RESUMEN
BACKGROUND: The occurrence of pressure injury in patients with diabetes during ICU hospitalization can result in severe complications, including infections and non-healing wounds. AIMS: The aim of this study was to predict the occurrence of pressure injury in ICU patients with diabetes using machine learning models. STUDY DESIGN: In this study, LASSO regression was used for feature screening, XGBoost was employed for machine learning model construction, ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score were used for evaluating the model's performance. RESULTS: Out of the 503 ICU patients with diabetes included in the study, pressure injury developed in 170 cases, resulting in an incidence rate of 33.8 %. The XGBoost model had a higher AUC for predicting pressure injury in patients with diabetes during ICU hospitalization (train: 0.896, 95 %CI: 0.863 to 0.929; test: 0.835, 95 % CI: 0.761-0.908). The importance of SHAP variables in the model from high to low was: 'Days in ICU', 'Mechanical Ventilation', 'Neutrophil Count', 'Consciousness', 'Glucose', and 'Warming Blanket'. CONCLUSION: The XGBoost machine learning model we constructed has shown high performance in predicting the occurrence of pressure injury in ICU patients with diabetes. Additionally, the SHAP method enables the interpretation of the results provided by the machine learning model. RELEVANCE TO CLINICAL PRACTICE: Improve the ability to predict the early occurrence of pressure injury in diabetic patients in the ICU. This will enable clinicians to intervene early and reduce the occurrence of complications.
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Unidades de Cuidados Intensivos , Aprendizaje Automático , Úlcera por Presión , Humanos , Úlcera por Presión/etiología , Aprendizaje Automático/normas , Aprendizaje Automático/estadística & datos numéricos , Masculino , Femenino , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Hospitalización/estadística & datos numéricos , Adulto , Incidencia , Diabetes Mellitus , Valor Predictivo de las Pruebas , Curva ROCRESUMEN
INTRODUCTION: Detection of occult hemorrhage (OH) before progression to clinically apparent changes in vital signs remains an important clinical problem in managing trauma patients. The resource-intensiveness associated with continuous clinical patient monitoring and rescue from frank shock makes accurate early detection and prediction with noninvasive measurement technology a desirable innovation. Despite significant efforts directed toward the development of innovative noninvasive diagnostics, the implementation and performance of the newest bedside technologies remain inadequate. This poor performance may reflect the limitations of univariate systems based on one sensor in one anatomic location. It is possible that when signals are measured with multiple modalities in multiple locations, the resulting multivariate anatomic and temporal patterns of measured signals may provide additional discriminative power over single technology univariate measurements. We evaluated the potential superiority of multivariate methods over univariate methods. Additionally, we utilized machine learning-based models to compare the performance of noninvasive-only to noninvasive-plus-invasive measurements in predicting the onset of OH. MATERIALS AND METHODS: We applied machine learning methods to preexisting datasets derived using the lower body negative pressure human model of simulated hemorrhage. Employing multivariate measured physiological signals, we investigated the extent to which machine learning methods can effectively predict the onset of OH. In particular, we applied 2 ensemble learning methods, namely, random forest and gradient boosting. RESULTS: Analysis of precision, recall, and area under the receiver operating characteristic curve showed a superior performance of multivariate approach to that of the univariate ones. In addition, when using both invasive and noninvasive features, random forest classifier had a recall 95% confidence interval (CI) of 0.81 to 0.86 with a precision 95% CI of 0.65 to 0.72. Interestingly, when only noninvasive features were employed, the results worsened only slightly to a recall 95% CI of 0.80 to 0.85 and a precision 95% CI of 0.61 to 0.73. CONCLUSIONS: Multivariate ensemble machine learning-based approaches for the prediction of hemodynamic instability appear to hold promise for the development of effective solutions. In the lower body negative pressure multivariate hemorrhage model, predictions based only on noninvasive measurements performed comparably to those using both invasive and noninvasive measurements.
