We present a scalable end-to-end classifier that uses streaming physiological and medication data to accurately predict the onset of sepsis, a life-threatening complication from infections that has high mortality and morbidity. Our proposed framework models the multivariate trajectories of continuous-valued physiological time series using multitask Gaussian processes, seamlessly accounting for the high uncertainty, frequent missingness, and irregular sampling rates typically associated with real clinical data. The Gaussian process is directly connected to a black-box classifier that predicts whether a patient will become septic, chosen in our case to be a recurrent neural network to account for the extreme variability in the length of patient encounters. We show how to scale the computations associated with the Gaussian process in a manner so that the entire system can be discriminatively trained end-to-end using backpropagation. In a large cohort of heterogeneous inpatient encounters at our university health system we find that it outperforms several baselines at predicting sepsis, and yields 19.4 and 55.5 improved areas under the Receiver Operating Characteristic and Precision Recall curves as compared to the NEWS score currently used by our hospital.
There is a large body of works on the development and validation of early warning scores to predict clinical deterioration and other related outcomes. For instance, the MEWS score @cite_23 and NEWS score @cite_15 are two of the more common scores used to assess overall clinical deterioration. In addition, the SIRS score for systemic inflammatory response syndrome was part of the original clinical definition of sepsis @cite_8 , although other scores designed for sepsis such as SOFA @cite_24 and qSOFA @cite_5 have been more popular in recent years. A more sophisticated regression-based approach called the Rothman Index @cite_17 is also in widespread use for detecting overall deterioration. Finally, @cite_19 used a Cox regression to predict sepsis using clinical time series data, although they do not account for temporal structure since they simply create feature and event-time pairs from raw data.
@cite_8 @cite_24 @cite_19 @cite_23 @cite_5 @cite_15 @cite_17
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Sepsis is a leading cause of death in the United States, with mortality highest among patients who develop septic shock. Early aggressive treatment decreases morbidity and mortality. Although automated screening tools can detect patients currently experiencing severe sepsis and septic shock, none predict those at greatest risk of developing shock. We analyzed routinely available physiological and laboratory data from intensive care unit patients and developed “TREWScore,” a targeted real-time early warning score that predicts which patients will develop septic shock. TREWScore identified patients before the onset of septic shock with an area under the ROC (receiver operating characteristic) curve (AUC) of 0.83 [95 confidence interval (CI), 0.81 to 0.85]. At a specificity of 0.67, TREWScore achieved a sensitivity of 0.85 and identified patients a median of 28.2 [interquartile range (IQR), 10.6 to 94.2] hours before onset. Of those identified, two-thirds were identified before any sepsis-related organ dysfunction. In comparison, the Modified Early Warning Score, which has been used clinically for septic shock prediction, achieved a lower AUC of 0.73 (95 CI, 0.71 to 0.76). A routine screening protocol based on the presence of two of the systemic inflammatory response syndrome criteria, suspicion of infection, and either hypotension or hyperlactatemia achieved a lower sensitivity of 0.74 at a comparable specificity of 0.64. Continuous sampling of data from the electronic health records and calculation of TREWScore may allow clinicians to identify patients at risk for septic shock and provide earlier interventions that would prevent or mitigate the associated morbidity and mortality. Objective. —To develop customized versions of the Simplified Acute Physiology Score II (SAPS II) and the 24-hour Mortality Probability Model II (MPM II24) to estimate the probability of mortality for intensive care unit patients with early severe sepsis. Design and Setting. —Logistic regression models developed for patients with severe sepsis in a database of adult medical and surgical intensive care units in 12 countries. Patients. —Of 11 458 patients in the intensive care unit for at least 24 hours, 1130 had severe sepsis based on criteria of the American College of Chest Physicians and the Society of Critical Care Medicine (systemic inflammatory response syndrome in response to infection, plus hypotension, hypoperfusion, or multiple organ dysfunction). Results. —In patients with severe sepsis, mortality was higher (48.0 vs 19.6 among other patients) and 28-day survival was lower. The customized SAPS II was well calibrated (P=.92 for the goodness-of-fit test) and discriminated well (area under the receiver operating characteristic [ROC] curve, 0.78). Performance in the validation sample was equally good (P=.85 for the goodness-of-fit test; area under the ROC curve, 0.79). The customized MPM II24was well calibrated (P=.92 for the goodness-of-fit test) and discriminated well (area under the ROC curve, 0.79). Performance in the validation sample was equally good (P=.52 for the goodness-of-fit test; area under the ROC curve, 0.75). The models are independent of each other; either can be used alone to estimate the probability of mortality of patients with severe sepsis. Conclusions. —Customization provides a simple technique to apply existing models to a subgroup of patients. Accurately assessing the probability of hospital mortality