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BMC Medical Informatics and Decision... Jun 2024Allogeneic Blood transfusion is common in hip surgery but is associated with increased morbidity. Accurate prediction of transfusion risk is necessary for minimizing...
BACKGROUND
Allogeneic Blood transfusion is common in hip surgery but is associated with increased morbidity. Accurate prediction of transfusion risk is necessary for minimizing blood product waste and preoperative decision-making. The study aimed to develop machine learning models for predicting perioperative blood transfusion in hip surgery and identify significant risk factors.
METHODS
Data of patients undergoing hip surgery between January 2013 and October 2021 in the Peking Union Medical College Hospital were collected to train and test predictive models. The primary outcome was perioperative red blood cell (RBC) transfusion within 72 h of surgery. Fourteen machine learning algorithms were established to predict blood transfusion risk incorporating patient demographic characteristics, preoperative laboratory tests, and surgical information. Discrimination, calibration, and decision curve analysis were used to evaluate machine learning models. SHapley Additive exPlanations (SHAP) was performed to interpret models.
RESULTS
In this study, 2431 hip surgeries were included. The Ridge Classifier performed the best with an AUC = 0.85 (95% CI, 0.81 to 0.88) and a Brier score = 0.21. Patient-related risk factors included lower preoperative hemoglobin, American Society of Anesthesiologists (ASA) Physical Status > 2, anemia, lower preoperative fibrinogen, and lower preoperative albumin. Surgery-related risk factors included longer operation time, total hip arthroplasty, and autotransfusion.
CONCLUSIONS
The machine learning model developed in this study achieved high predictive performance using available variables for perioperative blood transfusion in hip surgery. The predictors identified could be helpful for risk stratification, preoperative optimization, and outcomes improvement.
Topics: Humans; Machine Learning; Male; Female; Middle Aged; Blood Transfusion; Aged; Adult; Arthroplasty, Replacement, Hip; Risk Factors; Risk Assessment
PubMed: 38840126
DOI: 10.1186/s12911-024-02555-7 -
BMC Psychiatry Jun 2024Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with...
BACKGROUND
Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear.
METHODS
This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model.
RESULTS
We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65.
CONCLUSIONS
We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.
Topics: Humans; Empathy; Students, Medical; Cross-Sectional Studies; Male; Female; China; Education, Medical, Undergraduate; Physician-Patient Relations; Young Adult; Adult; Nomograms
PubMed: 38834981
DOI: 10.1186/s12888-023-05350-2 -
Scientific Reports Jun 2024The diagnosis of acute appendicitis and concurrent surgery referral is primarily based on clinical presentation, laboratory and radiological imaging. However, utilizing...
The diagnosis of acute appendicitis and concurrent surgery referral is primarily based on clinical presentation, laboratory and radiological imaging. However, utilizing such an approach results in as much as 10-15% of negative appendectomies. Hence, in the present study, we aimed to develop a machine learning (ML) model designed to reduce the number of negative appendectomies in pediatric patients with a high clinical probability of acute appendicitis. The model was developed and validated on a registry of 551 pediatric patients with suspected acute appendicitis that underwent surgical treatment. Clinical, anthropometric, and laboratory features were included for model training and analysis. Three machine learning algorithms were tested (random forest, eXtreme Gradient Boosting, logistic regression) and model explainability was obtained. Random forest model provided the best predictions achieving mean specificity and sensitivity of 0.17 ± 0.01 and 0.997 ± 0.001 for detection of acute appendicitis, respectively. Furthermore, the model outperformed the appendicitis inflammatory response (AIR) score across most sensitivity-specificity combinations. Finally, the random forest model again provided the best predictions for discrimination between complicated appendicitis, and either uncomplicated acute appendicitis or no appendicitis at all, with a joint mean sensitivity of 0.994 ± 0.002 and specificity of 0.129 ± 0.009. In conclusion, the developed ML model might save as much as 17% of patients with a high clinical probability of acute appendicitis from unnecessary surgery, while missing the needed surgery in only 0.3% of cases. Additionally, it showed better diagnostic accuracy than the AIR score, as well as good accuracy in predicting complicated acute appendicitis over uncomplicated and negative cases bundled together. This may be useful in centers that advocate for the conservative treatment of uncomplicated appendicitis. Nevertheless, external validation is needed to support these findings.
Topics: Humans; Appendicitis; Appendectomy; Child; Machine Learning; Female; Male; Adolescent; Child, Preschool; Acute Disease; Probability; Sensitivity and Specificity; Algorithms
PubMed: 38834671
DOI: 10.1038/s41598-024-63513-x -
Frontiers in Aging Neuroscience 2024The altered neuromelanin in substantia nigra pars compacta (SNpc) is a valuable biomarker in the detection of early-stage Parkinson's disease (EPD). Diagnosis via visual...
