networks (RNN). We trained these models and assessed them using a detailed dataset of confirmed cases, demographic data, and pertinent socio-economic factors. Our research aims to determine the most reliable and accurate model for forecasting SARS-CoV-2 cases in the region. We were able to test and optimize deep learning models to predict cases, with each model displaying diverse levels of accuracy and precision. A comprehensive evaluation of the models' performance discloses the most appropriate architecture for Malaysia's specific situation. This study supports ongoing efforts to combat the pandemic by offering valuable insights into the application of sophisticated deep-learning models for precise and timely SARS-CoV-2 case predictions. The findings hold considerable implications for public health decision-making, empowering authorities to create targeted and data-driven interventions to limit the virus's spread and minimize its effects on Malaysia's population.
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Affiliation(s)
- Muhammad Usman Tariq
- Abu Dhabi University, Abu Dhabi, United Arab Emirates
- Universiti Tun Hussein Onn Malaysia (UTHM), Parit Raja, Malaysia
| | | | - Muhammad Babar
- Robotics and Internet of Things Lab, Prince Sultan University, Riyadh, Saudi Arabia
| | - Ashir Ahmad
- College of Computer and Information Sciences, Prince Sultan University, Riyadh, Saudi Arabia
- Swinburne University of Technology, Melbourne, Australia
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27
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Estebanez-Pérez MJ, Martín-Valero R, Vinolo-Gil MJ, Pastora-Bernal JM. Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review. Healthcare (Basel) 2023; 11:1970. [PMID: 37444803 DOI: 10.3390/healthcare11131970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Long COVID syndrome has been recognized as a public health problem. Digital physiotherapy practice is an alternative that can better meet the needs of patients. The aim of this review was to synthesize the evidence of digital physiotherapy practice in Long COVID patients. A systematic review was carried out until December 2022. The review was complemented by an assessment of the risk of bias and methodological quality. A narrative synthesis of results was conducted, including subgroup analyses by intervention and clinical outcomes. Six articles, including 540 participants, were selected. Five articles were considered of high enough methodological quality. Parallel-group, single-blind, randomized controlled trials were the most commonly used research design. Tele-supervised home-based exercise training was the most commonly used intervention. Great heterogeneity in clinical outcomes and measurement tools was found. A subgroup analysis showed that digital physiotherapy is effective in improving clinical outcomes. Significant differences in favor of digital interventions over usual care were reported. Nevertheless, discrepancies regarding effectiveness were found. Improvements in clinical outcomes with digital physiotherapy were found to be at least non-inferior to usual care. This review provides new evidence that digital physiotherapy practice is an appropriate intervention for Long COVID patients, despite the inherent limitations of the review. Registration: CRD42022379004.
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Affiliation(s)
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, 29071 Málaga, Spain
| | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
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28
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Dipaola F, Gatti M, Giaj Levra A, Menè R, Shiffer D, Faccincani R, Raouf Z, Secchi A, Rovere Querini P, Voza A, Badalamenti S, Solbiati M, Costantino G, Savevski V, Furlan R. Multimodal deep learning for COVID-19 prognosis prediction in the emergency department: a bi-centric study. Sci Rep 2023; 13:10868. [PMID: 37407595 DOI: 10.1038/s41598-023-37512-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p < 0.32). As for ICU admission, the combined model MCC was superior (p < 0.024) to the tabular models. Our results suggest that a combined textual and tabular model can effectively predict COVID-19 prognosis which may assist ED physicians in their decision-making process.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Giaj Levra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Zainab Raouf
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Secchi
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- Emergency Department, IRCCS - Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Italy
| | - Salvatore Badalamenti
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Victor Savevski
- AI Center, IRCCS - Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy.
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29
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Diniz JM, Vasconcelos H, Souza J, Rb-Silva R, Ameijeiras-Rodriguez C, Freitas A. Comparing Decentralized Learning Methods for Health Data Models to Nondecentralized Alternatives: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e45823. [PMID: 37335606 PMCID: PMC10337426 DOI: 10.2196/45823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Considering the soaring health-related costs directed toward a growing, aging, and comorbid population, the health sector needs effective data-driven interventions while managing rising care costs. While health interventions using data mining have become more robust and adopted, they often demand high-quality big data. However, growing privacy concerns have hindered large-scale data sharing. In parallel, recently introduced legal instruments require complex implementations, especially when it comes to biomedical data. New privacy-preserving technologies, such as decentralized learning, make it possible to create health models without mobilizing data sets by using distributed computation principles. Several multinational partnerships, including a recent agreement between the United States and the European Union, are adopting these techniques for next-generation data science. While these approaches are promising, there is no clear and robust evidence synthesis of health care applications. OBJECTIVE The main aim is to compare the performance among health data models (eg, automated diagnosis and mortality prediction) developed using decentralized learning approaches (eg, federated and blockchain) to those using centralized or local methods. Secondary aims are comparing the privacy compromise and resource use among model architectures. METHODS We will conduct a systematic review using the first-ever registered research protocol for this topic following a robust search methodology, including several biomedical and computational databases. This work will compare health data models differing in development architecture, grouping them according to their clinical applications. For reporting purposes, a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram will be presented. CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies)-based forms will be used for data extraction and to assess the risk of bias, alongside PROBAST (Prediction Model Risk of Bias Assessment Tool). All effect measures in the original studies will be reported. RESULTS The queries and data extractions are expected to start on February 28, 2023, and end by July 31, 2023. The research protocol was registered with PROSPERO, under the number 393126, on February 3, 2023. With this protocol, we detail how we will conduct the systematic review. With that study, we aim to summarize the progress and findings from state-of-the-art decentralized learning models in health care in comparison to their local and centralized counterparts. Results are expected to clarify the consensuses and heterogeneities reported and help guide the research and development of new robust and sustainable applications to address the health data privacy problem, with applicability in real-world settings. CONCLUSIONS We expect to clearly present the status quo of these privacy-preserving technologies in health care. With this robust synthesis of the currently available scientific evidence, the review will inform health technology assessment and evidence-based decisions, from health professionals, data scientists, and policy makers alike. Importantly, it should also guide the development and application of new tools in service of patients' privacy and future research. TRIAL REGISTRATION PROSPERO 393126; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=393126. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45823.
