Timely and reliable evaluation of the effects of interventions: a framework for adaptive meta-analysis (FAME)

Most systematic reviews are retrospective and use aggregate data AD) from publications, meaning they can be unreliable, lag behind therapeutic developments and fail to influence ongoing or new trials. Commonly, the potential influence of unpublished or ongoing trials is overlooked when interpreting results, or determining the value of updating the meta-analysis or need to collect individual participant data (IPD). Therefore, we developed a Framework for Adaptive Metaanalysis (FAME) to determine prospectively the earliest opportunity for reliable AD meta-analysis. We illustrate FAME using two systematic reviews in men with metastatic (M1) and non-metastatic (M0)hormone-sensitive prostate cancer (HSPC)

Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential

What is the added value of using non-linear models to explore complex healthcare datasets?

Health care is a complex system and it is therefore expected to behave in a non-linear manner. It is important for the delivery of health interventions to patients that the best possible analysis of available data is undertaken. Many of the conventional models used for health care data are linear. This research compares the performance of linear models with non-linear models for two health care data sets of complex interventions. Logistic regression, latent class analysis and a classification artificial neural network were each used to model outcomes for patients using data from a randomised controlled trial of a cognitive behavioural complex intervention for non-specific low back pain. A Cox proportional hazards model and an artificial neural network were used to model survival and the hazards for different sub-groups of patients using an observational study of a cardiovascular rehabilitation complex intervention. The artificial neural network and an ordinary logistic regression were more accurate in classifying patient recovery from back pain than a logistic regression on latent class membership. The most sensitive models were the artificial neural network and the latent class logistic regression. The best overall performance was the artificial neural network, providing both sensitivity and accuracy. Survival was modelled equally well by the Cox model and the artificial neural network, when compared to the empirical Kaplan-Meier survival curve. Long term survival for the cardiovascular patients was strongly associated with secondary prevention medications, and fitness was also important. Moreover, improvement in fitness during the rehabilitation period to a fairly modest 'high fitness' category was as advantageous for long-term survival as having achieved that same level of fitness by the beginning of the rehabilitation period. Having adjusted for fitness, BMI was not a predictor of long term survival after a cardiac event or procedure. The Cox proportional hazards model was constrained by its assumptions to produce hazard trajectories proportional to the baseline hazard. The artificial neural network model produced hazard trajectories that vary, giving rise to hypotheses about how the predictors of survival interact in their influence on the hazard. The artificial neural network, an exemplar non-linear model, has been shown to match or exceed the capability of conventional models in the analysis of complex health care data sets

Sensing and Signal Processing in Smart Healthcare

In the last decade, we have witnessed the rapid development of electronic technologies that are transforming our daily lives. Such technologies are often integrated with various sensors that facilitate the collection of human motion and physiological data and are equipped with wireless communication modules such as Bluetooth, radio frequency identification, and near-field communication. In smart healthcare applications, designing ergonomic and intuitive human–computer interfaces is crucial because a system that is not easy to use will create a huge obstacle to adoption and may significantly reduce the efficacy of the solution. Signal and data processing is another important consideration in smart healthcare applications because it must ensure high accuracy with a high level of confidence in order for the applications to be useful for clinicians in making diagnosis and treatment decisions. This Special Issue is a collection of 10 articles selected from a total of 26 contributions. These contributions span the areas of signal processing and smart healthcare systems mostly contributed by authors from Europe, including Italy, Spain, France, Portugal, Romania, Sweden, and Netherlands. Authors from China, Korea, Taiwan, Indonesia, and Ecuador are also included

The Convergence of Human and Artificial Intelligence on Clinical Care - Part I

This edited book contains twelve studies, large and pilots, in five main categories: (i) adaptive imputation to increase the density of clinical data for improving downstream modeling; (ii) machine-learning-empowered diagnosis models; (iii) machine learning models for outcome prediction; (iv) innovative use of AI to improve our understanding of the public view; and (v) understanding of the attitude of providers in trusting insights from AI for complex cases. This collection is an excellent example of how technology can add value in healthcare settings and hints at some of the pressing challenges in the field. Artificial intelligence is gradually becoming a go-to technology in clinical care; therefore, it is important to work collaboratively and to shift from performance-driven outcomes to risk-sensitive model optimization, improved transparency, and better patient representation, to ensure more equitable healthcare for all

