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Objectives Analysis of routinely collected electronic health data is a key tool for long-term condition research and practice for hospitalised patients. This requires accurate and complete ascertainment of a broad range of diagnoses, something not always recorded on an admission document at a single point in time. This study aimed to ascertain how far back in time electronic hospital records need to be interrogated to capture long-term condition diagnoses.Design Retrospective observational study of routinely collected hospital electronic health record data.Setting Queen Elizabeth Hospital Birmingham (UK)-linked data held by the PIONEER acute care data hub.Participants Patients whose first recorded admission for chronic obstructive pulmonary disease (COPD) exacerbation (n=560) or acute stroke (n=2142) was between January and December 2018 and who had a minimum of 10 years of data prior to the index date.Outcome measures We identified the most common International Classification of Diseases version 10-coded diagnoses received by patients with COPD and acute stroke separately. For each diagnosis, we derived the number of patients with the diagnosis recorded at least once over the full 10-year lookback period, and then compared this with shorter lookback periods from 1 year to 9 years prior to the index admission.Results Seven of the top 10 most common diagnoses in the COPD dataset reached >90% completeness by 6 years of lookback. Atrial fibrillation and diabetes were >90% coded with 2–3 years of lookback, but hypertension and asthma completeness continued to rise all the way out to 10 years of lookback. For stroke, 4 of the top 10 reached 90% completeness by 5 years of lookback; angina pectoris was >90% coded at 7 years and previous transient ischaemic attack completeness continued to rise out to 10 years of lookback.Conclusion A 7-year lookback captures most, but not all, common diagnoses. Lookback duration should be tailored to the conditions being studied.

AimsMetabolic dysfunction Associated Steatotic Liver Disease (MASLD) outcomes such as MASH (metabolic dysfunction associated steatohepatitis), fibrosis and cirrhosis are ordinarily determined by resource-intensive and invasive biopsies. We aim to show that routine clinical tests offer sufficient information to predict these endpoints.MethodsUsing the LITMUS Metacohort derived from the European NAFLD Registry, the largest MASLD dataset in Europe, we create three combinations of features which vary in degree of procurement including a 19-variable feature set that are attained through a routine clinical appointment or blood test. This data was used to train predictive models using supervised machine learning (ML) algorithm XGBoost, alongside missing imputation technique MICE and class balancing algorithm SMOTE. Shapley Additive exPlanations (SHAP) were added to determine relative importance for each clinical variable.ResultsAnalysing nine biopsy-derived MASLD outcomes of cohort size ranging between 5385 and 6673 subjects, we were able to predict individuals at training set AUCs ranging from 0.719-0.994, including classifying individuals who are At-Risk MASH at an AUC = 0.899. Using two further feature combinations of 26-variables and 35-variables, which included composite scores known to be good indicators for MASLD endpoints and advanced specialist tests, we found predictive performance did not sufficiently improve. We are also able to present local and global explanations for each ML model, offering clinicians interpretability without the expense of worsening predictive performance.ConclusionsThis study developed a series of ML models of accuracy ranging from 71.9-99.4% using only easily extractable and readily available information in predicting MASLD outcomes which are usually determined through highly invasive means.

Aims: Overlapping asymmetric data sets are where a large cohort of observations have a small amount of information recorded, and within this group there exists a smaller cohort which have extensive further information available. Missing imputation is unwise if cohort size differs substantially; therefore, we aim to develop a way of modelling the smaller cohort whilst considering the larger. Methods: Through considering traditionally once penalized P-Spline approximations, we create a second penalty term through observing discrepancies in the marginal value of covariates that exist in both cohorts. Our now twice penalized P-Spline is designed to firstly prevent over/under-fitting of the smaller cohort and secondly to consider the larger cohort. Results: Through a series of data simulations, penalty parameter tunings, and model adaptations, our twice penalized model offers up to a 58% and 46% improvement in model fit upon a continuous and binary response, respectively, against existing B-Spline and once penalized P-Spline methods. Applying our model to an individual’s risk of developing steatohepatitis, we report an over 65% improvement over existing methods. Conclusions: We propose a twice penalized P-Spline method which can vastly improve the model fit of overlapping asymmetric data sets upon a common predictive endpoint, without the need for missing data imputation.

