An Intelligent Multicriteria Model for Diagnosing Dementia in People Infected with Human Immunodeficiency Virus

Hybrid models to detect dementia based on Machine Learning can provide accurate diagnoses in individuals with neurological disorders and cognitive complications caused by Human Immunodeficiency Virus (HIV) infection. This study proposes a hybrid approach, using Machine Learning algorithms associated with the multicriteria method of Verbal Decision Analysis (VDA). Dementia, which affects many HIV-infected individuals, refers to neurodevelopmental and mental disorders. Some manuals standardize the information used in the correct detection of neurological disorders with cognitive complications. Among the most common manuals used are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) of the American Psychiatric Association and the International Classification of Diseases, 10th edition (ICD-10)—both published byWorld Health Organization (WHO). The model is designed to explore the predictive of specific data. Furthermore, a well-defined database data set improves and optimizes the diagnostic models sought in the research.info:eu-repo/semantics/publishedVersio

Interpretable Machine Learning Model for Clinical Decision Making

Despite machine learning models being increasingly used in medical decision-making and meeting classification predictive accuracy standards, they remain untrusted black-boxes due to decision-makers\u27 lack of insight into their complex logic. Therefore, it is necessary to develop interpretable machine learning models that will engender trust in the knowledge they generate and contribute to clinical decision-makers intention to adopt them in the field. The goal of this dissertation was to systematically investigate the applicability of interpretable model-agnostic methods to explain predictions of black-box machine learning models for medical decision-making. As proof of concept, this study addressed the problem of predicting the risk of emergency readmissions within 30 days of being discharged for heart failure patients. Using a benchmark data set, supervised classification models of differing complexity were trained to perform the prediction task. More specifically, Logistic Regression (LR), Random Forests (RF), Decision Trees (DT), and Gradient Boosting Machines (GBM) models were constructed using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD). The precision, recall, area under the ROC curve for each model were used to measure predictive accuracy. Local Interpretable Model-Agnostic Explanations (LIME) was used to generate explanations from the underlying trained models. LIME explanations were empirically evaluated using explanation stability and local fit (R2). The results demonstrated that local explanations generated by LIME created better estimates for Decision Trees (DT) classifiers

Evaluation of a health system strengthening initiative in the Zambian prison system

Introduction: In 2013, the Zambian Correctional Service (ZCS) partnered with the Centre for Infectious Disease Research in Zambia on the Zambian Prisons Health System Strengthening project, seeking to tackle structural, organisational and cultural weaknesses within the prison health system. We present findings from a nested evaluation of the project impact on high, mid- level and facility-level health governance and health service arrangements in the Zambian Correctional Service. Methods: Mixed methods were used, including document review, indepth interviews with ministry (11) and prison facility (6) officials, focus group discussions (12) with male and female inmates in six of the eleven intervention prisons, and participant observation during project workshops and meetings. Ethical clearance and verbal informed consent were obtained for all activities. Analysis incorporated deductive and iterative inductive coding. Results: Outcomes: Improved knowledge of the prison health system strengthened political and bureaucratic will to materially address prison health needs. This found expression in a tripartite Memorandum of Understanding between the Ministry of Home Affairs, Ministry of Health (MOH) and Ministry of Community Development, and in the appointment of a permanent liaison between MOH and ZCS. Capacity-building workshops for ZCS Command resulted in strengthened health planning and management outcomes, including doubling ZCS health professional workforce (from 37 to78 between 2014 and 2016), new preservice basic health training for incoming ZCS officers and formation of facility-based prison health committees with a mandate for health promotion and protection. Mechanisms: Continuous and facilitated communication among major stakeholders and the emergence of interorganisational trust were critical. Enabling contextual factors included a permissive political environment, a shift within ZCS from a 'punitive' to 'correctional' organisational culture, and prevailing political and public health concerns about the spread of HIV and tuberculosis. Conclusion: While not a panacea, findings demonstrate that a 'systems' approach to seemingly intractable prison health system problems yielded a number of short-term tactical and long-term strategic improvements in the Zambian setting. Context-sensitive application of such an approach to other settings may yield positive outcomes