Information technologies for pain management

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. The importance of pain is attested by the fact that it is considered the fifth vital sign for indicating basic bodily functions, health and quality of life, together with the four other vital signs: blood pressure, body temperature, pulse rate and respiratory rate. However, while these four signals represent an objective physical parameter, the occurrence of pain expresses an emotional status that happens inside the mind of each individual and therefore, is highly subjective that makes difficult its management and evaluation. For this reason, the self-report of pain is considered the most accurate pain assessment method wherein patients should be asked to periodically rate their pain severity and related symptoms. Thus, in the last years computerised systems based on mobile and web technologies are becoming increasingly used to enable patients to report their pain which lead to the development of electronic pain diaries (ED). This approach may provide to health care professionals (HCP) and patients the ability to interact with the system anywhere and at anytime thoroughly changes the coordinates of time and place and offers invaluable opportunities to the healthcare delivery. However, most of these systems were designed to interact directly to patients without presence of a healthcare professional or without evidence of reliability and accuracy. In fact, the observation of the existing systems revealed lack of integration with mobile devices, limited use of web-based interfaces and reduced interaction with patients in terms of obtaining and viewing information. In addition, the reliability and accuracy of computerised systems for pain management are rarely proved or their effects on HCP and patients outcomes remain understudied. This thesis is focused on technology for pain management and aims to propose a monitoring system which includes ubiquitous interfaces specifically oriented to either patients or HCP using mobile devices and Internet so as to allow decisions based on the knowledge obtained from the analysis of the collected data. With the interoperability and cloud computing technologies in mind this system uses web services (WS) to manage data which are stored in a Personal Health Record (PHR). A Randomised Controlled Trial (RCT) was implemented so as to determine the effectiveness of the proposed computerised monitoring system. The six weeks RCT evidenced the advantages provided by the ubiquitous access to HCP and patients so as to they were able to interact with the system anywhere and at anytime using WS to send and receive data. In addition, the collected data were stored in a PHR which offers integrity and security as well as permanent on line accessibility to both patients and HCP. The study evidenced not only that the majority of participants recommend the system, but also that they recognize it suitability for pain management without the requirement of advanced skills or experienced users. Furthermore, the system enabled the definition and management of patient-oriented treatments with reduced therapist time. The study also revealed that the guidance of HCP at the beginning of the monitoring is crucial to patients' satisfaction and experience stemming from the usage of the system as evidenced by the high correlation between the recommendation of the application, and it suitability to improve pain management and to provide medical information. There were no significant differences regarding to improvements in the quality of pain treatment between intervention group and control group. Based on the data collected during the RCT a clinical decision support system (CDSS) was developed so as to offer capabilities of tailored alarms, reports, and clinical guidance. This CDSS, called Patient Oriented Method of Pain Evaluation System (POMPES), is based on the combination of several statistical models (one-way ANOVA, Kruskal-Wallis and Tukey-Kramer) with an imputation model based on linear regression. This system resulted in fully accuracy related to decisions suggested by the system compared with the medical diagnosis, and therefore, revealed it suitability to manage the pain. At last, based on the aerospace systems capability to deal with different complex data sources with varied complexities and accuracies, an innovative model was proposed. This model is characterized by a qualitative analysis stemming from the data fusion method combined with a quantitative model based on the comparison of the standard deviation together with the values of mathematical expectations. This model aimed to compare the effects of technological and pen-and-paper systems when applied to different dimension of pain, such as: pain intensity, anxiety, catastrophizing, depression, disability and interference. It was observed that pen-and-paper and technology produced equivalent effects in anxiety, depression, interference and pain intensity. On the contrary, technology evidenced favourable effects in terms of catastrophizing and disability. The proposed method revealed to be suitable, intelligible, easy to implement and low time and resources consuming. Further work is needed to evaluate the proposed system to follow up participants for longer periods of time which includes a complementary RCT encompassing patients with chronic pain symptoms. Finally, additional studies should be addressed to determine the economic effects not only to patients but also to the healthcare system

