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NHS Number Open Source Software: Implications for Digital Health Regulation and Development NHS数字开源软件:对数字健康监管和发展的启示
Pub Date : 2022-08-05 DOI: 10.1145/3538382
H. Thimbleby
A national example of open source digital healthcare is critiqued. The code for implementing numeric patient identifiers is surprisingly naïve and bug-ridden, despite patient identifiers being computationally trivial and a critical component of reliable healthcare. The issues raised are shown to be widespread, long term, and apparently unrecognized. Problems are traced back to inadequacies in the relevant standards, and, at every stage, regulation through to development, inadequate Software Engineering input. An important finding is that the relevant healthcare standards are inconsistent and written without sufficient rigor to be at all constructive for implementing digital systems. The widely recognized problems of interoperability may be traced back to diverse (and buggy) interpretations of vague standards.
开放源码数字医疗保健的一个国家例子受到了批评。尽管患者标识符在计算上是微不足道的,并且是可靠医疗保健的关键组成部分,但实现数字患者标识符的代码令人惊讶地是naïve并且充满了bug。所提出的问题被证明是广泛的、长期的,而且显然没有被认识到。问题可以追溯到相关标准的不足,并且在每个阶段,从规则到开发,软件工程输入不足。一个重要的发现是,相关的医疗保健标准是不一致的,并且没有足够的严谨性来实施数字系统。广泛认可的互操作性问题可以追溯到对模糊标准的不同(和错误的)解释。
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引用次数: 0
Evaluating Alarm Classifiers with High-confidence Data Programming 用高置信度数据编程评估报警分类器
Pub Date : 2022-07-22 DOI: 10.1145/3549942
Sydney Pugh, I. Ruchkin, Christopher P. Bonafide, S. Demauro, O. Sokolsky, Insup Lee, James Weimer
Classification of clinical alarms is at the heart of prioritization, suppression, integration, postponement, and other methods of mitigating alarm fatigue. Since these methods directly affect clinical care, alarm classifiers, such as intelligent suppression systems, need to be evaluated in terms of their sensitivity and specificity, which is typically calculated on a labeled dataset of alarms. Unfortunately, the collection and particularly labeling of such datasets requires substantial effort and time, thus deterring hospitals from investigating mitigations of alarm fatigue. This article develops a lightweight method for evaluating alarm classifiers without perfect alarm labels. The method relies on probabilistic labels obtained from data programming—a labeling paradigm based on combining noisy and cheap-to-obtain labeling heuristics. Based on these labels, the method produces confidence bounds for the sensitivity/specificity values from a hypothetical evaluation with manual labeling. Our experiments on five alarm datasets collected at Children’s Hospital of Philadelphia show that the proposed method provides accurate bounds on the classifier’s sensitivity/specificity, appropriately reflecting the uncertainty from noisy labeling and limited sample sizes.
临床警报的分类是优先级、抑制、整合、延迟和其他缓解警报疲劳方法的核心。由于这些方法直接影响临床护理,因此需要根据其灵敏度和特异性来评估警报分类器,如智能抑制系统,这通常是在标记的警报数据集上计算的。不幸的是,这些数据集的收集,特别是标记需要大量的精力和时间,因此阻碍了医院调查警报疲劳的缓解措施。本文开发了一种轻量级的方法来评估没有完美警报标签的警报分类器。该方法依赖于从数据编程中获得的概率标签——这是一种基于将噪声和廉价相结合来获得标签启发式的标签范式。基于这些标签,该方法通过手动标签的假设评估产生灵敏度/特异性值的置信界限。我们在费城儿童医院收集的五个警报数据集上的实验表明,所提出的方法为分类器的灵敏度/特异性提供了准确的界限,适当地反映了噪声标记和有限样本量的不确定性。
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引用次数: 4
Leveraging Mobile Sensing and Bayesian Change Point Analysis to Monitor Community-scale Behavioral Interventions: A Case Study on COVID-19 利用移动传感和贝叶斯变化点分析监测社区行为干预:新冠肺炎病例研究
Pub Date : 2022-07-20 DOI: 10.1145/3524886
Shashwat Kumar, Debajyoti Datta, Guimin Dong, Lihua Cai, Laura E. Barnes, M. Boukhechba
During pandemics, effective interventions require monitoring the problem at different scales and understanding the various tradeoffs between efficacy, privacy, and economic burden. To address these challenges, we propose a framework where we perform Bayesian change-point analysis on aggregate behavior markers extracted from mobile sensing data collected during the COVID-19 pandemic. Results generated by 598 participants for up to four months reveal rich insights: We observe an increase in smartphone usage around February 10th, followed by an increase in email usage around February 27th and, finally, a large reduction in participant’s mobility around March 13th. These behavior changes overlapped with important news events and government directives such as the naming of COVID-19, a spike in the number of reported cases in Europe, and the declaration of national emergency by President Trump. We also show that our detected change points align with changes in large scale external sources, including number of COVID-19 tweets, COVID-19 search traffic, and a large-scale foot traffic data collected by SafeGraph, providing further validation of our method. Our results show promise towards the feasibility of using mobile sensing to understand communities’ responses to public health interventions.
