Deep ensemble multitask classification of emergency medical call incidents combining multimodal data improves emergency medical dispatch

[EN] The objective of this work was to develop a predictive model to aid non-clinical dispatchers to classify emergency medical call incidents by their life-threatening level (yes/no), admissible response delay (undelayable, minutes, hours, days) and emergency system jurisdiction (emergency system/primary care) in real time. We used a total of 1 244 624 independent incidents from the Valencian emergency medical dispatch service in Spain, compiled in retrospective from 2009 to 2012, including clinical features, demographics, circumstantial factors and free text dispatcher observations. Based on them, we designed and developed DeepEMC2, a deep ensemble multitask model integrating four subnetworks: three specialized to context, clinical and text data, respectively, and another to ensemble the former. The four subnetworks are composed in turn by multi-layer perceptron modules, bidirectional long short-term memory units and a bidirectional encoding representations from transformers module. DeepEMC2 showed a macro F1-score of 0.759 in life-threatening classification, 0.576 in admissible response delay and 0.757 in emergency system jurisdiction. These results show a substantial performance increase of 12.5 %, 17.5 % and 5.1 %, respectively, with respect to the current in-house triage protocol of the Valencian emergency medical dispatch service. Besides, DeepEMC2 significantly outperformed a set of baseline machine learning models, including naive bayes, logistic regression, random forest and gradient boosting (¿ = 0.05). Hence, DeepEMC2 is able to: 1) capture information present in emergency medical calls not considered by the existing triage protocol, and 2) model complex data dependencies not feasible by the tested baseline models. Likewise, our results suggest that most of this unconsidered information is present in the free text dispatcher observations. To our knowledge, this study describes the first deep learning model undertaking emergency medical call incidents classification. Its adoption in medical dispatch centers would potentially improve emergency dispatch processes, resulting in a positive impact in patient wellbeing and health services sustainability.This work has been supported by the Valencian agency for security and emergency response project A1800173041, the Ministry of Science, Innovation and Universities of Spain program FPU18/06441 and the EU Horizon 2020 project InAdvance 825750Ferri-Borredà, P.; Sáez Silvestre, C.; Felix-De Castro, A.; Juan-Albarracín, J.; Blanes-Selva, V.; Sánchez-Cuesta, P.; Garcia-Gomez, JM. (2021). Deep ensemble multitask classification of emergency medical call incidents combining multimodal data improves emergency medical dispatch. Artificial Intelligence in Medicine. 117:1-13. https://doi.org/10.1016/j.artmed.2021.102088S11311

Detection of psychological stress using a hyperspectral imaging technique

The detection of stress at early stages is beneficial to both individuals and communities. However, traditional stress detection methods that use physiological signals are contact-based and require sensors to be in contact with test subjects for measurement. In this paper, we present a method to detect psychological stress in a non-contact manner using a human physiological response. In particular, we utilize a hyperspectral imaging (HSI) technique to extract the tissue oxygen saturation (StO2) value as a physiological feature for stress detection. Our experimental results indicate that this new feature may be independent from perspiration and ambient temperature. Trier Social Stress Tests (TSSTs) on 21 volunteers demonstrated a significant difference p\< 0.005 and a large practical discrimination (d 1/4 1.37) between normalized baseline and stress StO2 levels. The accuracy for stress recognition from baseline using a binary classifier was 76.19 and 88.1 percent for the automatic and manual selections of the classifier threshold, respectively. These results suggest that the StO2 level could serve as a new modality to recognize stress at standoff distances

A clinical patient vital signs parameter measurement, processing and predictive algorithm using ECG

