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Huang YC, Giri P, Ioachimescu O, Wong AKI. Editorial: AI and data science in pulmonary and critical care physiology and medicine. Front Physiol 2024; 15:1375414. [PMID: 38505705 PMCID: PMC10950206 DOI: 10.3389/fphys.2024.1375414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Yuh-Chin Huang
- Department of Medicine, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Paresh Giri
- Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | | | - An-Kwok Ian Wong
- Department of Medicine, Duke University Medical Center, Duke University, Durham, NC, United States
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Wong AKI, Kamaleswaran R. POSTCARDS from a SIESTA: Crossing the Translational and Generalizability Gap for Predictive Models of Acute Respiratory Distress Syndrome-Related Mortality. Crit Care Med 2023; 51:1814-1816. [PMID: 37971334 PMCID: PMC10926350 DOI: 10.1097/ccm.0000000000006061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- An-Kwok Ian Wong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
- Division of Translational Biomedical Informatics, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Rishikesan Kamaleswaran
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
- Division of Translational Biomedical Informatics, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Emory Critical Care Center, Emory University, Atlanta, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
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Charpignon ML, Byers J, Cabral S, Celi LA, Fernandes C, Gallifant J, Lough ME, Mlombwa D, Moukheiber L, Ong BA, Panitchote A, William W, Wong AKI, Nazer L. Critical Bias in Critical Care Devices. Crit Care Clin 2023; 39:795-813. [PMID: 37704341 DOI: 10.1016/j.ccc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Critical care data contain information about the most physiologically fragile patients in the hospital, who require a significant level of monitoring. However, medical devices used for patient monitoring suffer from measurement biases that have been largely underreported. This article explores sources of bias in commonly used clinical devices, including pulse oximeters, thermometers, and sphygmomanometers. Further, it provides a framework for mitigating these biases and key principles to achieve more equitable health care delivery.
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Affiliation(s)
- Marie-Laure Charpignon
- Institute for Data, Systems, and Society (IDSS), E18-407A, 50 Ames Street, Cambridge, MA 02142, USA.
| | - Joseph Byers
- Respiratory Therapy, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Stephanie Cabral
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chrystinne Fernandes
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Jack Gallifant
- Imperial College London NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Mary E Lough
- Stanford Health Care, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Donald Mlombwa
- Zomba Central Hospital, 8th Avenue, Zomba, Malawi; Kamuzu College of Health Sciences, Blantyre, Malawi; St. Luke's College of Health Sciences, Chilema-Zomba, Malawi
| | - Lama Moukheiber
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-330, Cambridge, MA 02139, USA
| | - Bradley Ashley Ong
- College of Medicine, University of the Philippines Manila, Calderon hall, UP College of Medicine, 547 Pedro Gil Street, Ermita Manila, Philippines
| | - Anupol Panitchote
- Faculty of Medicine, Khon Kaen University, 123 Mittraparp Highway, Muang District, Khon Kaen 40002, Thailand
| | - Wasswa William
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - An-Kwok Ian Wong
- Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, USA
| | - Lama Nazer
- King Hussein Cancer Center, Queen Rania Street 202, Amman, Jordan
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Charpignon ML, Carrel A, Jiang Y, Kwaga T, Cantada B, Hyslop T, Cox CE, Haines K, Koomson V, Dumas G, Morley M, Dunn J, Ian Wong AK. Going beyond the means: Exploring the role of bias from digital determinants of health in technologies. PLOS Digit Health 2023; 2:e0000244. [PMID: 37824494 PMCID: PMC10569586 DOI: 10.1371/journal.pdig.0000244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND In light of recent retrospective studies revealing evidence of disparities in access to medical technology and of bias in measurements, this narrative review assesses digital determinants of health (DDoH) in both technologies and medical formulae that demonstrate either evidence of bias or suboptimal performance, identifies potential mechanisms behind such bias, and proposes potential methods or avenues that can guide future efforts to address these disparities. APPROACH Mechanisms are broadly grouped into physical and biological biases (e.g., pulse oximetry, non-contact infrared thermometry [NCIT]), interaction of human factors and cultural practices (e.g., electroencephalography [EEG]), and interpretation bias (e.g, pulmonary function tests [PFT], optical coherence tomography [OCT], and Humphrey visual field [HVF] testing). This review scope specifically excludes technologies incorporating artificial intelligence and machine learning. For each technology, we identify both clinical and research recommendations. CONCLUSIONS Many of the DDoH mechanisms encountered in medical technologies and formulae result in lower accuracy or lower validity when applied to patients outside the initial scope of development or validation. Our clinical recommendations caution clinical users in completely trusting result validity and suggest correlating with other measurement modalities robust to the DDoH mechanism (e.g., arterial blood gas for pulse oximetry, core temperatures for NCIT). Our research recommendations suggest not only increasing diversity in development and validation, but also awareness in the modalities of diversity required (e.g., skin pigmentation for pulse oximetry but skin pigmentation and sex/hormonal variation for NCIT). By increasing diversity that better reflects patients in all scenarios of use, we can mitigate DDoH mechanisms and increase trust and validity in clinical practice and research.