Introduction Respiratory specialist ward care is associated with better outcomes for patients with COPD exacerbations. We assessed patient pathways and associated factors for people admitted to hospital with COPD exacerbations. Methods We analysed routinely collected electronic health data for patients admitted with COPD exacerbation in 2018 to Queen Elizabeth Hospital, Birmingham, UK. We extracted data on demographics, deprivation index, Elixhauser comorbidities, ward moves, length of stay, and in-hospital and 1-year mortality. We compared care pathways with recommended care pathways (transition from initial assessment area to respiratory wards or discharge). We used Markov state transition models to derive probabilities of following recommended pathways for patient subgroups. Results Of 42 555 patients with unplanned admissions during 2018, 571 patients were admitted at least once with an exacerbation of COPD. The mean±sd age was 51±11 years; 313 (55%) were women, 337 (59%) lived in the most deprived neighbourhoods and 45 (9%) were from non-white ethnic backgrounds. 428 (75.0%) had ≥4 comorbidities. Age >70 years was associated with higher in-hospital and 1-year mortality, more places of care (wards) and longer length of stay; having ≥4 comorbidities was associated with higher mortality and longer length of stay. Older age was associated with a significantly lower probability of following a recommended pathway (>70 years: 0.514, 95% CI 0.458–0.571; ≤70 years: 0.636, 95% CI 0.572–0.696; p=0.004). Conclusions Only older age was associated with a lower chance of following recommended hospital pathways of care. Such analyses could help refine appropriate care pathways for patients with COPD exacerbations.

BackgroundThe population prevalence of multimorbidity (the existence of at least 2 or more long-term conditions [LTCs] in an individual) is increasing among young adults, particularly in minority ethnic groups and individuals living in socioeconomically deprived areas. In this study, we applied a data-driven approach to identify clusters of individuals who had an early onset multimorbidity in an ethnically and socioeconomically diverse population. We identified associations between clusters and a range of health outcomes.Methods and findingsUsing linked primary and secondary care data from the Clinical Practice Research Datalink GOLD (CPRD GOLD), we conducted a cross-sectional study of 837,869 individuals with early onset multimorbidity (aged between 16 and 39 years old when the second LTC was recorded) registered with an English general practice between 2010 and 2020. The study population included 777,906 people of White ethnicity (93%), 33,915 people of South Asian ethnicity (4%), and 26,048 people of Black African/Caribbean ethnicity (3%). A total of 204 LTCs were considered. Latent class analysis stratified by ethnicity identified 4 clusters of multimorbidity in White groups and 3 clusters in South Asian and Black groups. We found that early onset multimorbidity was more common among South Asian (59%, 33,915) and Black (56% 26,048) groups compared to the White population (42%, 777,906). Latent class analysis revealed physical and mental health conditions that were common across all ethnic groups (i.e., hypertension, depression, and painful conditions). However, each ethnic group also presented exclusive LTCs and different sociodemographic profiles: In White groups, the cluster with the highest rates/odds of the outcomes was predominantly male (54%, 44,150) and more socioeconomically deprived than the cluster with the lowest rates/odds of the outcomes. On the other hand, South Asian and Black groups were more socioeconomically deprived than White groups, with a consistent deprivation gradient across all multimorbidity clusters. At the end of the study, 4% (34,922) of the White early onset multimorbidity population had died compared to 2% of the South Asian and Black early onset multimorbidity populations (535 and 570, respectively); however, the latter groups died younger and lost more years of life. The 3 ethnic groups each displayed a cluster of individuals with increased rates of primary care consultations, hospitalisations, long-term prescribing, and odds of mortality. Study limitations include the exclusion of individuals with missing ethnicity information, the age of diagnosis not reflecting the actual age of onset, and the exclusion of people from Mixed, Chinese, and other ethnic groups due to insufficient power to investigate associations between multimorbidity and health-related outcomes in these groups.ConclusionsThese findings emphasise the need to identify, prevent, and manage multimorbidity early in the life course. Our work provides additional insights into the excess burden of early onset multimorbidity in those from socioeconomically deprived and diverse groups who are disproportionately and more severely affected by multimorbidity and highlights the need to ensure healthcare improvements are equitable.