OBJECTIVES
The altered neuromelanin in substantia nigra pars compacta (SNpc) is a valuable biomarker in the detection of early-stage Parkinson's disease (EPD). Diagnosis via visual inspection or single radiomics based method is challenging. Thus, we proposed a novel hybrid model that integrates radiomics and deep learning methodologies to automatically detect EPD based on neuromelanin-sensitive MRI, namely short-echo-time Magnitude (setMag) reconstructed from quantitative susceptibility mapping (QSM).
METHODS
In our study, we collected QSM images including 73 EPD patients and 65 healthy controls, which were stratified into training-validation and independent test sets with an 8:2 ratio. Twenty-four participants from another center were included as the external validation set. Our framework began with the detection of the brainstem utilizing YOLO-v5. Subsequently, a modified LeNet was applied to obtain deep learning features. Meanwhile, 1781 radiomics features were extracted, and 10 features were retained after filtering. Finally, the classified models based on radiomics features, deep learning features, and the hybrid of both were established through machine learning algorithms, respectively. The performance was mainly evaluated using accuracy, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The saliency map was used to visualize the model.
RESULTS
The hybrid feature-based support vector machine (SVM) model showed the best performance, achieving ACC of 96.3 and 95.8% in the independent test set and external validation set, respectively. The model established by hybrid features outperformed the one radiomics feature-based (NRI: 0.245, IDI: 0.112). Furthermore, the saliency map showed that the bilateral "swallow tail" sign region was significant for classification.
CONCLUSION
The integration of deep learning and radiomic features presents a potent strategy for the computer-aided diagnosis of EPD. This study not only validates the accuracy of our proposed model but also underscores its interpretability, evidenced by differential significance across various anatomical sites.
PubMed: 38832074
DOI: 10.3389/fnagi.2024.1397896 -
Molecular Autism Jun 2024Categorization and its influence on perceptual discrimination are essential processes to organize information efficiently. Individuals with Autism Spectrum Condition...
BACKGROUND
Categorization and its influence on perceptual discrimination are essential processes to organize information efficiently. Individuals with Autism Spectrum Condition (ASC) are suggested to display enhanced discrimination on the one hand, but also to experience difficulties with generalization and ignoring irrelevant differences on the other, which underlie categorization. Studies on categorization and discrimination in ASC have mainly focused on one process at a time, however, and typically only used either behavioral or neural measures in isolation. Here, we aim to investigate the interrelationships between these perceptual processes using novel stimuli sampled from a well-controlled artificial stimulus space. In addition, we complement standard behavioral psychophysical tasks with frequency-tagging EEG (FT-EEG) to obtain a direct, non-task related neural index of discrimination and categorization.
METHODS
The study was completed by 38 adults with ASC and 38 matched neurotypical (NT) individuals. First, we assessed baseline discrimination sensitivity by administering FT-EEG measures and a complementary behavioral task. Second, participants were trained to categorize the stimuli into two groups. Finally, participants again completed the neural and behavioral discrimination sensitivity measures.
RESULTS
Before training, NT participants immediately revealed a categorical tuning of discrimination, unlike ASC participants who showed largely similar discrimination sensitivity across the stimuli. During training, both autistic and non-autistic participants were able to categorize the stimuli into two groups. However, in the initial training phase, ASC participants were less accurate and showed more variability, as compared to their non-autistic peers. After training, ASC participants showed significantly enhanced neural and behavioral discrimination sensitivity across the category boundary. Behavioral indices of a reduced categorical processing and perception were related to the presence of more severe autistic traits. Bayesian analyses confirmed overall results.
LIMITATIONS
Data-collection occurred during the COVID-19 pandemic.
CONCLUSIONS
Our behavioral and neural findings indicate that adults with and without ASC are able to categorize highly similar stimuli. However, while categorical tuning of discrimination sensitivity was spontaneously present in the NT group, it only emerged in the autistic group after explicit categorization training. Additionally, during training, adults with autism were slower at category learning. Finally, this multi-level approach sheds light on the mechanisms underlying sensory and information processing issues in ASC.
Topics: Humans; Male; Adult; Female; Electroencephalography; Young Adult; Autistic Disorder; Discrimination, Psychological; Learning; Photic Stimulation; Visual Perception; Autism Spectrum Disorder
PubMed: 38831439
DOI: 10.1186/s13229-024-00604-6 -
BMC Medical Research Methodology Jun 2024In contemporary society, depression has emerged as a prominent mental disorder that exhibits exponential growth and exerts a substantial influence on premature...
