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Mathematical modeling of the effects of vector control, treatment and mass awareness on the transmission dynamics of dengue fever 病媒控制、治疗和大众宣传对登革热传播动态影响的数学建模
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100159
Boniface Zacharia Naaly , Theresia Marijani , Augustino Isdory , Jufren Zakayo Ndendya

Dengue fever is a vital public health concern that affects about 40% of the world’s population. To address the dynamics of dengue disease, a mathematical model was formulated by incorporating three control strategies: vector control, treatment, and mass awareness. A stability analysis of the disease-free equilibrium (DFE) was conducted using the Jacobian matrix. The DFE was found to be locally and globally asymptotically stable when the effective reproductive number was less than one; otherwise, it was unstable. Additionally, an endemic equilibrium point (EEP) was identified. The global stability analysis of the EEP, performed using the Lyapunov method, showed that it is globally asymptotically stable whenever Re>1; otherwise, it is unstable. Bifurcation analysis revealed that the model system exhibits a forward bifurcation. Furthermore, sensitivity analysis of the effective reproduction number revealed that the most sensitive parameters are the biting rate (b) and insecticide efficacy (δ). Therefore, the results suggest that, in order to reduce new dengue cases, intervention strategies that decrease the biting rate, such as mosquito repellents and the use of insecticides to kill mosquitoes, should be implemented. Moreover, simulations were conducted for the extended model with vector control, treatment, and mass awareness. The results showed that the combination of vector control, treatment, and mass awareness has a more positive impact on the control of dengue fever than any single or paired intervention. Thus, for effective control of dengue fever, the three control measures should be implemented simultaneously, especially in endemic areas.

登革热是一个重要的公共卫生问题,影响着全球约 40% 的人口。针对登革热病的动态变化,我们建立了一个数学模型,其中包含三种控制策略:病媒控制、治疗和大众宣传。利用雅各布矩阵对无疾病平衡(DFE)进行了稳定性分析。结果发现,当有效繁殖数小于 1 时,无病平衡点在局部和全局上都趋于稳定;反之,则不稳定。此外,还确定了一个地方性平衡点(EEP)。利用 Lyapunov 方法对 EEP 进行的全局稳定性分析表明,当 Re>1 时,它是全局渐近稳定的;否则,它是不稳定的。分岔分析表明,模型系统呈现正向分岔。此外,对有效繁殖数量的敏感性分析表明,最敏感的参数是叮咬率(b)和杀虫剂效力(δ)。因此,结果表明,为了减少新的登革热病例,应实施降低叮咬率的干预策略,如驱蚊剂和使用杀虫剂杀灭蚊子。此外,还对包含病媒控制、治疗和大众宣传的扩展模型进行了模拟。结果表明,病媒控制、治疗和大众宣传相结合,比任何单一或成对的干预措施对登革热的控制都有更积极的影响。因此,为有效控制登革热,应同时实施这三种控制措施,特别是在登革热流行地区。
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引用次数: 0
Pediatric resident use, perceptions, and desires for improvement of a clinical secure messaging application 儿科住院医师对临床安全信息应用程序的使用、看法和改进愿望
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100162
Andrew W Halterman , Anneli R Cochrane , Andrew D Miller , Joy L Lee , William E Bennett Jr , Emily L Mueller

Background

Hospitals are transitioning away from traditional pagers to secure text messaging (STM) applications. STM is perceived to improve efficiency and accessibility. There is limited research on user's impressions of how STM impacts patient safety, provider wellness, and quality of patient care.

Objectives

To understand the use and perceptions of a clinical STM by pediatric residents at a free-standing quaternary care children's hospital.

Methods

A survey was conducted of pediatric residents regarding their experience with Diagnotes®. Demographic data were obtained along with use patterns, ability to perform tasks, and perceptions of intended purpose. Further questions evaluated agreement with communication strategies and satisfaction with features. Three open-ended questions asked about experience where STM impacted (1) patient care coordination and (2) patient safety. A final question asked for any additional STM feedback.

