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Diabetes mellitus type 2 is increasingly being called a modern preventable pandemic, as even with excellent available treatments, the rate of complications of diabetes is rapidly increasing. Predicting diabetes and identifying it in its early stages could make it easier to prevent, allowing enough time to implement therapies before it gets out of control. Leveraging longitudinal electronic medical record (EMR) data with deep learning has great potential for diabetes prediction. This paper examines the predictive competency of deep learning models in contrast to state-of-the-art machine learning models to incorporate the time dimension of risk. The proposed research investigates a variety of deep learning models and features for predicting diabetes. Model performance was appraised and compared in relation to predominant features, risk factors, training data density and visit history. The framework was implemented on the longitudinal EMR records of over 19K patients extracted from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Empirical findings demonstrate that deep learning models consistently outperform other state-of-the-art competitors with prediction accuracy of above 91%, without overfitting. Fasting blood sugar, hemoglobin A1c and body mass index are the key predictors of future onset of diabetes. Overweight, middle aged patients and patients with hypertension are more vulnerable to developing diabetes, consistent with what is already known. Model performance improves as training data density or the visit history of a patient increases. This study confirms the ability of the LSTM deep learning model to incorporate the time dimension of risk in its predictive capabilities.

The aim of this study is to characterize the performance of an inclination analysis for predicting the onset of heart failure (HF) from routinely collected clinical biomarkers extracted from primary care electronic medical records. A balanced dataset of 698 patients (with/without HF), including a minimum of five longitudinal measures of nine biomarkers (body mass index, diastolic and systolic blood pressure, fasting glucose, glycated hemoglobin, low-density and high-density lipoproteins, total cholesterol, and triglycerides) is used. The proposed algorithm achieves an accuracy of 0.89 (sensitivity of 0.89, specificity of 0.90) to predict the inclination of biomarkers (i.e., their trend towards a ‘survival’ or ‘collapse’ as defined by an inclination analysis) on a labeled, balanced dataset of 40 patients. Decision trees trained on the predicted inclination of biomarkers have significantly higher recall (0.69 vs. 0.53) and significantly higher negative predictive value (0.60 vs. 0.55) than those trained on the average values computed from the measures of biomarkers available before the onset of the disease, suggesting that an inclination analysis can help identify the onset of HF in the primary care patient population from routinely available clinical data. This exploratory study provides the basis for further investigations of inclination analyses to identify at-risk patients and generate preventive measures (i.e., personalized recommendations to reverse the trend of biomarkers towards collapse).

The aim of this study was to design a virtual peer-to-peer intervention for patients with type 2 diabetes (T2D) by grouping patients from specific segments using data from primary care electronic medical records (EMRs). Two opposing segments were identified: patients living with diabetes who tend to take several medications (“medication” segment: ~32%) and patients who do not take any diabetes-specific medications (“lifestyle” segment: ~15%). The remaining patients were from two intermediate segments and exhibited medication-taking behavior that placed them midway between the medication and lifestyle segments. Patients were grouped into six workshops (two workshops in each group: medication, lifestyle, and mixed group), including individuals with good and bad control of their disease. Measures of attitudes, learning, and motivation were addressed during and after the workshops. Results showed that patients in the lifestyle segment were more interested in T2D lifestyle control strategies, more satisfied with their in-workshop learning experience, and more motivated to set a goal than those in the medication segment. These results suggest that the proposed intervention may be more viable for patients in the lifestyle segment and that EMR data may be used to tailor behavioral interventions to specific patient groups. Future research is needed to investigate different segmentation approaches (e.g., using data related to smoking, drinking, diet, and physical activity) that could help tailor the intervention more effectively.