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Affiliation(s)
- José Miguel Diniz
- CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- PhD Program in Health Data Science, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Vasconcelos
- CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Júlio Souza
- CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Rb-Silva
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carolina Ameijeiras-Rodriguez
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Huang Y, Xu T, Yang Q, Pan C, Zhan L, Chen H, Zhang X, Chen C. Demand prediction of medical services in home and community-based services for older adults in China using machine learning. Front Public Health 2023; 11:1142794. [PMID: 37006569 PMCID: PMC10060662 DOI: 10.3389/fpubh.2023.1142794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundHome and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services.MethodsThis was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model.ResultsRandom Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education.ConclusionAndersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.
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Affiliation(s)
- Yucheng Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingke Xu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingren Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengxi Pan
- The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Xiamen, China
| | - Lu Zhan
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huajian Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangyang Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Xiangyang Zhang
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Center for Healthy China Research, Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Correspondence: Chun Chen
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Chavda VP, Valu DD, Parikh PK, Tiwari N, Chhipa AS, Shukla S, Patel SS, Balar PC, Paiva-Santos AC, Patravale V. Conventional and Novel Diagnostic Tools for the Diagnosis of Emerging SARS-CoV-2 Variants. Vaccines (Basel) 2023; 11:374. [PMID: 36851252 PMCID: PMC9960989 DOI: 10.3390/vaccines11020374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Accurate identification at an early stage of infection is critical for effective care of any infectious disease. The "coronavirus disease 2019 (COVID-19)" outbreak, caused by the virus "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)", corresponds to the current and global pandemic, characterized by several developing variants, many of which are classified as variants of concern (VOCs) by the "World Health Organization (WHO, Geneva, Switzerland)". The primary diagnosis of infection is made using either the molecular technique of RT-PCR, which detects parts of the viral genome's RNA, or immunodiagnostic procedures, which identify viral proteins or antibodies generated by the host. As the demand for the RT-PCR test grew fast, several inexperienced producers joined the market with innovative kits, and an increasing number of laboratories joined the diagnostic field, rendering the test results increasingly prone to mistakes. It is difficult to determine how the outcomes of one unnoticed result could influence decisions about patient quarantine and social isolation, particularly when the patients themselves are health care providers. The development of point-of-care testing helps in the rapid in-field diagnosis of the disease, and such testing can also be used as a bedside monitor for mapping the progression of the disease in critical patients. In this review, we have provided the readers with available molecular diagnostic techniques and their pitfalls in detecting emerging VOCs of SARS-CoV-2, and lastly, we have discussed AI-ML- and nanotechnology-based smart diagnostic techniques for SARS-CoV-2 detection.
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Affiliation(s)
- Vivek P. Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Disha D. Valu
- Formulation and Drug Product Development, Biopharma Division, Intas Pharmaceutical Ltd., 3000-548 Moraiya, Ahmedabad 380054, Gujarat, India
| | - Palak K. Parikh
- Department of Pharmaceutical Chemistry and Quality Assurance, L. M. College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Nikita Tiwari
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, Maharashtra, India
| | - Abu Sufiyan Chhipa
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad 382481, Gujarat, India
| | - Somanshi Shukla
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, Maharashtra, India
| | - Snehal S. Patel
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad 382481, Gujarat, India
| | - Pankti C. Balar
- Pharmacy Section, L. M. College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, Maharashtra, India
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Athanasiou M, Fragkozidis G, Zarkogianni K, Nikita KS. Long Short-term Memory-Based Prediction of the Spread of Influenza-Like Illness Leveraging Surveillance, Weather, and Twitter Data: Model Development and Validation. J Med Internet Res 2023; 25:e42519. [PMID: 36745490 PMCID: PMC9941907 DOI: 10.2196/42519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The potential to harness the plurality of available data in real time along with advanced data analytics for the accurate prediction of influenza-like illness (ILI) outbreaks has gained significant scientific interest. Different methodologies based on the use of machine learning techniques and traditional and alternative data sources, such as ILI surveillance reports, weather reports, search engine queries, and social media, have been explored with the ultimate goal of being used in the development of electronic surveillance systems that could complement existing monitoring resources. OBJECTIVE The scope of this study was to investigate for the first time the combined use of ILI surveillance data, weather data, and Twitter data along with deep learning techniques toward the development of prediction models able to nowcast and forecast weekly ILI cases. By assessing the predictive power of both traditional and alternative data sources on the use case of ILI, this study aimed to provide a novel approach for corroborating evidence and enhancing accuracy and reliability in the surveillance of infectious diseases. METHODS The model's input space consisted of information related to weekly ILI surveillance, web-based social (eg, Twitter) behavior, and weather conditions. For the design and development of the model, relevant data corresponding to the period of 2010 to 2019 and focusing on the Greek population and weather were collected. Long short-term memory (LSTM) neural networks were leveraged to efficiently handle the sequential and nonlinear nature of the multitude of collected data. The 3 data categories were first used separately for training 3 LSTM-based primary models. Subsequently, different transfer learning (TL) approaches were explored with the aim of creating various feature spaces combining the features extracted from the corresponding primary models' LSTM layers for the latter to feed a dense layer. RESULTS The primary model that learned from weather data yielded better forecast accuracy (root mean square error [RMSE]=0.144; Pearson correlation coefficient [PCC]=0.801) than the model trained with ILI historical data (RMSE=0.159; PCC=0.794). The best performance was achieved by the TL-based model leveraging the combination of the 3 data categories (RMSE=0.128; PCC=0.822). CONCLUSIONS The superiority of the TL-based model, which considers Twitter data, weather data, and ILI surveillance data, reflects the potential of alternative public sources to enhance accurate and reliable prediction of ILI spread. Despite its focus on the use case of Greece, the proposed approach can be generalized to other locations, populations, and social media platforms to support the surveillance of infectious diseases with the ultimate goal of reinforcing preparedness for future epidemics.