is a useful adjunct for clinical trials. (JAMA. 1995;273:644-650) An American College of Chest Physicians Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic parameters by which a patient may be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods when dealing with septic patients was recommended as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae. Objective: To determine whether the MS Functional Composite (MSFC) can predict future disease progression in patients with relapsing remitting MS (RR-MS). Background: The MSFC was recommended by the Clinical Outcomes Assessment Task Force of the National MS Society as a new clinical outcome measure for clinical trials. The MSFC, which contains a test of walking speed, arm dexterity, and cognitive function, is expressed as a single score on a continuous scale. It was thought to offer improved reliability and responsiveness compared with traditional clinical MS outcome measures. The predictive value of MSFC scores in RR-MS has not been determined. Methods: The authors conducted a follow-up study of patients with RR-MS who participated in a phase III study of interferon β-1a (AVONEX) to determine the predictive value of MSFC scores. MSFC scores were constructed from data obtained during the phase III trial. Patients were evaluated by neurologic and MRI examinations after an average interval of 8.1 years from the start of the clinical trial. The relationships between MSFC scores during the clinical trial and follow-up status were determined. Results: MSFC scores from the phase III clinical trial strongly predicted clinical and MRI status at the follow-up visit. Baseline MSFC scores, and change in MSFC score over 2 years correlated with both disability status and the severity of whole brain atrophy at follow-up. There were also significant correlations between MSFC scores during the clinical trial and patient-reported quality of life at follow-up. The correlation with whole brain atrophy at follow-up was stronger for baseline MSFC than for baseline EDSS. Conclusion: MSFC scores in patients with RR-MS predict the level of disability and extent of brain atrophy 6 to 8 years later. MSFC scores may prove useful to assign prognosis, monitor patients during early stages of MS, and to assess treatment effects. The risk of mortality associated with acute renal failure (ARF) after open-heart surgery continues to be distressingly high. Accurate prediction of ARF provides an opportunity to develop strategies for early diagnosis and treatment. The aim of this study was to develop a clinical score to predict postoperative ARF by incorporating the effect of all of its major risk factors. A total of 33,217 patients underwent open-heart surgery at the Cleveland Clinic Foundation (1993 to 2002). The primary outcome was ARF that required dialysis. The scoring model was developed in a randomly selected test set ( n = 15,838) and was validated on the remaining patients. Its predictive accuracy was compared by area under the receiver operating characteristic curve. The score ranges between 0 and 17 points. The ARF frequency at each score level in the validation set fell within the 95 confidence intervals (CI) of the corresponding frequency in the test set. Four risk categories of increasing severity (scores 0 to 2, 3 to 5, 6 to 8, and 9 to 13) were formed arbitrarily. The frequency of ARF across these categories in the test set ranged between 0.5 and 22.1 . The score was also valid in predicting ARF across all risk categories. The area under the receiver operating characteristic curve for the score in the test set was 0.81 (95 CI 0.78 to 0.83) and was similar to that in the validation set (0.82; 95 CI 0.80 to 0.85; P = 0.39). In conclusion, a score is valid and accurate in predicting ARF after open-heart surgery; along with increasing its clinical utility, the score can help in planning future clinical trials of ARF. Purpose – The purpose of this paper is to suggest an alternative to the widely used Times Cited criterion for analysing citation networks. The approach involves taking account of the natures of the papers that cite a given paper, so as to differentiate between papers that attract the same number of citations.Design methodology approach – ArticleRank is an algorithm that has been derived from Google's PageRank algorithm to measure the influence of journal articles. ArticleRank is applied to two datasets – a citation network based on an early paper on webometrics, and a self‐citation network based on the 19 most cited papers in the Journal of Documentation – using citation data taken from the Web of Knowledge database.Findings – ArticleRank values provide a different ranking of a set of papers from that provided by the corresponding Times Cited values, and overcomes the inability of the latter to differentiate between papers with the same numbers of citations. The difference in rankings between Times Cited ... NNScore is a neural-network-based scoring function designed to aid the computational identification of small-molecule ligands. While the test cases included in the original NNScore article demonstrated the utility of the program, the application examples were limited. The purpose of the current work is to further confirm that neural-network scoring functions are effective, even when compared to the scoring functions of state-of-the-art docking programs, such as AutoDock, the most commonly cited program, and AutoDock Vina, thought to be two orders of magnitude faster. Aside from providing additional validation of the original NNScore function, we here present a second neural-network scoring function, NNScore 2.0. NNScore 2.0 considers many more binding characteristics when predicting affinity than does the