Clinical researchers use prognostic modeling techniques to identify a-prior patient health status and characterize progression patterns. It is highly desirable to predict future health condition especially to implement preventive and intervention strategies in pre-diabetic individuals. Hidden Markov Model (HMM) and its variants are a class of models that provide predictions concerning future condition by exploiting sequences of clinical measurements obtained from a longitudinal sample of patients. Despite the advantages of using these models for prognostic modeling, it still face barriers and significant challenges, to effectively learn dynamic interactions, when using irregularly sampled longitudinal Electronic Medical Records (EMRs) data. Newton's divide difference method (NDDM) is a classical approach for handling irregular data in terms of divided difference. However, as it is polynomial approximation technique, it suffers with Runge Phenomenon. The problem can be even more severe when the interval is a bit extended. Therefore, to tackle this problem, we proposed a novel approximation method based on NDDM as a component with HMM in order to estimate the 8 years risk of developing Type 2 Diabetes Mellitus (T2DM) in a particular individual. The proposed method is evaluated on real world clinical data obtained from CPCSSN. The results demonstrated that our proposed technique has the ability to exploit the available irregularly sampled EMRs data for effective approximation and improved prediction accuracy.

Analysis of long-term multichannel EEG signals for automatic seizure detection is an active area of research that has seen application of methods from different domains of signal processing and machine learning. The majority of approaches developed in this context consist of extraction of hand-crafted features that are used to train a classifier for eventual seizure detection. Approaches that are data-driven, do not use hand-crafted features, and use small amounts of patients' historical EEG data for classifier training are few in number. The approach presented in this paper falls in the latter category, and is based on a signal-derived empirical dictionary approach, which utilizes empirical mode decomposition (EMD) and discrete wavelet transform (DWT) based dictionaries learned using a framework inspired by traditional methods of dictionary learning. Three features associated with traditional dictionary learning approaches, namely projection coefficients, coefficient vector and reconstruction error, are extracted from both EMD and DWT based dictionaries for automated seizure detection. This is the first time these features have been applied for automatic seizure detection using an empirical dictionary approach. Small amounts of patients' historical multi-channel EEG data are used for classifier training, and multiple classifiers are used for seizure detection using newer data. In addition, the seizure detection results are validated using 5-fold cross-validation to rule out any bias in the results. The CHB-MIT benchmark database containing long-term EEG recordings of pediatric patients is used for validation of the approach, and seizure detection performance comparable to the state-of-the-art is obtained. Seizure detection is performed using five classifiers, thereby allowing a comparison of the dictionary approaches, features extracted, and classifiers used. The best seizure detection performance is obtained using EMD based dictionary and reconstruction error feature and support vector machine classifier, with accuracy, sensitivity and specificity values of 88.2, 90.3, and 88.1%, respectively. Comparison is also made with other recent studies using the same database. The methodology presented in this paper is shown to be computationally efficient and robust for patient-specific automatic seizure detection. A data-driven methodology utilizing a small amount of patients' historical data is hence demonstrated as a practical solution for automatic seizure detection.

This study leverages data from a Canadian database of primary care Electronic Medical Records to develop machine learning models predicting type 2 diabetes mellitus (T2D), prediabetes, or normoglycemia. These models are used as a basis for extracting counterfactual explanations and derive personalized changes in biomarkers to prevent T2D onset, particularly in the still reversible prediabetic state. The models achieve satisfactory performance. Furthermore, feature importance analysis underscores the significance of fasting blood sugar and glycated hemoglobin, while counterfactuals explanations emphasize the centrality of keeping body mass index and cholesterol indicators within or close to the clinically desirable ranges. This research highlights the potential of machine learning and counterfactual explanations in guiding preventive interventions that may help slow down the progression from prediabetes to T2D on an individual basis, eventually fostering a recovery from prediabetes to a normoglycemic state. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetes Mellitus is an increasingly prevalent chronic disease characterized by the body’s inability to metabolize glucose. The objective of this study was to build an effective predictive model with high sensitivity and selectivity to better identify Canadian patients at risk of having Diabetes Mellitus based on patient demographic data and the laboratory results during their visits to medical facilities. Methods Using the most recent records of 13,309 Canadian patients aged between 18 and 90 years, along with their laboratory information (age, sex, fasting blood glucose, body mass index, high-density lipoprotein, triglycerides, blood pressure, and low-density lipoprotein), we built predictive models using Logistic Regression and Gradient Boosting Machine (GBM) techniques. The area under the receiver operating characteristic curve (AROC) was used to evaluate the discriminatory capability of these models. We used the adjusted threshold method and the class weight method to improve sensitivity – the proportion of Diabetes Mellitus patients correctly predicted by the model. We also compared these models to other learning machine techniques such as Decision Tree and Random Forest. Results The AROC for the proposed GBM model is 84.7% with a sensitivity of 71.6% and the AROC for the proposed Logistic Regression model is 84.0% with a sensitivity of 73.4%. The GBM and Logistic Regression models perform better than the Random Forest and Decision Tree models. Conclusions The ability of our model to predict patients with Diabetes using some commonly used lab results is high with satisfactory sensitivity. These models can be built into an online computer program to help physicians in predicting patients with future occurrence of diabetes and providing necessary preventive interventions. The model is developed and validated on the Canadian population which is more specific and powerful to apply on Canadian patients than existing models developed from US or other populations. Fasting blood glucose, body mass index, high-density lipoprotein, and triglycerides were the most important predictors in these models.