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Affiliation(s)
- Marie-Laure Charpignon
- Massachusetts Institute of Technology; Institute for Data, Systems, and Society; Laboratory for Information and Decision Systems, Boston, Massachusetts, United States of America
| | - Adrien Carrel
- CentraleSupélec, Université Paris-Saclay, Gif-sur-Yvette, France
- Imperial College London, London, United Kingdom
| | - Yihang Jiang
- Duke University, Pratt School of Engineering, Department of Biomedical Engineering, Durham, North Carolina, United States of America
| | - Teddy Kwaga
- Mbarara University of Science and Technology, Department of Ophthalmology, Mbarara, Uganda
| | - Beatriz Cantada
- Massachusetts Institute of Technology; Institute Community and Equity Office, Boston, Massachusetts, United States of America
| | - Terry Hyslop
- Duke University, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
| | - Christopher E. Cox
- Duke University, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Durham, North Carolina, United States of America
| | - Krista Haines
- Duke University, Department of Surgery, Durham, North Carolina, United States of America
| | - Valencia Koomson
- Tufts University, Department of Electrical and Computer Engineering, Boston, Massachusetts, United States of America
| | - Guillaume Dumas
- CHU Sainte-Justine Research Center, Department of Psychiatry, Université de Montréal, Montréal, Quebec, Canada
- Mila–Quebec AI Institute, University of Montreal, Montréal, Quebec, Canada
| | - Michael Morley
- Ophthalmic Consultants of Boston, Boston, Massachusetts, United States of America
- Assistant Clinical Professor of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jessilyn Dunn
- Duke University, Pratt School of Engineering, Department of Biomedical Engineering, Durham, North Carolina, United States of America
- Duke University, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
| | - An-Kwok Ian Wong
- Duke University, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
- Duke University, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Durham, North Carolina, United States of America
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Dempsey K, Lindsay M, Tcheng JE, Ian Wong AK. The High Price of Equity in Pulse Oximetry: A cost evaluation and need for interim solutions. medRxiv 2023:2023.09.21.23295939. [PMID: 37790369 PMCID: PMC10543063 DOI: 10.1101/2023.09.21.23295939] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Importance Disparities in pulse oximetry accuracy, disproportionately affecting patients of color, have been associated with serious clinical outcomes. Although many have called for pulse oximetry hardware replacement, the cost associated with this replacement is not known. Objective To estimate the cost of replacing all pulse oximetry hardware throughout a hospital system. Design Single-center survey, 2023. Setting Single center. Participants One academic medical center with three hospitals. Main Outcomes and Measures Cost of fleet replacement as identified by current day prices for hardware. Results New and used prices for 5,079/5,678 (89.5%) across three hospitals for pulse oximetry devices were found. The average equipment cost to replace pulse oximetry hardware is $15,704.12 per bed. Replacement and integration costs are estimated at $28.5-31.8 million for the entire medical system. Extrapolating these costs to 5,564 hospitals in the United States results in an estimated cost of $14.1 billion. Conclusions and Relevance "Simply replacing" pulse oximetry hardware to address disparities may be neither simple, cheap, or timely. Solutions for addressing pulse oximetry accuracy disparities leveraging current technology may be necessary. Trial Registration Pro00113724, exempt.
