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Since its emergence in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic with more than 55 million reported cases and 1.3 million estimated deaths worldwide. While epidemiological and clinical characteristics of COVID-19 have been reported, risk factors underlying the transition from mild to severe disease among patients remain poorly understood. In this retrospective study, we analysed data of 879 confirmed SARS-CoV-2 positive patients admitted to a two-site NHS Trust hospital in London, England, between January 1st and May 26th, 2020, with a majority of cases occurring in March and April. We extracted anonymised demographic data, physiological clinical variables and laboratory results from electronic healthcare records (EHR) and applied multivariate logistic regression, random forest and extreme gradient boosted trees. To evaluate the potential for early risk assessment, we used data available during patients’ initial presentation at the emergency department (ED) to predict deterioration to one of three clinical endpoints in the remainder of the hospital stay: admission to intensive care, need for invasive mechanical ventilation and in-hospital mortality. Based on the trained models, we extracted the most informative clinical features in determining these patient trajectories. Considering our inclusion criteria, we have identified 129 of 879 (15%) patients that required intensive care, 62 of 878 (7%) patients needing mechanical ventilation, and 193 of 619 (31%) cases of in-hospital mortality. Our models learned successfully from early clinical data and predicted clinical endpoints with high accuracy, the best model achieving area under the receiver operating characteristic (AUC-ROC) scores of 0.76 to 0.87 (F1 scores of 0.42–0.60). Younger patient age was associated with an increased risk of receiving intensive care and ventilation, but lower risk of mortality. Clinical indicators of a patient’s oxygen supply and selected laboratory results, such as blood lactate and creatinine levels, were most predictive of COVID-19 patient trajectories. Among COVID-19 patients machine learning can aid in the early identification of those with a poor prognosis, using EHR data collected during a patient’s first presentation at ED. Patient age and measures of oxygenation status during ED stay are primary indicators of poor patient outcomes.

Affect recognition is an interdisciplinary research field bringing together researchers from natural and social sciences. Affect recognition research aims to detect the affective state of a person based on observables, with the goal to, for example, provide reasoning for the person’s decision making or to support mental wellbeing (e.g., stress monitoring). Recently, beside of approaches based on audio, visual or text information, solutions relying on wearable sensors as observables, recording mainly physiological and inertial parameters, have received increasing attention. Wearable systems enable an ideal platform for long-term affect recognition applications due to their rich functionality and form factor, while providing valuable insights during everyday life through integrated sensors. However, existing literature surveys lack a comprehensive overview of state-of-the-art research in wearable-based affect recognition. Therefore, the aim of this paper is to provide a broad overview and in-depth understanding of the theoretical background, methods and best practices of wearable affect and stress recognition. Following a summary of different psychological models, we detail the influence of affective states on the human physiology and the sensors commonly employed to measure physiological changes. Then, we outline lab protocols eliciting affective states and provide guidelines for ground truth generation in field studies. We also describe the standard data processing chain and review common approaches related to the preprocessing, feature extraction and classification steps. By providing a comprehensive summary of the state-of-the-art and guidelines to various aspects, we would like to enable other researchers in the field to conduct and evaluate user studies and develop wearable systems.

In robotic radiosurgery, it is necessary to compensate for systematic latencies arising from target tracking and mechanical constraints. This compensation is usually achieved by means of an algorithm which computes the future target position. In most scientific works on respiratory motion prediction, only one or two algorithms are evaluated on a limited amount of very short motion traces. The purpose of this work is to gain more insight into the real world capabilities of respiratory motion prediction methods by evaluating many algorithms on an unprecedented amount of data. We have evaluated six algorithms, the normalized least mean squares (nLMS), recursive least squares (RLS), multi-step linear methods (MULIN), wavelet-based multiscale autoregression (wLMS), extended Kalman filtering, and ε-support vector regression (SVRpred) methods, on an extensive database of 304 respiratory motion traces. The traces were collected during treatment with the CyberKnife (Accuray, Inc., Sunnyvale, CA, USA) and feature an average length of 71 min. Evaluation was done using a graphical prediction toolkit, which is available to the general public, as is the data we used. The experiments show that the nLMS algorithm-which is one of the algorithms currently used in the CyberKnife-is outperformed by all other methods. This is especially true in the case of the wLMS, the SVRpred, and the MULIN algorithms, which perform much better. The nLMS algorithm produces a relative root mean square (RMS) error of 75% or less (i.e., a reduction in error of 25% or more when compared to not doing prediction) in only 38% of the test cases, whereas the MULIN and SVRpred methods reach this level in more than 77%, the wLMS algorithm in more than 84% of the test cases. Our work shows that the wLMS algorithm is the most accurate algorithm and does not require parameter tuning, making it an ideal candidate for clinical implementation. Additionally, we have seen that the structure of a patient's respiratory motion trace has strong influence on the outcome of prediction. Further work is needed to determine a priori the suitability of an individual's respiratory behaviour to motion prediction.

Marker-less optical head-tracking constitutes a comfortable alternative with no exposure to radiation for realtime monitoring in radiation therapy. Supporting information such as tissue thickness has the potential to improve spatial tracking accuracy. Here we study how accurate tissue thickness can be estimated from the near-infrared (NIR) backscatter obtained from laser scans. In a case study, optical data was recorded with a galvanometric laser scanner from three subjects. A tissue ground truth from MRI was robustly matched via customized bite blocks. We show that Gaussian Processes accurately model the relationship between NIR features and tissue thickness. They were able to predict the tissue thickness with less than 0.5 mm root mean square error. Individual scaling factors for all features and an additional incident angle feature had positive effects on this performance.

In extracranial robotic radiotherapy, tumour motion is compensated by tracking external and internal surrogates. To compensate system specific time delays, time series prediction of the external optical surrogates is used. We investigate whether the prediction accuracy can be increased by expanding the current clinical setup by an accelerometer, a strain belt and a flow sensor. Four previously published prediction algorithms are adapted to multivariate inputs—normalized least mean squares (nLMS), wavelet-based least mean squares (wLMS), support vector regression (SVR) and relevance vector machines (RVM)—and evaluated for three different prediction horizons. The measurement involves 18 subjects and consists of two phases, focusing on long term trends (M1) and breathing artefacts (M2). To select the most relevant and least redundant sensors, a sequential forward selection (SFS) method is proposed. Using a multivariate setting, the results show that the clinically used nLMS algorithm is susceptible to large outliers. In the case of irregular breathing (M2), the mean root mean square error (RMSE) of a univariate nLMS algorithm is 0.66 mm and can be decreased to 0.46 mm by a multivariate RVM model (best algorithm on average). To investigate the full potential of this approach, the optimal sensor combination was also estimated on the complete test set. The results indicate that a further decrease in RMSE is possible for RVM (to 0.42 mm). This motivates further research about sensor selection methods. Besides the optical surrogates, the sensors most frequently selected by the algorithms are the accelerometer and the strain belt. These sensors could be easily integrated in the current clinical setup and would allow a more precise motion compensation.

In modern robotic radiation therapy, tumor movements due to respiration can be compensated. The accuracy of these methods can be increased by time series prediction of external optical surrogates. An algorithm based on relevance vector machines (RVM) is introduced. We evaluate RVM with linear and nonlinear basis functions on a real patient data set containing 304 motion traces and compare it with a wavelet based least mean square algorithm (wLMS), the best algorithm for this data set so far. Linear RVM outperforms wLMS significantly and increases the prediction accuracy for 80.3% of the data. We show that real time prediction is possible in case of linear RVM and discuss how the predicted variance can be used to construct promising hybrid algorithms, which further reduce the prediction error.