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Characterizing Emergency Department Care for Patients With Histories of Incarceration

JACEP Open 2025年第1期6卷 100022-100022页

作者： Huang, Thomas Socrates, Vimig Ovchinnikova, Polina Faustino, Isaac Kumar, Anusha Safranek, Conrad Chi, Ling Wang, Emily A. Puglisi, Lisa Wong, Ambrose H. Wang, Karen H. Taylor, R. Andrew Department of Emergency Medicine Yale School of Medicine New Haven CT United States Department for Biomedical Informatics and Data Science Yale University School of Medicine New Haven CT United States Program of Computational Biology and Bioinformatics Yale University New Haven CT United States SEICHE Center for Health and Justice Yale School of Medicine New Haven CT United States Equity Research and Innovation Center Yale School of Medicine Yale University New Haven CT United States

Objectives: Patients with a history of incarceration experience bias from health care team members, barriers to privacy, and a multitude of health care disparities. We aimed to assess care processes delivered in emergency departments (EDs) for people with histories of incarceration. Methods: We utilized a fine-tuned large language model to identify patient incarceration status from 480,374 notes from the ED setting. We compared socio-demographic characteristics, comorbidities, and care processes, including disposition, restraint use, and sedation, between individuals with and without a history of incarceration. We then conducted multivariable logistic regression to assess the independent correlation of incarceration history and management in the ED while adjusting for demographic characteristics, health behaviors, presentation, and past medical history. Results: We found 1734 unique patient encounters with a history of incarceration from a total of 177,987 encounters. Patients with history of incarceration were more likely to be male, Black, Hispanic, or other race/ethnicity, currently unemployed or disabled, and had smoking and substance use histories, compared with those without. This cohort demonstrated higher odds of elopement (OR: 3.59 [95% CI: 2.41–5.12]), leaving against medical advice (OR: 2.39 [95% CI: 1.46–3.67]), and being subjected to sedation (OR: 3.89 [95% CI: 3.19–4.70]) and restraint use (OR: 3.76 [95% CI: 3.06–4.57]). After adjusting for covariates, the association between incarceration and elopement remained significant (adjusted odds ratio: 1.65 [95% CI: 1.08–2.43]), while associations with other dispositions, restraint use, and sedation did not persist. Conclusion: This study identified differences in patient characteristics and care processes in the ED for patients with histories of incarceration and demonstrated the potential of using natural language processing in measuring care processes in populations that are largely hidden, but highly prev

关键词： artificial intelligence emergency medicine incarceration large language models quality of health care

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Precision Rehabilitation for Patients Post-Stroke based on Electronic Health Records and Machine Learning

arXiv

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arXiv 2024年

作者： Gao, Fengyi Zhang, Xingyu Sivarajkumar, Sonish Denny, Parker E. Aldhahwani, Bayan M. Visweswaran, Shyam Shi, Ryan Hogan, William Bove, Allyn Wang, Yanshan Department of Health Information Management University of Pittsburgh PittsburghPA United States Department of Communication Science and Disorders University of Pittsburgh PittsburghPA United States Intelligent Systems Program School of Computing and Information University of Pittsburgh PittsburghPA United States Department of Physical Therapy University of Pittsburgh PittsburghPA United States Department of Medical Rehabilitation Sciences Umm Al-Qura University Makkah Saudi Arabia Department of Biomedical Informatics University of Pittsburgh PittsburghPA United States Department of Computer Science University of Pittsburgh Medical Center PittsburghPA United States Data Science Institute Medical College of Wisconsin MilwaukeeWI United States Hillman Cancer Center University of Pittsburgh Medical Center PittsburghPA United States

Objective In this study, we utilized statistical analysis and machine learning methods to examine whether rehabilitation exercises can improve patients post-stroke functional abilities, as well as forecast the improvement in functional abilities. Our dataset is patients’ rehabilitation exercises and demographic information recorded in the unstructured electronic health records (EHRs) data and free-text rehabilitation procedure notes. Through this study, our ultimate goal is to pinpoint the specific rehabilitation exercises that can effectively aid post-stroke patients in improving their functional outcomes in basic mobility (BM) and applied cognitive (AC) domains. data sources We collected data for 265 stroke patients from the University of Pittsburgh Medical Center, accessed through the Rehabilitation datamart With informatics iNfrastructure for Research (ReDWINE). Methods We employed a pre-existing natural language processing (NLP) algorithm to extract data on rehabilitation exercises and developed a rule-based NLP algorithm to extract Activity Measure for Post-Acute Care (AM-PAC) scores, covering basic mobility (BM) and applied cognitive (AC) domains, from procedure notes. AM-PAC scores were collected at the initial rehabilitation visit and followed up at one and two months—key recovery periods. Changes in AM-PAC scores were classified based on the minimal clinically important difference (MCID), and significance was assessed using Friedman and Wilcoxon tests. To identify impactful exercises, we used Chi-square tests, Fisher's exact tests, and logistic regression for odds ratios. Additionally, we developed five machine learning models—logistic regression (LR), Adaboost (ADB), support vector machine (SVM), gradient boosting (GB), and random forest (RF)—to predict outcomes in functional ability. Results Statistical analyses revealed significant associations between functional improvements and specific exercises. In the AC domain, the BALANCE exercise showed substant