As Big Data Analysis meets healthcare applications, domain-specific challenges and opportunities materialize in all aspects of data science. Advanced statistical methods and Artificial Intelligence (AI) on Electronic Health Records (EHRs) are used both for knowledge discovery purposes and clinical decision support. Such techniques enable the emerging Predictive, Preventative, Personalized, and Participatory Medicine (P4M) paradigm. Working with the Infectious Disease Clinic of the University Hospital of Modena, Italy, we have developed a range of Data–Driven (DD) approaches to solve critical clinical applications using statistics, Machine Learning (ML) and Big Data Analytics on real-world EHR. Here, we describe our perspective on the challenges we encountered. Some are connected to medical data and their sparse, scarce, and unbalanced nature. Others are bound to the application environment, as medical AI tools can affect people's health and life. For each of these problems, we report some available techniques to tackle them, present examples drawn from our experience, and propose which approaches, in our opinion, could lead to successful real-world, end-to-end implementations.DESY report numberDESY-22-153.

Data analytics processes such as scientific workflows tend to be executed repeatedly, with varying dependencies and input datasets. The case has been made in the past for tracking the provenance of the final information products through the workflow steps, to enable their reproducibility. In this paper, we explore the hypothesis that provenance traces recorded during execution are also instrumental to answering questions about the observed differences between sets of results obtained from similar but not identical workflow configurations. Such differences in configurations may be introduced deliberately, i.e., to explore process variations or accidentally, typically as the result of porting efforts or of changes in the computing environment. Using a commonly used workflow programming model as a reference, we consider both structural variations in the workflows as well as variations within their individual components. Our why-diff algorithm compares the graph representations of two provenance traces derived from two workflow variations. It produces a delta graph that can be used to produce human-readable explanations of the impact of workflow differences on observed output differences. We report with Neo4j graph database. Further, we report explanations of the difference between workflow results using a suite of synthetic workflows as well as real-world workflows.

AimsThe aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia.MethodsThis was an observational prospective study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients' medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO2/FiO2 ratio ResultsA total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth "boosted mixed model" included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example.ConclusionThis study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.

We illustrate how combining retrospective and prospectiveprovenance can yield scientifically meaningful hybrid provenancerepresentations of the computational histories of data produced during a script run. We use scripts from multiple disciplines (astrophysics, climate science, biodiversity data curation, and social network analysis), implemented in Python, R, and MATLAB, to highlight the usefulness of diverse forms of retrospectiveprovenance when coupled with prospectiveprovenance. Users provide prospective provenance, i.e., the conceptual workflows latent in scripts, via simple YesWorkflow annotations, embedded as script comments. Runtime observables can be linked to prospective provenance via relational views and queries. These observables could be found hidden in filenames or folder structures, be recorded in log files, or they can be automatically captured using tools such as noWorkflow or the DataONE RunManagers. The YesWorkflow toolkit, example scripts, and demonstration code are available via an open source repository.

Scientific workflow management systems offer features for composing complex computational pipelines from modular building blocks, executing the resulting automated workflows, and recording the provenance of data products resulting from workflow runs. Despite the advantages such features provide, many automated workflows continue to be implemented and executed outside of scientific workflow systems due to the convenience and familiarity of scripting languages (such as Perl, Python, R, and MATLAB), and to the high productivity many scientists experience when using these languages. YesWorkflow is a set of software tools that aim to provide such users of scripting languages with many of the benefits of scientific workflow systems. YesWorkflow requires neither the use of a workflow engine nor the overhead of adapting code to run effectively in such a system. Instead, YesWorkflow enables scientists to annotate existing scripts with special comments that reveal the computational modules and dataflows otherwise implicit in these scripts. YesWorkflow tools extract and analyze these comments, represent the scripts in terms of entities based on the typical scientific workflow model, and provide graphical renderings of this workflow-like view of the scripts. Future version of YesWorkflow will also allow the prospective provenance of the data products of these scripts to be queried in ways similar to those available to users of scientific workflow systems.

Scientific workflows and their supporting systems are becoming increasingly popular for compute-intensive and data-intensive scientific experiments. The advantages scientific workflows offer include rapid and easy workflow design, software and data reuse, scalable execution, sharing and collaboration, and other advantages that altogether facilitate “reproducible science”. In this context, provenance – information about the origin, context, derivation, ownership, or history of some artifact – plays a key role, since scientists are interested in examining and auditing the results of scientific experiments. However, in order to perform such analyses on scientific results as part of extended research collaborations, an adequate environment and tools are required. Concretely, the need arises for a repository that will facilitate the sharing of scientific workflows and their associated execution traces in an interoperable manner, also enabling querying and visualization. Furthermore, such functionality should be supported while taking performance and scalability into account. With this purpose in mind, we introduce PBase: a scientific workflow provenance repository implementing the ProvONE proposed standard, which extends the emerging W3C PROV standard for provenance data with workflow specific concepts. PBase is built on the Neo4j graph database, thus offering capabilities such as declarative and efficient querying. Our experiences demonstrate the power gained by supporting various types of queries for provenance data. In addition, PBase is equipped with a user friendly interface tailored for the visualization of scientific workflow provenance data, making the specification of queries and the interpretation of their results easier and more effective.

