A Framework for Evaluation and Identication of Time Series Models for Multi-Step Ahead Prediction of Physiological Signals

Significant interest exists in the potential to use continuous physiological monitoring to prevent respiratory complications and death, especially in the postoperative period. Smart alarm-threshold based systems are currently used with hospitalized patients. Despite clinical observations and research studies to support benefit from these systems, several concerns remain. For example, a small difference in a threshold may significantly increase the alarm rate. A significant increase in alarm related adverse outcomes has been reported by health care oversight organizations. Also, it has been recently shown that the signaled alarms are indeed late detections for clinical instability leading to a delayed recognition and less successful clinical intervention. This dissertation advances the state of art by moving from just monitoring towards prediction of physiological variables. Moving in this direction introduces research challenges in many aspects. Although existing literature describes many metrics for characterizing the prediction performance of time series models, these metrics may not be relevant for physiological signals. In these signals, clinicians are often concerned about specific regions of clinical interest. This dissertation develops and implements different types of metrics that can characterize the performance in predicting clinically relevant regions in physiological signals. In the era of massive data, biomedical devices are able to collect a large number of synchronized physiological signals recording a significant time history of a patient's physiological state. Directionality between physiological signals and which ones can be used to improve the ability to predict the other ones is an important research question. This dissertation uses a dynamic systems perspective to address this question. Metrics are also defined to characterize the improvement achieved by incorporating additional data into the prediction model of a physiological signal of interest. Although a rich literature exists on time series prediction models, these models traditionally consider the (absolute or square) error between the predicted and actual time series as an objective for optimization. This dissertation proposes two modeling frameworks for predicting clinical regions of interest in physiological signals. The physiological definition of the clinically relevant regions is incorporated in the model development and used to optimize models with respect to predictions of these regions.PhDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/116666/1/elmoaqet_1.pd

Modeling and Prediction in Diabetes Physiology

Diabetes is a group of metabolic diseases characterized by the inability of the organism to autonomously regulate the blood glucose levels. It requires continuing medical care to prevent acute complications and to reduce the risk of long-term complications. Inadequate glucose control is associated with damage, dysfunction and failure of various organs. The management of the disease is non trivial and demanding. With today’s standards of current diabetes care, good glucose regulation needs constant attention and decision-making by the individuals with diabetes. Empowering the patients with a decision support system would, therefore, improve their quality of life without additional burdens nor replacing human expertise. This thesis investigates the use of data-driven techniques to the purpose of glucose metabolism modeling and short-term blood-glucose predictions in Type I Diabetes Mellitus (T1DM). The goal was to use models and predictors in an advisory tool able to produce personalized short-term blood glucose predictions and on-the-spot decision making concerning the most adequate choice of insulin delivery, meal intake and exercise, to help diabetic subjects maintaining glycemia as close to normal as possible. The approaches taken to describe the glucose metabolism were discrete-time and continuous-time models on input-output form and statespace form, while the blood glucose short-term predictors, i.e., up to 120 minutes ahead, used ARX-, ARMAX- and subspace-based prediction

Multi-Task Time Series Analysis applied to Drug Response Modelling

Time series models such as dynamical systems are frequently fitted to a cohort of data, ignoring variation between individual entities such as patients. In this paper we show how these models can be personalised to an individual level while retaining statistical power, via use of multi-task learning (MTL). To our knowledge this is a novel development of MTL which applies to time series both with and without control inputs. The modelling framework is demonstrated on a physiological drug response problem which results in improved predictive accuracy and uncertainty estimation over existing state-of-the-art models.Comment: To appear in AISTATS 201

Model Predictive Control (MPC) of an Artificial Pancreas with Data-Driven Learning of Multi-Step-Ahead Blood Glucose Predictors

We present the design and \textit{in-silico} evaluation of a closed-loop insulin delivery algorithm to treat type 1 diabetes (T1D) consisting in a data-driven multi-step-ahead blood glucose (BG) predictor integrated into a Linear Time-Varying (LTV) Model Predictive Control (MPC) framework. Instead of identifying an open-loop model of the glucoregulatory system from available data, we propose to directly fit the entire BG prediction over a predefined prediction horizon to be used in the MPC, as a nonlinear function of past input-ouput data and an affine function of future insulin control inputs. For the nonlinear part, a Long Short-Term Memory (LSTM) network is proposed, while for the affine component a linear regression model is chosen. To assess benefits and drawbacks when compared to a traditional linear MPC based on an auto-regressive with exogenous (ARX) input model identified from data, we evaluated the proposed LSTM-MPC controller in three simulation scenarios: a nominal case with 3 meals per day, a random meal disturbances case where meals were generated with a recently published meal generator, and a case with 25$\%$ decrease in the insulin sensitivity. Further, in all the scenarios, no feedforward meal bolus was administered. For the more challenging random meal generation scenario, the mean $\pm$ standard deviation percent time in the range 70-180 [mg/dL] was 74.99 $\pm$ 7.09 vs. 54.15 $\pm$ 14.89, the mean $\pm$ standard deviation percent time in the tighter range 70-140 [mg/dL] was 47.78$\pm$8.55 vs. 34.62 $\pm$9.04, while the mean $\pm$ standard deviation percent time in sever hypoglycemia, i.e., $<$ 54 [mg/dl] was 1.00$\pm$3.18 vs. 9.45$\pm$11.71, for our proposed LSTM-MPC controller and the traditional ARX-MPC, respectively. Our approach provided accurate predictions of future glucose concentrations and good closed-loop performances of the overall MPC controller.Comment: 10 pages, 5 Figures, 2 Table

