A Machine Learning-Based Severity Prediction Tool for the Michigan Neuropathy Screening Instrument.

Diabetic sensorimotor polyneuropathy (DSPN) is a serious long-term complication of diabetes, which may lead to foot ulceration and amputation. Among the screening tools for DSPN, the Michigan neuropathy screening instrument (MNSI) is frequently deployed, but it lacks a straightforward rating of severity. A DSPN severity grading system has been built and simulated for the MNSI, utilizing longitudinal data captured over 19 years from the Epidemiology of Diabetes Interventions and Complications (EDIC) trial. Machine learning algorithms were used to establish the MNSI factors and patient outcomes to characterise the features with the best ability to detect DSPN severity. A nomogram based on multivariable logistic regression was designed, developed and validated. The extra tree model was applied to identify the top seven ranked MNSI features that identified DSPN, namely vibration perception (R), 10-gm filament, previous diabetic neuropathy, vibration perception (L), presence of callus, deformities and fissure. The nomogram's area under the curve (AUC) was 0.9421 and 0.946 for the internal and external datasets, respectively. The probability of DSPN was predicted from the nomogram and a DSPN severity grading system for MNSI was created using the probability score. An independent dataset was used to validate the model's performance. The patients were divided into four different severity levels, i.e., absent, mild, moderate, and severe, with cut-off values of 10.50, 12.70 and 15.00 for a DSPN probability of less than 50, 75 and 100%, respectively. We provide an easy-to-use, straightforward and reproducible approach to determine prognosis in patients with DSPN.

Nomogram-Based Chronic Kidney Disease Prediction Model for Type 1 Diabetes Mellitus Patients Using Routine Pathological Data.

Type 1 diabetes mellitus (T1DM) patients are a significant threat to chronic kidney disease (CKD) development during their life. However, there is always a high chance of delay in CKD detection because CKD can be asymptomatic, and T1DM patients bypass traditional CKD tests during their routine checkups. This study aims to develop and validate a prediction model and nomogram of CKD in T1DM patients using readily available routine checkup data for early CKD detection. This research utilized 1375 T1DM patients' sixteen years of longitudinal data from multi-center Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials conducted at 28 sites in the USA and Canada and considered 17 routinely available features. Three feature ranking algorithms, extreme gradient boosting (XGB), random forest (RF), and extremely randomized trees classifier (ERT), were applied to create three feature ranking lists, and logistic regression analyses were performed to develop CKD prediction models using these ranked feature lists to identify the best performing top-ranked features combination. Finally, the most significant features were selected to develop a multivariate logistic regression-based CKD prediction model for T1DM patients. This model was evaluated using sensitivity, specificity, accuracy, precision, and F1 score on train and test data. A nomogram of the final model was further generated for easy application in clinical practices. Hypertension, duration of diabetes, drinking habit, triglycerides, ACE inhibitors, low-density lipoprotein (LDL) cholesterol, age, and smoking habit were the top-8 features ranked by the XGB model and identified as the most important features for predicting CKD in T1DM patients. These eight features were selected to develop the final prediction model using multivariate logistic regression, which showed 90.04% and 88.59% accuracy in internal and test data validation. The proposed model showed excellent performance and can be used for CKD identification in T1DM patients during routine checkups.

Myoelectric Pattern Recognition Performance Enhancement Using Nonlinear Features.