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Affiliation(s)
- Maria Athanasiou
- School of Electrical and Computer Engineering, National Technical University of Athens, Zografos, Athens, Greece
| | - Georgios Fragkozidis
- School of Electrical and Computer Engineering, National Technical University of Athens, Zografos, Athens, Greece
| | - Konstantia Zarkogianni
- School of Electrical and Computer Engineering, National Technical University of Athens, Zografos, Athens, Greece
| | - Konstantina S Nikita
- School of Electrical and Computer Engineering, National Technical University of Athens, Zografos, Athens, Greece
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Abstract
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and is associated with pronounced hematopathologic findings. Peripheral blood features are heterogeneous and very often include neutrophilia, lymphopenia, myeloid left shift, abnormally segmented neutrophils, atypical lymphocytes/plasmacytoid lymphocytes, and atypical monocytes. Bone marrow biopsies and aspirates are often notable for histiocytosis and hemophagocytosis, whereas secondary lymphoid organs may exhibit lymphocyte depletion, pronounced plasmacytoid infiltrates, and hemophagocytosis. These changes are reflective of profound innate and adaptive immune dysregulation, and ongoing research efforts continue to identify clinically applicable biomarkers of disease severity and outcome.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Liu G, Jiang A, Cao L, Ling S, Wang X, Bu S, Lu F. Optic disc and retinal vascular features in first 6 years of Chinese children. Front Pediatr 2023; 11:1101768. [PMID: 37033190 PMCID: PMC10077150 DOI: 10.3389/fped.2023.1101768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Retinal microvasculature plays an important role in children's fundus lesions and even in their later life. However, little was known on the features of normal retina in early life. The purpose of this study was to explore the normal retinal features in the first 6 years of life and provide information for future research. Methods Children, aged from birth to 6 years old and diagnosed with various unilateral ocular diseases were included. Venous phase fundus fluorescein angiography images with the optic disc at the center were collected. Based on the ResUNet convolutional neural network, optic disc and retinal vascular features in the posterior retina were computed automatically. Results A total of 146 normal eyes of 146 children were included. Among different age groups, no changes were shown in the optic disc diameter (y = -0.00002x + 1.362, R2 = 0.025, p = 0.058). Retinal vessel density and fractal dimension are linearly and strongly correlated (r = 0.979, p < 0.001). Older children had smaller value of fractal dimension (y = -0.000026x + 1.549, R2 = 0.075, p = 0.001) and narrower vascular caliber if they were less than 3 years old (y = -0.008x + 84.861, R2 = 0.205, p < 0.001). No differences were in the density (y = -0.000007x + 0.134, R2 = 0.023, p = 0.067) and the curvature of retinal vessels (lnC = -0.00001x - 4.657, R2 = 0.001, p = 0.667). Conclusions Age and gender did not impact the optic disc diameter, vessel density, and vessel curvature significantly in this group of children. Trends of decreased vessel caliber in the first 3 years of life and decreased vessel complexity with age were observed. The structural characteristics provide information for future research to better understand the developmental origin of the healthy and diseased retina.
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Affiliation(s)
- Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Anna Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Saiguang Ling
- EVision Technology (Beijing) Co. LTD, Beijing, China
| | - Xi Wang
- EVision Technology (Beijing) Co. LTD, Beijing, China
| | - Shaochong Bu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Correspondence: Shaochong Bu Fang Lu
| | - Fang Lu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Shaochong Bu Fang Lu
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Styrzynski F, Zhakparov D, Schmid M, Roqueiro D, Lukasik Z, Solek J, Nowicki J, Dobrogowski M, Makowska J, Sokolowska M, Baerenfaller K. Machine Learning Successfully Detects Patients with COVID-19 Prior to PCR Results and Predicts Their Survival Based on Standard Laboratory Parameters in an Observational Study. Infect Dis Ther 2023; 12:111-129. [PMID: 36333475 PMCID: PMC9638383 DOI: 10.1007/s40121-022-00707-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In the current COVID-19 pandemic, clinicians require a manageable set of decisive parameters that can be used to (i) rapidly identify SARS-CoV-2 positive patients, (ii) identify patients with a high risk of a fatal outcome on hospital admission, and (iii) recognize longitudinal warning signs of a possible fatal outcome. METHODS This comparative study was performed in 515 patients in the Maria Skłodowska-Curie Specialty Voivodeship Hospital in Zgierz, Poland. The study groups comprised 314 patients with COVID-like symptoms who tested negative and 201 patients who tested positive for SARS-CoV-2 infection; of the latter, 72 patients with COVID-19 died and 129 were released from hospital. Data on which we trained several machine learning (ML) models included clinical findings on admission and during hospitalization, symptoms, epidemiological risk, and reported comorbidities and medications. RESULTS We identified a set of eight on-admission parameters: white blood cells, antibody-synthesizing lymphocytes, ratios of basophils/lymphocytes, platelets/neutrophils, and monocytes/lymphocytes, procalcitonin, creatinine, and C-reactive protein. The medical decision tree built using these parameters differentiated between SARS-CoV-2 positive and negative patients with up to 90-100% accuracy. Patients with COVID-19 who on hospital admission were older, had higher procalcitonin, C-reactive protein, and troponin I levels together with lower hemoglobin and platelets/neutrophils ratio were found to be at highest risk of death from COVID-19. Furthermore, we identified longitudinal patterns in C-reactive protein, white blood cells, and D dimer that predicted the disease outcome. CONCLUSIONS Our study provides sets of easily obtainable parameters that allow one to assess the status of a patient with SARS-CoV-2 infection, and the risk of a fatal disease outcome on hospital admission and during the course of the disease.