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.In the modern clinical and healthcare setting, the electronic collection and analysis of patient related vital signs and parameters are a fundamental part of the relevant treatment plan and positive patient response. Modern analytical techniques combined with readily available computer software today allow for the near real time analysis of digitally acquired measurements. In the clinical context, this can directly relate to patient survival rates and treatment success. The processing of clinical parameters, especially the Electrocardiogram (ECG) in the critical care setting has changed little in recent years and the analytical processes have mostly been managed by highly trained and experienced cardiac specialists. Warning, detection and measurement techniques are focused on the post processing of events relying heavily on averaging and analogue filtering to accurately capture waveform morphologies and deviations. This Ph.D. research investigates an alternative and the possibility to analyse, in the digital domain, bio signals with a focus on the ECG to determine if the feasibility of bit by bit or near real time analysis is indeed possible but more so if the data captured has any significance in the analysis and presentation of the wave patterns in a patient monitoring environment. The research and experiments have shown the potential for the development of logical models that address both the detection and short term predication of possible follow-on events with a focus on Myocardial Ischemic (MI) and Infraction based deviations. The research has shown that real time waveform processing compared to traditional graph based analysis, is both accurate and has the potential to be of benefit to the clinician by detecting deviations and morphologies in a real time domain. This is a significant step forward and has the potential to embed years of clinical experience into the measurement processes of clinical devices, in real terms. Also, providing expert analytical and identification input electronically at the patient bedside. The global human population is testing the healthcare systems and care capabilities with the shortage of clinical and healthcare providers in ever decreasing coverage of treatment that can be provided. The research is a moderate step in further realizing this and aiding the caregiver by providing true and relevant information and data, which assists in the clinical decision process and ultimately improving the required standard of patient care

The Stress Factors among the Call Takers of the Emergency Phone Numbers 112 and 150.

Abstrakt Tato bakalářská práce se věnuje problematice úrovně stresové zátěže, která působí na pracovníky ve službě Hasičského záchranného sboru České republiky zaměstnané na pozici operátorů linky tísňového volání 112 a 150. Vzhledem k tématu práce jsou v její teoretické části představeny základní informace o Hasičském záchranném sboru České republiky a o fungování jeho operačních středisek. Dále práce poskytuje souhrnné informace o telefonním centru tísňového volání 112, jeho historii a principy fungování. V práci jsou čtenářům přiblíženy pojmy související se stresem na pracovišti, důsledky které dlouhodobé působení stresu může na člověku zanechat a možnosti, jak stres zvládat a vyrovnávat se s ním. Empirická část práce je vytvořena kombinovaným vyhodnocením dat získaných prostřednictvím použití dotazníku a měření hodnot tepové frekvence hrudním pásem.Abstract This Bachelor work deals with an issue of level of stress affecting employees of the Fire Brigade of the Czech Republic working as emergency line 112 and 150 operators. The theoretical part of the work introduces basic information on the Fire Brigade of the Czech Republic and on operating its dispatch centres. The work furthermore provides summarised information regarding emergency call centre 112, its history and principles of its operation. The work also clarifies various terms related to workplace stress, consequences of long-term stress and possibilities how to manage and cope with stress. The empirical part consists of a combined evaluation of the data obtained through questionnaires and the measurement of the heart rate values by using a chest belt

A clinical patient vital signs parameter measurement, processing and predictive algorithm using ECG

In the modern clinical and healthcare setting, the electronic collection and analysis of patient related vital signs and parameters are a fundamental part of the relevant treatment plan and positive patient response. Modern analytical techniques combined with readily available computer software today allow for the near real time analysis of digitally acquired measurements. In the clinical context, this can directly relate to patient survival rates and treatment success. The processing of clinical parameters, especially the Electrocardiogram (ECG) in the critical care setting has changed little in recent years and the analytical processes have mostly been managed by highly trained and experienced cardiac specialists. Warning, detection and measurement techniques are focused on the post processing of events relying heavily on averaging and analogue filtering to accurately capture waveform morphologies and deviations. This Ph. D. research investigates an alternative and the possibility to analyse, in the digital domain, bio signals with a focus on the ECG to determine if the feasibility of bit by bit or near real time analysis is indeed possible but more so if the data captured has any significance in the analysis and presentation of the wave patterns in a patient monitoring environment. The research and experiments have shown the potential for the development of logical models that address both the detection and short term predication of possible follow-on events with a focus on Myocardial Ischemic (MI) and Infraction based deviations. The research has shown that real time waveform processing compared to traditional graph based analysis, is both accurate and has the potential to be of benefit to the clinician by detecting deviations and morphologies in a real time domain. This is a significant step forward and has the potential to embed years of clinical experience into the measurement processes of clinical devices, in real terms. Also, providing expert analytical and identification input electronically at the patient bedside. The global human population is testing the healthcare systems and care capabilities with the shortage of clinical and healthcare providers in ever decreasing coverage of treatment that can be provided. The research is a moderate step in further realizing this and aiding the caregiver by providing true and relevant information and data, which assists in the clinical decision process and ultimately improving the required standard of patient care.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Analysis and design of individual information systems to support health behavior change