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Affiliation(s)
- Katelyn Dempsey
- Duke University, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Durham, NC, USA
| | | | - James E. Tcheng
- Duke University, Department of Medicine, Division of Cardiology, Durham, NC, USA
| | - An-Kwok Ian Wong
- Duke University, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Durham, NC, USA
- Duke University, Department of Biostatistics and Bioinformatics, Division of Translational Biomedical Informatics, Durham, NC, USA
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Nam JJ, Wong AKI, Cantong D, Cook JA, Andrews Z, Levy JH. Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation: What We Need to Know and How to Manage for Prolonged Casualty Care. J Spec Oper Med 2023:6OZC-JIOV. [PMID: 37302145 DOI: 10.55460/6ozc-jiov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Coagulopathy can occur in trauma, and it can affect septic patients as a host tries to respond to infection. Sometimes, it can lead to disseminated intravascular coagulopathy (DIC) with a high potential for mortality. New research has delineated risk factors that include neutrophil extracellular traps and endothelial glycocalyx shedding. Managing DIC in septic patients focuses on first treating the underlying cause of sepsis. Further, the International Society on Thrombolysis and Haemostasis (ISTH) has DIC diagnostic criteria. "Sepsis-induced coagulopathy" (SIC) is a new category. Therapy of SIC focuses on treating the underlying infection and the ensuing coagulopathy. Most therapeutic approaches to SIC have focused on anticoagulant therapy. This review will discuss SIC and DIC and how they are relevant to prolonged casualty care (PCC).
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Joshi SP, Wong AKI, Brucker A, Ardito TA, Chow SC, Vaishnavi S, Lee PJ. Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231917. [PMID: 36121655 PMCID: PMC9486450 DOI: 10.1001/jamanetworkopen.2022.31917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress. OBJECTIVE To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period. DESIGN, SETTING, AND PARTICIPANTS This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group). INTERVENTIONS The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources. MAIN OUTCOMES AND MEASURES The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale). RESULTS Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04632368.
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Affiliation(s)
- Sangeeta P. Joshi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - An-Kwok Ian Wong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Amanda Brucker
- Section of Pulmonary and Critical Care, Durham Veterans Administration Medical Center, Durham, North Carolina
| | - Taylor A. Ardito
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sandeep Vaishnavi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
- Mindpath Health, Raleigh, North Carolina
| | - Patty J. Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
- Section of Pulmonary and Critical Care, Durham Veterans Administration Medical Center, Durham, North Carolina
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Wong AKI, Charpignon M, Kim H, Josef C, de Hond AAH, Fojas JJ, Tabaie A, Liu X, Mireles-Cabodevila E, Carvalho L, Kamaleswaran R, Madushani RWMA, Adhikari L, Holder AL, Steyerberg EW, Buchman TG, Lough ME, Celi LA. Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality. JAMA Netw Open 2021; 4:e2131674. [PMID: 34730820 PMCID: PMC9178439 DOI: 10.1001/jamanetworkopen.2021.31674] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Discrepancies in oxygen saturation measured by pulse oximetry (Spo2), when compared with arterial oxygen saturation (Sao2) measured by arterial blood gas (ABG), may differentially affect patients according to race and ethnicity. However, the association of these disparities with health outcomes is unknown. OBJECTIVE To examine racial and ethnic discrepancies between Sao2 and Spo2 measures and their associations with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter, retrospective, cross-sectional study included 3 publicly available electronic health record (EHR) databases (ie, the Electronic Intensive Care Unit-Clinical Research Database and Medical Information Mart for Intensive Care III and IV) as well as Emory Healthcare (2014-2021) and Grady Memorial (2014-2020) databases, spanning 215 hospitals and 382 ICUs. From 141 600 hospital encounters with recorded ABG measurements, 87 971 participants with first ABG measurements and an Spo2 of at least 88% within 5 minutes before the ABG test were included. EXPOSURES Patients with hidden hypoxemia (ie, Spo2 ≥88% but Sao2 <88%). MAIN OUTCOMES AND MEASURES Outcomes, stratified by race and ethnicity, were Sao2 for each Spo2, hidden hypoxemia prevalence, initial demographic characteristics (age, sex), clinical outcomes (in-hospital mortality, length of stay), organ dysfunction by scores (Sequential Organ Failure Assessment [SOFA]), and laboratory values (lactate and creatinine levels) before and 24 hours after the ABG measurement. RESULTS The first Spo2-Sao2 pairs from 87 971 patient encounters (27 713 [42.9%] women; mean [SE] age, 62.2 [17.0] years; 1919 [2.3%] Asian patients; 26 032 [29.6%] Black patients; 2397 [2.7%] Hispanic patients, and 57 632 [65.5%] White patients) were analyzed, with 4859 (5.5%) having hidden hypoxemia. Hidden hypoxemia was observed in all subgroups with varying incidence (Black: 1785 [6.8%]; Hispanic: 160 [6.0%]; Asian: 92 [4.8%]; White: 2822 [4.9%]) and was associated with greater organ dysfunction 24 hours after the ABG measurement, as evidenced by higher mean (SE) SOFA scores (7.2 [0.1] vs 6.29 [0.02]) and higher in-hospital mortality (eg, among Black patients: 369 [21.1%] vs 3557 [15.0%]; P < .001). Furthermore, patients with hidden hypoxemia had higher mean (SE) lactate levels before (3.15 [0.09] mg/dL vs 2.66 [0.02] mg/dL) and 24 hours after (2.83 [0.14] mg/dL vs 2.27 [0.02] mg/dL) the ABG test, with less lactate clearance (-0.54 [0.12] mg/dL vs -0.79 [0.03] mg/dL). CONCLUSIONS AND RELEVANCE In this study, there was greater variability in oxygen saturation levels for a given Spo2 level in patients who self-identified as Black, followed by Hispanic, Asian, and White. Patients with and without hidden hypoxemia were demographically and clinically similar at baseline ABG measurement by SOFA scores, but those with hidden hypoxemia subsequently experienced higher organ dysfunction scores and higher in-hospital mortality.
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Affiliation(s)
- An-Kwok Ian Wong
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
- Division of Pulmonary, Allergy, and Critical
Care Medicine, Duke University, Durham, North Carolina
| | - Marie Charpignon
- MIT Institute for Data, Systems and Society,
Cambridge, Massachusetts
| | - Han Kim
- Department of Biomedical Engineering, Johns
Hopkins University, Baltimore, Maryland
| | | | - Anne A. H. de Hond
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
- Leiden University Medical Centre, Department of
Information Technology and Digital Innovation, Leiden, the Netherlands
| | - Jhalique Jane Fojas
- Department of Neurology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Azade Tabaie
- Department of Biomedical Informatics, Emory
University, Atlanta, Georgia
| | - Xiaoli Liu
- School of Biological Science and Medical
Engineering, Beihang University, Beijing, China
| | | | - Leandro Carvalho
- Respiratory Institute, Cleveland Clinic,
Cleveland, Ohio
- Sociedade Mineira de Terapia Intensiva, Belo
Horizonte, Brazil
| | | | | | - Lasith Adhikari
- Connected Care and Personal Health, Philips
Research North America, Cambridge, Massachusetts
| | - Andre L. Holder
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Ewout W. Steyerberg
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
| | | | - Mary E. Lough
- Medicine–Primary Care and Population
Health, Stanford University, California
- Office of Research, Stanford Health Care,
Stanford, California
| | - Leo Anthony Celi
- Massachusetts Institute of Technology,
Laboratory for Computational Physiology, Cambridge
- Division of Pulmonary, Critical Care, and
Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan
School of Public Health, Boston, Massachusetts
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Ian Wong AK, McDonald A, Jones B, Berkowitz D. Patch-and-Glue: Novel Technique in Bronchoesophageal Fistula Repair and Broncholith Removal With Stent and Fibrin Glue. J Bronchology Interv Pulmonol 2021; 28:e45-e49. [PMID: 33208602 PMCID: PMC8126569 DOI: 10.1097/lbr.0000000000000732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/07/2020] [Indexed: 01/21/2023]
Affiliation(s)
- An-Kwok Ian Wong
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
| | - April McDonald
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
| | - Brittany Jones
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
| | - David Berkowitz
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
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Haddad NS, Nguyen DC, Kuruvilla ME, Morrison-Porter A, Anam F, Cashman KS, Ramonell RP, Kyu S, Saini AS, Cabrera-Mora M, Derrico A, Alter D, Roback JD, Horwath M, O’Keefe JB, Wu HM, Wong AKI, Dretler AW, Gripaldo R, Lane AN, Wu H, Chu HY, Lee S, Hernandez M, Engineer V, Varghese J, Patel R, Jalal A, French V, Guysenov I, Lane CE, Mengistsu T, Normile KE, Mnzava O, Le S, Sanz I, Daiss JL, Lee FEH. One-Stop Serum Assay Identifies COVID-19 Disease Severity and Vaccination Responses. Immunohorizons 2021; 5:322-335. [PMID: 34001652 PMCID: PMC9190970 DOI: 10.4049/immunohorizons.2100011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 01/13/2023] Open
Abstract
SARS-CoV-2 has caused over 100,000,000 cases and almost 2,500,000 deaths globally. Comprehensive assessment of the multifaceted antiviral Ab response is critical for diagnosis, differentiation of severity, and characterization of long-term immunity, especially as COVID-19 vaccines become available. Severe disease is associated with early, massive plasmablast responses. We developed a multiplex immunoassay from serum/plasma of acutely infected and convalescent COVID-19 patients and prepandemic and postpandemic healthy adults. We measured IgA, IgG, and/or IgM against SARS-CoV-2 nucleocapsid (N), spike domain 1 (S1), S1-receptor binding domain (RBD) and S1-N-terminal domain. For diagnosis, the combined [IgA + IgG + IgM] or IgG levels measured for N, S1, and S1-RBD yielded area under the curve values ≥0.90. Virus-specific Ig levels were higher in patients with severe/critical compared with mild/moderate infections. A strong prozone effect was observed in sera from severe/critical patients-a possible source of underestimated Ab concentrations in previous studies. Mild/moderate patients displayed a slower rise and lower peak in anti-N and anti-S1 IgG levels compared with severe/critical patients, but anti-RBD IgG and neutralization responses reached similar levels at 2-4 mo after symptom onset. Measurement of the Ab responses in sera from 18 COVID-19-vaccinated patients revealed specific responses for the S1-RBD Ag and none against the N protein. This highly sensitive, SARS-CoV-2-specific, multiplex immunoassay measures the magnitude, complexity, and kinetics of the Ab response and can distinguish serum Ab responses from natural SARS-CoV-2 infections (mild or severe) and mRNA COVID-19 vaccines.