在流行病期间,有效的干预措施需要在不同规模上监测问题,并了解疗效、隐私和经济负担之间的各种权衡。为了应对这些挑战,我们提出了一个框架,在该框架中,我们对从新冠肺炎大流行期间收集的移动传感数据中提取的聚合行为标记进行贝叶斯变化点分析。598名参与者在长达四个月的时间里得出的结果揭示了丰富的见解:我们观察到,在2月10日左右,智能手机的使用量有所增加,随后在2月27日左右,电子邮件的使用量也有所增加,最后,在3月13日左右,参与者的行动能力大幅下降。这些行为变化与重要的新闻事件和政府指令重叠,如新冠肺炎的命名、欧洲报告病例数的激增以及特朗普总统宣布国家紧急状态。我们还表明,我们检测到的变化点与大规模外部来源的变化一致,包括新冠肺炎推文数量、新冠肺炎搜索流量和SafeGraph收集的大规模步行流量数据,为我们的方法提供了进一步的验证。我们的研究结果表明,使用移动传感来了解社区对公共卫生干预措施的反应是可行的。
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引用次数: 2
Passive and Context-Aware In-Home Vital Signs Monitoring Using Co-Located UWB-Depth Sensor Fusion 使用同位置uwb深度传感器融合的被动和环境感知家庭生命体征监测
Pub Date : 2022-07-20 DOI: 10.1145/3549941
Zongxing Xie, Bing Zhou, Xi Cheng, E. Schoenfeld, Fan Ye
Basic vital signs such as heart and respiratory rates (HR and RR) are essential bio-indicators. Their longitudinal in-home collection enables prediction and detection of disease onset and change, providing for earlier health intervention. In this article, we propose a robust, non-touch vital signs monitoring system using a pair of co-located Ultra-Wide Band (UWB) and depth sensors. By extensive manual examination, we identify four typical temporal and spectral signal patterns and their suitable vital sign estimators. We devise a probabilistic weighted framework (PWF) that quantifies evidence of these patterns to update the weighted combination of estimator output to track the vital signs robustly. We also design a “heatmap”-based signal quality detector to exclude the disturbed signal from inadvertent motions. To monitor multiple co-habiting subjects in-home, we build a two-branch long short-term memory (LSTM) neural network to distinguish between individuals and their activities, providing activity context crucial to disambiguating critical from normal vital sign variability. To achieve reliable context annotation, we carefully devise the feature set of the consecutive skeletal poses from the depth data, and develop a probabilistic tracking model to tackle non-line-of-sight (NLOS) cases. Our experimental results demonstrate the robustness and superior performance of the individual modules as well as the end-to-end system for passive and context-aware vital sign monitoring.