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Hemorragia , Presión Negativa de la Región Corporal Inferior , Aprendizaje Automático , Humanos , Aprendizaje Automático/normas , Aprendizaje Automático/estadística & datos numéricos , Aprendizaje Automático/tendencias , Hemorragia/diagnóstico , Hemorragia/fisiopatología , Hemorragia/etiología , Presión Negativa de la Región Corporal Inferior/métodos , Presión Negativa de la Región Corporal Inferior/estadística & datos numéricosRESUMEN
El aprendizaje automático (machine learning) en cardiología es cada vez más frecuente en la literatura médica, pero los modelos de aprendizaje automático aún no han producido un cambio generalizado de la práctica clínica. En parte esto se debe a que el lenguaje utilizado para describir el aprendizaje automático procede de la informática y resulta menos familiar a los lectores de revistas clínicas. En esta revisión narrativa se proporcionan, en primer lugar, algunas orientaciones sobre cómo leer las revistas de aprendizaje automático y, a continuación, orientaciones adicionales para quienes se plantean iniciar un estudio utilizando el aprendizaje automático. Por último, se ilustra el estado actual de la técnica con breves resúmenes de 5 artículos que van desde un modelo de aprendizaje automático muy sencillo hasta otros muy sofisticados.(AU)
Machine learning in cardiology is becoming more commonplace in the medical literature; however, machine learning models have yet to result in a widespread change in practice. This is partly due to the language used to describe machine, which is derived from computer science and may be unfamiliar to readers of clinical journals. In this narrative review, we provide some guidance on how to read machine learning journals and additional guidance for investigators considering instigating a study using machine learning. Finally, we illustrate the current state of the art with brief summaries of 5 articles describing models that range from the very simple to the highly sophisticated.(AU)
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Humanos , Masculino , Femenino , Aprendizaje Automático/clasificación , Aprendizaje Automático/estadística & datos numéricos , Aprendizaje Automático/tendencias , Inteligencia Artificial , Cardiología/educación , Cardiología , Tecnología de la InformaciónRESUMEN
In rhinoplasty, it is necessary to consider the correlation between the anthropometric indicators of the nasal bone, so that it prevents surgical complications and enhances the patient's satisfaction. The penetrating form of high-energy electromagnetic radiation is highly impacted on human health, which has often raised concerns of alternative method for facial analysis. The critical stage to assess nasal morphology is the nasal analysis on its anthropology that is highly reliant on the understanding of the structural features of the nasal radix. For example, the shape and size of nasal bone features, skin thickness, and also body factors aggregated from different facial anthropology values. In medical diagnosis, however, the morphology of the nasal bone is determined manually and significantly relies on the clinician's expertise. Furthermore, the evaluation anthropological keypoint of the nasal bone is nonrepeatable and laborious, also finding widely differ and intralaboratory variability in the results because of facial soft tissue and equipment defects. In order to overcome these problems, we propose specialized convolutional neural network (CNN) architecture to accurately predict nasal measurement based on digital 2D photogrammetry. To boost performance and efficacy, it is deliberately constructed with many layers and different filter sizes, with less filters and optimizing parameters. Through its result, the back-propagation neural network (BPNN) indicated the correlation between differences in human body factors mentioned are height, weight known as body mass index (BMI), age, gender, and the nasal bone dimension of the participant. With full of parameters could the nasal morphology be diagnostic continuously. The model's performance is evaluated on various newest architecture models such as DenseNet, ConvNet, Inception, VGG, and MobileNet. Experiments were directly conducted on different facials. The results show the proposed architecture worked well in terms of nasal properties achieved which utilize four statistical criteria named mean average precision (mAP), mean absolute error (MAE), R-square (R 2), and T-test analyzed. Data has also shown that the nasal shape of Southeast Asians, especially Vietnamese, could be divided into different types in two perspective views. From cadavers for bony datasets, nasal bones can be classified into 2 morphological types in the lateral view which "V" shape was presented by 78.8% and the remains were "S" shape evaluated based on Lazovic (2015). With 2 angular dimension averages are 136.41 ± 7.99 and 104.25 ± 5.95 represented by the nasofrontal angle (g-n-prn) and the nasomental angle (n-prn-sn), respectively. For frontal view, classified by Hwang, Tae-Sun, et al. (2005), nasal morphology of Vietnamese participants could be divided into three types: type A was present in 57.6% and type B was present in 30.3% of the noses. In particular, types C, D, and E were not a common form of Vietnamese which includes the remaining number of participants. In conclusion, the proposed model performed the potential hybrid of CNN and BPNN with its application to give expected accuracy in terms of keypoint localization and nasal morphology regression. Nasal analysis can replace MRI imaging diagnostics that are reflected by the risk to human body.