As a wide-ranging socio-technical transformation, the digitalization has significantly influenced the world, bringing opportunities and challenges to our lives. Despite numerous benefits like the possibility to stay connected with people around the world, the increasing dispersion and use of digital technologies and media (DTM) pose risks to individuals’ well-being and health. Rising demands emerging from the digital world have been linked to digital stress, that is, stress directly or indirectly resulting from DTM (Ayyagari et al. 2011; Ragu-Nathan et al. 2008; Tarafdar et al. 2019; Weil and Rosen 1997), potentially intensifying individuals’ overall exposure to stress. Individuals experiencing this adverse consequence of digitalization are at elevated risk of developing severe mental health impairments (Alhassan et al. 2018; Haidt and Allen 2020; Scott et al. 2017), which is why various scholars emphasize that research should place a stronger focus on analyzing and shaping the role of the individual in a digital world, pursuing instrumental as well as humanistic objectives (Ameen et al. 2021; Baskerville 2011b). Information Systems (IS) research has long placed emphasis on the use of information and communication technology (ICT) in organizations, viewing an information system as the socio-technical system that emerges from individuals’ interaction with DTM in organizations. However, socio-technical information systems, as the essence of the IS discipline (Lee 2004; Sarker et al. 2019), are also present in different social contexts from private life. Acknowledging the increasing private use of DTM, such as smartphones and social networks, IS scholars have recently intensified their efforts to understand the human factor of IS (Avison and Fitzgerald 1991; Turel et al. 2021). A framework recently proposed by Matt et al. (2019) suggests three research angles: analyzing individuals’ behavior associated with their DTM use, analyzing what consequences arise from their DTM use behavior, and designing new technologies that promote positive or mitigate negative effects of individuals’ DTM use. Various recent studies suggest that individuals’ behavior seems to be an important lever influencing the outcomes of their DTM use (Salo et al. 2017; Salo et al. 2020; Weinstein et al. 2016). Therefore, this dissertation aims to contribute to IS research targeting the facilitation of a healthy DTM use behavior. It explores the use behavior, consequences, and design of DTM for individuals' use with the objective to deliver humanistic value by increasing individuals' health through supporting a behavior change related to their DTM use. The dissertation combines behavioral science and design science perspectives and applies pluralistic methodological approaches from qualitative (e.g., interviews, prototyping) and quantitative research (e.g., survey research, field studies), including mixed-methods approaches mixing both. Following the framework from Matt et al. (2019), the dissertation takes three perspectives therein: analyzing individuals’ behavior, analyzing individuals’ responses to consequences of DTM use, and designing information systems assisting DTM users. First, the dissertation presents new descriptive knowledge on individuals’ behavior related to their use of DTM. Specifically, it investigates how individuals behave when interacting with DTM, why they behave the way they do, and how their behavior can be influenced. Today, a variety of digital workplace technologies offer employees different ways of pursuing their goals or performing their tasks (Köffer 2015). As a result, individuals exhibit different behaviors when interacting with these technologies. The dissertation analyzes what interactional roles DTM users can take at the digital workplace and what may influence their behavior. It uses a mixed-methods approach and combines a quantitative study building on trace data from a popular digital workplace suite and qualitative interviews with users of this digital workplace suite. The empirical analysis yields eight user roles that advance the understanding of users’ behavior at the digital workplace and first insights into what factors may influence this behavior. A second study adds another perspective and investigates how habitual behavior can be changed by means of DTM design elements. Real-time feedback has been discussed as a promising way to do so (Schibuola et al. 2016; Weinmann et al. 2016). In a field experiment, employees working at the digital workplace are provided with an external display that presents real-time feedback on their office’s indoor environmental quality. The experiment examines if and to what extent the feedback influences their ventilation behavior to understand the effect of feedback as a means of influencing individuals’ behavior. The results suggest that real-time feedback can effectively alter individuals’ behavior, yet the feedback’s effectiveness reduces over time, possibly as a result of habituation to the feedback. Second, the dissertation presents new descriptive and prescriptive knowledge on individuals’ ways to mitigate adverse consequences arising from the digitalization of individuals. A frequently discussed consequence that digitalization has on individuals is digital stress. Although research efforts strive to determine what measures individuals can take to effectively cope with digital stress (Salo et al. 2017; Salo et al. 2020; Weinert 2018), further understanding of individuals’ coping behavior is needed (Weinert 2018). A group at high risk of suffering from the adverse effects of digital stress is adolescents because they grow up using DTM daily and are still developing their identity, acquiring mental strength, and adopting essential social skills. To facilitate a healthy DTM use, the dissertation explores what strategies adolescents use to cope with the demands of their DTM use. Combining a qualitative and a quantitative study, it presents 30 coping responses used by adolescents, develops five factors underlying adolescents’ activation of coping responses, and identifies gender- and age-related differences in their coping behavior. Third, the dissertation presents new prescriptive knowledge on the design of individual information systems supporting individuals in understanding and mitigating their perceived stress. Facilitated by the sensing capabilities of modern mobile devices, it explores the design and development of mobile systems that assess stress and support individuals in coping with stress by initiating a change of stress-related behavior. Since there is currently limited understanding of how to develop such systems, this dissertation explores various facets of their design and development. As a first step, it presents the development of a prototype aiming for life-integrated stress assessment, that is, the mobile sensor-based assessment of an individual’s stress without interfering with their daily routines. Data collected with the prototype yields a stress model relating sensor data to individuals’ perception of stress. To deliver a more generalized perspective on mobile stress assessment, the dissertation further presents a literature- and experience-based design theory comprising a design blueprint, design requirements, design principles, design features, and a discussion of potentially required trade-offs. Mobile stress assessment may be used for the development of mobile coping assistants. Aiming to assist individuals in effectively coping with stress and preventing future stress, a mobile coping assistant should recommend adequate coping strategies to the stressed individual in real-time or execute targeted actions within a defined scope of action automatically. While the implementation of a mobile coping assistant is yet up to future research, the dissertation presents an abstract design and algorithm for selecting appropriate coping strategies. To sum up, this dissertation contributes new knowledge on the digitalization of individuals to the IS knowledge bases, expanding both descriptive and prescriptive knowledge. Through the combination of diverse methodological approaches, it delivers knowledge on individuals’ behavior when using DTM, on the mitigation of consequences that may arise from individuals’ use of DTM, and on the design of individual information systems with the goal of facilitating a behavior change, specifically, regarding individuals’ coping with stress. Overall, the research contained in this dissertation may promote the development of digital assistants that support individuals’ in adopting a healthy DTM use behavior and thereby contribute to shaping a socio-technical environment that creates more benefit than harm for all individuals