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Affiliation(s)
- Filip Styrzynski
- Department of Rheumatology with Subdepartment of Internal Medicine, Medical University of Lodz, 90-419, Lodz, Poland
| | - Damir Zhakparov
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard-Strasse 9, 7265, Davos, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Marco Schmid
- University of Applied Sciences of the Grisons, 7000, Chur, Switzerland
| | - Damian Roqueiro
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - Zuzanna Lukasik
- Department of Rheumatology with Subdepartment of Internal Medicine, Medical University of Lodz, 90-419, Lodz, Poland
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard-Strasse 9, 7265, Davos, Switzerland
| | - Julia Solek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, 90-419, Lodz, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419, Lodz, Poland
| | - Jakub Nowicki
- Department of Paediatrics, Newborn Pathology and Bone Metabolic Diseases, Medical University of Lodz, 90-419, Lodz, Poland
| | - Milosz Dobrogowski
- Maria Sklodowska-Curie Specialty Voivodeship Hospital, 95-100, Zgierz, Poland
| | - Joanna Makowska
- Department of Rheumatology with Subdepartment of Internal Medicine, Medical University of Lodz, 90-419, Lodz, Poland.
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard-Strasse 9, 7265, Davos, Switzerland.
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), 7265, Davos, Switzerland.
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard-Strasse 9, 7265, Davos, Switzerland.
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.
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Sprockel Díaz JJ, Torres Tobar LA, Rodríguez Acosta MJ. Aplicación de la calculadora de probabilidad fenotípica FEN-COVID en pacientes hospitalizados por COVID-19 en una población latinoamericana. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introducción: la variabilidad del comportamiento clínico del COVID-19 puede ser uno de los determinantes que limitan la toma de decisiones terapéuticas. Se busca clasificar a pacientes latinoamericanos hospitalizados mediante la herramienta FEN-COVID para la identificación de fenotipos clínicos y determinar su asociación con mortalidad e ingreso a la unidad de cuidado intensivo (UCI). Métodos: estudio observacional de cohorte retrospectivo, que incluyó adultos hospitalizados en dos centros de tercer nivel de atención con COVID-19 confirmado entre septiembre 2020 y marzo 2021. A cada paciente seleccionado se asignó un fenotipo aplicando la calculadora FEN-COVID. Se llevó a cabo un análisis multivariado para documentar las asociaciones entre el fenotipo, las complicaciones hospitalarias y los desenlaces clínicos. Resultados: se identificaron 126 pacientes hospitalizados por COVID-19, edad promedio de 58 años, 45 mujeres (35.7%), 23% diabéticos, 45% hipertensos y 20% obesos. 108 (85.7%) fueron del fenotipo B y 18 (14.2%) fenotipo C. Aunque en este último los desenlaces fueron peores (requerimiento de UCI 77.8% vs 45.4% y mortalidad 66% vs 22%, OR 1.408, IC95% 3.191-5.243, p <0.007), esta asociación no se mantuvo en el análisis multivariado con OR 1.110 (IC95% 0.780 - 1.581, p de 0.555) Conclusión: los fenotipos identificados a partir de FEN-COVID parecen discriminar un subgrupo de pacientes que ostenta el peor comportamiento clínico, aunque no tuvo representación del fenotipo más leve. El análisis bivariado documentó asociación con la muerte o ingreso a UCI que no se mantuvo en el modelo multivariado.
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Pai KC, Su SA, Chan MC, Wu CL, Chao WC. Explainable machine learning approach to predict extubation in critically ill ventilated patients: a retrospective study in central Taiwan. BMC Anesthesiol 2022; 22:351. [PMID: 36376785 PMCID: PMC9664699 DOI: 10.1186/s12871-022-01888-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Weaning from mechanical ventilation (MV) is an essential issue in critically ill patients, and we used an explainable machine learning (ML) approach to establish an extubation prediction model.
Methods
We enrolled patients who were admitted to intensive care units during 2015–2019 at Taichung Veterans General Hospital, a referral hospital in central Taiwan. We used five ML models, including extreme gradient boosting (XGBoost), categorical boosting (CatBoost), light gradient boosting machine (LightGBM), random forest (RF) and logistic regression (LR), to establish the extubation prediction model, and the feature window as well as prediction window was 48 h and 24 h, respectively. We further employed feature importance, Shapley additive explanations (SHAP) plot, partial dependence plot (PDP) and local interpretable model-agnostic explanations (LIME) for interpretation of the model at the domain, feature, and individual levels.
Results
We enrolled 5,940 patients and found the accuracy was comparable among XGBoost, LightGBM, CatBoost and RF, with the area under the receiver operating characteristic curve using XGBoost to predict extubation was 0.921. The calibration and decision curve analysis showed well applicability of models. We also used the SHAP summary plot and PDP plot to demonstrate discriminative points of six key features in predicting extubation. Moreover, we employed LIME and SHAP force plots to show predicted probabilities of extubation and the rationale of the prediction at the individual level.