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Hueso Nasal/anatomía & histología , Hueso Nasal/diagnóstico por imagen , Redes Neurales de la Computación , Fotogrametría/métodos , Adulto , Antropometría/métodos , Biología Computacional , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Hueso Nasal/cirugía , Nariz/anatomía & histología , Nariz/diagnóstico por imagen , Nariz/cirugía , Fotogrametría/estadística & datos numéricos , Rinoplastia/métodos , Rinoplastia/estadística & datos numéricos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/estadística & datos numéricos , Adulto JovenAsunto(s)
COVID-19/inmunología , Infecciones por Coronaviridae/prevención & control , Proteínas de la Envoltura de Coronavirus/inmunología , Protección Cruzada , SARS-CoV-2/inmunología , Glicoproteína de la Espiga del Coronavirus/inmunología , Anticuerpos Antivirales/biosíntesis , Antígenos Virales/biosíntesis , COVID-19/epidemiología , COVID-19/virología , Resfriado Común/epidemiología , Resfriado Común/inmunología , Resfriado Común/virología , Coronaviridae/inmunología , Infecciones por Coronaviridae/epidemiología , Infecciones por Coronaviridae/inmunología , Infecciones por Coronaviridae/virología , Proteínas de la Envoltura de Coronavirus/genética , Proteínas M de Coronavirus/genética , Proteínas M de Coronavirus/inmunología , Proteínas de la Nucleocápside de Coronavirus/genética , Proteínas de la Nucleocápside de Coronavirus/inmunología , Reacciones Cruzadas , Enfermedades Endémicas , Humanos , Aprendizaje Automático/estadística & datos numéricos , Fosfoproteínas/genética , Fosfoproteínas/inmunología , SARS-CoV-2/patogenicidad , Homología de Secuencia de Aminoácido , Glicoproteína de la Espiga del Coronavirus/genéticaRESUMEN
BACKGROUND & AIMS: Saliva and stool microbiota are altered in cirrhosis. Since stool is logistically difficult to collect compared to saliva, it is important to determine their relative diagnostic and prognostic capabilities. We aimed to determine the ability of stool vs. saliva microbiota to differentiate between groups based on disease severity using machine learning (ML). METHODS: Controls and outpatients with cirrhosis underwent saliva and stool microbiome analysis. Controls vs. cirrhosis and within cirrhosis (based on hepatic encephalopathy [HE], proton pump inhibitor [PPI] and rifaximin use) were classified using 4 ML techniques (random forest [RF], support vector machine, logistic regression, and gradient boosting) with AUC comparisons for stool, saliva or both sample types. Individual microbial contributions were computed using feature importance of RF and Shapley additive explanations. Finally, thresholds for including microbiota were varied between 2.5% and 10%, and core microbiome (DESeq2) analysis was performed. RESULTS: Two hundred and sixty-nine participants, including 87 controls and 182 patients with cirrhosis, of whom 57 had HE, 78 were on PPIs and 29 on rifaximin were included. Regardless of the ML model, stool microbiota had a significantly higher AUC in differentiating groups vs. saliva. Regarding individual microbiota: autochthonous taxa drove the difference between controls vs. patients with cirrhosis, oral-origin microbiota the difference between PPI users/non-users, and pathobionts and autochthonous taxa the difference between rifaximin users/non-users and patients with/without HE. These were consistent with the core microbiome analysis results. CONCLUSIONS: On ML analysis, stool microbiota composition is significantly more informative in differentiating between controls and patients with cirrhosis, and those with varying cirrhosis severity, compared to saliva. Despite logistic challenges, stool should be preferred over saliva for microbiome analysis. LAY SUMMARY: Since it is harder to collect stool than saliva, we wanted to test whether microbes from saliva were better than stool in differentiating between healthy people and those with cirrhosis and, among those with cirrhosis, those with more severe disease. Using machine learning, we found that microbes in stool were more accurate than saliva alone or in combination, therefore, stool should be preferred for analysis and collection wherever possible.