基本生命体征,如心率和呼吸频率(HR和RR)是必不可少的生物指标。他们在家中的纵向收集能够预测和检测疾病的发病和变化,为早期的健康干预提供帮助。在本文中,我们提出了一种鲁棒的非接触式生命体征监测系统,该系统使用一对共置超宽带(UWB)和深度传感器。通过大量的人工检查,我们确定了四种典型的时间和频谱信号模式及其合适的生命体征估计器。我们设计了一个概率加权框架(PWF),量化这些模式的证据,以更新估计器输出的加权组合,以鲁棒地跟踪生命体征。我们还设计了一个基于“热图”的信号质量检测器,以排除无意运动中的干扰信号。为了在家中监测多个共同居住的受试者,我们建立了一个双分支长短期记忆(LSTM)神经网络来区分个体和他们的活动,提供了对消除临界和正常生命体征变异性的歧义至关重要的活动背景。为了实现可靠的上下文注释,我们从深度数据中精心设计了连续骨骼姿势的特征集,并开发了一个概率跟踪模型来处理非视线(NLOS)情况。我们的实验结果证明了单个模块以及被动和上下文感知生命体征监测的端到端系统的鲁棒性和卓越性能。
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引用次数: 7
BioLumin: An Immersive Mixed Reality Experience for Interactive Microscopic Visualization and Biomedical Research Annotation BioLumin:一种用于交互式微观可视化和生物医学研究注释的沉浸式混合现实体验
Pub Date : 2022-07-18 DOI: 10.1145/3548777
Aviv Elor, Steve Whittaker, Sri Kurniawan, Sam Michael
Many recent breakthroughs in medical diagnostics and drug discovery arise from deploying machine learning algorithms to large-scale data sets. However, a significant obstacle to such approaches is that they depend on high-quality annotations generated by domain experts. This study develops and evaluates BioLumin, a novel immersive mixed reality environment that enables users to virtually shrink down to the microscopic level for navigation and annotation of 3D reconstructed images. We discuss how domain experts were consulted in the specification of a pipeline to enable automatic reconstruction of biological models for mixed reality environments, driving the design of a 3DUI system to explore whether such a system allows accurate annotation of complex medical data by non-experts. To examine the usability and feasibility of BioLumin, we evaluated our prototype through a multi-stage mixed-method approach. First, three domain experts offered expert reviews, and subsequently, nineteen non-expert users performed representative annotation tasks in a controlled setting. The results indicated that the mixed reality system was learnable and that non-experts could generate high-quality 3D annotations after a short training session. Lastly, we discuss design considerations for future tools like BioLumin in medical and more general scientific contexts.
最近在医学诊断和药物发现方面的许多突破都源于将机器学习算法部署到大规模数据集。然而,这种方法的一个重大障碍是,它们依赖于领域专家生成的高质量注释。这项研究开发并评估了BioLumin,这是一种新颖的沉浸式混合现实环境,使用户能够虚拟地缩小到微观水平,用于3D重建图像的导航和注释。我们讨论了在管道规范中如何咨询领域专家,以实现混合现实环境中生物模型的自动重建,从而推动3DUI系统的设计,以探索这种系统是否允许非专家对复杂的医学数据进行准确注释。为了检验BioLumin的可用性和可行性,我们通过多阶段混合方法评估了我们的原型。首先,三位领域专家提供了专家评审,随后,19位非专家用户在受控环境中执行了具有代表性的注释任务。结果表明,混合现实系统是可学习的,非专家可以在短时间的训练后生成高质量的3D注释。最后,我们讨论了在医学和更一般的科学背景下,BioLumin等未来工具的设计考虑因素。
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引用次数: 0
SCouT: Synthetic Counterfactuals via Spatiotemporal Transformers for Actionable Healthcare SCouT:通过时空变换器实现可操作医疗保健的合成反制造
Pub Date : 2022-07-09 DOI: 10.1145/3617180
Bhishma Dedhia, Roshini Balasubramanian, N. Jha
The Synthetic Control method has pioneered a class of powerful data-driven techniques to estimate the counterfactual reality of a unit from donor units. At its core, the technique involves a linear model fitted on the pre-intervention period that combines donor outcomes to yield the counterfactual. However, linearly combining spatial information at each time instance using time-agnostic weights fails to capture important inter-unit and intra-unit temporal contexts and complex nonlinear dynamics of real data. We instead propose an approach to use local spatiotemporal information before the onset of the intervention as a promising way to estimate the counterfactual sequence. To this end, we suggest a Transformer model that leverages particular positional embeddings, a modified decoder attention mask, and a novel pre-training task to perform spatiotemporal sequence-to-sequence modeling. Our experiments on synthetic data demonstrate the efficacy of our method in the typical small donor pool setting and its robustness against noise. We also generate actionable healthcare insights at the population and patient levels by simulating a state-wide public health policy to evaluate its effectiveness, an in silico trial for asthma medications to support randomized controlled trials, and a medical intervention for patients with Friedreich’s ataxia to improve clinical decision-making and promote personalized therapy.