original NNScore. The network output of NNScore 2.0 also differs from that of NNScore 1.0; rather than a binary classification of ligand potency, NNScore 2.0 provides a single estimate of the pKd. To fac... Scholars are increasingly citing electronic “web references” which are not preserved in libraries or full text archives. WebCite is a new standard for citing web references. To “webcite” a document involves archiving the cited Web page through www.webcitation.org and citing the WebCite permalink instead of (or in addition to) the unstable live Web page. This journal has amended its “instructions for authors” accordingly, asking authors to archive cited Web pages before submitting a manuscript. Almost 200 other journals are already using the system. We discuss the rationale for WebCite, its technology, and how scholars, editors, and publishers can benefit from the service. Citing scholars initiate an archiving process of all cited Web references, ideally before they submit a manuscript. Authors of online documents and websites which are expected to be cited by others can ensure that their work is permanently available by creating an archived copy using WebCite and providing the citation information including the WebCite link on their Web document(s). Editors should ask their authors to cache all cited Web addresses (Uniform Resource Locators, or URLs) “prospectively” before submitting their manuscripts to their journal. Editors and publishers should also instruct their copyeditors to cache cited Web material if the author has not done so already. Finally, WebCite can process publisher submitted “citing articles” (submitted for example as eXtensible Markup Language [XML] documents) to automatically archive all cited Web pages shortly before or on publication. Finally, WebCite can act as a focussed crawler, caching retrospectively references of already published articles. Copyright issues are addressed by honouring respective Internet standards (robot exclusion files, no-cache and no-archive tags). Long-term preservation is ensured by agreements with libraries and digital preservation organizations. The resulting WebCite Index may also have applications for research assessment exercises, being able to measure the impact of Web services and published Web documents through access and Web citation metrics. @PARASPLIT [J Med Internet Res 2005;7(5):e60] Abstract Documents in computer-readable form can be used to provide information about other documents, i.e. those they cite. To do this efficiently requires procedures for computer recognition of citing statements. This is not easy, especially for multi-sentence citing statements. Computer recognition procedures have been developed which are accurate to the following extent: 73 of the words in statements selected by computer procedures as being citing statements are words which are correctly attributable to the corresponding documents. The retrieval effectiveness of computer-recognized citing statements was tested in the following way. First, for eight retrieval requests in inorganiic chemistry, average recall by search of Chemical Abstracts Service indexing and Chemical Abstracts abstract text words was found to be 50 . Words from citing statements referring to the papers to be retrieved were then added to the index terms and abstract words as additional access points, and searching was repeated. Average recall increased to 70 . Only words from citing statements published within a year of the cited papers were used. The retrieval effect of citing statement words alone (published within a year) without index or abstract terms was the following: average recall was 40 . When just the words of the titles of the cited papers were added to those citing statement words, average recall increased to 50 . We measure media bias by estimating ideological scores for several major media outlets. To compute this, we count the times that a particular media outlet cites various think tanks and policy groups, and then compare this with the times that members of Congress cite the same groups. Our results show a strong liberal bias: all of the news outlets we examine, except Fox News' Special Report and the Washington Times, received scores to the left of the average member of Congress. Consistent with claims made by conservative critics, CBS Evening News and the New York Times received scores far to the left of center. The most centrist media outlets were PBS NewsHour, CNN's Newsnight, and ABC's Good Morning America; among print outlets, USA Today was closest to the center. All of our findings refer strictly to news content; that is, we exclude editorials, letters, and the like. "The editors in Los Angeles killed the story. They told Witcover that it didn't ‘come off’ and that it was an ‘opinion’ story.… The solution was simple, they told him. All he had to do was get other people to make the same points and draw the same conclusions and then write the article in their words" (emphasis in original). Timothy Crouse, Boys on the Bus [1973, p. 116]. A citing sentence is one that appears in a scientific article and cites previous work. Citing sentences have been studied and used in many applications. For example, they have been used in scientific paper summarization, automatic survey generation, paraphrase identification, and citation function classification. Citing sentences that cite multiple papers are common in scientific writing. This observation should be taken into consideration when using citing sentences in applications. For instance, when a citing sentence is used in a summary of a scientific paper, only the fragments of the sentence that are relevant to the summarized paper should be included in the summary. In this