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Affiliation(s)
- Natalie S. Haddad
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,MicroB-plex, Inc., Atlanta, GA
| | - Doan C. Nguyen
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Merin E. Kuruvilla
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Andrea Morrison-Porter
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,MicroB-plex, Inc., Atlanta, GA
| | - Fabliha Anam
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Kevin S. Cashman
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA;,Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Richard P. Ramonell
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Shuya Kyu
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Ankur Singh Saini
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA;,Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Monica Cabrera-Mora
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Andrew Derrico
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - David Alter
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - John D. Roback
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Michael Horwath
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - James B. O’Keefe
- Division of Primary Care, Department of Medicine, Emory University, Atlanta, GA
| | - Henry M. Wu
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA
| | - An-Kwok Ian Wong
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | | | - Ria Gripaldo
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Andrea N. Lane
- Department of Biostatistics and Bioinformatics, Emory University Atlanta, GA
| | - Hao Wu
- Department of Biostatistics and Bioinformatics, Emory University Atlanta, GA
| | - Helen Y. Chu
- Department of Medicine, University of Washington, Seattle, WA
| | - Saeyun Lee
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Mindy Hernandez
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Vanessa Engineer
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - John Varghese
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Rahul Patel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Anum Jalal
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA
| | - Victoria French
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Ilya Guysenov
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Christopher E. Lane
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Tesfaye Mengistsu
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | | | - Onike Mnzava
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Sang Le
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA;,Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA;,Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | | | - F. Eun-Hyung Lee
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA;,Lowance Center for Human Immunology, Emory University, Atlanta, GA
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11
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Perez Alday EA, Gu A, J Shah A, Robichaux C, Ian Wong AK, Liu C, Liu F, Bahrami Rad A, Elola A, Seyedi S, Li Q, Sharma A, Clifford GD, Reyna MA. Classification of 12-lead ECGs: the PhysioNet/Computing in Cardiology Challenge 2020. Physiol Meas 2021. [PMID: 33176294 DOI: 10.13026/f4ab-0814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Vast 12-lead ECGs repositories provide opportunities to develop new machine learning approaches for creating accurate and automatic diagnostic systems for cardiac abnormalities. However, most 12-lead ECG classification studies are trained, tested, or developed in single, small, or relatively homogeneous datasets. In addition, most algorithms focus on identifying small numbers of cardiac arrhythmias that do not represent the complexity and difficulty of ECG interpretation. This work addresses these issues by providing a standard, multi-institutional database and a novel scoring metric through a public competition: the PhysioNet/Computing in Cardiology Challenge 2020. APPROACH A total of 66 361 12-lead ECG recordings were sourced from six hospital systems from four countries across three continents; 43 101 recordings were posted publicly with a focus on 27 diagnoses. For the first time in a public competition, we required teams to publish open-source code for both training and testing their algorithms, ensuring full scientific reproducibility. MAIN RESULTS A total of 217 teams submitted 1395 algorithms during the Challenge, representing a diversity of approaches for identifying cardiac abnormalities from both academia and industry. As with previous Challenges, high-performing algorithms exhibited significant drops ([Formula: see text]10%) in performance on the hidden test data. SIGNIFICANCE Data from diverse institutions allowed us to assess algorithmic generalizability. A novel evaluation metric considered different misclassification errors for different cardiac abnormalities, capturing the outcomes and risks of different diagnoses. Requiring both trained models and code for training models improved the generalizability of submissions, setting a new bar in reproducibility for public data science competitions.
