Dynamic Risk Models for Characterising Chronic Diseases' Behaviour Using Process Mining Techniques

[ES] Los modelos de riesgo en el ámbito de la salud son métodos estadísticos que brindan advertencias tempranas sobre el riesgo de una persona de sufrir un episodio adverso en el futuro. Por lo general, utilizan la información almacenada de forma rutinaria en los sistemas de información hospitalaria para ofrecer una probabilidad individual de desarrollar un resultado negativo futuro en un período determinado. Concretamente, en el campo de las enfermedades crónicas que comparten factores de riesgo comunes, los modelos de riesgo se basan en el análisis de esos factores de riesgo -tensión arterial elevada, glucemia elevada, lípidos sanguíneos anormales, sobrepeso y obesidad- y sus medidas biométricas asociadas. Estas medidas se recopilan durante la práctica clínica de manera periódica y, se incorporan a los modelos de riesgo para apoyar a los médicos en la toma de decisiones. Para crear modelos de riesgo que incluyan la variable temporal, se podrían utilizar técnicas basadas en datos (Data-Driven), de forma que se tuviera en cuenta el historial de los pacientes almacenado en los registros médicos electrónicos, extrayendo conocimiento de los datos en bruto. Sin embargo, en el ámbito de la salud, los resultados de la minería de datos suelen ser percibidos por los expertos en salud como cajas negras y, en consecuencia, no confían en sus decisiones. El paradigma Interactivo permite a los expertos comprender los resultados, para que los profesionales puedan corregir esos modelos de acuerdo con su conocimiento y experiencia, proporcionando modelos perceptivos y cognitivos. En este contexto, la minería de procesos es una técnica de minería de datos que permite la implementación del paradigma Interactivo, ofreciendo una comprensión clara del proceso de atención y proporcionando modelos comprensibles para el ser humano. Las condiciones crónicas generalmente se describen mediante imágenes estáticas de variables, como factores genéticos, fisiológicos, ambientales y de comportamiento. Sin embargo, la perspectiva dinámica, temporal y de comportamiento no se consideran comúnmente en los modelos de riesgo. Eso significa que el último estado de riesgo se convierte en el estado real del paciente. No obstante, la condición de los pacientes podría verse influenciada por sus condiciones dinámicas pasadas. El objetivo de esta tesis es proporcionar una visión novedosa del riesgo asociado a un paciente, basada en tecnologías Data-Driven que ofrezcan una visión dinámica de su evolución con respecto a su condición crónica. Técnicamente, supone abordar los modelos de riesgo incorporando la perspectiva dinámica y comportamental de los pacientes gracias a la información incluida en la Historia Clínica Electrónica. Los resultados obtenidos a lo largo de esta tesis muestran cómo las tecnologías de minería de procesos pueden aportar una visión dinámica e interactiva de los modelos de riesgo de enfermedades crónicas. Estos resultados pueden ayudar a los profesionales de la salud en la práctica diaria para una mejor comprensión del estado de salud de los pacientes y una mejor clasificación de su estado de riesgo.[CA] Els models de risc en l'àmbit de la salut són mètodes estadístics que brinden advertències primerenques sobre el risc d'una persona de patir un episodi advers en el futur. Generalment, utilitzen la informació emmagatzemada de forma rutinària en els sistemes d'informació hospitalària per a oferir una probabilitat individual de desenrotllar un resultat negatiu futur en un període determinat. Concretament, en el camp de les malalties cròniques que compartixen factors de risc comú, els models de risc es basen en l'anàlisi d'eixos factors de risc -tensió arterial elevada, glucèmia elevada, lípids sanguinis anormals, sobrecàrrega i obesitat- i les seues mesures biomètriques associades. Estes mesures es recopilen durant la pràctica clínica ben sovint de manera periòdica i, en conseqüència, s'incorporen als models de risc i recolzen la presa de decisions dels metges. Per a crear estos models de risc que incloguen la variable temporal es podrien utilitzar tècniques basades en dades (Data-Driven) , de manera que es tinguera en compte l'historial dels pacients disponible en els registres mèdics electrònics, extraient coneixement de les dades en brut. No obstant això, en l'àmbit de la salut, els resultats de la mineria de dades solen ser percebuts pels experts en salut com a caixes negres i, en conseqüència, no confien en les decisions dels algoritmes. El paradigma Interactiu permet