Conclusions
We developed an extubation prediction model with high accuracy and visualised explanations aligned with clinical workflow, and the model may serve as an autonomous screen tool for timely weaning.
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Sabharwal R, Miah SJ, Fosso Wamba S. Extending artificial intelligence research in the clinical domain: a theoretical perspective. ANNALS OF OPERATIONS RESEARCH 2022:1-32. [PMID: 36407943 PMCID: PMC9641309 DOI: 10.1007/s10479-022-05035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Academic research to the utilization of artificial intelligence (AI) has been proliferated over the past few years. While AI and its subsets are continuously evolving in the fields of marketing, social media and finance, its application in the daily practice of clinical care is insufficiently explored. In this systematic review, we aim to landscape various application areas of clinical care in terms of the utilization of machine learning to improve patient care. Through designing a specific smart literature review approach, we give a new insight into existing literature identified with AI technologies in the clinical domain. Our review approach focuses on strategies, algorithms, applications, results, qualities, and implications using the Latent Dirichlet Allocation topic modeling. A total of 305 unique articles were reviewed, with 115 articles selected using Latent Dirichlet Allocation topic modeling, meeting our inclusion criteria. The primary result of this approach incorporates a proposition for future research direction, abilities, and influence of AI technologies and displays the areas of disease management in clinics. This research concludes with disease administrative ramifications, limitations, and directions for future research.
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Affiliation(s)
- Renu Sabharwal
- Newcastle Business School, The University of Newcastle, Callaghan, NSW Australia
| | - Shah J. Miah
- Newcastle Business School, The University of Newcastle, Callaghan, NSW Australia
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Giotta M, Trerotoli P, Palmieri VO, Passerini F, Portincasa P, Dargenio I, Mokhtari J, Montagna MT, De Vito D. Application of a Decision Tree Model to Predict the Outcome of Non-Intensive Inpatients Hospitalized for COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13016. [PMID: 36293594 PMCID: PMC9602523 DOI: 10.3390/ijerph192013016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 05/05/2023]
Abstract
Many studies have identified predictors of outcomes for inpatients with coronavirus disease 2019 (COVID-19), especially in intensive care units. However, most retrospective studies applied regression methods to evaluate the risk of death or worsening health. Recently, new studies have based their conclusions on retrospective studies by applying machine learning methods. This study applied a machine learning method based on decision tree methods to define predictors of outcomes in an internal medicine unit with a prospective study design. The main result was that the first variable to evaluate prediction was the international normalized ratio, a measure related to prothrombin time, followed by immunoglobulin M response. The model allowed the threshold determination for each continuous blood or haematological parameter and drew a path toward the outcome. The model's performance (accuracy, 75.93%; sensitivity, 99.61%; and specificity, 23.43%) was validated with a k-fold repeated cross-validation. The results suggest that a machine learning approach could help clinicians to obtain information that could be useful as an alert for disease progression in patients with COVID-19. Further research should explore the acceptability of these results to physicians in current practice and analyze the impact of machine learning-guided decisions on patient outcomes.
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Affiliation(s)
- Massimo Giotta
- School of Specialization in Medical Statistics and Biometry, School of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Paolo Trerotoli
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Vincenzo Ostilio Palmieri
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Francesca Passerini
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Piero Portincasa
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Ilaria Dargenio
- School of Specialization in Medical Statistics and Biometry, School of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Jihad Mokhtari
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Medical School, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Maria Teresa Montagna
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Danila De Vito
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Medical School, University of Bari Aldo Moro, 70121 Bari, Italy
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Martinez-Millana A, Saez-Saez A, Tornero-Costa R, Azzopardi-Muscat N, Traver V, Novillo-Ortiz D. Artificial intelligence and its impact on the domains of universal health coverage, health emergencies and health promotion: An overview of systematic reviews. Int J Med Inform 2022; 166:104855. [PMID: 35998421 PMCID: PMC9551134 DOI: 10.1016/j.ijmedinf.2022.104855] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Artificial intelligence is fueling a new revolution in medicine and in the healthcare sector. Despite the growing evidence on the benefits of artificial intelligence there are several aspects that limit the measure of its impact in people's health. It is necessary to assess the current status on the application of AI towards the improvement of people's health in the domains defined by WHO's Thirteenth General Programme of Work (GPW13) and the European Programme of Work (EPW), to inform about trends, gaps, opportunities, and challenges. OBJECTIVE To perform a systematic overview of systematic reviews on the application of artificial intelligence in the people's health domains as defined in the GPW13 and provide a comprehensive and updated map on the application specialties of artificial intelligence in terms of methodologies, algorithms, data sources, outcomes, predictors, performance, and methodological quality. METHODS A systematic search in MEDLINE, EMBASE, Cochrane and IEEEXplore was conducted between January 2015 and June 2021 to collect systematic reviews using a combination of keywords related to the domains of universal health coverage, health emergencies protection, and better health and wellbeing as defined by the WHO's PGW13 and EPW. Eligibility criteria was based on methodological quality and the inclusion of practical implementation of artificial intelligence. Records were classified and labeled using ICD-11 categories into the domains of the GPW13. Descriptors related to the area of implementation, type of modeling, data entities, outcomes and implementation on care delivery were extracted using a structured form and methodological aspects of the included reviews studies was assessed using the AMSTAR checklist. RESULTS The search strategy resulted in the screening of 815 systematic reviews from which 203 were assessed for eligibility and 129 were included in the review. The most predominant domain for artificial intelligence applications was Universal Health Coverage (N = 98) followed by Health Emergencies (N = 16) and Better Health and Wellbeing (N = 15). Neoplasms area on Universal Health Coverage was the disease area featuring most of the applications (21.7 %, N = 28). The reviews featured analytics primarily over both public and private data sources (67.44 %, N = 87). The most used type of data was medical imaging (31.8 %, N = 41) and predictors based on regions of interest and clinical data. The most prominent subdomain of Artificial Intelligence was Machine Learning (43.4 %, N = 56), in which Support Vector Machine method was predominant (20.9 %, N = 27). Regarding the purpose, the application of Artificial Intelligence I is focused on the prediction of the diseases (36.4 %, N = 47). With respect to the validation, more than a half of the reviews (54.3 %, N = 70) did not report a validation procedure and, whenever available, the main performance indicator was the accuracy (28.7 %, N = 37). According to the methodological quality assessment, a third of the reviews (34.9 %, N = 45) implemented methods for analysis the risk of bias and the overall AMSTAR score below was 5 (4.01 ± 1.93) on all the included systematic reviews. CONCLUSION Artificial intelligence is being used for disease modelling, diagnose, classification and prediction in the three domains of GPW13. However, the evidence is often limited to laboratory and the level of adoption is largely unbalanced between ICD-11 categoriesand diseases. Data availability is a determinant factor on the developmental stage of artificial intelligence applications. Most of the reviewed studies show a poor methodological quality and are at high risk of bias, which limits the reproducibility of the results and the reliability of translating these applications to real clinical scenarios. The analyzed papers show results only in laboratory and testing scenarios and not in clinical trials nor case studies, limiting the supporting evidence to transfer artificial intelligence to actual care delivery.