Results

Of 169 surveys, there were 112 respondents (66.3 % response rate). Respondents unanimously endorsed daily STM use on their personal mobile devices with good knowledge of basic features. Respondents were overall satisfied with Diagnotes® (73.9 %) including the ability to communicate efficiently (84.8 %) and effectively (79.5 %). Yet only 32.1 % were satisfied with Diagnotes® training. Only 59.5 % believed Diagnotes® was appropriate for urgent patient care needs and only 43.2 % believed its purpose was to inform the team of patient emergencies. Key qualitative themes included improved coordination of patient care tasks through STM, but there were concerns raised around sending and receiving messages, the additional cognitive burden placed by STM, and differences in culture of use that created conflict.

Conclusions

Diagnotes® is viewed positively including use for effective coordination of patient care and familiarity of functions of Diagnotes®. Barriers included unclear interprofessional expectations for use. Future research should incorporate a broad range of healthcare professionals' perceptions and co-creation of STM best practice guidelines for use, including around urgent or emergent patient care issues.

背景医院正在从传统的传呼机向安全短信(STM)应用过渡。人们认为 STM 可以提高效率和可及性。关于 STM 对患者安全、医疗服务提供者健康和患者护理质量的影响,用户印象方面的研究还很有限。方法对儿科住院医师进行了一项关于 Diagnotes® 使用体验的调查。调查内容包括人口统计学数据、使用模式、执行任务的能力以及对预期目的的看法。其他问题还包括对交流策略的认同度和对功能的满意度。三个开放式问题询问了 STM 对以下方面的影响:(1)患者护理协调;(2)患者安全。最后一个问题是询问有关 STM 的其他反馈。受访者一致认可在个人移动设备上日常使用 STM,并对其基本功能非常了解。受访者对 Diagnotes® 的总体满意度为 73.9%,其中包括高效沟通能力(84.8%)和有效沟通能力(79.5%)。然而,只有 32.1 % 的受访者对 Diagnotes® 的培训感到满意。只有 59.5 % 的人认为 Diagnotes® 适合紧急病人护理需求,只有 43.2 % 的人认为 Diagnotes® 的目的是向团队通报病人的紧急情况。主要的定性主题包括通过 STM 改善了患者护理任务的协调,但也有人对发送和接收信息、STM 带来的额外认知负担以及造成冲突的使用文化差异表示担忧。障碍包括对使用的跨专业期望不明确。未来的研究应广泛纳入医护专业人员的看法,并共同创建 STM 最佳实践指南,包括围绕紧急或突发患者护理问题的使用。
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引用次数: 0
Machine learning from real data: A mental health registry case study 从真实数据中进行机器学习:心理健康登记案例研究
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2023.100132
Elisabetta Gentili , Giorgia Franchini , Riccardo Zese , Marco Alberti , Maria Ferrara , Ilaria Domenicano , Luigi Grassi

Imbalanced datasets can impair the learning performance of many Machine Learning techniques. Nevertheless, many real-world datasets, especially in the healthcare field, are inherently imbalanced. For instance, in the medical domain, the classes representing a specific disease are typically the minority of the total cases. This challenge justifies the substantial research effort spent in the past decades to tackle data imbalance at the data and algorithm levels. In this paper, we describe the strategies we used to deal with an imbalanced classification task on data extracted from a database generated from the Electronic Health Records of the Mental Health Service of the Ferrara Province, Italy. In particular, we applied balancing techniques to the original data, such as random undersampling and oversampling, and Synthetic Minority Oversampling Technique for Nominal and Continuous (SMOTE-NC). In order to assess the effectiveness of the balancing techniques on the classification task at hand, we applied different Machine Learning algorithms. We employed cost-sensitive learning as well and compared its results with those of the balancing methods. Furthermore, a feature selection analysis was conducted to investigate the relevance of each feature. Results show that balancing can help find the best setting to accomplish classification tasks. Since real-world imbalanced datasets are increasingly becoming the core of scientific research, further studies are needed to improve already existing techniques.