The multichannel electrode array used for electromyogram (EMG) pattern recognition provides good performance, but it has a high cost, is computationally expensive, and is inconvenient to wear. Therefore, researchers try to use as few channels as possible while maintaining improved pattern recognition performance. However, minimizing the number of channels affects the performance due to the least separable margin among the movements possessing weak signal strengths. To meet these challenges, two time-domain features based on nonlinear scaling, the log of the mean absolute value (LMAV) and the nonlinear scaled value (NSV), are proposed. In this study, we validate the proposed features on two datasets, the existing four feature extraction methods, variable window size, and various signal-to-noise ratios (SNR). In addition, we also propose a feature extraction method where the LMAV and NSV are grouped with the existing 11 time-domain features. The proposed feature extraction method enhances accuracy, sensitivity, specificity, precision, and F1 score by 1.00%, 5.01%, 0.55%, 4.71%, and 5.06% for dataset 1, and 1.18%, 5.90%, 0.66%, 5.63%, and 6.04% for dataset 2, respectively. Therefore, the experimental results strongly suggest the proposed feature extraction method, for taking a step forward with regard to improved myoelectric pattern recognition performance.

Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification Using Nerve Conduction Studies.

Background: Diabetic sensorimotor polyneuropathy (DSPN) is a major form of complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is very common and well-established in the field of research, its application in DSPN diagnosis using nerve conduction studies (NCS), is very limited in the existing literature. Method: In this study, the NCS data were collected from the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. The NCS variables are median motor velocity (m/sec), median motor amplitude (mV), median motor F-wave (msec), median sensory velocity (m/sec), median sensory amplitude (µV), Peroneal Motor Velocity (m/sec), peroneal motor amplitude (mv), peroneal motor F-wave (msec), sural sensory velocity (m/sec), and sural sensory amplitude (µV). Three different feature ranking techniques were used to analyze the performance of eight different conventional classifiers. Results: The ensemble classifier outperformed other classifiers for the NCS data ranked when all the NCS features were used and provided an accuracy of 93.40%, sensitivity of 91.77%, and specificity of 98.44%. The random forest model exhibited the second-best performance using all the ten features with an accuracy of 93.26%, sensitivity of 91.95%, and specificity of 98.95%. Both ensemble and random forest showed the kappa value 0.82, which indicates that the models are in good agreement with the data and the variables used and are accurate to identify DSPN using these ML models. Conclusion: This study suggests that the ensemble classifier using all the ten NCS variables can predict the DSPN severity which can enhance the management of DSPN patients.

Machine Learning-Based Diabetic Neuropathy and Previous Foot Ulceration Patients Detection Using Electromyography and Ground Reaction Forces during Gait.

Diabetic neuropathy (DN) is one of the prevalent forms of neuropathy that involves alterations in biomechanical changes in the human gait. Diabetic foot ulceration (DFU) is one of the pervasive types of complications that arise due to DN. In the literature, for the last 50 years, researchers have been trying to observe the biomechanical changes due to DN and DFU by studying muscle electromyography (EMG) and ground reaction forces (GRF). However, the literature is contradictory. In such a scenario, we propose using Machine learning techniques to identify DN and DFU patients by using EMG and GRF data. We collected a dataset from the literature which involves three patient groups: Control (n = 6), DN (n = 6), and previous history of DFU (n = 9) and collected three lower limb muscles EMG (tibialis anterior (TA), vastus lateralis (VL), gastrocnemius lateralis (GL)), and three GRF components (GRFx, GRFy, and GRFz). Raw EMG and GRF signals were preprocessed, and different feature extraction techniques were applied to extract the best features from the signals. The extracted feature list was ranked using four different feature ranking techniques, and highly correlated features were removed. In this study, we considered different combinations of muscles and GRF components to find the best performing feature list for the identification of DN and DFU. We trained eight different conventional ML models: Discriminant analysis classifier (DAC), Ensemble classification model (ECM), Kernel classification model (KCM), k-nearest neighbor model (KNN), Linear classification model (LCM), Naive Bayes classifier (NBC), Support vector machine classifier (SVM), and Binary decision classification tree (BDC), to find the best-performing algorithm and optimized that model. We trained the optimized the ML algorithm for different combinations of muscles and GRF component features, and the performance matrix was evaluated. Our study found the KNN algorithm performed well in identifying DN and DFU, and we optimized it before training. We found the best accuracy of 96.18% for EMG analysis using the top 22 features from the chi-square feature ranking technique for features from GL and VL muscles combined. In the GRF analysis, the model showed 98.68% accuracy using the top 7 features from the Feature selection using neighborhood component analysis for the feature combinations from the GRFx-GRFz signal. In conclusion, our study has shown a potential solution for ML application in DN and DFU patient identification using EMG and GRF parameters. With careful signal preprocessing with strategic feature extraction from the biomechanical parameters, optimization of the ML model can provide a potential solution in the diagnosis and stratification of DN and DFU patients from the EMG and GRF signals.