关键词： Statistical tests

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Towards a Visual-Language Foundation Model for Computational Pathology

arXiv

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arXiv 2023年

作者： Lu, Ming Y. Chen, Bowen Williamson, Drew F.K. Chen, Richard J. Liang, Ivy Ding, Tong Jaume, Guillaume Odintsov, Igor Zhang, Andrew Le, Long Phi Gerber, Georg Parwani, Anil V. Mahmood, Faisal Department of Pathology Brigham and Women’s Hospital Harvard Medical School BostonMA United States Department of Pathology Massachusetts General Hospital Harvard Medical School BostonMA United States Cancer Program Broad Institute of Harvard and MIT CambridgeMA United States Cancer Data Science Program Dana-Farber Cancer Institute BostonMA United States Department of Biomedical Informatics Harvard Medical School BostonMA United States CambridgeMA United States Health Sciences and Technology Harvard-MIT CambridgeMA United States Harvard John A. Paulson School of Engineering And Applied Sciences Harvard University CambridgeMA United States Department of Pathology Wexner Medical Center Ohio State University ColumbusOH United States Harvard Data Science Initiative Harvard University CambridgeMA United States

The accelerated adoption of digital pathology and advances in deep learning have enabled the development of powerful models for various pathology tasks across a diverse array of diseases and patient cohorts1–13. However, model training is often difficult due to label scarcity in the medical domain and the model’s usage is limited by the specific task and disease for which it is trained1–3, 14, 15. Additionally, most models in histopathology leverage only image data, a stark contrast to how humans teach each other and reason about histopathologic entities. We introduce CONtrastive learning from Captions for Histopathology (CONCH), a visual-language foundation model developed using diverse sources of histopathology images, biomedical text, and notably over 1.17 million image-caption pairs via task-agnostic pretraining. Evaluated on a suite of 13 diverse benchmarks, CONCH can be transferred to a wide range of downstream tasks involving either or both histopathology images and text, achieving state-of-the-art performance on histology image classification, segmentation, captioning, text-to-image and image-to-text retrieval. CONCH represents a substantial leap over concurrent visual-language pretrained systems for histopathology, with the potential to directly facilitate a wide array of machine learning-based workflows requiring minimal or no further supervised fine-tuning. © 2023, CC BY-NC-ND.

关键词： Pathology

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Graph Representation Learning in Biomedicine

arXiv

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arXiv 2021年

作者： Li, Michelle M. Huang, Kexin Zitnik, Marinka Bioinformatics and Integrative Genomics Program Harvard Medical School BostonMA02115 United States Health Data Science Program Harvard T.H. Chan School of Public Health BostonMA02115 United States Department of Biomedical Informatics Harvard Medical School BostonMA02115 United States Broad Institute of MIT and Harvard CambridgeMA02142 United States Harvard Data Science Initiative CambridgeMA02138 United States

Biomedical networks (or graphs) are universal descriptors for systems of interacting elements, from molecular interactions and disease co-morbidity to healthcare systems and scientific knowledge. Advances in artificial intelligence, specifically deep learning, have enabled us to model, analyze, and learn with such networked data. In this review, we put forward an observation that long-standing principles of systems biology and medicine-while often unspoken in machine learning research-provide the conceptual grounding for representation learning on graphs, explain its current successes and limitations, and even inform future advancements. We synthesize a spectrum of algorithmic approaches that, at their core, leverage graph topology to embed networks into compact vector spaces. We also capture the breadth of ways in which representation learning has dramatically improved the state-of-the-art in biomedical machine learning. Exemplary domains covered include identifying variants underlying complex traits, disentangling behaviors of single cells and their effects on health, assisting in diagnosis and treatment of patients, and developing safe and effective medicines. © 2021, CC BY.