In contemporary society, depression has emerged as a prominent mental disorder that exhibits exponential growth and exerts a substantial influence on premature mortality. Although numerous research applied machine learning methods to forecast signs of depression. Nevertheless, only a limited number of research have taken into account the severity level as a multiclass variable. Besides, maintaining the equality of data distribution among all the classes rarely happens in practical communities. So, the inevitable class imbalance for multiple variables is considered a substantial challenge in this domain. Furthermore, this research emphasizes the significance of addressing class imbalance issues in the context of multiple classes. We introduced a new approach Feature group partitioning (FGP) in the data preprocessing phase which effectively reduces the dimensionality of features to a minimum. This study utilized synthetic oversampling techniques, specifically Synthetic Minority Over-sampling Technique (SMOTE) and Adaptive Synthetic (ADASYN), for class balancing. The dataset used in this research was collected from university students by administering the Burn Depression Checklist (BDC). For methodological modifications, we implemented heterogeneous ensemble learning stacking, homogeneous ensemble bagging, and five distinct supervised machine learning algorithms. The issue of overfitting was mitigated by evaluating the accuracy of the training, validation, and testing datasets. To justify the effectiveness of the prediction models, balanced accuracy, sensitivity, specificity, precision, and f1-score indices are used. Overall, comprehensive analysis demonstrates the discrimination between the Conventional Depression Screening (CDS) and FGP approach. In summary, the results show that the stacking classifier for FGP with SMOTE approach yields the highest balanced accuracy, with a rate of 92.81%. The empirical evidence has demonstrated that the FGP approach, when combined with the SMOTE, able to produce better performance in predicting the severity of depression. Most importantly the optimization of the training time of the FGP approach for all of the classifiers is a significant achievement of this research.
Topics: Humans; Machine Learning; Depression; Algorithms; Severity of Illness Index; Sensitivity and Specificity; Female
PubMed: 38831346
DOI: 10.1186/s12874-024-02249-8 -
PloS One 2024In order to ensure the safety of coal mine production, a mine water source identification model is proposed to improve the accuracy of mine water inrush source...
In order to ensure the safety of coal mine production, a mine water source identification model is proposed to improve the accuracy of mine water inrush source identification and effectively prevent water inrush accidents based on kernel principal component analysis (KPCA) and improved sparrow search algorithm (ISSA) optimized kernel extreme learning machine (KELM). Taking Zhaogezhuang mine as the research object, firstly, Na+, Ca2+, Mg2+, Cl-, SO2- 4 and HCO- 3 were selected as evaluation indexes, and their correlation was analyzed by SPSS27 software, with reducing the dimension of the original data by KPCA. Secondly, the Sine Chaotic Mapping, dynamic adaptive weights, and Cauchy Variation and Reverse Learning were introduced to improve the Sparrow Search Algorithm (SSA) to strengthen global search ability and stability. Meanwhile, the ISSA was used to optimize the kernel parameters and regularization coefficients in the KELM to establish a mine water inrush source discrimination model based on the KPCA-ISSA-KELM. Then, the mine water source data are input into the model for discrimination in compared with discrimination results of KPCA-SSA-KELM, KPCA-KELM, ISSA-KELM, SSA-KELM and KELM models. The results of the study show as follows: The discrimination results of the KPCA-ISSA-KELM model are in agreement with the actual results. Compared with the other models, the accuracy of the KPCA-ISSA-KELM model is improved by 8.33%, 12.5%, 4.17%, 21.83%, and 25%, respectively. Finally, when these models were applied to discriminate water sources in a coal mine in Shanxi, and the misjudgment rates of each model were 28.57%, 19.05%, 14.29%, 23.81%, 9.52% and 4.76%, respectively. From this, the KPCA-ISSA-KLEM model is the most accurate about discrimination and significantly better than other models in other evaluation indicators, verifying the universality and stability of the model. It can be effectively applied to the discrimination of inrush water sources in mines, providing important guarantees for mine safety production.
Topics: Algorithms; Principal Component Analysis; Machine Learning; Coal Mining; Mining; Models, Theoretical
PubMed: 38829898
DOI: 10.1371/journal.pone.0299476 -
Frontiers in Medicine 2024Delirium is the most common neuropsychological complication among older adults admitted to the intensive care unit (ICU) and is often associated with a poor prognosis....