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Heces/microbiología , Encefalopatía Hepática/diagnóstico , Cirrosis Hepática/diagnóstico , Tamizaje Masivo/normas , Saliva/microbiología , Anciano , Femenino , Encefalopatía Hepática/fisiopatología , Humanos , Cirrosis Hepática/fisiopatología , Aprendizaje Automático/normas , Aprendizaje Automático/estadística & datos numéricos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Microbiota/fisiología , Persona de Mediana Edad , PronósticoRESUMEN
OBJECTIVES: Prognostication of neurologic status among survivors of in-hospital cardiac arrests remains a challenging task for physicians. Although models such as the Cardiac Arrest Survival Post-Resuscitation In-hospital score are useful for predicting neurologic outcomes, they were developed using traditional statistical techniques. In this study, we derive and compare the performance of several machine learning models with each other and with the Cardiac Arrest Survival Post-Resuscitation In-hospital score for predicting the likelihood of favorable neurologic outcomes among survivors of resuscitation. DESIGN: Analysis of the Get With The Guidelines-Resuscitation registry. SETTING: Seven-hundred fifty-five hospitals participating in Get With The Guidelines-Resuscitation from January 1, 2001, to January 28, 2017. PATIENTS: Adult in-hospital cardiac arrest survivors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 117,674 patients in our cohort, 28,409 (24%) had a favorable neurologic outcome, as defined as survival with a Cerebral Performance Category score of less than or equal to 2 at discharge. Using patient characteristics, pre-existing conditions, prearrest interventions, and periarrest variables, we constructed logistic regression, support vector machines, random forests, gradient boosted machines, and neural network machine learning models to predict favorable neurologic outcome. Events prior to October 20, 2009, were used for model derivation, and all subsequent events were used for validation. The gradient boosted machine predicted favorable neurologic status at discharge significantly better than the Cardiac Arrest Survival Post-Resuscitation In-hospital score (C-statistic: 0.81 vs 0.73; p < 0.001) and outperformed all other machine learning models in terms of discrimination, calibration, and accuracy measures. Variables that were consistently most important for prediction across all models were duration of arrest, initial cardiac arrest rhythm, admission Cerebral Performance Category score, and age. CONCLUSIONS: The gradient boosted machine algorithm was the most accurate for predicting favorable neurologic outcomes in in-hospital cardiac arrest survivors. Our results highlight the utility of machine learning for predicting neurologic outcomes in resuscitated patients.
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Predicción/métodos , Paro Cardíaco/complicaciones , Aprendizaje Automático/normas , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Anciano , Área Bajo la Curva , Estudios de Cohortes , Femenino , Paro Cardíaco/epidemiología , Paro Cardíaco/mortalidad , Humanos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Pronóstico , Curva ROC , Sobrevivientes/estadística & datos numéricosRESUMEN
We combined our generalized energy-based fragmentation (GEBF) approach and machine learning (ML) technique to construct quantum mechanics (QM) quality force fields for proteins. In our scheme, the training sets for a protein are only constructed from its small subsystems, which capture all short-range interactions in the target system. The energy of a given protein is expressed as the summation of atomic contributions from QM calculations of various subsystems, corrected by long-range Coulomb and van der Waals interactions. With the Gaussian approximation potential (GAP) method, our protocol can automatically generate training sets with high efficiency. To facilitate the construction of training sets for proteins, we store all trained subsystem data in a library. If subsystems in the library are detected in a new protein, corresponding datasets can be directly reused as a part of the training set on this new protein. With two polypeptides, 4ZNN and 1XQ8 segment, as examples, the energies and forces predicted by GEBF-GAP are in good agreement with those from conventional QM calculations, and dihedral angle distributions from GEBF-GAP molecular dynamics (MD) simulations can also well reproduce those from ab initio MD simulations. In addition, with the training set generated from GEBF-GAP, we also demonstrate that GEBF-ML force fields constructed by neural network (NN) methods can also show QM quality. Therefore, the present work provides an efficient and systematic way to build QM quality force fields for biological systems.
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Fragmentos de Péptidos/química , alfa-Sinucleína/química , Bases de Datos de Compuestos Químicos , Conjuntos de Datos como Asunto , Humanos , Aprendizaje Automático/estadística & datos numéricos , Simulación de Dinámica Molecular/estadística & datos numéricos , Teoría Cuántica , TermodinámicaRESUMEN
BACKGROUND: There are few large studies examining and predicting the diversified cardiovascular/noncardiovascular comorbidity relationships with stroke. We investigated stroke risks in a very large prospective cohort of patients with multimorbidity, using two common clinical rules, a clinical multimorbid index and a machine-learning (ML) approach, accounting for the complex relationships among variables, including the dynamic nature of changing risk factors. METHODS: We studied a prospective U.S. cohort of 3,435,224 patients from medical databases in a 2-year investigation. Stroke outcomes were examined in relationship to diverse multimorbid conditions, demographic variables, and other inputs, with ML accounting for the dynamic nature of changing multimorbidity risk factors, two clinical risk scores, and a clinical multimorbid index. RESULTS: Common clinical risk scores had moderate and comparable c indices with stroke outcomes in the training and external validation samples (validation-CHADS2: c index 0.812, 95% confidence interval [CI] 0.808-0.815; CHA2DS2-VASc: c index 0.809, 95% CI 0.805-0.812). A clinical multimorbid index had higher discriminant validity values for both the training/external validation samples (validation: c index 0.850, 95% CI 0.847-0.853). The ML-based algorithms yielded the highest discriminant validity values for the gradient boosting/neural network logistic regression formulations with no significant differences among the ML approaches (validation for logistic regression: c index 0.866, 95% CI 0.856-0.876). Calibration of the ML-based formulation was satisfactory across a wide range of predicted probabilities. Decision curve analysis demonstrated that clinical utility for the ML-based formulation was better than that for the two current clinical rules and the newly developed multimorbid tool. Also, ML models and clinical stroke risk scores were more clinically useful than the "treat all" strategy. CONCLUSION: Complex relationships of various comorbidities uncovered using a ML approach for diverse (and dynamic) multimorbidity changes have major consequences for stroke risk prediction. This approach may facilitate automated approaches for dynamic risk stratification in the significant presence of multimorbidity, helping in the decision-making process for risk assessment and integrated/holistic management.