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Affiliation(s)
- Antonio Martinez-Millana
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Aida Saez-Saez
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Roberto Tornero-Costa
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Vicente Traver
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
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Ramón A, Zaragozá M, Torres AM, Cascón J, Blasco P, Milara J, Mateo J. Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab. J Clin Med 2022; 11:jcm11164729. [PMID: 36012968 PMCID: PMC9410189 DOI: 10.3390/jcm11164729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Among the IL-6 inhibitors, tocilizumab is the most widely used therapeutic option in patients with SARS-CoV-2-associated severe respiratory failure (SRF). The aim of our study was to provide evidence on predictors of poor outcome in patients with COVID-19 treated with tocilizumab, using machine learning (ML) techniques. We conducted a retrospective study, analyzing the clinical, laboratory and sociodemographic data of patients admitted for severe COVID-19 with SRF, treated with tocilizumab. The extreme gradient boost (XGB) method had the highest balanced accuracy (93.16%). The factors associated with a worse outcome of tocilizumab use in terms of mortality were: baseline situation at the start of tocilizumab treatment requiring invasive mechanical ventilation (IMV), elevated ferritin, lactate dehydrogenase (LDH) and glutamate-pyruvate transaminase (GPT), lymphopenia, and low PaFi [ratio between arterial oxygen pressure and inspired oxygen fraction (PaO2/FiO2)] values. The factors associated with a worse outcome of tocilizumab use in terms of hospital stay were: baseline situation at the start of tocilizumab treatment requiring IMV or supplemental oxygen, elevated levels of ferritin, glutamate-oxaloacetate transaminase (GOT), GPT, C-reactive protein (CRP), LDH, lymphopenia, and low PaFi values. In our study focused on patients with severe COVID-19 treated with tocilizumab, the factors that were weighted most strongly in predicting worse clinical outcome were baseline status at the start of tocilizumab treatment requiring IMV and hyperferritinemia.
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Affiliation(s)
- Antonio Ramón
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Marta Zaragozá
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Ana María Torres
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Joaquín Cascón
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Pilar Blasco
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Javier Milara
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Centre for Biomedical Research Network on Respiratory Diseases (CIBERES), Health Institute Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Jorge Mateo
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
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Pishgar M, Harford S, Theis J, Galanter W, Rodríguez-Fernández JM, Chaisson LH, Zhang Y, Trotter A, Kochendorfer KM, Boppana A, Darabi H. A process mining- deep learning approach to predict survival in a cohort of hospitalized COVID-19 patients. BMC Med Inform Decis Mak 2022; 22:194. [PMID: 35879715 PMCID: PMC9309593 DOI: 10.1186/s12911-022-01934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Various machine learning and artificial intelligence methods have been used to predict outcomes of hospitalized COVID-19 patients. However, process mining has not yet been used for COVID-19 prediction. We developed a process mining/deep learning approach to predict mortality among COVID-19 patients and updated the prediction in 6-h intervals during the first 72 h after hospital admission. METHODS The process mining/deep learning model produced temporal information related to the variables and incorporated demographic and clinical data to predict mortality. The mortality prediction was updated in 6-h intervals during the first 72 h after hospital admission. Moreover, the performance of the model was compared with published and self-developed traditional machine learning models that did not use time as a variable. The performance was compared using the Area Under the Receiver Operator Curve (AUROC), accuracy, sensitivity, and specificity. RESULTS The proposed process mining/deep learning model outperformed the comparison models in almost all time intervals with a robust AUROC above 80% on a dataset that was imbalanced. CONCLUSIONS Our proposed process mining/deep learning model performed significantly better than commonly used machine learning approaches that ignore time information. Thus, time information should be incorporated in models to predict outcomes more accurately.
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Affiliation(s)
- M Pishgar
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - S Harford
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - J Theis
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA
| | - W Galanter
- Departments of Medicine and Pharmacy Systems, Outcomes and Policy, UIC, Chicago, USA
| | | | | | - Y Zhang
- University of Illinois Hospital (UIH), UIC, Chicago, USA
| | - A Trotter
- Department of Medicine, UIC, Chicago, USA
| | | | - A Boppana
- University of Illinois Hospital (UIH), UIC, Chicago, USA
| | - H Darabi
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago (UIC), 842 W Taylor Street, MC 251, Chicago, IL, 60607, USA.