不平衡数据集会损害许多机器学习技术的学习性能。然而,现实世界中的许多数据集,尤其是医疗保健领域的数据集,本身就是不平衡的。例如,在医疗领域,代表特定疾病的类别通常只占病例总数的少数。因此,在过去几十年里,人们花费了大量精力在数据和算法层面解决数据不平衡问题。在本文中,我们介绍了在处理从意大利费拉拉省心理健康服务电子健康记录数据库中提取的数据的不平衡分类任务时所采用的策略。特别是,我们对原始数据采用了平衡技术,如随机欠采样和超采样,以及用于名义和连续的合成少数群体超采样技术(SMOTE-NC)。为了评估平衡技术对当前分类任务的有效性,我们采用了不同的机器学习算法。我们还采用了成本敏感学习,并将其结果与平衡方法的结果进行了比较。此外,我们还进行了特征选择分析,以研究每个特征的相关性。结果表明,平衡有助于找到完成分类任务的最佳设置。由于真实世界的不平衡数据集正日益成为科学研究的核心,因此需要进一步的研究来改进现有的技术。
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引用次数: 0
Sentiment visualization of correlation of loneliness mapped through social intelligence analysis 通过社会智能分析绘制孤独相关性的情感可视化图谱
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100144
Hurmat Ali Shah, Marco Agus, Mowafa Househ

Background

Loneliness is a global public health issue affecting a considerable number of people as well as burdening the public health system and increasing the risk of other life-threatening and life-damaging conditions. In USA an estimated 17% adults aged 18–70 report loneliness. The monetary loss as result of loneliness is estimated to be between USD 8074.80 and USD 12,0777.70 per person per year in the United Kingdom. But the dynamics of loneliness are not understood. Social media platforms have become a valuable source of data to study this phenomenon.

Objectives

This paper aims to visualize the frequency of loneliness-related themes and topics in Twitter data. By using natural language (NLP) processing, sentiment analysis, and topic modeling, we seek to understand prevalent sentiments and concerns. Through interactive tree maps and radar plots, we present an engaging view of loneliness dimensions, allowing users to explore and gain insights into this issue on social media. We focus on comparative analysis of USA and India through analyzing tweets from both countries on loneliness. These two countries are the biggest countries population-wise where access to Twitter is legally allowed.

Methods

This study consists of two parts. In the first part, we employ NLP techniques and machine learning algorithms to extract and analyze tweets containing keywords related to loneliness. Through sentiment analysis and topic modeling, we discern linguistic patterns and contextual information to categorize the recurring themes and topics. Advanced text analytics is used to gain nuanced insights into the experiences, emotions, and challenges connected with loneliness. In the second part, interactive visualizations are developed to present the findings in an engaging and intuitive manner. Techniques such as tree maps and radar plots are utilized to transform the analyzed data into visually appealing representations.

Results

The analysis of Twitter data yields valuable knowledge about the prevalence and nature of themes and topics associated with loneliness. The interactive visualizations present a comprehensive view of the sentiments and concerns expressed by Twitter users. These interactive plots provide a holistic view of the distribution of themes and topics associated with loneliness, allowing experts to explore and interact with the data, gaining deeper insights into the complexities surrounding this issue.

Conclusion

This paper successfully explores themes and topics related to loneliness on Twitter by employing NLP, sentiment analysis, and topic modeling. The interactive visualizations enhance the accessibility and usability of the findings, providing valuable insights for various stakeholders. The study contributes to a deeper comprehension of loneliness in the context of social media.