The objective of this inductive research was to investigate: 1) the relationship between diabetes mellitus and individual risk factors of metabolic syndrome (MetS), in a non-conservative setting; 2) the prediction of future onset of diabetes using relevant risk factors of MetS; and 3) to investigate the relative performance of machine learning methods when data sampling techniques are used to generate balanced training sets. The dataset used in this research contains 667 907 records for a period ranging from 2003 to 2013. Quantifying the contribution of individual risk factors of MetS in the development of diabetes in a non-conservative setting logistic regression analysis was performed. Our analyses contradict the view that diabetes is commonly associated with low levels of high-density lipoprotein (HDL). Instead, our results demonstrate that the increased levels of HDL are positively correlated with diabetes onset, particularly in women. We also proposed J48 decision tree and Naïve Bayes methods for prediction of future onset of diabetes using relevant risk factors obtained from logistic regression analysis, over balanced and unbalanced datasets. The results demonstrated the supremacy of Naïve Bayes with K-medoids under-sampling technique as compared to random under-sampling, oversampling, and no sampling. It is achieved on average 79% receiver operating characteristic performance with the increased true positive rate. The results of this paper suggest further research to clarify the pathophysiological significance of HDL and pathways in the development of diabetes.

Abstract Background Mobile health apps (mHealth apps) are increasing in popularity and utility for the management of many chronic diseases. Although the current reimbursement structure for mHealth apps is lagging behind the rapidly improving functionality, more clinicians will begin to recommend these apps as they prove their clinical worth. Payors such as the government or private insurance companies will start to reimburse for the use of these technologies, especially if they add value to patients by providing timely support, a more streamlined patient experience, and greater patient convenience. Payors are likely to see benefits for providers, as these apps could help increase productivity between in-office encounters without having to resort to expensive in-person visits when patients are having trouble managing their disease. Key findings To guide and perhaps speed up adoption of mHealth apps by patients and providers, analysis and evaluation of existing apps needs to be carried out and more feedback must be provided to app developers. In this paper, an evaluation of 35 mHealth apps claiming to provide cognitive behavioural therapy was conducted to assess the quality of the patient-provider relationship and evidence-based practices embedded in these apps. The mean score across the apps was 4.9 out of 20 functional criteria all of which were identified as important to the patient-provider relationship. The median score was 5 out of these 20 functional criteria. Conclusion Overall, the apps reviewed were mostly stand-alone apps that do not enhance the patient-provider relationship, improve patient accountability or help providers support patients more effectively between visits. Large improvements in patient experience and provider productivity can be made through enhanced integration of mHealth apps into the healthcare system.