关键词： Vector spaces

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Multimodal AI predicts clinical outcomes of drug combinations from preclinical data

arXiv

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arXiv 2025年

作者： Huang, Yepeng Su, Xiaorui Ullanat, Varun Liang, Ivy Clegg, Lindsay Olabode, Damilola Ho, Nicholas John, Bino Gibbs, Megan Zitnik, Marinka Department of Biomedical Informatics Harvard Medical School BostonMA United States Program in Biological and Biomedical Sciences Harvard Medical School BostonMA United States Harvard College CambridgeMA United States Clinical Pharmacology and Quantitative Pharmacology Clinical Pharmacology & Safety Sciences R&D AstraZeneca GaithersburgMD United States Clinical Pharmacology and Quantitative Pharmacology Clinical Pharmacology & Safety Sciences R&D AstraZeneca WalthamMA United States Program in Computational Biology Carnegie Mellon University PittsburghPA United States Imaging and Data Analytics Clinical Pharmacology & Safety Sciences R&D AstraZeneca WalthamMA United States Kempner Institute for the Study of Natural and Artificial Intelligence Harvard University AllstonMA United States Broad Institute of MIT and Harvard CambridgeMA United States Harvard Data Science Initiative CambridgeMA United States

Predicting clinical outcomes from preclinical data is essential for identifying safe and effective drug combinations, reducing late-stage clinical failures, and accelerating the development of precision therapies. Current models rely on structural or target-based features to identify high-efficacy, low-toxicity drug combinations. However, these approaches fail to incorporate the multimodal data necessary for accurate, clinically-relevant predictions. Here, we introduce MADRIGAL, a multimodal AI model that learns from structural, pathway, cell viability, and transcriptomic data to predict drug combination effects across 953 clinical outcomes and 21,842 compounds, including combinations of approved drugs and novel compounds in development. MADRIGAL uses a transformer bottleneck module to unify preclinical drug data modalities while handling missing data during training and inference—a major challenge in multimodal learning. It outperforms single-modality methods and state-of-the-art models in predicting adverse drug interactions. MADRIGAL performs virtual screening of anticancer drug combinations and supports polypharmacy management for type II diabetes and metabolic dysfunction-associated steatohepatitis (MASH). It identifies transporter-mediated drug interactions. MADRIGAL predicts resmetirom, the first and only FDA-approved drug for MASH, among therapies with the most favorable safety profile. It supports personalized cancer therapy by integrating genomic profiles from cancer patients. Using primary acute myeloid leukemia samples and patient-derived xenograft models, it predicts the efficacy of personalized drug combinations. Integrating MADRIGAL with a large language model allows users to describe clinical outcomes in natural language, improving safety assessment by identifying potential adverse interactions and toxicity risks. MADRIGAL provides a multimodal approach for designing combination therapies with improved predictive accuracy and clinical relevance. Copy

关键词： Diseases

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Advancing the Use of Longitudinal Electronic Health Records: Tutorial for Uncovering Real-World Evidence in Chronic Disease Outcomes

引用

Journal of Medical Internet Research 2025年第1期27卷 e71873页

作者： Huang, Feiqing Hou, Jue Zhou, Ningxuan Greco, Kimberly Lin, Chenyu Sweet, Sara Morini Wen, Jun Shen, Lechen Gonzalez, Nicolas Zhang, Sinian Liao, Katherine P. Cai, Tianrun Xia, Zongqi Bourgeois, Florence T. Cai, Tianxi Department of Biostatistics Harvard T.H. Chan School of Public Health Boston MA United States Harvard-MIT Center for Regulatory Science Harvard Medical School Boston MA United States Division of Biostatistics and Health Data Science School of Public Health University of Minnesota Minneapolis MN United States Department of Biomedical Informatics Harvard Medical School Boston MA United States Department of Engineering University of Toronto Toronto ON Canada Division of Rheumatology Inflammation and Immunity Brigham and Women's Hospital Boston MA United States Department of Neurology University of Pittsburgh Pittsburgh PA United States Computational Health Informatics Program (CHIP) Boston Children's Hospital Boston MA United States Department of Pediatrics Harvard Medical School Boston MA United States

Managing chronic diseases requires ongoing monitoring of disease activity and therapeutic responses to optimize treatment plans. With the growing availability of disease-modifying therapies, it is crucial to investigate comparative effectiveness and long-term outcomes beyond those available from randomized clinical trials. We introduce a comprehensive pipeline for generating reproducible and generalizable real-world evidence on disease outcomes by leveraging electronic health record data. The pipeline first generates scalable disease outcomes by linking electronic health record data with registry data containing a small sample of labeled outcomes. It then applies causal analysis using these scalable outcomes to evaluate therapies for chronic diseases. The implementation of the pipeline is illustrated in a case study based on multiple sclerosis. Our approach addresses challenges in real-world evidence generation for disease activity of chronic conditions, specifically the lack of direct observations on key outcomes and biases arising from imperfect or incomplete data. We present advanced machine learning techniques such as semisupervised and ensemble methods to impute missing outcome data, further incorporating steps for calibrated causal analyses and bias correction. ©Feiqing Huang, Jue Hou, Ningxuan Zhou, Kimberly Greco, Chenyu Lin, Sara Morini Sweet, Jun Wen, Lechen Shen, Nicolas Gonzalez, Sinian Zhang, Katherine P Liao, Tianrun Cai, Zongqi Xia, Florence T Bourgeois, Tianxi Cai.