背景孤独是一个全球性的公共卫生问题,影响着相当多的人,也给公共卫生系统造成负担,并增加了其他危及生命和损害生命的疾病的风险。在美国,估计有 17% 年龄在 18-70 岁之间的成年人感到孤独。据估计,在英国,每人每年因孤独造成的经济损失在 8074.80 美元到 12077.70 美元之间。但人们并不了解孤独的动态。本文旨在可视化 Twitter 数据中与孤独相关的主题和话题的频率。通过使用自然语言(NLP)处理、情感分析和话题建模,我们试图了解普遍的情感和关注点。通过交互式树状图和雷达图,我们展示了孤独感的各个维度,让用户能够在社交媒体上探索并深入了解这一问题。通过分析美国和印度有关孤独的推文,我们重点对这两个国家进行了比较分析。就人口而言,这两个国家是允许合法访问 Twitter 的最大国家。第一部分,我们采用 NLP 技术和机器学习算法来提取和分析包含与孤独相关的关键词的推文。通过情感分析和主题建模,我们发现了语言模式和上下文信息,从而对重复出现的主题和话题进行分类。先进的文本分析技术可帮助我们深入了解与孤独有关的经历、情感和挑战。在第二部分中,我们开发了交互式可视化工具,以引人入胜的直观方式展示研究结果。利用树状图和雷达图等技术将分析数据转化为具有视觉吸引力的表现形式。结果对推特数据的分析产生了关于与孤独相关的主题和话题的普遍性和性质的宝贵知识。交互式可视化展示了 Twitter 用户所表达的情感和关注点的全貌。这些交互式图表提供了与孤独相关的主题和话题分布的整体视图,让专家能够探索数据并与之互动,从而更深入地了解围绕这一问题的复杂性。 结论 本文通过使用 NLP、情感分析和话题建模,成功地探索了 Twitter 上与孤独相关的主题和话题。交互式可视化提高了研究结果的可访问性和可用性,为不同利益相关者提供了有价值的见解。这项研究有助于深入理解社交媒体背景下的孤独感。
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引用次数: 0
Robust optimization of geometrical properties of flow diverter stents for treating cerebral aneurysm: A proof-of-concept study 治疗脑动脉瘤的分流支架几何特性的稳健优化:概念验证研究
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100167
Zahra Darbandi , Mahkame Sharbatdar , Mehrdad Raisee
This study presents a novel approach to optimize the design of flow diverter (FD) stents for cerebral aneurysm (CA) treatment. By addressing sources of uncertainty in cardiovascular simulations, including geometrical and physical properties and boundary conditions, we aim to assess the applicability of robust optimization techniques to the FD design, establishing a foundation for acquiring robust FDs that are capable of operating consistently under various real-world scenarios. Blood flow in a simplified 2-dimensional CA and FD model was simulated through computational fluid dynamics (CFD). A design space exploration method, incorporating Latin hypercube sampling and Kriging surrogate models, was employed to obtain the optimal solution. The objective was to maximize the reduction in velocity and vorticity within the CA sac. This study used non-intrusive polynomial chaos expansion (PCE) to quantify and propagate the input uncertainties through the computational model and compute the statistical moments of velocity and vorticity reductions. To assess the effect of uncertain sources on objective functions, a sensitivity analysis method based on Sobol indices was applied. Robust optimization involved simultaneously optimizing the mean and standard deviation of velocity reduction. Additionally, we accounted for patients’ specific conditions and repeated the robust optimization. The results indicate that blood Hematocrit and inlet velocity are the most impactful uncertain sources in FD optimization. Moreover, the obtained Pareto front shows that in robust designs, FD struts are concentrated in the distal region of the CA neck, while optimal designs have more struts in the proximal region. This study proposes an FD that compromises robustness and optimality with a velocity reduction of 72.31 % and a standard deviation of 0.00343.
本研究提出了一种新方法来优化用于治疗脑动脉瘤(CA)的分流(FD)支架的设计。通过解决心血管模拟中的不确定性来源(包括几何和物理特性以及边界条件),我们旨在评估稳健优化技术在分流支架设计中的适用性,为获得能在各种实际情况下稳定运行的稳健分流支架奠定基础。通过计算流体动力学(CFD)模拟了简化的二维 CA 和 FD 模型中的血流。采用设计空间探索方法,结合拉丁超立方采样和 Kriging 代理模型,获得了最佳解决方案。目标是最大限度地降低 CA 囊内的速度和涡度。本研究采用非侵入式多项式混沌扩展(PCE)来量化输入不确定性并通过计算模型传播,同时计算速度和涡度降低的统计矩。为了评估不确定源对目标函数的影响,采用了基于索布尔指数的敏感性分析方法。稳健优化包括同时优化速度降低的平均值和标准偏差。此外,我们还考虑了患者的具体情况,并重复进行了稳健优化。结果表明,血液血细胞比容和入口速度是 FD 优化中影响最大的不确定因素。此外,获得的帕累托前沿显示,在稳健设计中,FD 支杆集中在 CA 颈部的远端区域,而优化设计则在近端区域有更多的支杆。本研究提出了一种兼顾稳健性和优化性的 FD,速度降低了 72.31%,标准偏差为 0.00343。
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引用次数: 0
Mathematical modelling of COVID-19 transmission with optimal control and cost-effectiveness analysis 通过优化控制和成本效益分析建立 COVID-19 传播的数学模型
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100155
Jufren Zakayo Ndendya, Goodluck Mlay, Herieth Rwezaura