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Aprendizaje Automático/normas , Medición de Riesgo/normas , Accidente Cerebrovascular/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Estudios de Cohortes , Femenino , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Modelos Logísticos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Multimorbilidad/tendencias , Estudios Prospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control , Estados Unidos/epidemiologíaRESUMEN
The current article paper is aimed at assessing and comparing the seasonal check-in behavior of individuals in Shanghai, China, using location-based social network (LBSN) data and a variety of spatiotemporal analytic techniques. The article demonstrates the uses of location-based social network's data by analyzing the trends in check-ins throughout a three-year term for health purpose. We obtained the geolocation data from Sina Weibo, one of the biggest renowned Chinese microblogs (Weibo). The composed data is converted to geographic information system (GIS) type and assessed using temporal statistical analysis and spatial statistical analysis using kernel density estimation (KDE) assessment. We have applied various algorithms and trained machine learning models and finally satisfied with sequential model results because the accuracy we got was leading amongst others. The location cataloguing is accomplished via the use of facts about the characteristics of physical places. The findings demonstrate that visitors' spatial operations are more intense than residents' spatial operations, notably in downtown. However, locals also visited outlying regions, and tourists' temporal behaviors vary significantly while citizens' movements exhibit a more steady stable behavior. These findings may be used in destination management, metro planning, and the creation of digital cities.
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Macrodatos , Minería de Datos/estadística & datos numéricos , Aprendizaje Automático/estadística & datos numéricos , Medios de Comunicación Sociales/estadística & datos numéricos , Viaje/estadística & datos numéricos , China , Ciudades , Biología Computacional , Árboles de Decisión , Sistemas de Información Geográfica , Humanos , Estaciones del Año , Red Social , Análisis Espacio-TemporalRESUMEN
Importance: Machine learning algorithms could be used as the basis for clinical decision-making aids to enhance clinical practice. Objective: To assess the ability of machine learning algorithms to predict dementia incidence within 2 years compared with existing models and determine the optimal analytic approach and number of variables required. Design, Setting, and Participants: This prognostic study used data from a prospective cohort of 15â¯307 participants without dementia at baseline to perform a secondary analysis of factors that could be used to predict dementia incidence. Participants attended National Alzheimer Coordinating Center memory clinics across the United States between 2005 and 2015. Analyses were conducted from March to May 2021. Exposures: 258 variables spanning domains of dementia-related clinical measures and risk factors. Main Outcomes and Measures: The main outcome was incident all-cause dementia diagnosed within 2 years of baseline assessment. Results: In a sample of 15â¯307 participants (mean [SD] age, 72.3 [9.8] years; 9129 [60%] women and 6178 [40%] men) without dementia at baseline, 1568 (10%) received a diagnosis of dementia within 2 years of their initial assessment. Compared with 2 existing models for dementia risk prediction (ie, Cardiovascular Risk Factors, Aging, and Incidence of Dementia Risk Score, and the Brief Dementia Screening Indicator), machine learning algorithms were superior in predicting incident all-cause dementia within 2 years. The gradient-boosted trees algorithm had a mean (SD) overall accuracy of 92% (1%), sensitivity of 0.45 (0.05), specificity of 0.97 (0.01), and area under the curve of 0.92 (0.01) using all 258 variables. Analysis of variable importance showed that only 6 variables were required for machine learning algorithms to achieve an accuracy of 91% and area under the curve of at least 0.89. Machine learning algorithms also identified up to 84% of participants who received an initial dementia diagnosis that was subsequently reversed to mild cognitive impairment or cognitively unimpaired, suggesting possible misdiagnosis. Conclusions and Relevance: These findings suggest that machine learning algorithms could accurately predict incident dementia within 2 years in patients receiving care at memory clinics using only 6 variables. These findings could be used to inform the development and validation of decision-making aids in memory clinics.