关键词： calibration causal inference chronic disease outcomes data imputation electronic health records longitudinal disease activity machine learning real-world evidence

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Latent Regression and Ordination Risk of Infectious Disease and Climate

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Procedia Computer science 2021年 179卷 25-32页

作者： Rezzy Eko Caraka Rung Ching Chen Youngjo Lee Prana Ugiana Gio Arif Budiarto Bens Pardamean College of Informatics Chaoyang University of Technology 168 Jifong East Road Wufong Dist. Taichung City 41349 Taiwan (R.O.C.). Department of Statistics College of Natural Science Seoul National University Gwanak-gu Seoul 08826 Korea Bioinformatics and Data Science Research Center Bina Nusantara University Jakarta Indonesia Department of Mathematics Universitas Sumatera Utara Medan 20222 Indonesia Computer Science Department School of Computer Science Bina Nusantara University Jakarta Indonesia 11480 Computer Science Department BINUS Graduate Program - Master of Computer Science Program Bina Nusantara University Indonesia.

Global warming arising from climate change can increase the spread of deadly diseases. Effort is needed to develop a set of policies for the government to stem or reduce health risks from global warming. The purpose of this paper is to examine more detail and comprehensively about the relationship among climate and event disease count in Taiwan using the partial least square latent regression model. The results obtained that of the 17 types of diseases in Taiwan, that has the most significant loading factor is Amoebiasis, Malaria and Chikungunya. At the same time, climate variables that have the biggest most significant factor are Number day with max temp more than 30, Number day Temp more than 25, and Rainfall PH. Cronbach’s Alpha infectious disease 0.9696 and climate 0.2813. At the same time, the value of Dillon Goldstein’s rho infectious disease 0.974 and climate 0.6404, respectively.

关键词： Disease Counts Climate Latent PLS Regression

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AI-based Automatic Segmentation of Prostate on Multi-modality Images: A Review

arXiv

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arXiv 2024年

作者： Jin, Rui Li, Derun Xiang, Dehui Zhang, Lei Zhou, Hailing Shi, Fei Zhu, Weifang Cai, Jing Peng, Tao Chen, Xinjian School of Future Science and Engineering Soochow University Suzhou China Department of Urology Peking University First Hospital Xicheng District Beijing100034 China MIPAV Lab The School of Electronic and Information Engineering Soochow University Jiangsu China Graduate Program of Medical Physics and Data Science Research Center Duke Kunshan University Jiangsu Kunshan215316 China Department of Mechanical Engineering and Product Design Engineering Swinburne University of Technology Melbourne Australia Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong Department of Radiation Oncology UT Southwestern Medical Center DallasTX United States The State Key Laboratory of Radiation Medicine and Protection Soochow University Jiangsu China

Prostate cancer represents a major threat to health. Early detection is vital in reducing the mortality rate among prostate cancer patients. One approach involves using multi-modality (CT, MRI, US, etc.) computer-aided diagnosis (CAD) systems for the prostate region. However, prostate segmentation is challenging due to imperfections in the images and the prostate’s complex tissue structure. The advent of precision medicine and a significant increase in clinical capacity have spurred the need for various data-driven tasks in the field of medical imaging. Recently, numerous machine learning and data mining tools have been integrated into various medical areas, including image segmentation. This article proposes a new classification method that differentiates supervision types, either in number or kind, during the training phase. Subsequently, we conducted a survey on artificial intelligence (AI)-based automatic prostate segmentation methods, examining the advantages and limitations of each. Additionally, we introduce variants of evaluation metrics for the verification and performance assessment of the segmentation method and summarize the current challenges. Finally, future research directions and development trends are discussed, reflecting the outcomes of our literature survey, suggesting high-precision detection and treatment of prostate cancer as a promising avenue. Impact Statement — Prostate cancer remains a significant health threat, necessitating early detection to reduce mortality rates. Current diagnostic approaches, particularly in medical imaging, face challenges in accurate prostate segmentation due to the organ's complex structure and imaging imperfections. Our review paper delves into AI-based automatic segmentation methods across various imaging modalities (CT, MRI, US), emphasizing their strengths, weaknesses, and the specific challenges they address. By classifying segmentation techniques based on supervision levels, we provide a comprehensive analys