paper, we present and compare three different approaches for identifying the fragments of a citing sentence that are related to a given target reference. Our methods are: word classification, sequence labeling, and segment classification. Our experiments show that segment classification achieves the best results. In recent years scholars have built maps of science by connecting the academic fields that cite each other, are cited together, or that cite a similar literature. But since scholars cannot always publish in the fields they cite, or that cite them, these science maps are only rough proxies for the potential of a scholar, organization, or country, to enter a new academic field. Here we use a large dataset of scholarly publications disambiguated at the individual level to create a map of science-or research space-where links connect pairs of fields based on the probability that an individual has published in both of them. We find that the research space is a significantly more accurate predictor of the fields that individuals and organizations will enter in the future than citation based science maps. At the country level, however, the research space and citations based science maps are equally accurate. These findings show that data on career trajectories-the set of fields that individuals have previously published in-provide more accurate predictors of future research output for more focalized units-such as individuals or organizations-than citation based science maps. In a document network such as a citation network of scientific documents, web-logs, etc., the content produced by authors exhibits their interest in certain topics. In addition some authors influence other authors' interests. In this work, we propose to model the influence of cited authors along with the interests of citing authors. Moreover, we hypothesize that apart from the citations present in documents, the context surrounding the citation mention provides extra topical information about the cited authors. However, associating terms in the context to the cited authors remains an open problem. We propose novel document generation schemes that incorporate the context while simultaneously modeling the interests of citing authors and influence of the cited authors. Our experiments show significant improvements over baseline models for various evaluation criteria such as link prediction between document and cited author, and quantitatively explaining unseen text. A new form of document coupling called co-citation is defined as the frequency with which two documents are cited together. The co-citation frequency of two scientific papers can be determined by comparing lists of citing documents in the Science Citation Index and counting identical entries. Networks of co-cited papers can be generated for specific scientific specialties, and an example is drawn from the literature of particle physics. Co-citation patterns are found to differ significantly from bibliographic coupling patterns, but to agree generally with patterns of direct citation. Clusters of co-cited papers provide a new way to study the specialty structure of science. They may provide a new approach to indexing and to the creation of SDI profiles. Alzheimer's Disease (AD), the most common type of dementia, is a severe neurodegenerative disorder. Identifying markers that can track the progress of the disease has recently received increasing attentions in AD research. A definitive diagnosis of AD requires autopsy confirmation, thus many clinical cognitive measures including Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog) have been designed to evaluate the cognitive status of the patients and used as important criteria for clinical diagnosis of probable AD. In this paper, we propose a multi-task learning formulation for predicting the disease progression measured by the cognitive scores and selecting markers predictive of the progression. Specifically, we formulate the prediction problem as a multi-task regression problem by considering the prediction at each time point as a task. We capture the intrinsic relatedness among different tasks by a temporal group Lasso regularizer. The regularizer consists of two components including an L2,1-norm penalty on the regression weight vectors, which ensures that a small subset of features will be selected for the regression models at all time points, and a temporal smoothness term which ensures a small deviation between two regression models at successive time points. We have performed extensive evaluations using various types of data at the baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database for predicting the future MMSE and ADAS-Cog scores. Our experimental studies demonstrate the effectiveness of the proposed algorithm for capturing the progression trend and the cross-sectional group differences of AD severity. Results also show that most markers selected by the proposed algorithm are consistent with findings from existing cross-sectional studies. In this paper, we propose a “Response to Name Dataset” for autism spectrum disorder (ASD) study as well as a multimodal ASD auxiliary screening system based on machine learning. ASD children are characterized by their impaired interpersonal communication abilities and lack of response. In the proposed dataset, the reactions of children are recorded by cameras upon calling their names. The responsiveness of each child is then evaluated by a clinician with a score among 0, 1 and 2 following the Autism Diagnostic Observation Schedule (ADOS). We then develop a rule-based multimodal framework to quantitatively evaluate each child. Our system involves speech recognition based automatic name calling detection, face detection alignment, head pose estimation, and considers the response speed, eye contact duration and head orientation to output the final prediction. Compared to existing work, our dataset characterizes a more precise and detailed scoring system with clinical trial standards, as well as a more spontaneous setting by incorporating less lab-controlled sessions with dynamic cluttered environments, multi-pose mobile captured videos, and flexible number of accompanying adults. Experiments show that our machine predicted scores align closely with human professional diagnosis, showing promising potential in early screening of ASD, and shedding light on future clinical applications. Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply reusing the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability, and billing reasons, rather than for developing new algorithms. With increasing excitement surrounding “secondary use of medical records” and “Big Data” analytics, it is important to understand the limitations of current databases and what needs to change in order to enter an era of “precision medicine.” This review article covers many of the issues involved in the collection and preprocessing of critical care data. The three challenges in critical care are considered: compartmentalization, corruption, and complexity. A range of applications addressing these issues are covered, including the modernization of static acuity scoring; online patient tracking; personalized prediction and risk assessment; artifact detection; state estimation; and incorporation of multimodal data sources such as genomic and free text data. Citation relationship between scientific publications has been successfully used for scholarly bibliometrics, information retrieval and data mining tasks, and citation-based recommendation algorithms are well documented. While previous studies investigated citation relations from various viewpoints, most of them share the same assumption that, if paper1 cites paper2 (or author1 cites author2), they are connected, regardless of citation importance, sentiment, reason, topic, or motivation. However, this assumption is oversimplified. In this study, we employ an innovative "context-rich heterogeneous network" approach, which paves a new way for citation recommendation task. In the network, we characterize 1) the importance of citation relationships between citing and cited papers, and 2) the topical citation motivation. Unlike earlier studies, the citation information, in this paper, is characterized by citation textual contexts extracted from the full-text citing paper. We also propose algorithm to cope with the situation when large portion of full-text missing information exists in the bibliographic repository. Evaluation results show that, context-rich heterogeneous network can significantly enhance the citation recommendation performance. Graphical abstractDisplay Omitted New method to estimate patient condition during a hospital visit.Patient condition is computed by summing risks measured in each of 26 variables.Leverages data already in the EMR: vital signs, lab results, nursing assessments.Rothman Index, a measure of patient condition, is independent of diagnosis and spans all acuity levels.May help clinicians to improve continuity of care and to detect trends. Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients.A survey of Electronic Medical Record data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single-variable risks. The model's validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals.Outcome validation across hospitals yields an area under the receiver operating characteristic curve(AUC) of Â?0.92when separating hospice deceased from all other discharge categories, an AUC of Â?0.93 when predicting 24-h mortalityand an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomesreflective of patient condition across the acuity spectrum indicates utility in both medical-surgical unitsand critical care units. The model output, which we call the Rothman Index, may provide clinicians witha longitudinal view of patient condition to help address known challenges in caregiver communication,continuity of care, and earlier detection of acuity trends. Previous research indicates that during the past 20 years, the highest-quality work has been published in an increasingly diverse and larger group of journals. In this article, we examine whether this diversification has also affected the handful of elite journals that are traditionally considered to be the best. We examine citation patterns during the past 40 years of seven long-standing traditionally elite journals and six journals that have been increasing in importance during the past 20 years. To be among the top 5 or 1 cited papers, papers now need about twice as many citations as they did 40 years ago. Since the late 1980s and early 1990s, elite journals have been publishing a decreasing proportion of these top-cited papers. This also applies to the two journals that are typically considered as the top venues and often used as bibliometric indicators of "excellence": Science and Nature. On the other hand, several new and established journals are publishing an increasing proportion of the most-cited papers. These changes bring new challenges and opportunities for all parties. Journals can enact policies to increase or maintain their relative position in the journal hierarchy. Researchers now have the option to publish in more diverse venues knowing that their work can still reach the same audiences. Finally, evaluators and administrators need to know that although there will always be a certain prestige associated with publishing in "elite" journals, journal hierarchies are in constant flux.