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Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Aprendizaje Automático/estadística & datos numéricos , Medición de Riesgo/métodos , Anciano , Área Bajo la Curva , Demencia/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Estados UnidosRESUMEN
OBJECTIVES: Tracking nonfatal overdoses in the escalating opioid overdose epidemic is important but challenging. The objective of this study was to create an innovative case definition of opioid overdose in North Carolina emergency medical services (EMS) data, with flexible methodology for application to other states' data. METHODS: This study used de-identified North Carolina EMS encounter data from 2010-2015 for patients aged >12 years to develop a case definition of opioid overdose using an expert knowledge, rule-based algorithm reflecting whether key variables identified drug use/poisoning or overdose or whether the patient received naloxone. We text mined EMS narratives and applied a machine-learning classification tree model to the text to predict cases of opioid overdose. We trained models on the basis of whether the chief concern identified opioid overdose. RESULTS: Using a random sample from the data, we found the positive predictive value of this case definition to be 90.0%, as compared with 82.7% using a previously published case definition. Using our case definition, the number of unresponsive opioid overdoses increased from 3412 in 2010 to 7194 in 2015. The corresponding monthly rate increased by a factor of 1.7 from January 2010 (3.0 per 1000 encounters; n = 261 encounters) to December 2015 (5.1 per 1000 encounters; n = 622 encounters). Among EMS responses for unresponsive opioid overdose, the prevalence of naloxone use was 83%. CONCLUSIONS: This study demonstrates the potential for using machine learning in combination with a more traditional substantive knowledge algorithm-based approach to create a case definition for opioid overdose in EMS data.
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Algoritmos , Servicios Médicos de Urgencia/estadística & datos numéricos , Aprendizaje Automático/tendencias , Sobredosis de Opiáceos/diagnóstico , Adulto , Servicios Médicos de Urgencia/organización & administración , Femenino , Humanos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Sobredosis de Opiáceos/epidemiologíaRESUMEN
OBJECTIVES: Prognostication of outcome is an essential step in defining therapeutic goals after cardiac arrest. Gray-white-matter ratio obtained from brain CT can predict poor outcome. However, manual placement of regions of interest is a potential source of error and interrater variability. Our objective was to assess the performance of poor outcome prediction by automated quantification of changes in brain CTs after cardiac arrest. DESIGN: Observational, derivation/validation cohort study design. Outcome was determined using the Cerebral Performance Category upon hospital discharge. Poor outcome was defined as death or unresponsive wakefulness syndrome/coma. CTs were automatically decomposed using coregistration with a brain atlas. SETTING: ICUs at a large, academic hospital with circulatory arrest center. PATIENTS: We identified 433 cardiac arrest patients from a large previously established database with brain CTs within 10 days after cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Five hundred sixteen brain CTs were evaluated (derivation cohort n = 309, validation cohort n = 207). Patients with poor outcome had significantly lower radiodensities in gray matter regions. Automated GWR_si (putamen/posterior limb of internal capsule) was performed with an area under the curve of 0.86 (95%-CI: 0.80-0.93) for CTs taken later than 24 hours after cardiac arrest (similar performance in the validation cohort). Poor outcome (Cerebral Performance Category 4-5) was predicted with a specificity of 100% (95% CI, 87-100%, derivation; 88-100%, validation) at a threshold of less than 1.10 and a sensitivity of 49% (95% CI, 36-58%, derivation) and 38% (95% CI, 27-50%, validation) for CTs later than 24 hours after cardiac arrest. Sensitivity and area under the curve were lower for CTs performed within 24 hours after cardiac arrest. CONCLUSIONS: Automated gray-white-matter ratio from brain CT is a promising tool for prediction of poor neurologic outcome after cardiac arrest with high specificity and low-to-moderate sensitivity. Prediction by gray-white-matter ratio at the basal ganglia level performed best. Sensitivity increased considerably for CTs performed later than 24 hours after cardiac arrest.