als experts comprendre els resultats, perquè els professionals puguen corregir eixos models d'acord amb el seu coneixement i experiència, proporcionant models perceptius i cognitius. En este context, la mineria de processos és una tècnica de mineria de dades que permet la implementació del paradigma Interactiu, oferint una comprensió clara del procés d'atenció i proporcionant models comprensibles per al ser humà. Les condicions cròniques generalment es descriuen per mitjà d'imatges estàtiques de variables, com a factors genètics, fisiològics, ambientals i de comportament. No obstant això, la perspectiva dinàmica, temporal i de comportament no es consideren comunament en els models de risc. Això significa que l'últim estat de risc es convertix en l'estat real del pacient. No obstant això, la condició dels pacients podria veure's influenciada per les seues condicions dinàmiques passades. L'objectiu d'esta tesi és proporcionar una visió nova del risc, associat a un pacient, basada en tecnologies Data-Driven que oferisquen una visió dinàmica de l'evo\-lució dels pacients respecte a la seua condició crònica. Tècnicament, suposa abordar els models de risc incorporant la perspectiva dinàmica i el comportament dels pacients als models de risc gràcies a la informació inclosa en la Història Clínica Electrònica. Els resultats obtinguts al llarg d'esta tesi mostren com les tecnologies de mineria de processos poden aportar una visió dinàmica i interactiva dels models de risc de malalties cròniques. Estos resultats poden ajudar els professionals de la salut en la pràctica diària per a una millor comprensió de l'estat de salut dels pacients i una millor classificació del seu estat de risc.[EN] Risk models in the healthcare domain are statistical methods that provide early warnings about a person's risk for an adverse episode in the future. They usually use the information routinely stored in Hospital Information Systems to offer an individual probability for developing a future negative outcome in a given period. Concretely, in the field of chronic diseases that share common risk factors, risk models are based on the analysis of those risk factors -raised blood pressure, raised glucose levels, abnormal blood lipids, and overweight and obesity- and their associated biometric measures. These measures are collected during clinical practice frequently in a periodic manner, and accordingly, they are incorporated into the risk models to support clinicians' decision-making. Data-Driven techniques could be used to create these temporal-aware risk models, considering the patients' history included in Electronic Health Records, and extracting knowledge from raw data. However, in the healthcare domain, Data Mining results are usually perceived by the health experts as black-boxes, and in consequence, they do not trust in the algorithms' decisions. The Interactive paradigm allows experts to understand the results, in that sense, professionals can correct those models according to their knowledge and experience, providing perceptual and cognitive models. In this context, Process Mining is a Data Mining technique that enables the implementation of the Interactive paradigm, offering a clear care process understanding and providing human-understandable models. Chronic conditions are usually described by static pictures of variables, such as genetic, physiological, environmental, and behavioural factors. Nevertheless, the dynamic, temporal, and behavioural perspectives are not commonly considered in the risk models. That means the last status of the risk becomes the actual status of the patient. However, the patients' condition could be influenced by their past dynamic circumstances. The objective of this thesis is to provide a novel risk vision based on Data-Driven technologies offering a dynamic view of the patients' evolution regarding their chro\-nic condition. Technically, it supposes to approach risk models incorporating the dynamic and behavioural perspective of patients to the risk models thanks to the information included in the Electronic Health Records. The results obtained throughout this thesis show how Process Mining technologies can bring a dynamic and interactive view of chronic disease risk models. These results can support health professionals in daily practice for a better understanding of the patients' health condition and a better classification of their risk status.Valero Ramón, Z. (2022). Dynamic Risk Models for Characterising Chronic Diseases' Behaviour Using Process Mining Techniques [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/181652TESI