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Ramón A, Torres AM, Milara J, Cascón J, Blasco P, Mateo J. eXtreme Gradient Boosting-based method to classify patients with COVID-19. J Investig Med 2022; 70:jim-2021-002278. [PMID: 35850970 DOI: 10.1136/jim-2021-002278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/08/2023]
Abstract
Different demographic, clinical and laboratory variables have been related to the severity and mortality following SARS-CoV-2 infection. Most studies applied traditional statistical methods and in some cases combined with a machine learning (ML) method. This is the first study to date to comparatively analyze five ML methods to select the one that most closely predicts mortality in patients admitted with COVID-19. The aim of this single-center observational study is to classify, based on different types of variables, adult patients with COVID-19 at increased risk of mortality. SARS-CoV-2 infection was defined by a positive reverse transcriptase PCR. A total of 203 patients were admitted between March 15 and June 15, 2020 to a tertiary hospital. Data were extracted from the electronic medical record. Four supervised ML algorithms (k-nearest neighbors (KNN), decision tree (DT), Gaussian naïve Bayes (GNB) and support vector machine (SVM)) were compared with the eXtreme Gradient Boosting (XGB) method proposed to have excellent scalability and high running speed, among other qualities. The results indicate that the XGB method has the best prediction accuracy (92%), high precision (>0.92) and high recall (>0.92). The KNN, SVM and DT approaches present moderate prediction accuracy (>80%), moderate recall (>0.80) and moderate precision (>0.80). The GNB algorithm shows relatively low classification performance. The variables with the greatest weight in predicting mortality were C reactive protein, procalcitonin, glutamyl oxaloacetic transaminase, glutamyl pyruvic transaminase, neutrophils, D-dimer, creatinine, lactic acid, ferritin, days of non-invasive ventilation, septic shock and age. Based on these results, XGB is a solid candidate for correct classification of patients with COVID-19.
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Affiliation(s)
- Antonio Ramón
- Pharmacy Department, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Ana Maria Torres
- Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Javier Milara
- Pharmacy Department, General University Hospital Consortium of Valencia, Valencia, Spain
- Pharmacy Department, University of Valencia, Valencia, Spain
| | - Joaquín Cascón
- Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Pilar Blasco
- Pharmacy Department, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Jorge Mateo
- Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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Supporting Clinical COVID-19 Diagnosis with Routine Blood Tests Using Tree-Based Entropy Structured Self-Organizing Maps. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Data classification is an automatic or semi-automatic process that, utilizing artificial intelligence algorithms, learns the variable and class relationships of a dataset for use a posteriori in situations where the class result is unknown. For many years, work on this topic has been aimed at increasing the hit rates of algorithms. However, when the problem is restricted to applications in healthcare, besides the concern with performance, it is also necessary to design algorithms whose results are understandable by the specialists responsible for making the decisions. Among the problems in the field of medicine, a current focus is related to COVID-19: AI algorithms may contribute to early diagnosis. Among the available COVID-19 data, the blood test is a typical procedure performed when the patient seeks the hospital, and its use in the diagnosis allows reducing the need for other diagnostic tests that can impact the detection time and add to costs. In this work, we propose using self-organizing map (SOM) to discover attributes in blood test examinations that are relevant for COVID-19 diagnosis. We applied SOM and an entropy calculation in the definition of a hierarchical, semi-supervised and explainable model named TESSOM (tree-based entropy-structured self-organizing maps), in which the main feature is enhancing the investigation of groups of cases with high levels of class overlap, as far as the diagnostic outcome is concerned. Framing the TESSOM algorithm in the context of explainable artificial intelligence (XAI) makes it possible to explain the results to an expert in a simplified way. It is demonstrated in the paper that the use of the TESSOM algorithm to identify attributes of blood tests can help with the identification of COVID-19 cases. It providing a performance increase in 1.489% in multiple scenarios when analyzing 2207 cases from three hospitals in the state of São Paulo, Brazil. This work is a starting point for researchers to identify relevant attributes of blood tests for COVID-19 and to support the diagnosis of other diseases.
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Alabbad DA, Almuhaideb AM, Alsunaidi SJ, Alqudaihi KS, Alamoudi FA, Alhobaishi MK, Alaqeel NA, Alshahrani MS. Machine learning model for predicting the length of stay in the intensive care unit for Covid-19 patients in the eastern province of Saudi Arabia. INFORMATICS IN MEDICINE UNLOCKED 2022; 30:100937. [PMID: 35441086 PMCID: PMC9010025 DOI: 10.1016/j.imu.2022.100937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 virus has spread rapidally throughout the world. Managing resources is one of the biggest challenges that healthcare providers around the world face during the pandemic. Allocating the Intensive Care Unit (ICU) beds' capacity is important since COVID-19 is a respiratory disease and some patients need to be admitted to the hospital with an urgent need for oxygen support, ventilation, and/or intensive medical care. In the battle against COVID-19, many governments utilized technology, especially Artificial Intelligence (AI), to contain the pandemic and limit its hazardous effects. In this paper, Machine Learning models (ML) were developed to help in detecting the COVID-19 patients’ need for the ICU and the estimated duration of their stay. Four ML algorithms were utilized: Random Forest (RF), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Ensemble models were trained and validated on a dataset of 895 COVID-19 patients admitted to King Fahad University hospital in the eastern province of Saudi Arabia. The conducted experiments show that the Length of Stay (LoS) in the ICU can be predicted with the highest accuracy by applying the RF model for prediction, as the achieved accuracy was 94.16%. In terms of the contributor factors to the length of stay in the ICU, correlation results showed that age, C-Reactive Protein (CRP), nasal oxygen support days are the top related factors. By searching the literature, there is no published work that used the Saudi Arabia dataset to predict the need for ICU with the number of days needed. This contribution is hoped to pave the path for hospitals and healthcare providers to manage their resources more efficiently and to help in saving lives.