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Affiliation(s)
- Erick A Perez Alday
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Annie Gu
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - An-Kwok Ian Wong
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, United States of America
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Feifei Liu
- School of Science, Shandong Jianzhu University, Jinan, Shandong, People's Republic of China
| | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Andoni Elola
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- Department of Communications Engineering, University of the Basque Country, Spain
| | - Salman Seyedi
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Qiao Li
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
- These authors are joint senior authors
| | - Matthew A Reyna
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- These authors are joint senior authors
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12
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Perez Alday EA, Gu A, J Shah A, Robichaux C, Ian Wong AK, Liu C, Liu F, Bahrami Rad A, Elola A, Seyedi S, Li Q, Sharma A, Clifford GD, Reyna MA. Classification of 12-lead ECGs: the PhysioNet/Computing in Cardiology Challenge 2020. Physiol Meas 2021; 41:124003. [PMID: 33176294 PMCID: PMC8015789 DOI: 10.1088/1361-6579/abc960] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Vast 12-lead ECGs repositories provide opportunities to develop new machine learning approaches for creating accurate and automatic diagnostic systems for cardiac abnormalities. However, most 12-lead ECG classification studies are trained, tested, or developed in single, small, or relatively homogeneous datasets. In addition, most algorithms focus on identifying small numbers of cardiac arrhythmias that do not represent the complexity and difficulty of ECG interpretation. This work addresses these issues by providing a standard, multi-institutional database and a novel scoring metric through a public competition: the PhysioNet/Computing in Cardiology Challenge 2020. APPROACH A total of 66 361 12-lead ECG recordings were sourced from six hospital systems from four countries across three continents; 43 101 recordings were posted publicly with a focus on 27 diagnoses. For the first time in a public competition, we required teams to publish open-source code for both training and testing their algorithms, ensuring full scientific reproducibility. MAIN RESULTS A total of 217 teams submitted 1395 algorithms during the Challenge, representing a diversity of approaches for identifying cardiac abnormalities from both academia and industry. As with previous Challenges, high-performing algorithms exhibited significant drops ([Formula: see text]10%) in performance on the hidden test data. SIGNIFICANCE Data from diverse institutions allowed us to assess algorithmic generalizability. A novel evaluation metric considered different misclassification errors for different cardiac abnormalities, capturing the outcomes and risks of different diagnoses. Requiring both trained models and code for training models improved the generalizability of submissions, setting a new bar in reproducibility for public data science competitions.