Clustered marginalization of minorities during social transitions induced by co-evolution of behaviour and network structure

Large-scale transitions in societies are associated with both individual behavioural change and restructuring of the social network. These two factors have often been considered independently, yet recent advances in social network research challenge this view. Here we show that common features of societal marginalization and clustering emerge naturally during transitions in a co-evolutionary adaptive network model. This is achieved by explicitly considering the interplay between individual interaction and a dynamic network structure in behavioural selection. We exemplify this mechanism by simulating how smoking behaviour and the network structure get reconfigured by changing social norms. Our results are consistent with empirical findings: The prevalence of smoking was reduced, remaining smokers were preferentially connected among each other and formed increasingly marginalised clusters. We propose that self-amplifying feedbacks between individual behaviour and dynamic restructuring of the network are main drivers of the transition. This generative mechanism for co-evolution of individual behaviour and social network structure may apply to a wide range of examples beyond smoking.Comment: 16 pages, 5 figure

Research Opportunities and Visions for Smart and Pervasive Health

Improving the health of the nation's population and increasing the capabilities of the US healthcare system to support diagnosis, treatment, and prevention of disease is a critical national and societal priority. In the past decade, tremendous advances in expanding computing capabilities--sensors, data analytics, networks, advanced imaging, and cyber-physical systems--have, and will continue to, enhance healthcare and health research, with resulting improvements in health and wellness. However, the cost and complexity of healthcare continues to rise alongside the impact of poor health on productivity and quality of life. What is lacking are transformative capabilities that address significant health and healthcare trends: the growing demands and costs of chronic disease, the greater responsibility placed on patients and informal caregivers, and the increasing complexity of health challenges in the US, including mental health, that are deeply rooted in a person's social and environmental context.Comment: A Computing Community Consortium (CCC) white paper, 12 page

Outbreak of Fatal Childhood Lead Poisoning Related to Artisanal Gold Mining in Northwestern Nigeria, 2010.

Background: In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. Objectives: To determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children aged <5 years in need of emergency chelation therapy for lead poisoning. Methods: We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children aged 2-59 months, and soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood-lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. Results: We surveyed 119 family compounds. One hundred eighteen of 463 (25%) children aged <5 years had died in the last year. We tested 59% (204/345) of children, aged <5 years, and all were lead poisoned (≥10 µg/dL); 97% (198/204) of children had blood-lead levels ≥45 µg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling significant risk factors for death in the previous year from suspected lead poisoning included: the child's age, the mother performing ore-processing activities, community well as primary water source, and the soil-lead concentration in the compound. Conclusion: The high levels of environmental contamination, percentage of children aged <5 years with elevated blood-lead levels (97%, >45 µg/dL), and incidence of convulsions among children prior to death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities

Social safety nets in fragile states : a community-based school feeding program in Togo

This paper reviews a small community-based school feeding program launched in Togo in response to the 2007/08 food price crisis. The discussion focuses on the operational and policy lessons emerging from the program, to better understand opportunities for scale up and sustainability in the future. A focus of the discussion is how to build safety nets in fragile states and in situations where there is weak and fragmented government capacity to deliver services to disadvantaged and vulnerable communities. In this context school feeding is explored as an entry point through the use of informal mechanisms based on the commitment of communities and civil society. The analysis is premised on quantitative and qualitative analysis carried out at program sites. The discussion identifies the operational challenges and opportunities in customizing school feeding within Togo with an emphasis on targeting, cost effectiveness, procurement and institutional aspects. Evidence on the economic and social benefits of the program is also presented, focusing on dietary impacts, as well as household and local community effects. The objective of the discussion is to share lessons learned from evaluation findings so that they can be useful for implementing similar programs in the future in Togo itself or in other countries. Findings from the analysis highlight the possibilities of implementing school feeding in a low capacity setting and the scope for using the program as a springboard towards a broader and more comprehensive social safety net.Food&Beverage Industry,Education For All,Safety Nets and Transfers,Disability,Rural Poverty Reduction

Social and behavioral determinants of health in the era of artificial intelligence with electronic health records: A scoping review

