Properties of Healthcare Teaming Networks as a Function of Network Construction Algorithms

Network models of healthcare systems can be used to examine how providers collaborate, communicate, refer patients to each other. Most healthcare service network models have been constructed from patient claims data, using billing claims to link patients with providers. The data sets can be quite large, making standard methods for network construction computationally challenging and thus requiring the use of alternate construction algorithms. While these alternate methods have seen increasing use in generating healthcare networks, there is little to no literature comparing the differences in the structural properties of the generated networks. To address this issue, we compared the properties of healthcare networks constructed using different algorithms and the 2013 Medicare Part B outpatient claims data. Three different algorithms were compared: binning, sliding frame, and trace-route. Unipartite networks linking either providers or healthcare organizations by shared patients were built using each method. We found that each algorithm produced networks with substantially different topological properties. Provider networks adhered to a power law, and organization networks to a power law with exponential cutoff. Censoring networks to exclude edges with less than 11 shared patients, a common de-identification practice for healthcare network data, markedly reduced edge numbers and greatly altered measures of vertex prominence such as the betweenness centrality. We identified patterns in the distance patients travel between network providers, and most strikingly between providers in the Northeast United States and Florida. We conclude that the choice of network construction algorithm is critical for healthcare network analysis, and discuss the implications for selecting the algorithm best suited to the type of analysis to be performed.Comment: With links to comprehensive, high resolution figures and networks via figshare.co

Properties of healthcare teaming networks as a function of network construction algorithms

This is the final version. Available on open access from Public Library of Science via the DOI in this recordData Availability: The Center for Medicare Services Outpatient Claims DE-SynPUF (DE-SynPUF)\cite{RN120} test set is publicly available from the CMS web site. The full 2013 Medicare Part B Limited Data Set for Medicare claims can be obtained from the Center for Medicare Services. This data is bound by a privacy and limited distribution agreement, as well as HIPAA regulations, and thus cannot be made public with this manuscript. However, the files can be requested from the Center for Medicare Services by individual investigators and used to reproduce our findings. Release of the derived networks is also limited by Medicare requirements to remove nodes and edges where the total number of shared patients 11 shared patients, and these are available on figshare.com as referenced in the Supplemental Data section of the manuscript.Network models of healthcare systems can be used to examine how providers collaborate, communicate, refer patients to each other, and to map how patients traverse the network of providers. Most healthcare service network models have been constructed from patient claims data, using billing claims to link a patient with a specific provider in time. The data sets can be quite large (106±108 individual claims per year), making standard methods for network construction computationally challenging and thus requiring the use of alternate construction algorithms. While these alternate methods have seen increasing use in generating healthcare networks, there is little to no literature comparing the differences in the structural properties of the generated networks, which as we demonstrate, can be dramatically different. To address this issue, we compared the properties of healthcare networks constructed using different algorithms from 2013 Medicare Part B outpatient claims data. Three different algorithms were compared: Binning, sliding frame, and trace-route. Unipartite networks linking either providers or healthcare organizations by shared patients were built using each method. We find that each algorithm produced networks with substantially different topological properties, as reflected by numbers of edges, network density, assortativity, clustering coefficients and other structural measures. Provider networks adhered to a power law, while organization networks were best fit by a power law with exponential cutoff. Censoring networks to exclude edges with less than 11 shared patients, a common de-identification practice for healthcare network data, markedly reduced edge numbers and network density, and greatly altered measures of vertex prominence such as the betweenness centrality. Data analysis identified patterns in the distance patients travel between network providers, and a striking set of teaming relationships between providers in the Northeast United States and Florida, likely due to seasonal residence patterns of Medicare beneficiaries. We conclude that the choice of network construction algorithm is critical for healthcare network analysis, and discuss the implications of our findings for selecting the algorithm best suited to the type of analysis to be performed.National Institute of HealthPhilip Templeton FoundationUniversity of Rochester Center for Health Informatic

A survey of simulation techniques in commerce and defence

Despite the developments in Modelling and Simulation (M&S) tools and techniques over the past years, there has been a gap in the M&S research and practice in healthcare on developing a toolkit to assist the modellers and simulation practitioners with selecting an appropriate set of techniques. This study is a preliminary step towards this goal. This paper presents some results from a systematic literature survey on applications of M&S in the commerce and defence domains that could inspire some improvements in the healthcare. Interim results show that in the commercial sector Discrete-Event Simulation (DES) has been the most widely used technique with System Dynamics (SD) in second place. However in the defence sector, SD has gained relatively more attention. SD has been found quite useful for qualitative and soft factors analysis. From both the surveys it becomes clear that there is a growing trend towards using hybrid M&S approaches