Machine Learning-Based Epileptic Seizure Detection Methods Using Wavelet and EMD-Based Decomposition Techniques: A Review.

Epileptic seizures are temporary episodes of convulsions, where approximately 70 percent of the diagnosed population can successfully manage their condition with proper medication and lead a normal life. Over 50 million people worldwide are affected by some form of epileptic seizures, and their accurate detection can help millions in the proper management of this condition. Increasing research in machine learning has made a great impact on biomedical signal processing and especially in electroencephalogram (EEG) data analysis. The availability of various feature extraction techniques and classification methods makes it difficult to choose the most suitable combination for resource-efficient and correct detection. This paper intends to review the relevant studies of wavelet and empirical mode decomposition-based feature extraction techniques used for seizure detection in epileptic EEG data. The articles were chosen for review based on their Journal Citation Report, feature selection methods, and classifiers used. The high-dimensional EEG data falls under the category of '3N' biosignals-nonstationary, nonlinear, and noisy; hence, two popular classifiers, namely random forest and support vector machine, were taken for review, as they are capable of handling high-dimensional data and have a low risk of over-fitting. The main metrics used are sensitivity, specificity, and accuracy; hence, some papers reviewed were excluded due to insufficient metrics. To evaluate the overall performances of the reviewed papers, a simple mean value of all metrics was used. This review indicates that the system that used a Stockwell transform wavelet variant as a feature extractor and SVM classifiers led to a potentially better result.

Performance Analysis of Conventional Machine Learning Algorithms for Identification of Chronic Kidney Disease in Type 1 Diabetes Mellitus Patients.

Chronic kidney disease (CKD) is one of the severe side effects of type 1 diabetes mellitus (T1DM). However, the detection and diagnosis of CKD are often delayed because of its asymptomatic nature. In addition, patients often tend to bypass the traditional urine protein (urinary albumin)-based CKD detection test. Even though disease detection using machine learning (ML) is a well-established field of study, it is rarely used to diagnose CKD in T1DM patients. This research aimed to employ and evaluate several ML algorithms to develop models to quickly predict CKD in patients with T1DM using easily available routine checkup data. This study analyzed 16 years of data of 1375 T1DM patients, obtained from the Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials directed by the National Institute of Diabetes, Digestive, and Kidney Diseases, USA. Three data imputation techniques (RF, KNN, and MICE) and the SMOTETomek resampling technique were used to preprocess the primary dataset. Ten ML algorithms including logistic regression (LR), k-nearest neighbor (KNN), Gaussian naïve Bayes (GNB), support vector machine (SVM), stochastic gradient descent (SGD), decision tree (DT), gradient boosting (GB), random forest (RF), extreme gradient boosting (XGB), and light gradient-boosted machine (LightGBM) were applied to developed prediction models. Each model included 19 demographic, medical history, behavioral, and biochemical features, and every feature's effect was ranked using three feature ranking techniques (XGB, RF, and Extra Tree). Lastly, each model's ROC, sensitivity (recall), specificity, accuracy, precision, and F-1 score were estimated to find the best-performing model. The RF classifier model exhibited the best performance with 0.96 (±0.01) accuracy, 0.98 (±0.01) sensitivity, and 0.93 (±0.02) specificity. LightGBM performed second best and was quite close to RF with 0.95 (±0.06) accuracy. In addition to these two models, KNN, SVM, DT, GB, and XGB models also achieved more than 90% accuracy.

