Characterizing non-heroin opioid overdoses using electronic health records.

Introduction: The opioid epidemic is a modern public health emergency. Common interventions to alleviate the opioid epidemic aim to discourage excessive prescription of opioids. However, these methods often take place over large municipal areas (state-level) and may fail to address the diversity that exists within each opioid case (individual-level). An intervention to combat the opioid epidemic that takes place at the individual-level would be preferable. Methods: This research leverages computational tools and methods to characterize the opioid epidemic at the individual-level using the electronic health record data from a large, academic medical center. To better understand the characteristics of patients with opioid use disorder (OUD) we leveraged a self-controlled analysis to compare the healthcare encounters before and after an individual\u27s first overdose event recorded within the data. We further contrast these patients with matched, non-OUD controls to demonstrate the unique qualities of the OUD cohort. Results: Our research confirms that the rate of opioid overdoses in our hospital significantly increased between 2006 and 2015 (P \u3c 0.001), at an average rate of 9% per year. We further found that the period just prior to the first overdose is marked by conditions of pain or malignancy, which may suggest that overdose stems from pharmaceutical opioids prescribed for these conditions. Conclusions: Informatics-based methodologies, like those presented here, may play a role in better understanding those individuals who suffer from opioid dependency and overdose, and may lead to future research and interventions that could successfully prevent morbidity and mortality associated with this epidemic

Preserving Differential Privacy in Convolutional Deep Belief Networks

The remarkable development of deep learning in medicine and healthcare domain presents obvious privacy issues, when deep neural networks are built on users' personal and highly sensitive data, e.g., clinical records, user profiles, biomedical images, etc. However, only a few scientific studies on preserving privacy in deep learning have been conducted. In this paper, we focus on developing a private convolutional deep belief network (pCDBN), which essentially is a convolutional deep belief network (CDBN) under differential privacy. Our main idea of enforcing epsilon-differential privacy is to leverage the functional mechanism to perturb the energy-based objective functions of traditional CDBNs, rather than their results. One key contribution of this work is that we propose the use of Chebyshev expansion to derive the approximate polynomial representation of objective functions. Our theoretical analysis shows that we can further derive the sensitivity and error bounds of the approximate polynomial representation. As a result, preserving differential privacy in CDBNs is feasible. We applied our model in a health social network, i.e., YesiWell data, and in a handwriting digit dataset, i.e., MNIST data, for human behavior prediction, human behavior classification, and handwriting digit recognition tasks. Theoretical analysis and rigorous experimental evaluations show that the pCDBN is highly effective. It significantly outperforms existing solutions

Who are the Users of Speed Regulation Assistance? Comparing Driver Characteristics of Casual and Intensive System Users

Speed regulation assistance can contribute to road safety provided that drivers use the systems on a regular basis. With the objective to gain knowledge about drivers who use Cruise Control and the Speed Limiter, a comparison of the characteristics of casual and intensive users was performed with survey data. The results show that gender and annual mileage play a role for the usage frequency of Cruise Control, whereas the usage frequency of the Speed Limiter depends on age. Consistent effects of the car use for business matters and the use of other invehicle technologies were found on the usage frequency of both systems. The predominant motive to reduce speeding found for both systems corresponds with the objective of speed regulation assistance as a safety measure. It was complemented with a comfort benefit perceived by Cruise Control users

Predicting Multiple ICD-10 Codes from Brazilian-Portuguese Clinical Notes

ICD coding from electronic clinical records is a manual, time-consuming and expensive process. Code assignment is, however, an important task for billing purposes and database organization. While many works have studied the problem of automated ICD coding from free text using machine learning techniques, most use records in the English language, especially from the MIMIC-III public dataset. This work presents results for a dataset with Brazilian Portuguese clinical notes. We develop and optimize a Logistic Regression model, a Convolutional Neural Network (CNN), a Gated Recurrent Unit Neural Network and a CNN with Attention (CNN-Att) for prediction of diagnosis ICD codes. We also report our results for the MIMIC-III dataset, which outperform previous work among models of the same families, as well as the state of the art. Compared to MIMIC-III, the Brazilian Portuguese dataset contains far fewer words per document, when only discharge summaries are used. We experiment concatenating additional documents available in this dataset, achieving a great boost in performance. The CNN-Att model achieves the best results on both datasets, with micro-averaged F1 score of 0.537 on MIMIC-III and 0.485 on our dataset with additional documents.Comment: Accepted at BRACIS 202

Temporal Properties of Diagnosis Code Time Series in Aggregate

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Risk prediction for chronic kidney disease progression using heterogeneous electronic health record data and time series analysis

BACKGROUND: As adoption of electronic health records continues to increase, there is an opportunity to incorporate clinical documentation as well as laboratory values and demographics into risk prediction modeling. OBJECTIVE: The authors develop a risk prediction model for chronic kidney disease (CKD) progression from stage III to stage IV that includes longitudinal data and features drawn from clinical documentation. METHODS: The study cohort consisted of 2908 primary-care clinic patients who had at least three visits prior to January 1, 2013 and developed CKD stage III during their documented history. Development and validation cohorts were randomly selected from this cohort and the study datasets included longitudinal inpatient and outpatient data from these populations. Time series analysis (Kalman filter) and survival analysis (Cox proportional hazards) were combined to produce a range of risk models. These models were evaluated using concordance, a discriminatory statistic. RESULTS: A risk model incorporating longitudinal data on clinical documentation and laboratory test results (concordance 0.849) predicts progression from state III CKD to stage IV CKD more accurately when compared to a similar model without laboratory test results (concordance 0.733,

Dynamical phenotyping: using temporal analysis of clinically collected physiologic data to stratify populations.

Using glucose time series data from a well measured population drawn from an electronic health record (EHR) repository, the variation in predictability of glucose values quantified by the time-delayed mutual information (TDMI) was explained using a mechanistic endocrine model and manual and automated review of written patient records. The results suggest that predictability of glucose varies with health state where the relationship (e.g., linear or inverse) depends on the source of the acuity. It was found that on a fine scale in parameter variation, the less insulin required to process glucose, a condition that correlates with good health, the more predictable glucose values were. Nevertheless, the most powerful effect on predictability in the EHR subpopulation was the presence or absence of variation in health state, specifically, in- and out-of-control glucose versus in-control glucose. Both of these results are clinically and scientifically relevant because the magnitude of glucose is the most commonly used indicator of health as opposed to glucose dynamics, thus providing for a connection between a mechanistic endocrine model and direct insight to human health via clinically collected data

A Bayesian Analysis of Dynamics in Free Recall

We develop a probabilistic model of human memory performance in free recall experiments. In these experiments, a subject first studies a list of words and then tries to recall them. To model these data, we draw on both previous psychological research and statistical topic models of text documents. We assume that memories are formed by assimilating the semantic meaning of studied words (represented as a distribution over topics) into a slowly changing latent context (represented in the same space). During recall, this context is reinstated and used as a cue for retrieving studied words. By conceptualizing memory retrieval as a dynamic latent variable model, we are able to use Bayesian inference to represent uncertainty and reason about the cognitive processes underlying memory. We present a particle filter algorithm for performing approximate posterior inference, and evaluate our model on the prediction of recalled words in experimental data. By specifying the model hierarchically, we are also able to capture inter-subject variability.