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Affiliation(s)
- Erick A Perez Alday
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Annie Gu
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - An-Kwok Ian Wong
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA, United States of America
| | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Feifei Liu
- School of Science, Shandong Jianzhu University, Jinan, Shandong, People's Republic of China
| | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Andoni Elola
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- Department of Communications Engineering, University of the Basque Country, Spain
| | - Salman Seyedi
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Qiao Li
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
- These authors are joint senior authors
| | - Matthew A Reyna
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
- These authors are joint senior authors
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13
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Haddad NS, Nguyen DC, Kuruvilla ME, Morrison-Porter A, Anam F, Cashman KS, Ramonell RP, Kyu S, Saini AS, Cabrera-Mora M, Derrico A, Alter D, Roback JD, Horwath M, O'Keefe JB, Wu HM, Ian Wong AK, Dretler AW, Gripaldo R, Lane AN, Wu H, Lee S, Hernandez M, Engineer V, Varghese J, Le S, Sanz I, Daiss JL, Eun-Hyung Lee F. Elevated SARS-CoV-2 Antibodies Distinguish Severe Disease in Early COVID-19 Infection. bioRxiv 2020. [PMID: 33299998 DOI: 10.1101/2020.12.04.410589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background SARS-CoV-2 has caused over 36,000,000 cases and 1,000,000 deaths globally. Comprehensive assessment of the multifaceted anti-viral antibody response is critical for diagnosis, differentiation of severe disease, and characterization of long-term immunity. Initial observations suggest that severe disease is associated with higher antibody levels and greater B cell/plasmablast responses. A multi-antigen immunoassay to define the complex serological landscape and clinical associations is essential. Methods We developed a multiplex immunoassay and evaluated serum/plasma from adults with RT-PCR-confirmed SARS-CoV-2 infections during acute illness (N=52) and convalescence (N=69); and pre-pandemic (N=106) and post-pandemic (N=137) healthy adults. We measured IgA, IgG, and/or IgM against SARS-CoV-2 Nucleocapsid (N), Spike domain 1 (S1), receptor binding domain (S1-RBD) and S1-N-terminal domain (S1-NTD). Results To diagnose infection, the combined [IgA+IgG+IgM] or IgG for N, S1, and S1-RBD yielded AUC values -0.90 by ROC curves. From days 6-30 post-symptom onset, the levels of antigen-specific IgG, IgA or [IgA+IgG+IgM] were higher in patients with severe/critical compared to mild/moderate infections. Consistent with excessive concentrations of antibodies, a strong prozone effect was observed in sera from severe/critical patients. Notably, mild/moderate patients displayed a slower rise and lower peak in anti-N and anti-S1 IgG levels compared to severe/critical patients, but anti-RBD IgG and neutralization responses reached similar levels at 2-4 months. Conclusion This SARS-CoV-2 multiplex immunoassay measures the magnitude, complexity and kinetics of the antibody response against multiple viral antigens. The IgG and combined-isotype SARS-CoV-2 multiplex assay is highly diagnostic of acute and convalescent disease and may prognosticate severity early in illness. One Sentence Summary In contrast to patients with moderate infections, those with severe COVID-19 develop prominent, early antibody responses to S1 and N proteins.
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14
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Wong AKI, Cheung PC, Kamaleswaran R, Martin GS, Holder AL. Machine Learning Methods to Predict Acute Respiratory Failure and Acute Respiratory Distress Syndrome. Front Big Data 2020; 3:579774. [PMID: 33693419 PMCID: PMC7931901 DOI: 10.3389/fdata.2020.579774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
Acute respiratory failure (ARF) is a common problem in medicine that utilizes significant healthcare resources and is associated with high morbidity and mortality. Classification of acute respiratory failure is complicated, and it is often determined by the level of mechanical support that is required, or the discrepancy between oxygen supply and uptake. These phenotypes make acute respiratory failure a continuum of syndromes, rather than one homogenous disease process. Early recognition of the risk factors for new or worsening acute respiratory failure may prevent that process from occurring. Predictive analytical methods using machine learning leverage clinical data to provide an early warning for impending acute respiratory failure or its sequelae. The aims of this review are to summarize the current literature on ARF prediction, to describe accepted procedures and common machine learning tools for predictive tasks through the lens of ARF prediction, and to demonstrate the challenges and potential solutions for ARF prediction that can improve patient outcomes.