Type 2 Diabetes Mellitus (T2DM) is a chronic, progressive metabolic disorder characterized by hyperglycemia resulting from abnormalities in insulin secretion, insulin action, or both. It is associated with an increased risk of developing vascular complication of micro as well as macro nature. Because of its inconspicuous and heterogeneous character, the management of T2DM is very complex. Modeling physiological processes over time demonstrating the patient’s evolving health condition is imperative to comprehending the patient’s current status of health, projecting its likely dynamics and assessing the requisite care and treatment measures in future. Hidden Markov Model (HMM) is an effective approach for such prognostic modeling. However, the nature of the clinical setting, together with the format of the Electronic Medical Records (EMRs) data, in particular the sparse and irregularly sampled clinical data which is well understood to present significant challenges, has confounded standard HMM. In the present study, we proposed an approximation technique based on Newton’s Divided Difference Method (NDDM) as a component with HMM to determine the risk of developing diabetes in an individual over different time horizons using irregular and sparsely sampled EMRs data. The proposed method is capable of exploiting available sequences of clinical measurements obtained from a longitudinal sample of patients for effective imputation and improved prediction performance. Furthermore, results demonstrated that the discrimination capability of our proposed method, in prognosticating diabetes risk, is superior to the standard HMM.

Secure patterns provide a solution for the security requirement of the software. There are large number of secure patterns, and it is quite difficult to choose an appropriate pattern. Moreover, selection of these patterns needs security knowledge; generally, developers are not specialized in the domain of security knowledge. This paper can help in the selection of secure pattern on the basis of tradeoffs of the secure pattern using text categorization. A repository of secure design patterns is used as a data set and a repository of requirements artifacts in the form of software requirements specification (SRS) are used for this paper. A text categorization scheme, which begins with preprocessing, indexing of secure patterns, ends up by querying SRS features for retrieving secure design pattern using document retrieval model. For the evaluation of the proposed model, we have used three different domains’ SRS. These three SRS documents represent three different domains, i.e., e-commerce, social media, and desktop utility program. A traditional precision and recall method along with F-measure used for evaluation of information/document retrieval model is used to evaluate the results. F-measure for 17 different design problems shows around 81% accuracy with recall up to 0.69%.

Forty-four percent of Canadians over the age of 20 have a non-communicable disease (NCD). Millions of Canadians are at risk of developing the complications of NCDs; millions have already experienced those complications. Fortunately, the evidence base for NCD prevention and behavior change is large and growing and digital technologies can deliver them at scale and with high fidelity. However, the current model of in-person primary care is not designed nor capable of operationalizing that evidence. New developments in artificial intelligence that can predict who will develop NCD or the complications of NCD are increasingly available, making the challenge of delivering disease prevention even more urgent. This paper presents findings from stakeholder engagement on a design architecture to address three initial barriers to large-scale deployment of health management and behavior change evidence: 1) the challenges of regulating mobile health apps, 2) the challenge of creating a value-based rationale for payers to invest in deploying mobile health apps at scale, and 3) the high cost of customer acquisition for delivering mobile health apps to those at risk. [ABSTRACT FROM AUTHOR]

All complex systems are potentially predisposed to failure. Healthcare systems are complex systems that are prone to many errors that can result in dire consequences for patients and healthcare providers. The healthcare system in Canada is under unprecedented strain due to shortages of healthcare providers, provider burnout, inefficient workflows, and a lack of appropriate digital infrastructure. We used failure mode and effects analysis (FMEA) to identify the failure modes for care provided in primary care settings. We identified failure modes in appointment scheduling, patient-provider communications, referrals, laboratory and diagnostic procedures, and medication prescriptions as the main failure modes. To mitigate the detected risks, we recommend solutions to ‘close the loop’ on failure modes to prevent patients from falling through the cracks, as vulnerable patients who cannot advocate for themselves are most likely to do so. We provide preliminary requirements for a regulatory regime for electronic health records that can reduce provider burnout, improve regulatory compliance, and improve system efficiency, all while improving patient safety, experience, and outcomes. [ABSTRACT FROM AUTHOR]