Interpreting patient-Specific risk prediction using contextual decomposition of BiLSTMs: Application to children with asthma

Background: Predictive modeling with longitudinal electronic health record (EHR) data offers great promise for accelerating personalized medicine and better informs clinical decision-making. Recently, deep learning models have achieved state-of-The-Art performance for many healthcare prediction tasks. However, deep models lack interpretability, which is integral to successful decision-making and can lead to better patient care. In this paper, we build upon the contextual decomposition (CD) method, an algorithm for producing importance scores from long short-Term memory networks (LSTMs). We extend the method to bidirectional LSTMs (BiLSTMs) and use it in the context of predicting future clinical outcomes using patients' EHR historical visits. Methods: We use a real EHR dataset comprising 11071 patients, to evaluate and compare CD interpretations from LSTM and BiLSTM models. First, we train LSTM and BiLSTM models for the task of predicting which pre-school children with respiratory system-related complications will have asthma at school-Age. After that, we conduct quantitative and qualitative analysis to evaluate the CD interpretations produced by the contextual decomposition of the trained models. In addition, we develop an interactive visualization to demonstrate the utility of CD scores in explaining predicted outcomes. Results: Our experimental evaluation demonstrate that whenever a clear visit-level pattern exists, the models learn that pattern and the contextual decomposition can appropriately attribute the prediction to the correct pattern. In addition, the results confirm that the CD scores agree to a large extent with the importance scores generated using logistic regression coefficients. Our main insight was that rather than interpreting the attribution of individual visits to the predicted outcome, we could instead attribute a model's prediction to a group of visits. Conclusion: We presented a quantitative and qualitative evidence that CD interpretations can explain patient-specific predictions using CD attributions of individual visits or a group of visits. - 2019 The Author(s).This work is supported in part by Sidra Medicine under grant (SDR200043). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Scopu

Effectiveness of palivizumab immunoprophylaxis in preterm infants against respiratory syncytial virus disease in Qatar

Ahmad Abushahin, Ibrahim Janahi, Amjad Tuffaha Department of Pediatrics, Section of Pediatric Pulmonology, Hamad Medical Corporation, Doha, Qatar Objective: The primary objective of this study was to document the hospitalization rate due to respiratory syncytial virus (RSV) and compliance with palivizumab use in preterm infants receiving palivizumab immunoprophylaxis during 2009–2012 RSV seasons.Design: This is a descriptive single-center cohort study. Infants who were ≤35-week gestational age were eligible for enrollment if they received the first palivizumab dose between November 1 and March 31 (2009–2010, 2010–2011, 2011–2012). Primary endpoint was defined as RSV hospitalization of duration 24 hours or longer.Results: The cumulative RSV hospitalization rate in the registry (2009–2012) was 1.9%. The compliance rate was 85.7%. It showed steady increase across the 3 successive RSV seasons, 2009–2010, 2010–2011, and 2011–2012 (57.7% vs 92.6%, 94.2%, respectively, p<0.05). The RSV hospitalization rate decreased from 3.7% for 2009–2010 to 1.3% for 2010–2011 and 1.7% for 2011–2012 RSV seasons. No deaths and no side effects linked to palivizumab injections were reported for any subjects enrolled.Conclusion: Our study provides national data regarding characteristics, compliance rate, and hospitalization outcomes for preterm infants receiving palivizumab in Qatar. Our data is consistent with the previously reported efficacy and safety profile of palivizumab. Keywords: palivizumab, preterm, bronchopulmonary dysplasia, bronchiolitis, passive immunization, immunoprophylaxis, RS

HBV: Genomic Structure, HBVsAg Isolation and innovative Virotherapy Initiation in the Middle East

Hepatitis B virus (HBV) is one of the world’s major infectious diseases with 350 million people who are chronic carriers of HBV [1]. Significant minorities go on to develop liver cirrhosis or hepatocellular carcinoma and over 1 million die annually from HBV-diseased liver. Janahi E. at faculty of science, Bahrain University, Bahrain has submitted the following information [2], on HBV-genome organization as part of his Ph.D. degree (2007) in Imperial College, England. HBV genomic organization has 4 Open Reading Frames (ORFs) i.e. Pre-S/S Gene, Pre-C/C ORF, P ORF and X ORF. Regulatory Elements has 4 promoters (pre S2, pre S1, C promoters and X promoters), Pregenomic RNA, Enhancers (Enh 1 and Enh 2) where they are involved in cccDNA formation, Glococorticoid-Responsive Element which is located in X ORF and P ORF overlapping, Polyadenylation Signal (Direct Repeat 1 (DR1) and Direct Repeat 2 (DR2)), Epsilon-Stem Loop and Post-Transcriptional Regulatory Element. HBV genotype D is prevalent in our Middle East area. The HBV genome is a partially relaxed-circular dsDNA molecule consisting of a full length strand (minus strand) with a single unique nick and a complementary (positive strand) of variable length. HBV is considered as a para-retrovirus because its replication involves the reverse transcription of an intermediate-RNA function, of pre-genomic RNA (pgRNA). Replication of HBV genome starts with the encapsidation of the pgRNA and encodes HBV polymerase into an immature nucleocapsid formed by the viral core antigen

Chronic childhood illness in the Arab world

Chronic childhood illness has great physical, social, and psychological impacts on children and their families across the globe. Despite global concerns regarding the welfare and needs of this population, relatively little is known about the actual prevalence and impact of chronic childhood illnesses in the Arab world. This chapter summarizes important findings of studies with the prevalence of chronic childhood illnesses in the Arab world, and the impact of chronic illness on child and families and reviews healthcare services provided to this population. For the purpose of this chapter, we define the term Arab world as related to distinct geographic areas encompassing portions of the 22 Arab League stretching over Africa and Asia

Building Bridges through Science

Science is ideally suited to connect people from different cultures and thereby foster mutual understanding. To promote international life science collaboration, we have launched "The Science Bridge" initiative. Our current project focuses on partnership between Western and Middle Eastern neuroscience communities