Pipe failure prediction and impacts assessment in a water distribution network

Abstract Water distribution networks (WDNs) aim to provide water with desirable quantity, quality and pressure to the consumers. However, in case of pipe failure, which is the cumulative effect of physical, operational and weather-related factors, the WDN might fail to meet these objectives. Rehabilitation and replacement of some components of WDNs, such as pipes, is a common practice to improve the condition of the network to provide an acceptable level of service. The overall aim of this thesis is to predict—long-term, annually and short-term—the pipe failure propensity and assess the impacts of a single pipe failure on the level of service. The long-term and annual predictions facilitate the need for effective capital investment, whereas the short-term predictions have an operational use, enabling the water utilities to adjust the daily allocation and planning of resources to accommodate possible increase in pipe failure. The proposed methodology was implemented to the cast iron (CI) pipes in a UK WDN. The long-term and annual predictions are made using a novel combination of Evolutionary Polynomial Regression (EPR) and K-means clustering. The inclusion of K-means improves the predictions’ accuracy by using a set of models instead of a single model. The long-term predictive models consider physical factors, while the annual predictions also include weather-related factors. The analysis is conducted on a group level assuming that pipes with similar properties have similar breakage patterns. Soil type is another aggregation criterion since soil properties are associated with the corrosion of metallic pipes. The short-term predictions are based on a novel Artificial Neural Network (ANN) model that predicts the variations above a predefined threshold in the number of failures in the following days. The ANN model uses only existing weather data to make predictions reducing their uncertainty. The cross-validation technique is used to derive an accurate estimate of accuracy of EPR and ANN models by guaranteeing that all observations are used for both training and testing, and each observation is used for testing only once. The impact of pipe failure is assessed considering its duration, the topology of the network, the geographic location of the failed pipe and the time. The performance indicators used are the ratio of unsupplied demand and the number of customers with partial or no supply. Two scenarios are examined assuming that the failure occurs when there is a peak in either pressure or demand. The pressure-deficient conditions are simulated by introducing a sequence of artificial elements to all the demand nodes with pressure less than the required. This thesis proposes a new combination of a group-based method for deriving the failure rate and an individual-pipe method for evaluating the impacts on the level of service. Their conjunction indicates the most critical pipes. The long-term approach improves the accuracy of predictions, particularly for the groups with very low or very high failure frequency, considering diameter, age and length. The annual predictions accurately predict the fluctuation of failure frequency and its peak during the examined period. The EPR models indicate a strong direct relationship between low temperatures and failure frequency. The short-term predictions interpret the intra-year variation of failure frequency, with most failures occurring during the coldest months. The exhaustive trials led to the conclusion that the use of four consecutive days as input and the following two days as output results in the highest accuracy. The analysis of the relative significance of each input variable indicates that the variables that capture the intensity of low temperatures are the most influential. The outputs of the impact assessment indicate that the failure of most of the pipes in both scenarios (i.e. peak in pressure and demand) would have low impacts (i.e. low ratio of unsupplied demand and small number of affected nodes). This can be explained by the fact that the examined network is a large real-life network, and a single failure of a distribution pipe is likely to cause pressure-deficient conditions in a small part of it, whereas performance elsewhere is mostly satisfactory. Furthermore, the complex structure of the WDN allows them to recover from local pipe failures, exploiting the topological redundancy provided by closed loops, so that the flow could reach a given demand node through alternative paths

INTEGRATION OF INTERNET OF THINGS AND HEALTH RECOMMENDER SYSTEMS

The Internet of Things (IoT) has become a part of our lives and has provided many enhancements to day-to-day living. In this project, IoT in healthcare is reviewed. IoT-based healthcare is utilized in remote health monitoring, observing chronic diseases, individual fitness programs, helping the elderly, and many other healthcare fields. There are three main architectures of smart IoT healthcare: Three-Layer Architecture, Service-Oriented Based Architecture (SoA), and The Middleware-Based IoT Architecture. Depending on the required services, different IoT architecture are being used. In addition, IoT healthcare services, IoT healthcare service enablers, IoT healthcare applications, and IoT healthcare services focusing on Smartwatch are presented in this research. Along with IoT in smart healthcare, Health Recommender Systems integration with IoT is important. Main Recommender Systems including Content-based filtering, Collaborative-based filtering, Knowledge-based filtering, and Hybrid filtering with machine learning algorithms are described for the Health Recommender Systems. In this study, a framework is presented for the IoT-based Health Recommender Systems. Also, a case is investigated on how different algorithms can be used for Recommender Systems and their accuracy levels are presented. Such a framework can help with the health issues, for example, risk of going to see the doctor during pandemic, taking quick actions in any health emergencies, affordability of healthcare services, and enhancing the personal lifestyle using recommendations in non-critical conditions. The proposed framework can necessitate further development of IoT-based Health Recommender Systems so that people can mitigate their medical emergencies and live a healthy life