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Affiliation(s)
- Dina A Alabbad
- Department of Computer Engineering, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Abdullah M Almuhaideb
- Department of Networks and Communications, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Shikah J Alsunaidi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Kawther S Alqudaihi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Fatimah A Alamoudi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Maha K Alhobaishi
- Department of Computer Engineering, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Naimah A Alaqeel
- Department of Computer Engineering, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
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46
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Triage in the time of COVID-19. Lancet Digit Health 2022; 4:e210-e211. [PMID: 35279398 PMCID: PMC8906812 DOI: 10.1016/s2589-7500(22)00001-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022]
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901.
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Affiliation(s)
- Thomas De Corte
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | | | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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48
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 08/26/2024] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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49
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Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res 2022; 11:102. [PMID: 35340277 PMCID: PMC8921693 DOI: 10.12688/f1000research.108667.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background: iron and calcium dysmetabolism, with hyperferritinemia, hypoferremia, hypocalcemia and anemia have been documented in the majority of COVID-19 patients at later/worse stages. Furthermore, complementary to ACE2, both sialic acid (SA) molecules and CD147 proved relevant host receptors for SARS-CoV-2 entry, which explains the viral attack to multiple types of cells, including erythrocytes, endothelium and neural tissue. Several authors advocated that cell ferroptosis may be the core and final cell degenerative mechanism. Methods: a literature research was performed in several scientific search engines, such as PubMed Central, Cochrane Library, Chemical Abstract Service. More than 500 articles were retrieved until mid-December 2021, to highlight the available evidence about the investigated issues. Results: based on COVID-19 literature data, we have highlighted a few pathophysiological mechanisms, associated with virus-based cation dysmetabolism, multi-organ attack, mitochondria degeneration and ferroptosis. Our suggested elucidated pathological sequence is: a) spike protein subunit S1 docking with sialylated membrane glycoproteins/receptors (ACE2, CD147), and S2 subunit fusion with the lipid layer; b) cell membrane morpho-functional changes due to the consequent electro-chemical variations and viroporin action, which induce an altered ion channel function and intracellular cation accumulation; c) additional intracellular iron concentration due to a deregulated hepcidin-ferroportin axis, with higher hepcidin levels. Viral invasion may also affect erythrocytes/erythroid precursors, endothelial cells and macrophages, through SA and CD147 receptors, with relative hemoglobin and iron/calcium dysmetabolism. AB0 blood group, hemochromatosis, or environmental elements may represent possible factors which affect individual susceptibility to COVID-19. Conclusions: our literature analysis confirms the combined role of SA molecules, ACE2, CD147, viroporins and hepcidin in determining the cation dysmetabolism and final ferroptosis in the cells infected by SARS-CoV-2. The altered ion channels and electrochemical gradients of the cell membrane have a pivotal role in the virus entry and cell dysmetabolism, with subsequent multi-organ immune-inflammatory degeneration and erythrocyte/hemoglobin alterations.
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Affiliation(s)
- Attilio Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, AP, 63074, Italy
| | | | - Emidio Troiani
- Cardiology Unit, Social Security Institute, State Hospital, Cailungo, 47893, San Marino
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division,, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
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Validation of the Performance of A1HPV6, a Triage Blood Test for the Early Diagnosis and Prognosis of SARS-CoV-2 Infection. GASTRO HEP ADVANCES 2022; 1:393-402. [PMID: 35174366 PMCID: PMC8818442 DOI: 10.1016/j.gastha.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022]
Abstract
Background and Aims Apolipoprotein A1 (A1) and haptoglobin (HP) serum levels are associated with the spread and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We have constructed and validated a multivariable risk calculator (A1HPV6) integrating A1, HP, alpha2-macroglobulin, and gamma glutamyl transferase to improve the performances of virological biomarkers. Methods In a prospective observational study of hospitalized patients with nonsevere SARS-CoV-2 infection, A1HPV6 was constructed in 127 patients and validated in 116. The specificity was assessed in 7482 controls representing the general population. The primary diagnostic endpoint was the area under the receiver operating characteristic curve in patients with positive SARS-CoV-2 PCR. The primary prognostic endpoint was the age-and-sex adjusted risk of A1HPV6 to predict patients with WHO-stage > 4 (W > 4) severity. We assessed the kinetics of the A1HPV6 components in a nonhuman primate model (NHP), from baseline to 7 days (D7) after SARS-CoV-2 infection. Results The area under the receiver operating characteristic curve for A1HPV6 was 0.99 (95% CI 0.97–0.99) in the validation subset, which was not significantly different from that in the construction subset, 0.99 (0.99–0.99; P = .80), like for sensitivity 92% (85–96) vs 94% (88–97; P = .29). A1HPV6 was associated with W > 4, with a significant odds ratio of 1.3 (1.1–1.5; 0.002). In NHP, A1 levels decreased (P < .01) at D2 and normalized at D4; HP levels increased at D2 and peaked at D4. In patients, A1 concentration was very low at D2 vs controls (P < .01) and increased at D14 (P < .01) but was still lower than controls; HP increased at D2 and remained elevated at D14. Conclusion These results validate the diagnostic and prognostic performances of A1HPV6. Similar kinetics of apolipoprotein A1, HP, and alpha-2-macroglobulin were observed in the NHP model. ClinicalTrials.gov number, NCT01927133.
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