Background: There is growing evidence that social and behavioral determinants of health (SBDH) play a substantial effect in a wide range of health outcomes. Electronic health records (EHRs) have been widely employed to conduct observational studies in the age of artificial intelligence (AI). However, there has been little research into how to make the most of SBDH information from EHRs. Methods: A systematic search was conducted in six databases to find relevant peer-reviewed publications that had recently been published. Relevance was determined by screening and evaluating the articles. Based on selected relevant studies, a methodological analysis of AI algorithms leveraging SBDH information in EHR data was provided. Results: Our synthesis was driven by an analysis of SBDH categories, the relationship between SBDH and healthcare-related statuses, and several NLP approaches for extracting SDOH from clinical literature. Discussion: The associations between SBDH and health outcomes are complicated and diverse; several pathways may be involved. Using Natural Language Processing (NLP) technology to support the extraction of SBDH and other clinical ideas simplifies the identification and extraction of essential concepts from clinical data, efficiently unlocks unstructured data, and aids in the resolution of unstructured data-related issues. Conclusion: Despite known associations between SBDH and disease, SBDH factors are rarely investigated as interventions to improve patient outcomes. Gaining knowledge about SBDH and how SBDH data can be collected from EHRs using NLP approaches and predictive models improves the chances of influencing health policy change for patient wellness, and ultimately promoting health and health equity. Keywords: Social and Behavioral Determinants of Health, Artificial Intelligence, Electronic Health Records, Natural Language Processing, Predictive ModelComment: 32 pages, 5 figure

Considering Human Aspects on Strategies for Designing and Managing Distributed Human Computation

A human computation system can be viewed as a distributed system in which the processors are humans, called workers. Such systems harness the cognitive power of a group of workers connected to the Internet to execute relatively simple tasks, whose solutions, once grouped, solve a problem that systems equipped with only machines could not solve satisfactorily. Examples of such systems are Amazon Mechanical Turk and the Zooniverse platform. A human computation application comprises a group of tasks, each of them can be performed by one worker. Tasks might have dependencies among each other. In this study, we propose a theoretical framework to analyze such type of application from a distributed systems point of view. Our framework is established on three dimensions that represent different perspectives in which human computation applications can be approached: quality-of-service requirements, design and management strategies, and human aspects. By using this framework, we review human computation in the perspective of programmers seeking to improve the design of human computation applications and managers seeking to increase the effectiveness of human computation infrastructures in running such applications. In doing so, besides integrating and organizing what has been done in this direction, we also put into perspective the fact that the human aspects of the workers in such systems introduce new challenges in terms of, for example, task assignment, dependency management, and fault prevention and tolerance. We discuss how they are related to distributed systems and other areas of knowledge.Comment: 3 figures, 1 tabl

Associations between family functioning and adolescent health behaviors

Background: The obesity epidemic has been a concern across the globe, affecting about 20% of adolescents in the U.S. Physical activity and nutrition-related behaviors that develop during adolescence carry through into adulthood. Adolescents’ perceptions of how their family functions may be associated with health behaviors, including physical activity and diet. Objective: To determine whether there is an association between perceived family functioning and adolescent health behaviors among a national sample of adolescents aged 11 to 16 who participated in the 2009-2010 Health Behaviors of School-Aged Children survey. Methods: Participants reported on demographics and measures of family function, which included satisfaction with family relationships (very satisfied, satisfied, not satisfied) and mother/father knowledge of daily life (knowledge of friends, money spending; and time spent during free time, at night, and after school). In addition, adolescents reported on levels of physical activity and frequency of fruit and vegetable consumption. A series of analysis of covariance (ANCOVA) models were constructed to examine the associations between the measures of family function and health behaviors, controlling for socioeconomic status, race/ethnicity, and age. Separate models were conducted for males and females. Results: Participants (n=12,624) were racially diverse (52% white, 20% African American, 27% other) and 26% identified as Hispanic/Latino. Sixty-five percent of participants reported being satisfied with family relationships, 34% reported that their mothers were very knowledgeable of their daily life, while 21% reported that their fathers were very knowledgeable. Results of the ANCOVAs determined that all three family function measures were associated with physical activity, fruit and vegetable consumption. Individuals who reported greater satisfaction with their family relationships and whose mother and/or father were more knowledgeable about their lives were more physically active and consumed more fruits and vegetables (p\u3c0.05). Conclusion: Study results suggest that family functioning may be a significant factor in determining adolescent healthful behavior. Family function may be helpful when understanding the process of adolescent development and internalization of health behaviors. Further research may include family-centered interventions to increase positive family function