Synthetic Observational Health Data with GANs: from slow adoption to a boom in medical research and ultimately digital twins?

After being collected for patient care, Observational Health Data (OHD) can further benefit patient well-being by sustaining the development of health informatics and medical research. Vast potential is unexploited because of the fiercely private nature of patient-related data and regulations to protect it. Generative Adversarial Networks (GANs) have recently emerged as a groundbreaking way to learn generative models that produce realistic synthetic data. They have revolutionized practices in multiple domains such as self-driving cars, fraud detection, digital twin simulations in industrial sectors, and medical imaging. The digital twin concept could readily apply to modelling and quantifying disease progression. In addition, GANs posses many capabilities relevant to common problems in healthcare: lack of data, class imbalance, rare diseases, and preserving privacy. Unlocking open access to privacy-preserving OHD could be transformative for scientific research. In the midst of COVID-19, the healthcare system is facing unprecedented challenges, many of which of are data related for the reasons stated above. Considering these facts, publications concerning GAN applied to OHD seemed to be severely lacking. To uncover the reasons for this slow adoption, we broadly reviewed the published literature on the subject. Our findings show that the properties of OHD were initially challenging for the existing GAN algorithms (unlike medical imaging, for which state-of-the-art model were directly transferable) and the evaluation synthetic data lacked clear metrics. We find more publications on the subject than expected, starting slowly in 2017, and since then at an increasing rate. The difficulties of OHD remain, and we discuss issues relating to evaluation, consistency, benchmarking, data modelling, and reproducibility.Comment: 31 pages (10 in previous version), not including references and glossary, 51 in total. Inclusion of a large number of recent publications and expansion of the discussion accordingl

Leveraging Historical Medical Records as a Proxy via Multimodal Modeling and Visualization to Enrich Medical Diagnostic Learning

Simulation-based Medical Education (SBME) has been developed as a cost-effective means of enhancing the diagnostic skills of novice physicians and interns, thereby mitigating the need for resource-intensive mentor-apprentice training. However, feedback provided in most SBME is often directed towards improving the operational proficiency of learners, rather than providing summative medical diagnoses that result from experience and time. Additionally, the multimodal nature of medical data during diagnosis poses significant challenges for interns and novice physicians, including the tendency to overlook or over-rely on data from certain modalities, and difficulties in comprehending potential associations between modalities. To address these challenges, we present DiagnosisAssistant, a visual analytics system that leverages historical medical records as a proxy for multimodal modeling and visualization to enhance the learning experience of interns and novice physicians. The system employs elaborately designed visualizations to explore different modality data, offer diagnostic interpretive hints based on the constructed model, and enable comparative analyses of specific patients. Our approach is validated through two case studies and expert interviews, demonstrating its effectiveness in enhancing medical training.Comment: Accepted by IEEE VIS 202

Machine Learning for Physiological Time Series: Representing and Controlling Blood Glucose for Diabetes Management

Type 1 diabetes is a chronic health condition affecting over one million patients in the US, where blood glucose (sugar) levels are not well regulated by the body. Researchers have sought to use physiological data (e.g., blood glucose measurements) collected from wearable devices to manage this disease, either by forecasting future blood glucose levels for predictive alarms, or by automating insulin delivery for blood glucose management. However, the application of machine learning (ML) to these data is hampered by latent context, limited supervision and complex temporal dependencies. To address these challenges, we develop and evaluate novel ML approaches in the context of i) representing physiological time series, particularly for forecasting blood glucose values and ii) decision making for when and how much insulin to deliver. When learning representations, we leverage the structure of the physiological sequence as an implicit information stream. In particular, we a) incorporate latent context when predicting adverse events by jointly modeling patterns in the data and the context those patterns occurred under, b) propose novel types of self-supervision to handle limited data and c) propose deep models that predict functions underlying trajectories to encode temporal dependencies. In the context of decision making, we use reinforcement learning (RL) for blood glucose management. Through the use of an FDA-approved simulator of the glucoregulatory system, we achieve strong performance using deep RL with and without human intervention. However, the success of RL typically depends on realistic simulators or experimental real-world deployment, neither of which are currently practical for problems in health. Thus, we propose techniques for leveraging imperfect simulators and observational data. Beyond diabetes, representing and managing physiological signals is an important problem. By adapting techniques to better leverage the structure inherent in the data we can help overcome these challenges.PHDComputer Science & EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/163134/1/ifox_1.pd

Developing Virtual Reality Simulations for Office-Based Medical Emergencies

Virtual reality simulation may significantly benefit a geographically dispersed learner demographic in the medical outpatient setting. Our research used an immersive virtual reality platform as a novel way to recreate high-risk medical scenarios targeted for office-based emergencies. Using a design-based research approach we designed virtual-reality-based simulation scenarios to prepare interprofessional office personnel for emergencies. Learners were connected using laptop computers, via a browser interface, with learner controlled team member avatars and educator controlled patient avatars. The virtual environment was modeled after a multi-provider healthcare office setting in a large suburban health network. Evaluation occurred via post-event surveys and feedback transcribed from video recordings and debriefings. Three office-based emergency scenarios were created (chest pain, respiratory distress/allergic reaction, and suicidal risk), with progressively smaller changes to the virtual environment with each iterative improvement. In total, 18 individuals representative of a typical outpatient office interprofessional care team participated in the study. Qualitative design-related feedback from participants and faculty improved the educational environment, artifacts, and scenarios. Participant feedback was overwhelmingly positive and enthusiastic about the use of virtual reality-based simulations to explore teamwork, build scope of practice, and rehearse infrequently used clinical skills. We successfully created novel outpatient virtual reality simulations in a first-person-perspective virtual environment. Pilot testing revealed successful rapid development, implementation, and participant orientation, with the ability to present learning opportunities. Future efforts will include assessments and attempt to overcome development barriers by switching to a more versatile platform

Gait Analysis of Horses for Lameness Detection with Radar Sensors

This paper presents the preliminary investigation of the use of radar signatures to detect and assess lameness of horses and its severity. Radar sensors in this context can provide attractive contactless sensing capabilities, as a complementary or alternative technology to the current techniques for lameness assessment using video-graphics and inertial sensors attached to the horses' body. The paper presents several examples of experimental data collected at the Weipers Centre Equine Hospital at the University of Glasgow, showing the micro- Doppler signatures of horses and preliminary results of their analysis