The present global health threat is the novel coronavirus disease (COVID-19), caused by a new strain of the SARS-CoV-2 coronavirus. In this study, have employed optimal control theory, aided by Pontryagin’s Maximum Principle, to explore optimal control measures. Specifically, we have investigated time-dependent intervention strategies, including the proper use of personal protective measures and vaccination. Bifurcation analysis was conducted and results shows that the model system exhibit a forward bifurcation. The optimal control system have been numerically simulated using the fourth-order Runge–Kutta methods. The results show that the implementation of the combination of the two interventions was more significant and effective in minimizing the spread of the COVID-19 than the implementation of a single control measure. These findings underscore the significance of multifaceted intervention approaches over singular control measures. Notably, the combined implementation of interventions emerges as markedly more effective in containing COVID-19 transmission. Moreover, our study identifies personal protective measures as a particularly cost-effective intervention, offering substantial relief from the burden of the pandemic within the population. We anticipate that our research will inform evidence-based approaches to pandemic control and aid in the ongoing global efforts to safeguard public health.

新型冠状病毒病(COVID-19)是当前全球健康面临的威胁,它是由 SARS-CoV-2 冠状病毒的新菌株引起的。在本研究中,我们运用最优控制理论,并在庞特里亚金最大原则的帮助下,探索了最优控制措施。具体而言,我们研究了随时间变化的干预策略,包括正确使用个人防护措施和接种疫苗。我们进行了分岔分析,结果表明模型系统呈现正向分岔。使用四阶 Runge-Kutta 方法对优化控制系统进行了数值模拟。结果表明,与实施单一控制措施相比,实施两种干预措施的组合对最大限度地减少 COVID-19 的传播更为显著和有效。这些发现强调了多方面干预方法比单一控制措施更有意义。值得注意的是,联合实施干预措施在遏制 COVID-19 传播方面明显更为有效。此外,我们的研究还发现,个人防护措施是一种特别具有成本效益的干预措施,可大大减轻大流行病在人群中造成的负担。我们预计,我们的研究将为以证据为基础的大流行病控制方法提供信息,并有助于全球为保障公共健康所做的不懈努力。
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引用次数: 0
Fuzzy information granulation towards benign and malignant lung nodules classification 肺结节良恶性分类的模糊信息粒化
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100153
Fatemeh Amini , Roya Amjadifard , Azadeh Mansouri

Lung cancer is the second common cancer with the highest death rate in the world. Cancer diagnosis in the early stages is a critical factor for increasing the treatment speed. This paper proposes a new machine learning method based on a fuzzy approach to detect benign and malignant lung nodules to early-diagnose lung cancer by investigating the computed tomography (CT) images. First, the lung nodule images are pre-processed via the Gabor wavelet transform. Then, some of the texture features are extracted from the transformed domain based on the statistical characteristics and histogram of the local patterns of images. Finally, based on the fuzzy information granulation (FIG) method, which is widely recognized as being able to distinguish between similar textures, a FIG-based classifier is introduced to classify the benign and malignant lung nodules. The clinical data set used for this research are a combination of 150 CT scans of LIDC and SPIE-APPM data sets. Also the LIDC data set is analyzed alone. The results show that the proposed method can be an innovative alternative to classify the benign and malignant nodules in the CT images.