Probabilistic forecasting using stochastic diffusion models, with applications to cohort processes of marriage and fertility

We study prediction and error propagation in Hernes, Gompertz, and logistic models for innovation diffusion. We develop a unifying framework in which the models are linearized with respect to cohort age and predictions are derived from the underlying linear process. We develop and compare methods for deriving the predictions and show how Monte Carlo simulation can be used to estimate prediction uncertainty for a wide class of underlying linear processes. For an important special case, random walk with, we develop an analytic prediction variance estimator. Both the Monte Carlo method and the analytic variance estimator allow the forecasters to make precise the level of within-model prediction uncertainty in innovation diffusion models. Empirical applications to first births, first marriages and cumulative fertility illustrate the usefulness of these methods.

Improving Patient Safety, Patient Flow and Physician Well-Being in Emergency Departments

Over 151 million people visit US Emergency Departments (EDs) annually. The diverse nature and overwhelming volume of patient visits make the ED one of the most complicated settings in healthcare to study. ED overcrowding is a recognized worldwide public health problem, and its negative impacts include patient safety concerns, increased patient length of stay, medical errors, patients left without being seen, ambulance diversions, and increased health system expenditure. Additionally, ED crowding has been identified as a leading contributor to patient morbidity and mortality. Furthermore, this chaotic working environment affects the well-being of all ED staff through increased frustration, workload, stress, and higher rates of burnout which has a direct impact on patient safety. This research takes a step-by-step approach to address these issues by first forecasting the daily and hourly patient arrivals, including their Emergency Severity Index (ESI) levels, to an ED utilizing time series forecasting models and machine learning models. Next, we developed an agent-based discrete event simulation model where both patients and physicians are modeled as unique agents for capturing activities representative of ED. Using this model, we develop various physician shift schedules, including restriction policies and overlapping policies, to improve patient safety and patient flow in the ED. Using the number of handoffs as the patient safety metric, which represents the number of patients transferred from one physician to another, patient time in the ED, and throughput for patient flow, we compare the new policies to the current practices. Additionally, using this model, we also compare the current patient assignment algorithm used by the partner ED to a novel approach where physicians determine patient assignment considering their workload, time remaining in their shift, etc. Further, to identify the optimal physician staffing required for the ED for any given hour of the day, we develop a Mixed Integer Linear Programming (MILP) model where the objective is to minimize the combined cost of physician staffing in the ED, patient waiting time, and handoffs. To develop operations schedules, we surveyed over 70 ED physicians and incorporated their feedback into the MILP model. After developing multiple weekly schedules, these were tested in the validated simulation model to evaluate their efficacy in improving patient safety and patient flow while accounting for the ED staffing budget. Finally, in the last phase, to comprehend the stress and burnout among attending and resident physicians working in the ED for the shift, we collected over 100 hours of physiological responses from 12 ED physicians along with subjective metrics on stress and burnout during ED shifts. We compared the physiological signals and subjective metrics to comprehend the difference between attending and resident physicians. Further, we developed machine learning models to detect the early onset of stress to assist physicians in decision-making

Gaussian process regression for forecasting battery state of health

Accurately predicting the future capacity and remaining useful life of batteries is necessary to ensure reliable system operation and to minimise maintenance costs. The complex nature of battery degradation has meant that mechanistic modelling of capacity fade has thus far remained intractable; however, with the advent of cloud-connected devices, data from cells in various applications is becoming increasingly available, and the feasibility of data-driven methods for battery prognostics is increasing. Here we propose Gaussian process (GP) regression for forecasting battery state of health, and highlight various advantages of GPs over other data-driven and mechanistic approaches. GPs are a type of Bayesian non-parametric method, and hence can model complex systems whilst handling uncertainty in a principled manner. Prior information can be exploited by GPs in a variety of ways: explicit mean functions can be used if the functional form of the underlying degradation model is available, and multiple-output GPs can effectively exploit correlations between data from different cells. We demonstrate the predictive capability of GPs for short-term and long-term (remaining useful life) forecasting on a selection of capacity vs. cycle datasets from lithium-ion cells.Comment: 13 pages, 7 figures, published in the Journal of Power Sources, 201

Space Station Human Factors Research Review. Volume 4: Inhouse Advanced Development and Research

A variety of human factors studies related to space station design are presented. Subjects include proximity operations and window design, spatial perceptual issues regarding displays, image management, workload research, spatial cognition, virtual interface, fault diagnosis in orbital refueling, and error tolerance and procedure aids