Tweet My Street is a cross-disciplinary project exploring the extent to which data derived from Twitter can reveal more about spatial and temporal behaviours and the meanings attached to these locally. This is done with a longer-term view to supporting the coproduction and delivery of local services, complaint mechanisms and horizontal community support networks. The project has involved the development of a web-based software application capable of retrieving, storing and visualising geo-located “tweets” (and associated digital content) from Twitter’s Firehose. This has been piloted in Newcastle upon Tyne (UK) and has proven a scalable tool that can aid the analysis of social media data geographically. Beyond explaining efforts to analyse pilot data via this software, this paper elucidates three methodological challenges encountered during early collaboration. These include issues relating to “proximity” with subjects, ethics and critical questions about scholars’ digital responsibilities during the neogeographic turn.

The ability to measure the use and impact of published data sets is key to the success of the open data/open science paradigm. A direct measure of impact would require tracking data (re)use in the wild, which is difficult to achieve. This is therefore commonly replaced by simpler metrics based on data download and citation counts. In this paper we describe a scenario where it is possible to track the trajectory of a dataset after its publication, and show how this enables the design of accurate models for ascribing credit to data originators. A Data Trajectory (DT) is a graph that encodes knowledge of how, by whom, and in which context data has been re-used, possibly after several generations. We provide a theoretical model of DTs that is grounded in the W3C PROV data model for provenance, and we show how DTs can be used to automatically propagate a fraction of the credit associated with transitively derived datasets, back to original data contributors. We also show this model of transitive credit in action by means of a Data Reuse Simulator. In the longer term, our ultimate hope is that credit models based on direct measures of data reuse will provide further incentives to data publication. We conclude by outlining a research agenda to address the hard questions of creating, collecting, and using DTs systematically across a large number of data reuse instances in the wild.

Experimental science can be thought of as the exploration of a large research space, in search of a few valuable results. While it is this “Golden Data” that gets published, the history of the exploration is often as valuable to the scientists as some of its outcomes. We envision an e-research infrastructure that is capable of systematically and automatically recording such history – an assumption that holds today for a number of workflow management systems routinely used in e-science. In keeping with our gold rush metaphor, the provenance of a valuable result is a “Golden Trail”. Logically, this represents a detailed account of how the Golden Data was arrived at, and technically it is a sub-graph in the much larger graph of provenance traces that collectively tell the story of the entire research (or of some of it).In this paper we describe a model and architecture for a repository dedicated to storing provenance traces and selectively retrieving Golden Trails from it. As traces from multiple experiments over long periods of time are accommodated, the trails may be sub-graphs of one trace, or they may be the logical representation of a virtual experiment obtained by joining together traces that share common data.The project has been carried out within the Provenance Working Group of the Data Observation Network for Earth (DataONE) NSF project. Ultimately, our longer-term plan is to integrate the provenance repository into the data preservation architecture currently being developed by DataONE.

Scientific workflows and their supporting systems are becoming increasingly popular for compute-intensive and data-intensive scientific experiments. The advantages scientific workflows offer include rapid and easy workflow design, software and data reuse, scalable execution, sharing and collaboration, and other advantages that altogether facilitate “reproducible scienceâ€. In this context, provenance – information about the origin, context, derivation, ownership, or history of some artifact – plays a key role, since scientists are interested in examining and auditing the results of scientific experiments. However, in order to perform such analyses on scientific results as part of extended research collaborations, an adequate environment and tools are required. Concretely, the need arises for a repository that will facilitate the sharing of scientific workflows and their associated execution traces in an interoperable manner, also enabling querying and visualization. Furthermore, such functionality should be supported while taking performance and scalability into account. With this purpose in mind, we introduce PBase: a scientific workflow provenance repository implementing the ProvONE proposed standard, which extends the emerging W3C PROV standard for provenance data with workflow specific concepts. PBase is built on the Neo4j graph database, thus offering capabilities such as declarative and efficient querying. Our experiences demonstrate the power gained by supporting various types of queries for provenance data. In addition, PBase is equipped with a user friendly interface tailored for the visualization of scientific workflow provenance data, making the specification of queries and the interpretation of their results easier and more effective.