Visual Anomaly Detection in Event Sequence Data

Anomaly detection is a common analytical task that aims to identify rare cases that differ from the typical cases that make up the majority of a dataset. When applied to the analysis of event sequence data, the task of anomaly detection can be complex because the sequential and temporal nature of such data results in diverse definitions and flexible forms of anomalies. This, in turn, increases the difficulty in interpreting detected anomalies. In this paper, we propose an unsupervised anomaly detection algorithm based on Variational AutoEncoders (VAE) to estimate underlying normal progressions for each given sequence represented as occurrence probabilities of events along the sequence progression. Events in violation of their occurrence probability are identified as abnormal. We also introduce a visualization system, EventThread3, to support interactive exploration and interpretations of anomalies within the context of normal sequence progressions in the dataset through comprehensive one-to-many sequence comparison. Finally, we quantitatively evaluate the performance of our anomaly detection algorithm and demonstrate the effectiveness of our system through a case study

Medical data processing and analysis for remote health and activities monitoring

Recent developments in sensor technology, wearable computing, Internet of Things (IoT), and wireless communication have given rise to research in ubiquitous healthcare and remote monitoring of human\u2019s health and activities. Health monitoring systems involve processing and analysis of data retrieved from smartphones, smart watches, smart bracelets, as well as various sensors and wearable devices. Such systems enable continuous monitoring of patients psychological and health conditions by sensing and transmitting measurements such as heart rate, electrocardiogram, body temperature, respiratory rate, chest sounds, or blood pressure. Pervasive healthcare, as a relevant application domain in this context, aims at revolutionizing the delivery of medical services through a medical assistive environment and facilitates the independent living of patients. In this chapter, we discuss (1) data collection, fusion, ownership and privacy issues; (2) models, technologies and solutions for medical data processing and analysis; (3) big medical data analytics for remote health monitoring; (4) research challenges and opportunities in medical data analytics; (5) examples of case studies and practical solutions

Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study

OBJECTIVE To assess the association between macrolide antibiotics prescribing during pregnancy and major malformations, cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder in children. DESIGN Population based cohort study. SETTING The UK Clinical Practice Research Datalink. PARTICIPANTS The study cohort included 104 605 children born from 1990 to 2016 whose mothers were prescribed one macrolide monotherapy (erythromycin, clarithromycin, or azithromycin) or one penicillin monotherapy from the fourth gestational week to delivery. Two negative control cohorts consisted of 82 314 children whose mothers were prescribed macrolides or penicillins before conception, and 53 735 children who were siblings of the children in the study cohort. MAIN OUTCOME MEASURES Risks of any major malformations and system specific major malformations (nervous, cardiovascular, gastrointestinal, genital, and urinary) after macrolide or penicillin prescribing during the first trimester (four to 13 gestational weeks), second to third trimester (14 gestational weeks to birth), or any trimester of pregnancy. Additionally, risks of cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder. RESULTS Major malformations were recorded in 186 of 8632 children (21.55 per 1000) whose mothers were prescribed macrolides and 1666 of 95 973 children (17.36 per 1000) whose mothers were prescribed penicillins during pregnancy. Macrolide prescribing during the first trimester was associated with an increased risk of any major malformation compared with penicillin (27.65 v 17.65 per 1000, adjusted risk ratio 1.55, 95% confidence interval 1.19 to 2.03) and specifically cardiovascular malformations (10.60 v 6.61 per 1000, 1.62, 1.05 to 2.51). Macrolide prescribing in any trimester was associated with an increased risk of genital malformations (4.75 v 3.07 per 1000, 1.58, 1.14 to 2.19, mainly hypospadias). Erythromycin in the first trimester was associated with an increased risk of any major malformation (27.39 v 17.65 per 1000, 1.50, 1.13 to 1.99). No statistically significant associations were found for other system specific malformations or for neurodevelopmental disorders. Findings were robust to sensitivity analyses. CONCLUSIONS Prescribing macrolide antibiotics during the first trimester of pregnancy was associated with an increased risk of any major malformation and specifically cardiovascular malformations compared with penicillin antibiotics. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations. These findings show that macrolides should be used with caution during pregnancy and if feasible alternative antibiotics should be prescribed until further research is available. TRIAL REGISTRATION ClinicalTrials.gov NCT0394862

Pattern discovery in adverse event data

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Adverse paediatric outcomes of macrolide antibiotics treatment in pregnancy