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Encéfalo/diagnóstico por imagen , Paro Cardíaco/complicaciones , Aprendizaje Automático/normas , Tomografía Computarizada por Rayos X/instrumentación , Anciano , Estudios de Cohortes , Femenino , Paro Cardíaco/diagnóstico por imagen , Humanos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Curva ROC , Tomografía Computarizada por Rayos X/métodos , Estudios de Validación como AsuntoRESUMEN
Species of Mycobacteriaceae cause disease in animals and humans, including tuberculosis and leprosy. Individuals infected with organisms in the Mycobacterium tuberculosis complex (MTBC) or non-tuberculous mycobacteria (NTM) may present identical symptoms, however the treatment for each can be different. Although the NTM infection is considered less vital due to the chronicity of the disease and the infrequency of occurrence in healthy populations, diagnosis and differentiation among Mycobacterium species currently require culture isolation, which can take several weeks. The use of volatile organic compounds (VOCs) is a promising approach for species identification and in recent years has shown promise for use in the rapid analysis of both in vitro cultures as well as ex vivo diagnosis using breath or sputum. The aim of this contribution is to analyze VOCs in the culture headspace of seven different species of mycobacteria and to define the volatilome profiles that are discriminant for each species. For the pre-concentration of VOCs, solid-phase micro-extraction (SPME) was employed and samples were subsequently analyzed using gas chromatography-quadrupole mass spectrometry (GC-qMS). A machine learning approach was applied for the selection of the 13 discriminatory features, which might represent clinically translatable bacterial biomarkers.
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Metaboloma , Mycobacterium abscessus/química , Complejo Mycobacterium avium/química , Mycobacterium avium/química , Mycobacterium bovis/química , Mycobacterium/química , Compuestos Orgánicos Volátiles/aislamiento & purificación , Biomarcadores/análisis , Cromatografía de Gases y Espectrometría de Masas/métodos , Aprendizaje Automático/estadística & datos numéricos , Mycobacterium/metabolismo , Mycobacterium abscessus/metabolismo , Mycobacterium avium/metabolismo , Complejo Mycobacterium avium/metabolismo , Mycobacterium bovis/metabolismo , Análisis de Componente Principal , Microextracción en Fase Sólida , Compuestos Orgánicos Volátiles/clasificación , Compuestos Orgánicos Volátiles/metabolismoRESUMEN
OBJECTIVE: Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC. METHODS: The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared. RESULTS: A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient's clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes. CONCLUSIONS: Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.
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Servicios de Atención de Salud a Domicilio/normas , Aprendizaje Automático/normas , Medición de Riesgo/métodos , Infección de Heridas/prevención & control , Anciano , Algoritmos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Predicción/métodos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Modelos Logísticos , Aprendizaje Automático/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo/normas , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Infección de Heridas/epidemiologíaRESUMEN
Importance: Electronic health records (EHRs) provide a low-cost means of accessing detailed longitudinal clinical data for large populations. A lung cancer cohort assembled from EHR data would be a powerful platform for clinical outcome studies. Objective: To investigate whether a clinical cohort assembled from EHRs could be used in a lung cancer prognosis study. Design, Setting, and Participants: In this cohort study, patients with lung cancer were identified among 76â¯643 patients with at least 1 lung cancer diagnostic code deposited in an EHR in Mass General Brigham health care system from July 1988 to October 2018. Patients were identified via a semisupervised machine learning algorithm, for which clinical information was extracted from structured and unstructured data via natural language processing tools. Data completeness and accuracy were assessed by comparing with the Boston Lung Cancer Study and against criterion standard EHR review results. A prognostic model for non-small cell lung cancer (NSCLC) overall survival was further developed for clinical application. Data were analyzed from March 2019 through July 2020. Exposures: Clinical data deposited in EHRs for cohort construction and variables of interest for the prognostic model were collected. Main Outcomes and Measures: The primary outcomes were the performance of the lung cancer classification model and the quality of the extracted variables; the secondary outcome was the performance of the prognostic model. Results: Among 76â¯643 patients with at least 1 lung cancer diagnostic code, 42â¯069 patients were identified as having lung cancer, with a positive predictive value of 94.4%. The study cohort consisted of 35â¯375 patients (16â¯613 men [47.0%] and 18â¯756 women [53.0%]; 30â¯140 White individuals [85.2%], 1040 Black individuals [2.9%], and 857 Asian individuals [2.4%]) after excluding patients with lung cancer history and less than 14 days of follow-up after initial diagnosis. The median (interquartile range) age at diagnosis was 66.7 (58.4-74.1) years. The area under the receiver operating characteristic curves of the prognostic model for overall survival with NSCLC were 0.828 (95% CI, 0.815-0.842) for 1-year prediction, 0.825 (95% CI, 0.812-0.836) for 2-year prediction, 0.814 (95% CI, 0.800-0.826) for 3-year prediction, 0.814 (95% CI, 0.799-0.828) for 4-year prediction, and 0.812 (95% CI, 0.798-0.825) for 5-year prediction. Conclusions and Relevance: These findings suggest the feasibility of assembling a large-scale EHR-based lung cancer cohort with detailed longitudinal clinical measurements and that EHR data may be applied in cancer progression with a set of generalizable approaches.