肺癌是世界上死亡率最高的第二大常见癌症。癌症的早期诊断是提高治疗速度的关键因素。本文提出了一种新的基于模糊方法的机器学习方法,通过研究计算机断层扫描(CT)图像来检测肺结节的良性和恶性,从而早期诊断肺癌。首先,通过 Gabor 小波变换对肺结节图像进行预处理。然后,根据图像局部模式的统计特征和直方图,从变换域中提取一些纹理特征。最后,基于模糊信息粒化(FIG)方法,引入基于 FIG 的分类器对肺部结节进行良性和恶性分类。本研究使用的临床数据集是 LIDC 和 SPIE-APPM 数据集 150 张 CT 扫描图像的组合。此外,还单独分析了 LIDC 数据集。结果表明,所提出的方法可以作为一种创新的替代方法来对 CT 图像中的良性和恶性结节进行分类。
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引用次数: 0
Irreversible electroporation for tissue ablation: A 3D computational platform 用于组织消融的不可逆电穿孔:三维计算平台
Pub Date : 2024-01-01 DOI: 10.1016/j.cmpbup.2024.100163
Sudip Kumar Das , Srinivasan Jayaraman

Background and objective:

Globally, irreversible electroporation (IRE) emerges as a promising technique for tissue ablation as it overcomes the limitations of the benchmark techniques. However, achieving the desired and safe ablation volume of tissue pivots on multiple factors, such as pulse profile, shape, and number of electrodes, besides the IRE treatment parameters, like pulse type, field strength, number of pulses, pulse length, and frequency. This work aims to develop a 3D computation platform that predicts the ablation volume using the IRE procedure and provides insights such as electric field, temperature and its corresponding cell survival regions. Thereby, such a platform aids in selecting optimized treatment parameters to avoid thermal damage. In addition, the developed IRE model estimates the relationship between the pulse protocol and different electrode geometries, number of electrodes, and electrode configurations.

Methods:

The computational model for IRE is developed with Laplace’s equation and Penn’s bio-heat equation for the electric potential and temperature profiles, respectively, and the Finite Difference method is considered for the numerical solution. The statistical Fermi equation-based Peleg model has been adapted to estimate the ablation volume as a function of the magnitude of the electric field and other electric field parameters.

Results:

The tissue ablation platform allows computation and visualization of ablation volume estimation using the IRE technique with a pair of plate-type and multiple pairs of needle-type electrodes. IRE treatment with different combinations of electric pulse parameters, i.e., pulse length, voltage, and number of pulses, causes different levels of temperature rise. By adapting our platform, one can avoid thermal damage in the IRE treatment with the right combination of pulse parameters. For instance, one can apply a maximum of 10 pulses restricting temperature within 50°C in the IRE treatment of cervical tissue with a couple of pairs of needle-type electrodes and 100μs electric pulses of 3000V.

Conclusion:

The proposed IRE model aids in treatment planning for tissue ablation with 3D visual outputs through the platform’s user interface for better clinical insights, including interpretability, data resolution, and computational cost.