Künstliche Intelligenz und Gesundheit

Der Einsatz von künstlicher Intelligenz im Gesundheitsbereich verspricht besonders großen Nutzen durch eine bessere Versorgung sowie effizientere Abläufe und bietet damit letztlich auch ökonomische Vorteile. Dem stehen unter anderem Befürchtungen entgegen, dass sich durch den Einsatz von künstlicher Intelligenz das Arzt-Patienten-Verhältnis verändern könnte, Arbeitsplätze gefährdet seien oder die Ökonomisierung des Gesundheitswesens einen weiteren Schub erfahren könnte. Zuweilen wird die Debatte um diese Technologie, zumal in der Öffentlichkeit, emotional und fern sachlicher Argumente geführt. Die Autorinnen und Autoren untersuchen die Geschichte des KI-Einsatzes in der Medizin, deren öffentliche Wahrnehmung, Governance der KI, die Möglichkeiten und Grenzen der Technik sowie Einsatzgebiete, die bisher noch nicht oder nur wenig im Fokus der Aufmerksamkeit waren. Dabei erweist sich die KI als leistungsfähiges Werkzeug, das zahlreiche ethische und soziale Fragen aufwirft, die bei der Einführung anderer Technologien bereits gestellt wurden; allerdings gibt es auch neue Herausforderungen, denen sich Professionen, Politik und Gesellschaft stellen müssen

Automatic stress detection in emergency (telephone) calls

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