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Neoplasias Pulmonares/mortalidad , Aprendizaje Automático/normas , Algoritmos , Área Bajo la Curva , Boston/epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Aprendizaje Automático/estadística & datos numéricos , Masculino , Pronóstico , Curva ROC , Análisis de Supervivencia , Sobrevivientes/estadística & datos numéricosRESUMEN
miRNAs (or microRNAs) are small, endogenous, and noncoding RNAs construct of about 22 nucleotides. Cumulative evidence from biological experiments shows that miRNAs play a fundamental and important role in various biological processes. Therefore, the classification of miRNA is a critical problem in computational biology. Due to the short length of mature miRNAs, many researchers are working on precursor miRNAs (pre-miRNAs) with longer sequences and more structural features. Pre-miRNAs can be divided into two groups as mirtrons and canonical miRNAs in terms of biogenesis differences. Compared to mirtrons, canonical miRNAs are more conserved and easier to be identified. Many existing pre-miRNA classification methods rely on manual feature extraction. Moreover, these methods focus on either sequential structure or spatial structure of pre-miRNAs. To overcome the limitations of previous models, we propose a nucleotide-level hybrid deep learning method based on a CNN and LSTM network together. The prediction resulted in 0.943 (%95 CI ± 0.014) accuracy, 0.935 (%95 CI ± 0.016) sensitivity, 0.948 (%95 CI ± 0.029) specificity, 0.925 (%95 CI ± 0.016) F1 Score and 0.880 (%95 CI ± 0.028) Matthews Correlation Coefficient. When compared to the closest results, our proposed method revealed the best results for Acc., F1 Score, MCC. These were 2.51%, 1.00%, and 2.43% higher than the closest ones, respectively. The mean of sensitivity ranked first like Linear Discriminant Analysis. The results indicate that the hybrid CNN and LSTM networks can be employed to achieve better performance for pre-miRNA classification. In future work, we study on investigation of new classification models that deliver better performance in terms of all the evaluation criteria.
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Biología Computacional/estadística & datos numéricos , Aprendizaje Profundo/estadística & datos numéricos , Aprendizaje Automático/estadística & datos numéricos , MicroARNs/clasificación , Algoritmos , Humanos , MicroARNs/genética , Redes Neurales de la ComputaciónRESUMEN
PURPOSE: To facilitate the demonstration of the prognostic value of radiomics, multicenter radiomics studies are needed. Pooling radiomic features of such data in a statistical analysis is however challenging, as they are sensitive to the variability in scanner models, acquisition protocols and reconstruction settings, which is often unavoidable in a multicentre retrospective analysis. A statistical harmonization strategy called ComBat was utilized in radiomics studies to deal with the "center-effect". The goal of the present work was to integrate a transfer learning (TL) technique within ComBat-and recently developed alternate versions of ComBat with improved flexibility (M-ComBat) and robustness (B-ComBat)-to allow the use of a previously determined harmonization transform to the radiomic feature values of new patients from an already known center. MATERIAL AND METHODS: The proposed TL approach were incorporated in the four versions of ComBat (standard, B, M, and B-M ComBat). The proposed approach was evaluated using a dataset of 189 locally advanced cervical cancer patients from 3 centers, with magnetic resonance imaging (MRI) and positron emission tomography (PET) images, with the clinical endpoint of predicting local failure. The impact performance of the TL approach was evaluated by comparing the harmonization achieved using only parts of the data to the reference (harmonization achieved using all the available data). It was performed through three different machine learning pipelines. RESULTS: The proposed TL technique was successful in harmonizing features of new patients from a known center in all versions of ComBat, leading to predictive models reaching similar performance as the ones developed using the features harmonized with all the data available. CONCLUSION: The proposed TL approach enables applying a previously determined ComBat transform to new, previously unseen data.