合成控制方法开创了一类强大的数据驱动技术,用于从供体单位估计单位的反事实真实性。其核心是,该技术涉及一个拟合在干预前时期的线性模型,该模型结合捐赠者的结果来产生反事实。然而,使用时间不可知权重对每个时间实例的空间信息进行线性组合,无法捕捉重要的单元间和单元内时间上下文以及真实数据的复杂非线性动态。相反,我们提出了一种在干预开始前使用局部时空信息的方法,作为估计反事实序列的一种有前途的方法。为此,我们提出了一个Transformer模型,该模型利用特定的位置嵌入、修改的解码器注意力掩码和一个新颖的预训练任务来执行时空序列到序列建模。我们在合成数据上的实验证明了我们的方法在典型的小供体池设置中的有效性及其对噪声的鲁棒性。我们还通过模拟全州范围的公共卫生政策来评估其有效性,模拟哮喘药物的计算机试验来支持随机对照试验,以及对弗里德里希共济失调患者的医疗干预来改善临床决策并促进个性化治疗,从而在人群和患者层面产生可操作的医疗见解。
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引用次数: 1
Obesity Prediction with EHR Data: A deep learning approach with interpretable elements. 用电子病历数据预测肥胖:一种具有可解释元素的深度学习方法。
Pub Date : 2022-07-01 Epub Date: 2022-04-07 DOI: 10.1145/3506719
Mehak Gupta, Thao-Ly T Phan, H Timothy Bunnell, Rahmatollah Beheshti

Childhood obesity is a major public health challenge. Early prediction and identification of the children at an elevated risk of developing childhood obesity may help in engaging earlier and more effective interventions to prevent and manage obesity. Most existing predictive tools for childhood obesity primarily rely on traditional regression-type methods using only a few hand-picked features and without exploiting longitudinal patterns of children's data. Deep learning methods allow the use of high-dimensional longitudinal datasets. In this paper, we present a deep learning model designed for predicting future obesity patterns from generally available items on children's medical history. To do this, we use a large unaugmented electronic health records dataset from a large pediatric health system in the US. We adopt a general LSTM network architecture and train our proposed model using both static and dynamic EHR data. To add interpretability, we have additionally included an attention layer to calculate the attention scores for the timestamps and rank features of each timestamp. Our model is used to predict obesity for ages between 3-20 years using the data from 1-3 years in advance. We compare the performance of our LSTM model with a series of existing studies in the literature and show it outperforms their performance in most age ranges.

儿童肥胖是一项重大的公共卫生挑战。早期预测和识别儿童期肥胖风险较高的儿童可能有助于采取更早和更有效的干预措施来预防和管理肥胖。大多数现有的儿童肥胖预测工具主要依赖于传统的回归型方法,只使用几个精心挑选的特征,而没有利用儿童数据的纵向模式。深度学习方法允许使用高维纵向数据集。在本文中,我们提出了一个深度学习模型,旨在从儿童病史的一般可用项目中预测未来的肥胖模式。为了做到这一点,我们使用了来自美国大型儿科卫生系统的大型未增强电子健康记录数据集。我们采用一种通用的LSTM网络架构,并使用静态和动态EHR数据训练我们提出的模型。为了增加可解释性,我们还增加了一个注意层来计算时间戳的注意分数和每个时间戳的排名特征。我们的模型使用提前1-3年的数据来预测3-20岁之间的肥胖。我们将LSTM模型的性能与文献中的一系列现有研究进行了比较,并表明它在大多数年龄范围内的性能优于它们。
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引用次数: 35
Detecting Smartwatch-based Behavior Change in Response to a Multi-domain Brain Health Intervention. 检测基于智能手表的行为变化,以应对多领域脑健康干预。
Pub Date : 2022-07-01 Epub Date: 2022-04-07 DOI: 10.1145/3508020
Diane J Cook, Miranda Strickland, Maureen Schmitter-Edgecombe

In this study, we introduce and validate a computational method to detect lifestyle change that occurs in response to a multi-domain healthy brain aging intervention. To detect behavior change, digital behavior markers (DM) are extracted from smartwatch sensor data and a Permutation-based Change Detection (PCD) algorithm quantifies the change in marker-based behavior from a pre-intervention, one-week baseline. To validate the method, we verify that changes are successfully detected from synthetic data with known pattern differences. Next, we employ this method to detect overall behavior change for n=28 BHI subjects and n=17 age-matched control subjects. For these individuals, we observe a monotonic increase in behavior change from the baseline week with a slope of 0.7460 for the intervention group and a slope of 0.0230 for the control group. Finally, we utilize a random forest algorithm to perform leave-one-subject-out prediction of intervention versus control subjects based on digital marker delta values. The random forest predicts whether the subject is in the intervention or control group with an accuracy of 0.87. This work has implications for capturing objective, continuous data to inform our understanding of intervention adoption and impact.