Background: Over the last 20 years, concerns have been raised about rare but serious adverse outcomes associated with macrolide use during pregnancy. Currently there was no consensus about whether macrolides are considered safe in pregnancy or not. This PhD study aims to examine the association between maternal exposure of macrolide antibiotics during pregnancy and adverse paediatric outcomes where short-term fetal hypoxia could be aetiologically involved. Methods: I first conducted a systematic review and meta-analysis of both random controlled trials and observational studies to investigate the association. I prioritized comparisons of macrolides with alternative antibiotics (mainly penicillins) for comparability of indication and effect. I then performed a large cohort study using a mother-baby linkage derived from the Clinical Practice Research Datalink (CPRD), a UK-representative primary care database. The cohort study assessed the association between macrolide (versus penicillin) prescribing during pregnancy and major malformations, cerebral palsy, epilepsy, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) in children. Results: The systematic review and meta-analysis found consistent evidence for an association between macrolide antibiotics use during early pregnancy and an increased risk of miscarriage, inconsistent evidence for cerebral palsy and epilepsy, and insufficient evidence for malformations, stillbirth and neonatal death. The cohort study demonstrated that prescribing macrolides compared with penicillins during the first trimester of pregnancy (4 to 13 Gestational Week) was associated with increased risks of any major malformation and specifically cardiovascular malformations. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations (mostly hypospadias). Erythromycin in the first trimester was found to be associated with an increased risk of any major malformation. Indication bias, unmeasured confounding, live-birth bias and outcome misclassification were unlikely to explain the findings. Conclusions: Considering the widespread use of macrolides during pregnancy, international collaboration is in urgent need to bring together existing datasets for large-scale analyses of high quality trial and observational cohorts that have accurate measurements of macrolides treatment and specific child outcomes. Analyses should pre-specify treatment exposure periods based on the critical period of specific outcomes. The findings of this study warrant cautious use of macrolides in pregnancy and recommendation of alternative antibiotics where feasible

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

The safety of antipsychotic use during pregnancy

Aim: To investigate the patterns of gestational antipsychotics use and whether exposure to antipsychotic medications in pregnancy is associated with gestational diabetes mellitus (GDM) in mothers and seizure, attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), preterm birth (PTB) and small for gestational age (SFGA) in subsequent children. Methods: Firstly, a methodological review was conducted to review the methodological characteristics of existing observational studies that investigate the association between prenatal central nervous system (CNS) drugs use and CNS disorders. Secondly, a systematic review and meta-analysis was conducted to evaluate the evidence-based association between gestational antipsychotic use and GDM. Thirdly, a cross-sectional study was conducted to investigate the patterns and trends of antipsychotics use during pregnancy in the United Kingdom (UK) and Hong Kong (HK). Lastly, seven cohort studies were conducted to investigate the association between antipsychotics use in pregnancy and the risk of above-mentioned outcomes, respectively. Results: 4.64% and 0.34% of pregnancies were prescribed at least one prescription of antipsychotic during pregnancy in the UK and HK, respectively. When women who continued using antipsychotics during pregnancy were compared with those who had stopped, there was no evidence to demonstrate an increased risk of GDM. No evidence supported prenatal exposure to antipsychotics can increase the risk of ADHD/ASD/SFGA. Children with prenatal antipsychotics exposure was associated with an increased risk of seizure (HR 1.49, 95% CI 1.11-1.99) and PTB (OR 1.40, 95%CI 1.13-1.75), comparing to those without. However, further sibling-matched analyses and negative control analyses indicated no evidence supported the above-mentioned associations. Conclusion: This PhD project did not suggest an increased risk of GDM in mothers or seizure/ADHD/ASD/PTB/SFGA in children regarding antipsychotics use during pregnancy. Women are not recommended to stop their regular antipsychotic prescription during pregnancy due to the risk of developing GDM or delivering an offspring with seizure/ADHD/ASD/PTB/SFGA

The emerging landscape of health research based on biobanks linked to electronic health records: Existing resources, statistical challenges, and potential opportunities

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154448/1/sim8445_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154448/2/sim8445.pd

Consortium for the Study of Pregnancy Treatments (Co-OPT): An international birth cohort to study the effects of antenatal corticosteroids

BACKGROUND: Antenatal corticosteroids (ACS) are widely prescribed to improve outcomes following preterm birth. Significant knowledge gaps surround their safety, long-term effects, optimal timing and dosage. Almost half of women given ACS give birth outside the "therapeutic window" and have not delivered over 7 days later. Overtreatment with ACS is a concern, as evidence accumulates of risks of unnecessary ACS exposure. METHODS: The Consortium for the Study of Pregnancy Treatments (Co-OPT) was established to address research questions surrounding safety of medications in pregnancy. We created an international birth cohort containing information on ACS exposure and pregnancy and neonatal outcomes by combining data from four national/provincial birth registers and one hospital database, and follow-up through linked population-level data from death registers and electronic health records. RESULTS AND DISCUSSION: The Co-OPT ACS cohort contains 2.28 million pregnancies and babies, born in Finland, Iceland, Israel, Canada and Scotland, between 1990 and 2019. Births from 22 to 45 weeks' gestation were included; 92.9% were at term (≥ 37 completed weeks). 3.6% of babies were exposed to ACS (67.0% and 77.9% of singleton and multiple births before 34 weeks, respectively). Rates of ACS exposure increased across the study period. Of all ACS-exposed babies, 26.8% were born at term. Longitudinal childhood data were available for 1.64 million live births. Follow-up includes diagnoses of a range of physical and mental disorders from the Finnish Hospital Register, diagnoses of mental, behavioural, and neurodevelopmental disorders from the Icelandic Patient Registers, and preschool reviews from the Scottish Child Health Surveillance Programme. The Co-OPT ACS cohort is the largest international birth cohort to date with data on ACS exposure and maternal, perinatal and childhood outcomes. Its large scale will enable assessment of important rare outcomes such as perinatal mortality, and comprehensive evaluation of the short- and long-term safety and efficacy of ACS