Knowledge accumulation and vaccine innovation: lessons from polio and HIV/AIDS

This thesis contrasts vaccine innovation efforts in the cases of poliomyelitis and HIV/AIDS. It addresses the question of why some fields of human endeavour can be seen to yield positive change more quickly than others. The thesis develops a perspective that views innovation as a cumulative learning process. It employs the notion of a ‘testing regime’ to draw attention to the role of testing in driving this carefully managed learning process during the development of vaccines. Repeated testing, under conditions that are varied using instruments and skill, generates knowledge that is reliable and robust for technological purposes. Governance is needed to co-ordinate this process of testing to ensure the resulting knowledge growth is shared and cumulative. This lens is used to explore the creation of intermediate conditions, the development of instrumentalities, and the role of governance in vaccine innovation processes. The thesis uses the notion of ‘social visions’ to explore how attention directed to poliomyelitis contrasted with neglect and apathy afforded to AIDS in its early manifestations. Shared, rather than competing, visions are found to play a significant role in setting the vaccine innovation process in motion. However, the thesis finds that key pathogenic features of the virus and certain ethical and safety stances make learning and the accumulation of technological knowledge inherently difficult. Importantly, the thesis finds policy measures can mitigate or exacerbate these learning challenges considerably. Whilst greater market support and increased research funding tend to be positive contributions to vaccine development, this research shows they are only part of what is needed to take ideas through to innovation. The empirical evidence gathered in this thesis, when viewed through the testing regime lens, suggests that science and innovation are distinct activities but their inter-relationships can be enhanced with the development of an infrastructure focussed on nurturing skills, fostering the use of new techniques, encouraging the development of new instruments, and implementing governance measures to co-ordinate testing efforts and resources

HIV Testing

It can be said that now is the best time for everyone infected to become aware of their own HIV status. The state of the art in HIV management progressively reveals that antiretroviral treatment can prevent transmission, as well as chronic damage in the human body, if started early. Unfortunately, antiretrovirals are not widely available in many places, especially in developing countries. In these parts of the world, diagnosis of HIV infection must be kept in the agenda as a priority, in order to understand specific details of local epidemics and as an effort to interrupt the chain of HIV transmission

Signal Fusion and Semantic Similarity Evaluation for Social Media Based Adverse Drug Event Detection

Recent advancements in pharmacovigilance tasks have shown the usage of social media as a resource to obtain real-time signals for drug surveillance. Researchers demonstrated a good potential for the detection of Adverse Drug Events (ADEs) using social media much earlier than the traditional reporting systems maintained by official regulatory authorities like the United States Food and Drug Administration (FDA). Existing automated drug surveillance systems have used various types of social media channels and search query logs for monitoring ADE signals.;In this thesis, we address two key performance issues related to automated drug surveillance systems. The first is to improve the ADE signal detection by analyzing signals from multiple social media channels, and the second is usage of semantic similarity to evaluate ADE narratives detected by drug surveillance systems. Most current approaches for detecting ADEs from social media rely on a single channel: forums or microblogs or query logs. In this study we propose a new methodology to fuse signals from different social media channels. We use graphical causal models to discover potentially hidden connections between data channels, and then use such associations to generate signals for ADEs. Further, prior work have not emphasized much on the language of healthcare consumers, which is often casual and informal in expressing health issues on social media. There is a high potential to miss the semantic similarity between ADE terms extracted from social media and terms from formal official narratives when the two sets of terms do not share exact text. Thus, we exhibit the usage of semantic similarity to enhance accuracy of detected ADEs, and evaluated similarity measurement algorithms developed over biomedical vocabularies in ADE surveillance domain. We experimented on a dataset of drugs which had FDA black box warnings with a retrospective analysis spanning years 2008 to 2015. The results show a better detection rate and an improved performance in terms of precision, recall and timeliness using our proposed methods

Perceived symptom manageability - synthesis of a new use of a known concept based on a sample of HIV outpatients