在这项研究中,我们引入并验证了一种计算方法,用于检测多领域健康脑老龄化干预所带来的生活方式变化。为了检测行为变化,我们从智能手表传感器数据中提取了数字行为标记(DM),并采用基于置换的变化检测(PCD)算法量化了与干预前一周基线相比基于标记的行为变化。为了验证该方法,我们验证了从已知模式差异的合成数据中成功检测出变化。接下来,我们采用这种方法检测了 28 名 BHI 受试者和 17 名年龄匹配的对照组受试者的整体行为变化。对于这些受试者,我们观察到行为变化从基线周开始单调增长,干预组的斜率为 0.7460,对照组的斜率为 0.0230。最后,我们利用随机森林算法,根据数字标记德尔塔值,对干预组和对照组受试者进行 "一例淘汰"(leave-one-subject-out)预测。随机森林预测受试者属于干预组还是对照组的准确率为 0.87。这项工作对获取客观、连续的数据以帮助我们了解干预措施的采用和影响具有重要意义。
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引用次数: 0
Food, Mood, Context: Examining College Students’ Eating Context and Mental Well-being 食物、情绪、情境:大学生饮食情境与心理健康的关系
Pub Date : 2022-06-01 DOI: 10.1145/3533390
M. B. Morshed, S. S. Kulkarni, Koustuv Saha, Richard Li, L. G. Roper, L. Nachman, Hong Lu, Lucia Mirabella, Sanjeev Srivastava, K. de Barbaro, M. de Choudhury, T. Plötz, G. Abowd
Deviant eating behavior such as skipping meals and consuming unhealthy meals has a significant association with mental well-being in college students. However, there is more to what an individual eats. While eating patterns form a critical component of their mental well-being, insights and assessments related to the interplay of eating patterns and mental well-being remain under-explored in theory and practice. To bridge this gap, we use an existing real-time eating detection system that captures context during meals to examine how college students’ eating context associates with their mental well-being, particularly their affect, anxiety, depression, and stress. Our findings suggest that students’ irregularity or skipping meals negatively correlates with their mental well-being, whereas eating with family and friends positively correlates with improved mental well-being. We discuss the implications of our study in designing dietary intervention technologies and guiding student-centric well-being technologies.
不规律的饮食行为,如不吃饭和吃不健康的饭,与大学生的心理健康有着显著的联系。然而,一个人吃的东西还有更多。虽然饮食模式是他们心理健康的重要组成部分,但与饮食模式和心理健康相互作用相关的见解和评估在理论和实践中仍有待深入探讨。为了弥补这一差距,我们使用了一个现有的实时饮食检测系统,该系统可以捕捉用餐过程中的环境,来研究大学生的饮食环境如何与他们的心理健康相关,特别是他们的情绪、焦虑、抑郁和压力。我们的研究结果表明,学生的不规律或不吃饭与他们的心理健康呈负相关,而与家人和朋友一起吃饭与心理健康的改善呈正相关。我们讨论了我们的研究在设计饮食干预技术和指导以学生为中心的幸福技术方面的意义。
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引用次数: 8
Federated Learning for Healthcare Domain - Pipeline, Applications and Challenges 医疗保健领域的联邦学习——管道、应用和挑战
Pub Date : 2022-05-12 DOI: 10.1145/3533708
Madhura Joshi, Ankit Pal, Malaikannan Sankarasubbu
Federated learning is the process of developing machine learning models over datasets distributed across data centers such as hospitals, clinical research labs, and mobile devices while preventing data leakage. This survey examines previous research and studies on federated learning in the healthcare sector across a range of use cases and applications. Our survey shows what challenges, methods, and applications a practitioner should be aware of in the topic of federated learning. This paper aims to lay out existing research and list the possibilities of federated learning for healthcare industries.
联邦学习是在分布在数据中心(如医院、临床研究实验室和移动设备)的数据集上开发机器学习模型的过程,同时防止数据泄露。本调查通过一系列用例和应用程序检查了以前关于医疗保健部门联合学习的研究和研究。我们的调查显示了从业者在联邦学习主题中应该了解的挑战、方法和应用。本文旨在列出现有的研究,并列出联邦学习在医疗保健行业的可能性。
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引用次数: 30
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ACM transactions on computing for healthcare
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