背景和目的:在全球范围内,不可逆电穿孔(IRE)克服了基准技术的局限性,成为一种前景广阔的组织消融技术。然而,除了 IRE 治疗参数(如脉冲类型、场强、脉冲数、脉冲长度和频率)外,实现理想而安全的组织消融量还取决于多种因素,如脉冲轮廓、形状和电极数量。这项工作旨在开发一个三维计算平台,利用 IRE 程序预测消融体积,并提供电场、温度及其相应的细胞存活区域等信息。因此,该平台有助于选择优化的治疗参数,避免热损伤。此外,所开发的 IRE 模型还能估算出脉冲方案与不同电极几何形状、电极数量和电极配置之间的关系。方法:IRE 的计算模型采用拉普拉斯方程和佩恩生物热方程分别计算电动势和温度曲线,并考虑采用有限差分法进行数值求解。结果:该组织消融平台可利用一对板式电极和多对针式电极的 IRE 技术进行消融体积估算的计算和可视化。使用不同的电脉冲参数组合(即脉冲长度、电压和脉冲数)进行 IRE 治疗会导致不同程度的温升。通过调整我们的平台,可以在 IRE 治疗中通过正确的脉冲参数组合避免热损伤。例如,在对颈椎组织进行 IRE 治疗时,使用几对针型电极和 100μs 3000V 的电脉冲,最多可应用 10 个脉冲,将温度控制在 50°C 以内。
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引用次数: 0
Predicting Hypotensive Events in the ICU Settings Using Patient's Short-term Physiological History and Contextual Data 利用患者的短期生理史和背景数据预测ICU环境中的低血压事件
Pub Date : 2023-02-01 DOI: 10.1016/j.cmpbup.2023.100100
M. C. Moghadam, Ehsan Masoumi, S. Kendale, N. Bagherzadeh
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引用次数: 0
Evaluation of available risk scores to predict multiple cardiovascular complications for patients with type 2 diabetes mellitus using electronic health records 利用电子健康记录评估2型糖尿病患者多种心血管并发症的可用风险评分
Pub Date : 2023-01-01 DOI: 10.1016/j.cmpbup.2022.100087
Joyce C Ho , Lisa R Staimez , K M Venkat Narayan , Lucila Ohno-Machado , Roy L Simpson , Vicki Stover Hertzberg

Aims

Various cardiovascular risk prediction models have been developed for patients with type 2 diabetes mellitus. Yet few models have been validated externally. We perform a comprehensive validation of existing risk models on a heterogeneous population of patients with type 2 diabetes using secondary analysis of electronic health record data.

Methods

Electronic health records of 47,988 patients with type 2 diabetes between 2013 and 2017 were used to validate 16 cardiovascular risk models, including 5 that had not been compared previously, to estimate the 1-year risk of various cardiovascular outcomes. Discrimination and calibration were assessed by the c-statistic and the Hosmer-Lemeshow goodness-of-fit statistic, respectively. Each model was also evaluated based on the missing measurement rate. Sub-analysis was performed to determine the impact of race on discrimination performance.

Results

There was limited discrimination (c-statistics ranged from 0.51 to 0.67) across the cardiovascular risk models. Discrimination generally improved when the model was tailored towards the individual outcome. After recalibration of the models, the Hosmer-Lemeshow statistic yielded p-values above 0.05. However, several of the models with the best discrimination relied on measurements that were often imputed (up to 39% missing).

Conclusion

No single prediction model achieved the best performance on a full range of cardiovascular endpoints. Moreover, several of the highest-scoring models relied on variables with high missingness frequencies such as HbA1c and cholesterol that necessitated data imputation and may not be as useful in practice. An open-source version of our developed Python package, cvdm, is available for comparisons using other data sources.

目的已经为2型糖尿病患者开发了各种心血管风险预测模型。然而,很少有模型经过外部验证。我们使用电子健康记录数据的二次分析,对2型糖尿病异质人群的现有风险模型进行了全面验证。方法使用2013年至2017年间47988名2型糖尿病患者的电子健康记录来验证16个心血管风险模型,其中包括5个以前没有比较过的模型,以估计各种心血管结果的1年风险。判别和校正分别通过c-统计量和Hosmer-Lemeshow拟合优度统计量进行评估。每个模型也根据缺失测量率进行了评估。进行了子分析,以确定种族对歧视表现的影响。结果心血管风险模型之间的差异有限(c统计量范围为0.51至0.67)。当模型针对个人结果进行调整时,歧视通常会得到改善。在重新校准模型后,Hosmer-Lemeshow统计得出的p值高于0.05。然而,有几个判别力最好的模型依赖于经常估算的测量结果(高达39%的缺失)。结论没有一个单一的预测模型在所有心血管终点上都能达到最佳性能。此外,一些得分最高的模型依赖于缺失频率高的变量,如HbA1c和胆固醇,这些变量需要进行数据插补,在实践中可能没有那么有用。我们开发的Python包的开源版本cvdm可用于使用其他数据源进行比较。
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引用次数: 2
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Computer methods and programs in biomedicine update
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