关键词： Computer aided diagnosis

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Exploring disparities of teleconsultation readiness: A comparative analysis of healthcare facilities in Indonesia

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DIGITAL HEALTH 2024年 10卷

作者： Daniel Chriswinanto Adityo Nugroho Katherina Adisaputro Mitra Andini Sigilipoe Ida Ayu Triastuti Suryani Hutomo Ardhinta Bellano Septarda Aryososepti Yuwono Caraka Randi Yusuf Dedik Sulistiawan Balqis Gusbela Jason C Hsu Emily Chia-Yu Su Faculty of Medicine Universitas Kristen Duta Wacana Yogyakarta IndonesiaGraduate Institute of Biomedical Informatics College of Medical Science and Technology Taipei Medical University Taipei Faculty of Medicine Universitas Kristen Duta Wacana Yogyakarta Indonesia Faculty of Public Health Universitas Ahmad Dahlan Yogyakarta IndonesiaSchool of Public Health Taipei Medical University Taipei International PhD Program in Biotech and Healthcare Management College of Management Taipei Medical University Taipei International PhD Program in Biotech and Healthcare Management College of Management Taipei Medical University TaipeiClinical Data Center Office of Data Science Taipei Medical University TaipeiClinical Big Data Research Center Taipei Medical University Hospital TaipeiResearch Center of Health Care Industry Data Science College of Management Taipei Medical University Taipei Graduate Institute of Biomedical Informatics College of Medical Science and Technology Taipei Medical University TaipeiClinical Big Data Research Center Taipei Medical University Hospital TaipeiInstitute of Biomedical Informatics College of Medicine National Yang Ming Chiao Tung University Taipei

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Mapping Emergency Medicine data to the Observational Medical Outcomes Partnership Common data Model: A Gap Analysis of the American College of Emergency Physicians Clinical Emergency data Registry

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JACEP Open 2025年第1期6卷 100016-100016页

作者： Cohen, Inessa Diao, Zihan Goyal, Pawan Gupta, Aarti Hawk, Kathryn Malcom, Bill Malicki, Caitlin Sharma, Dhruv Sweeney, Brian Weiner, Scott G. Venkatesh, Arjun Taylor, R. Andrew Department of Emergency Medicine Yale School of Medicine New Haven CT United States Section for Biomedical Informatics and Data Science Yale University School of Medicine New Haven CT United States Program of Computational Biology and Bioinformatics Yale University New Haven CT United States American College of Emergency Physicians Washington DC United States Department of Emergency Medicine Brigham and Women's Hospital Boston MA United States Center for Outcomes Research and Evaluation (CORE) Section of Cardiovascular Medicine Yale School of Medicine New Haven CT United States

Objectives: This study aims to conduct a gap analysis to determine the feasibility of mapping electronic health record data from the Clinical Emergency data Registry (CEDR) to the Observational Medical Outcomes Partnership Common data Model (OMOP-CDM). Methods: We employed a structured approach using a custom-built comparison matrix. This matrix facilitated the alignment of CEDR data fields with the corresponding elements in the OMOP-CDM schema. Each field was evaluated for compatibility, with categorization into 3 distinct types: direct matches, fields requiring transformation, and fields with no OMOP-CDM equivalent. The mapping process was informed by consultations with the Observational Health data sciences and informatics community forums and was guided by existing documentation and best practices in data harmonization. We performed descriptive analyses, quantifying the extent of direct matches and identifying the specific transformations needed for each CEDR-CDM field to ensure compliance with the OMOP-CDM model. Results: Our analysis indicates a high degree of compatibility between CEDR and OMOP, with over 90% (244/269) of CEDR fields being successfully mapped. Specifically, 173 fields had direct matches, whereas 71 required transformations. Challenges identified include addressing fields unique to CEDR with no OMOP-CDM equivalent and managing the transformations required for proper alignment. Conclusion: The OMOP-CDM presents a promising framework for standardizing emergency medicine data, thereby enhancing future query automation, analytics, and cross-institutional collaboration. Despite the potential challenges in capturing unique CEDR fields and addressing necessary transformations, most emergency department data can be standardized within the OMOP-CDM, fostering broader insights and applications in research and public health. © 2024 The Author(s)

关键词： databases electronic health records emergency service informatics opioid/adverse effects quality of health care registries

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