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Affiliation(s)
- An-Kwok Ian Wong
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | | | | | - Greg S. Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Andre L. Holder
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
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15
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Wong AKI, Cheung PC, Zhang J, Cotsonis G, Kutner M, Gay PC, Collop NA. Randomized Controlled Trial of a Novel Communication Device Assessed During Noninvasive Ventilation Therapy. Chest 2020; 159:1531-1539. [PMID: 33011202 DOI: 10.1016/j.chest.2020.09.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV), a form of positive airway pressure (PAP) therapy, is the standard of care for various forms of acute respiratory failure (ARF). Communication impairment is a side effect of NIV, impedes patient care, contributes to distress and intolerance, and potentially increases intubation rates. This study aimed to evaluate communication impairment during CPAP therapy and demonstrate communication device improvement with a standardized protocol. RESEARCH QUESTION How does an oronasal mask affect communication intelligibility? How does use of an NIV communication device change this communication intelligibility? STUDY DESIGN AND METHODS A single-center randomized controlled trial (36 outpatients with OSA on CPAP therapy) assessed exposure to CPAP 10 cm H2O and PAP communication devices (SPEAX, Ataia Medical). Communication impairment was evaluated by reading selected words and sentences for partners to record and were tabulated as %words correct. Each outpatient-partner pair performed three assessments: (1) baseline (conversing normally), (2) mask baseline (conversing with PAP), and (3) randomized to functioning device (conversing with PAP and device) or sham device. After each stage, both outpatients and partners completed Likert surveys regarding perceived intelligibility and comfort. RESULTS While conversing with PAP, word and sentence intelligibility decreased relatively by 52% (87% vs 41%) and relatively by 57% (94% vs 40%), respectively, compared with normal conversation. Word and sentence intelligibility in the intervention arm increased relatively by 75% (35% vs 61%; P < .001) and by 126% (33% vs 76%; P < .001) higher than the control arm, respectively. The device improved outpatient-perceived PAP comfort relatively by 233% (15% vs 50%, P = .042) and partner-perceived comfort by relatively 245% (20% vs 69%, P = .0074). INTERPRETATION Use of this PAP communication device significantly improves both intelligibility and comfort. This is one of the first studies quantifying communication impairment during PAP delivery. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03795753; URL: www.clinicaltrials.gov.
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Affiliation(s)
- An-Kwok Ian Wong
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Emory University Department of Medicine.
| | | | | | - George Cotsonis
- Emory University Department of Biostatistics and Bioinformatics
| | - Michael Kutner
- Emory University Department of Biostatistics and Bioinformatics
| | - Peter C Gay
- Mayo Clinic Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Nancy A Collop
- Emory University Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Emory University Department of Medicine
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16
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Kane-Gill SL, Visweswaran S, Saul MI, Wong AKI, Penrod LE, Handler SM. Computerized detection of adverse drug reactions in the medical intensive care unit. Int J Med Inform 2011; 80:570-8. [PMID: 21621453 DOI: 10.1016/j.ijmedinf.2011.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/21/2011] [Accepted: 04/22/2011] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit. METHOD This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration. Alerts were assessed using 3 objective published adverse drug reaction determination instruments. An event was considered an adverse drug reaction when 2 out of 3 instruments had agreement of possible, probable or definite. Positive predictive values were calculated as the proportion of alerts that occurred, divided by the number of times that alerts occurred and adverse drug reactions were confirmed. RESULTS 145 patients were eligible for evaluation. For the 48 patients (50% male) having an alert, the mean±SD age was 62±19 years. A total of 253 alerts were generated. Positive predictive values were 1.0, 0.55, 0.38 and 0.33 for vancomycin, glucose, sodium, and blood urea nitrogen, respectively. A quinidine alert was not generated during the evaluation. CONCLUSIONS Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information.
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Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University Pittsburgh, Pittsburgh, PA 15261, United States.
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17
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Visweswaran S, Wong AKI, Barmada MM. A Bayesian method for identifying genetic interactions. AMIA Annu Symp Proc 2009; 2009:673-677. [PMID: 20351939 PMCID: PMC2815434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An important challenge in the analysis of single nucleotide polymorphism (SNP) data is the identification of SNPs that interact in a nonlinear fashion in their association with disease. Such epistatic interactions among genetic variants at multiple loci likely underlie the inheritance of common diseases. We have developed a novel method called the Bayesian combinatorial method (BCM) for detecting combination of genetic variants that are predictive of disease. When compared with the multifactor dimensionality reduction (MDR), a widely used combinatorial method, BCM has significantly greater power to detect interactions and is computationally more efficient.
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Affiliation(s)
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Visweswaran S, Wong AKI. Bayesian combinatorial partitioning for detecting interactions among genetic variants. Summit Transl Bioinform 2009; 2009:133. [PMID: 21347185 PMCID: PMC3041553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Detecting epistatic (nolinear) interactions among single nucleotide polymorphisms (SNPs) at multiple loci is important in the analysis of genomic data in association studies. We developed a Bayesian combinatorial partitioning (BCP) for detecting such interactions among SNPs that are predictive of disease. When compared with multifactor dimensionality reduction (MDR), a widely used combinatorial partitioning method for detecting interactions, BCP has significantly greater power and is computationally more efficient.
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Affiliation(s)
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - An-Kwok Ian Wong
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
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