DeepCare: A Deep Dynamic Memory Model for Predictive Medicine

Personalized predictive medicine necessitates the modeling of patient illness and care processes, which inherently have long-term temporal dependencies. Healthcare observations, recorded in electronic medical records, are episodic and irregular in time. We introduce DeepCare, an end-to-end deep dynamic neural network that reads medical records, stores previous illness history, infers current illness states and predicts future medical outcomes. At the data level, DeepCare represents care episodes as vectors in space, models patient health state trajectories through explicit memory of historical records. Built on Long Short-Term Memory (LSTM), DeepCare introduces time parameterizations to handle irregular timed events by moderating the forgetting and consolidation of memory cells. DeepCare also incorporates medical interventions that change the course of illness and shape future medical risk. Moving up to the health state level, historical and present health states are then aggregated through multiscale temporal pooling, before passing through a neural network that estimates future outcomes. We demonstrate the efficacy of DeepCare for disease progression modeling, intervention recommendation, and future risk prediction. On two important cohorts with heavy social and economic burden -- diabetes and mental health -- the results show improved modeling and risk prediction accuracy.Comment: Accepted at JBI under the new name: "Predicting healthcare trajectories from medical records: A deep learning approach

Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry.

Background Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography-determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP. Methods and Results Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher-ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78-0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52-0.67]; Duke coronary artery disease score, 0.74 [0.68-0.79]; ML model 1, 0.62 [0.55-0.69]; ML model 2, 0.73 [0.67-0.80]; all P<0.001; statistical model, 0.81 [0.75-0.87], P=0.128). Conclusions Based on a ML framework, quantitative atherosclerosis characterization has been shown to be the most important feature when compared with clinical, laboratory, and qualitative measures in identifying patients at risk of RPP

Using neurite orientation dispersion and density imaging and tracts constrained by underlying anatomy to differentiate between subjects along the Alzheimer's disease continuum

OBJECTIVE: To assess the involvement of the white matter of the brain in the pathology of Alzheimer’s disease. Using Neurite Orientation Density and Dispersion Imaging (NODDI) and the probabilistic white matter parcellation tool Tracula as a means for understanding whether alterations in the white matter underlie changes in perceived cognitive abilities across the spectrum from health aging to Alzheimer’s disease. METHOD: Data were obtained from 28 participants in the Health Outreach Program for the Elderly (HOPE) at the Boston University Alzheimer’s Disease Center (BU ADC) Clinical Core Registry. MRI scans included an MPRAGE T1 scan, multi-b shell diffusion scan and a High Angular Resolution Diffusion Imaging scan (HARDI). Scans were processed with Freesurfer v6.0 and the NODDI Python2.7 toolkit. The resulting data included the orientation dispersion index (ODI) and Fractional Anisotropy (FA) values for cortical and subcortical regions in the DKT atlas space as well as specific Tracts Constrained by Underlying Anatomy (TRACULA) measurements for 18 specific established white matter tracts. Statistical models using measures of pathway integrity (FA and ODI data) were used to assess relationships with Informant Cognitive Change Index (ICCI), self-described Cognitive Change Index (CCI), and Clinical Dementia Rating (CDR) values. RESULTS: Measures of white matter integrity within several tracts predicted ICCI and CDR well in statistical models. FA and ODI values of the bilateral superior longitudinal fasciculi, inferior longitudinal fasciculi, and the cingulum bundle tracts were all related to ICCI and CDR. None of the known tracts’ FA or ODI values were related to CCI. CONCLUSIONS: Measures of white matter pathway integrity were predictive of ICCI and CDR scores but not CCI. These finding support the notion that self-report of cognitive abilities may be compromised by alterations in insight and reinforce the need for informed study partners and clinical ratings to evaluate potential MCI and AD

Prediction of progression in idiopathic pulmonary fibrosis using CT scans atbaseline: A quantum particle swarm optimization - Random forest approach

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by an unpredictable progressive declinein lung function. Natural history of IPF is unknown and the prediction of disease progression at the time ofdiagnosis is notoriously difficult. High resolution computed tomography (HRCT) has been used for the diagnosisof IPF, but not generally for monitoring purpose. The objective of this work is to develop a novel predictivemodel for the radiological progression pattern at voxel-wise level using only baseline HRCT scans. Mainly, thereare two challenges: (a) obtaining a data set of features for region of interest (ROI) on baseline HRCT scans andtheir follow-up status; and (b) simultaneously selecting important features from high-dimensional space, andoptimizing the prediction performance. We resolved the first challenge by implementing a study design andhaving an expert radiologist contour ROIs at baseline scans, depending on its progression status in follow-upvisits. For the second challenge, we integrated the feature selection with prediction by developing an algorithmusing a wrapper method that combines quantum particle swarm optimization to select a small number of featureswith random forest to classify early patterns of progression. We applied our proposed algorithm to analyzeanonymized HRCT images from 50 IPF subjects from a multi-center clinical trial. We showed that it yields aparsimonious model with 81.8% sensitivity, 82.2% specificity and an overall accuracy rate of 82.1% at the ROIlevel. These results are superior to other popular feature selections and classification methods, in that ourmethod produces higher accuracy in prediction of progression and more balanced sensitivity and specificity witha smaller number of selected features. Our work is the first approach to show that it is possible to use onlybaseline HRCT scans to predict progressive ROIs at 6 months to 1year follow-ups using artificial intelligence

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

<i>Aims/hypothesis</i> The aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as quality-adjusted life expectancy. <i>Methods</i> Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control. <i>Results</i> The models forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: –0.48 to 1.03). <i>Conclusions/interpretations</i> The UKPDS Outcomes Model is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in Type 2 diabetes