A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations.

BACKGROUND: Diabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system. METHOD: For designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features. RESULTS: Top-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%-90%, and above 90%, respectively. CONCLUSIONS: The findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients.

Force-Invariant Improved Feature Extraction Method for Upper-Limb Prostheses of Transradial Amputees.

A force-invariant feature extraction method derives identical information for all force levels. However, the physiology of muscles makes it hard to extract this unique information. In this context, we propose an improved force-invariant feature extraction method based on nonlinear transformation of the power spectral moments, changes in amplitude, and the signal amplitude along with spatial correlation coefficients between channels. Nonlinear transformation balances the forces and increases the margin among the gestures. Additionally, the correlation coefficient between channels evaluates the amount of spatial correlation; however, it does not evaluate the strength of the electromyogram signal. To evaluate the robustness of the proposed method, we use the electromyogram dataset containing nine transradial amputees. In this study, the performance is evaluated using three classifiers with six existing feature extraction methods. The proposed feature extraction method yields a higher pattern recognition performance, and significant improvements in accuracy, sensitivity, specificity, precision, and F1 score are found. In addition, the proposed method requires comparatively less computational time and memory, which makes it more robust than other well-known feature extraction methods.

Performance Analysis of Conventional Machine Learning Algorithms for Diabetic Sensorimotor Polyneuropathy Severity Classification.

BACKGROUND: Diabetic peripheral neuropathy (DSPN), a major form of diabetic neuropathy, is a complication that arises in long-term diabetic patients. Even though the application of machine learning (ML) in disease diagnosis is a very common and well-established field of research, its application in diabetic peripheral neuropathy (DSPN) diagnosis using composite scoring techniques like Michigan Neuropathy Screening Instrumentation (MNSI), is very limited in the existing literature. METHOD: In this study, the MNSI data were collected from the Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials. Two different datasets with different MNSI variable combinations based on the results from the eXtreme Gradient Boosting feature ranking technique were used to analyze the performance of eight different conventional ML algorithms. RESULTS: The random forest (RF) classifier outperformed other ML models for both datasets. However, all ML models showed almost perfect reliability based on Kappa statistics and a high correlation between the predicted output and actual class of the EDIC patients when all six MNSI variables were considered as inputs. CONCLUSIONS: This study suggests that the RF algorithm-based classifier using all MNSI variables can help to predict the DSPN severity which will help to enhance the medical facilities for diabetic patients.

Performance analysis of noninvasive electrophysiological methods for the assessment of diabetic sensorimotor polyneuropathy in clinical research: a systematic review and meta-analysis with trial sequential analysis.

Despite the availability of various clinical trials that used different diagnostic methods to identify diabetic sensorimotor polyneuropathy (DSPN), no reliable studies that prove the associations among diagnostic parameters from two different methods are available. Statistically significant diagnostic parameters from various methods can help determine if two different methods can be incorporated together for diagnosing DSPN. In this study, a systematic review, meta-analysis, and trial sequential analysis (TSA) were performed to determine the associations among the different parameters from the most commonly used electrophysiological screening methods in clinical research for DSPN, namely, nerve conduction study (NCS), corneal confocal microscopy (CCM), and electromyography (EMG), for different experimental groups. Electronic databases (e.g., Web of Science, PubMed, and Google Scholar) were searched systematically for articles reporting different screening tools for diabetic peripheral neuropathy. A total of 22 studies involving 2394 participants (801 patients with DSPN, 702 controls, and 891 non-DSPN patients) were reviewed systematically. Meta-analysis was performed to determine statistical significance of difference among four NCS parameters, i.e., peroneal motor nerve conduction velocity, peroneal motor nerve amplitude, sural sensory nerve conduction velocity, and sural sensory nerve amplitude (all p < 0.001); among three CCM parameters, including nerve fiber density, nerve branch density, and nerve fiber length (all p < 0.001); and among four EMG parameters, namely, time to peak occurrence (from 0 to 100% of the stance phase) of four lower limb muscles, including the vastus lateralis (p < 0.001), tibialis anterior (p = 0.63), lateral gastrocnemius (p = 0.01), and gastrocnemius medialis (p = 0.004), and the vibration perception threshold (p < 0.001). Moreover, TSA was conducted to estimate the robustness of the meta-analysis. Most of the parameters showed statistical significance between each other, whereas some were statistically nonsignificant. This meta-analysis and TSA concluded that studies including NCS and CCM parameters were conclusive and robust. However, the included studies on EMG were inconclusive, and additional clinical trials are required.