Кибербезопасность в образовательных сетях

The paper discusses the possible impact of digital space on a human, as well as human-related directions in cyber-security analysis in the education: levels of cyber-security, social engineering role in cyber-security of education, “cognitive vaccination”. “A Human” is considered in general meaning, mainly as a learner. The analysis is provided on the basis of experience of hybrid war in Ukraine that have demonstrated the change of the target of military operations from military personnel and critical infrastructure to a human in general. Young people are the vulnerable group that can be the main goal of cognitive operations in long-term perspective, and they are the weakest link of the System.У статті обговорюється можливий вплив цифрового простору на людину, а також пов'язані з людиною напрямки кібербезпеки в освіті: рівні кібербезпеки, роль соціального інжинірингу в кібербезпеці освіти, «когнітивна вакцинація». «Людина» розглядається в загальному значенні, головним чином як та, що навчається. Аналіз надається на основі досвіду гібридної війни в Україні, яка продемонструвала зміну цілей військових операцій з військовослужбовців та критичної інфраструктури на людину загалом. Молодь - це вразлива група, яка може бути основною метою таких операцій в довгостроковій перспективі, і вони є найслабшою ланкою системи.В документе обсуждается возможное влияние цифрового пространства на человека, а также связанные с ним направления в анализе кибербезопасности в образовании: уровни кибербезопасности, роль социальной инженерии в кибербезопасности образования, «когнитивная вакцинация». «Человек» рассматривается в общем смысле, в основном как ученик. Анализ представлен на основе опыта гибридной войны в Украине, которая продемонстрировала изменение цели военных действий с военного персонала и критической инфраструктуры на человека в целом. Молодые люди являются уязвимой группой, которая может быть главной целью когнитивных операций в долгосрочной перспективе, и они являются самым слабым звеном Систем

Evolving attackers against wireless sensor networks using genetic programming

Recent hardware developments have made it possible for the Internet of Things (IoT) to be built. A wide variety of industry sectors, including manufacturing, utilities, agriculture, transportation, and healthcare are actively seeking to incorporate IoT technologies in their operations. The increased connectivity and data sharing that give IoT systems their advantages also increase their vulnerability to attack. In this study, the authors explore the automated generation of attacks using genetic programming (GP), so that defences can be tested objectively in advance of deployment. In the authors' system, the GP-generated attackers targeted publish-subscribe communications within a wireless sensor networks that was protected by an artificial immune intrusion detection system (IDS) taken from the literature. The GP attackers successfully suppressed more legitimate messages than the hand-coded attack used originally to test the IDS, whilst reducing the likelihood of detection. Based on the results, it was possible to reconfigure the IDS to improve its performance. Whilst the experiments were focussed on establishing a proof-of-principle rather than a turnkey solution, they indicate that GP-generated attackers have the potential to improve the protection of systems with large attack surfaces, in a way that is complementary to traditional testing and certification

Simulation Intelligence: Towards a New Generation of Scientific Methods

The original "Seven Motifs" set forth a roadmap of essential methods for the field of scientific computing, where a motif is an algorithmic method that captures a pattern of computation and data movement. We present the "Nine Motifs of Simulation Intelligence", a roadmap for the development and integration of the essential algorithms necessary for a merger of scientific computing, scientific simulation, and artificial intelligence. We call this merger simulation intelligence (SI), for short. We argue the motifs of simulation intelligence are interconnected and interdependent, much like the components within the layers of an operating system. Using this metaphor, we explore the nature of each layer of the simulation intelligence operating system stack (SI-stack) and the motifs therein: (1) Multi-physics and multi-scale modeling; (2) Surrogate modeling and emulation; (3) Simulation-based inference; (4) Causal modeling and inference; (5) Agent-based modeling; (6) Probabilistic programming; (7) Differentiable programming; (8) Open-ended optimization; (9) Machine programming. We believe coordinated efforts between motifs offers immense opportunity to accelerate scientific discovery, from solving inverse problems in synthetic biology and climate science, to directing nuclear energy experiments and predicting emergent behavior in socioeconomic settings. We elaborate on each layer of the SI-stack, detailing the state-of-art methods, presenting examples to highlight challenges and opportunities, and advocating for specific ways to advance the motifs and the synergies from their combinations. Advancing and integrating these technologies can enable a robust and efficient hypothesis-simulation-analysis type of scientific method, which we introduce with several use-cases for human-machine teaming and automated science