BACKGROUND AND OBJECTIVE
Delirium is the most common neuropsychological complication among older adults admitted to the intensive care unit (ICU) and is often associated with a poor prognosis. This study aimed to construct and validate an interpretable machine learning (ML) for early delirium prediction in older ICU patients.
METHODS
This was a retrospective observational cohort study and patient data were extracted from the Medical Information Mart for Intensive Care-IV database. Feature variables associated with delirium, including predisposing factors, disease-related factors, and iatrogenic and environmental factors, were selected using least absolute shrinkage and selection operator regression, and prediction models were built using logistic regression, decision trees, support vector machines, extreme gradient boosting (XGBoost), k-nearest neighbors and naive Bayes methods. Multiple metrics were used for evaluation of performance of the models, including the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, recall, F1 score, calibration plot, and decision curve analysis. SHapley Additive exPlanations (SHAP) were used to improve the interpretability of the final model.
RESULTS
Nine thousand seven hundred forty-eight adults aged 65 years or older were included for analysis. Twenty-six features were selected to construct ML prediction models. Among the models compared, the XGBoost model demonstrated the best performance including the highest AUC (0.836), accuracy (0.765), sensitivity (0.713), recall (0.713), and F1 score (0.725) in the training set. It also exhibited excellent discrimination with AUC of 0.810, good calibration, and had the highest net benefit in the validation cohort. The SHAP summary analysis showed that Glasgow Coma Scale, mechanical ventilation, and sedation were the top three risk features for outcome prediction. The SHAP dependency plot and SHAP force analysis interpreted the model at both the factor level and individual level, respectively.
CONCLUSION
ML is a reliable tool for predicting the risk of critical delirium in elderly patients. By combining XGBoost and SHAP, it can provide clear explanations for personalized risk prediction and more intuitive understanding of the effect of key features in the model. The establishment of such a model would facilitate the early risk assessment and prompt intervention for delirium.
PubMed: 38828233
DOI: 10.3389/fmed.2024.1399848 -
AMIA Joint Summits on Translational... 2024Access to real-world data streams like electronic medical records (EMRs) has accelerated the development of supervised machine learning (ML) models for clinical...
Access to real-world data streams like electronic medical records (EMRs) has accelerated the development of supervised machine learning (ML) models for clinical applications. However, few studies investigate the differential impact of particular features in the EMR on model performance under temporal dataset shift. To explain how features in the EMR impact models over time, this study aggregates features into by their source (e.g. medication orders, diagnosis codes and lab results) and based on their reflection of patient pathophysiology or healthcare processes. We adapt Shapley values to explain feature groups' and feature categories' marginal contribution to initial and sustained model performance. We investigate three standard clinical prediction tasks and find that while feature contributions to initial performance differ across tasks, pathophysiological features help mitigate temporal discrimination deterioration. These results provide interpretable insights on how specific feature groups contribute to model performance and robustness to temporal dataset shift.
PubMed: 38827052
DOI: No ID Found -
Heliyon May 2024Most prognostic indexes for ischemic stroke mortality lack radiologic information. We aimed to create and validate a deep learning-based mortality prediction model using...
OBJECTIVE
Most prognostic indexes for ischemic stroke mortality lack radiologic information. We aimed to create and validate a deep learning-based mortality prediction model using brain diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), and clinical factors.
METHODS
Data from patients with ischemic stroke who admitted to tertiary hospital during acute periods from 2013 to 2019 were collected and split into training (n = 1109), validation (n = 437), and internal test (n = 654). Data from patients from secondary cardiovascular center was used for external test set (n = 507). The algorithm for predicting mortality, based on DWI and ADC (DLP_DWI), was initially trained. Subsequently, important clinical factors were integrated into this model to create the integrated model (DLP_INTG). The performance of DLP_DWI and DLP_INTG was evaluated by using time-dependent area under the receiver operating characteristic curves (TD AUCs) and Harrell concordance index (C-index) at one-year mortality.
RESULTS
The TD AUC of DLP_DWI was 0.643 in internal test set, and 0.785 in the external dataset. DLP_INTG had a higher performance at predicting one-year mortality than premise score in internal dataset (TD- AUC: 0.859 vs. 0.746; p = 0.046), and in external dataset (TD- AUC: 0.876 vs. 0.808; p = 0.007). DLP_DWI and DLP_INTG exhibited strong discrimination for the high-risk group for one-year mortality.
INTERPRETATION
A deep learning model using brain DWI, ADC and the clinical factors was capable of predicting mortality in patients with ischemic stroke.
PubMed: 38826743
DOI: 10.1016/j.heliyon.2024.e31000