Design, Construction and Testing of IoT Based Automated Indoor Vertical Hydroponics Farming Test-Bed in Qatar.

Growing plants in the gulf region can be challenging as it is mostly desert, and the climate is dry. A few species of plants have the capability to grow in such a climate. However, those plants are not suitable as a food source. The aim of this work is to design and construct an indoor automatic vertical hydroponic system that does not depend on the outside climate. The designed system is capable to grow common type of crops that can be used as a food source inside homes without the need of large space. The design of the system was made after studying different types of vertical hydroponic systems in terms of price, power consumption and suitability to be built as an indoor automated system. A microcontroller was working as a brain of the system, which communicates with different types of sensors to control all the system parameters and to minimize the human intervention. An open internet of things (IoT) platform was used to store and display the system parameters and graphical interface for remote access. The designed system is capable of maintaining healthy growing parameters for the plants with minimal input from the user. The functionality of the overall system was confirmed by evaluating the response from individual system components and monitoring them in the IoT platform. The system was consuming 120.59 and 230.59 kWh respectively without and with air conditioning control during peak summer, which is equivalent to the system running cost of 13.26 and 25.36 Qatari Riyal (QAR) respectively. This system was circulating around 104 k gallons of nutrient solution monthly however, only 8-10 L water was consumed by the system. This system offers real-time notifications to alert the hydroponic system user when the conditions are not favorable. So, the user can monitor several parameters without using laboratory instruments, which will allow to control the entire system remotely. Moreover, the system also provides a wide range of information, which could be essential for plant researchers and provides a greater understanding of how the key parameters of hydroponic system correlate with plant growth. The proposed platform can be used both for quantitatively optimizing the setup of the indoor farming and for automating some of the most labor-intensive maintenance activities. Moreover, such a monitoring system can also potentially be used for high-level decision making, once enough data will be collected. This work presents significant opportunities for the people who live in the gulf region to produce food as per their requirements.

Prophylactic valproic acid treatment prevents schizophrenia-related behaviour in Disc1-L100P mutant mice.

BACKGROUND: Schizophrenia is a neurodevelopmental disorder with onset early in adulthood. Disrupted-In-Schizophrenia-1 (DISC1) is a susceptibility gene for schizophrenia and other psychiatric disorders. Disc1-L100P mutant mice show behaviors relevant to schizophrenia at 12 weeks, but not at 8 weeks of age, and may be useful for investigating the onset of schizophrenia in early adulthood. METHODS: We investigated whether early valproic acid treatment would prevent behavioral, cellular and gene expression abnormalities in Disc1-L100P mutants. RESULTS: Valproic acid prevented hyperactivity and deficits in prepulse inhibition and latent inhibition in Disc1-L100P mice. Genome-wide transcription profiling identified Lcn2 (lipocalin2) transcripts as being elevated by the Disc1 mutation and corrected by valproate. Disc1-L100P mice also had increased glial cell numbers in the subventricular zone, which was normalized by valproate. Genetic deletion of Lcn2 normalized glial cell numbers and behavior in Disc1-L100P mutants. CONCLUSIONS: Pharmacological treatments are a feasible way of preventing abnormal behaviour in a genetic model of schizophrenia. Lcn2 is a potential novel drug target for early intervention in schizophrenia.