Symptom management issues are regularly discussed in medical follow-up appointments, however, despite the integration of patients' perspectives in symptom management negotiations, traditional-ly used measures (i.e., symptom severity and frequency) to identify symptoms that need management do not seem to capture the patient's needs and, consequently, patients' expectations are frequently unmet 141. Although symptom frequency, symptom severity, and associated distress or bother are considered core indicators of the patient's individual experience of perceived symptoms 13,60,75,142,143, they do not truly cap-ture the wholeness of PLWHs' lived experience associated with symptoms in the chronic phase of the HIV trajectory. Therefore, they only allow the identification of a limited number of symptoms that need man-agement due to symptom expression and associated distress. Moreover, symptom lists that were invented before cART was widely available may not have been adapted to new symptom profiles, and are of limited value to capture symptoms of concern to patients in a chronic phase. Subjective illness theories, such as the Common sense Theory by Leventhal et al. (1992) support the assumption that objective measures may be of limited importance to patients, as illness perception is greatly determined by individual concepts and interpretations. Patients, according to this model, base the assessment of symptoms that need management not only on symptom expression, but rather on a combination of their own interpretation of perceived symptoms, illness representation (e.g., cause, time-line, control), personal (such as demographic and cul-tural) factors, and social support. Moreover, these factors are mutually influential and individual weighted. Symptom severity or frequency, thus, may or may not be the most important aspects when pa-tients express concern about a symptom. Moreover, to our knowledge, there is no instrument or concept currently used which integrates dimensions of daily living with HIV to identify symptoms that need man-agement in the chronic phase of HIV. The most promising approach to caring for patients with chronic diseases is to approach the illness as a collaborative endeavor, acknowledging the patient as an expert of his condition, living context, and emotional situation. Health care providers and patients not only exchange information but also are partners for negotiating approaches to symptom self-management in every-day life. Comparing the parameters used to identify symptoms that need management and those important for patient self-management in daily life, it becomes clear that the patient perspective on consequences of a symptom for daily life are often neglected. In order to assess a patient's unique and individual perception of symptoms that need management, and in the future, the success of symptom management interventions, we therefore propose to use a meas-ure representing this individuality and uniqueness. As in clinical encounters, patients often describe their life with symptoms using sentences like "I can't manage symptom x or y anymore", or "well, yes, symp-toms are well manageable," thus directly referring to their ability to influence the impact of the symptoms on their life, we suggest "perceived symptom manageability" to meet this condition: the patient is the only person who is able to assess the perceived manageability of a symptom in the context of his or her lived experience

Fertility and HIV Infection : Fertility Decision-making Challenges of Mutually- Disclosed Discordant Couples and Young People

Background: Sexuality and reproduction in mature generalised HIV epidemics pose significant dilemma to both HIV infected and negative people. Sexually active young people and HIV serodiscordant couples are faced with difficult decision-making about procreation and HIV transmission. Insufficient data exists about fertility decision-making and how to handle sexuality and fertility among the HIV-infected youth and mutually disclosed discordant couples. Aim: To explore the influence of HIV on fertility decision-making among young people and people in HIV-discordant relationship in Uganda Methods: The four studies used qualitative (focus group discussions - study I, II, and III) and quantitative methods (semi-structured questionnaire - study III and IV). We explored the views of the youth on reasons for high fertility in Uganda and how decisions are made among the youth in the general population (study I) and among HIV-infected youth (study II). A cross sectional study (study III) assessed fertility decision-making among the discordant couples, and a prospective cohort (study IV) assessed how HIV-infected and negative youth sustain their fertility decisions over a period of one year. Thematic and content analysis were used for qualitative data and uni-variate, bi-variate and multivariate analysis for the quantitative data. Results: Patriarchy, culture and religion contribute to sustaining high fertility in Uganda (paper I). The majority (57%) would like to have children but have to grapple with the dilemma of HIV transmission to partner (paper II and III). Less than a half (44%) among the HIV-infected youth compared to two thirds (61%) among the HIV-negative youth made a consistent fertility decision, OR = 0.52 (0.38, 0.70). In total, 24% among the HIV-negative and 18% among the HIV-infected continued to use contraception throughout the year, OR 0.63 (0.41, 0.98), while 12% and 28% among the HIV-negative and infected respectively did not use contraception, OR 2.80 (1.80, 4.36) (paper IV). Conclusions: Young people in central Uganda are still strongly influenced by the patriarchal, cultural and religious norms with the male gender enjoying a superior position. This compels women to desire many boys for their security and happiness (paper I). Many HIV serodiscordant couples in central Uganda desire to have children and are planning to conceive but the highest desire for children is among the young people (paper III, IV). The desire to have children hinders safe sex practice among HIV sero-discordant couples (paper II). The discordant couples committed to condom use have to risk HIV transmission, or look for a sero-concordant partner to get children. Others seek high-risk concurrent partnerships for children and sexual pleasure (paper II). HIV infected youth are not empowered to practice or sustain consistent contraceptive use or adopt preventive strategies (paper I, IV). The current dialogue with health workers is not increasing contraceptive use, especially among the HIV-infected youth (paper IV). Implications: Uganda s cultural norms still favour high fertility and having HIV infection cannot remove the quest to fulfil patriarchal obligations. If not assisted, PLHIV will continue to practice high-risk sex to reproduce. A multi-sectoral approach uniting cultural, political and public institutions is needed to design programs that may stem the HIV epidemic. Strengthening family planning services should include planning for conception for the PLHIV. Critically, in addition to the need for the cultural re-learning processes to desire less children, we need to introduce low-cost harm reduction techniques for reproduction (timed intercourse, sperm washing) to assist PLHIV who want to have children to do so with minimal HIV transmission