Soft Tissue Sarcomas: A 16-Year Experience of a Tertiary Referral Hospital in North Jordan.

Background and Objectives: Sarcomas are rare malignant tumors of mesenchymal origin. Their low prevalence and histological heterogeneity make their diagnosis a challenging task. To the best of our knowledge, the epidemiology of soft tissue sarcomas (STSs) was not well studied in Jordan. This study thus aimed to determine STS epidemiologic trends at King Abdullah University Hospital (KAUH); a tertiary hospital that provides cancer healthcare for 70% of the population in Irbid Governorate, North Jordan. The findings of this study will provide a good reference point of the burden of STSs in Jordan and the Middle East region. Materials and Methods: All cases with confirmed STS diagnoses who attended KAUH from January 2003 until December 2018 were included in the initial analysis. Bone sarcomas, gastrointestinal stromal tumors and uterine sarcomas were not included in the study. Information collected from the pathology reports and electronic medical records was used to determine STS prevalence, incidence rate, age and gender distributions, histological types and anatomic location. Cases were reviewed by three pathologists with interest in soft tissue tumors. The findings were compared with literature. Results: In total, 157 STS cases were reported (1.9% of cancers diagnosed at KAUH during the 16-year study period). Crude annual incidence rate (IR) per 100,000 person-years ranged from 0.48 in 2015 to 1.83 in 2011 (average = 1.04). Age-standardized IR (ASR)(World WHO 2000-2025) was 1.37. Male:female ratio was 1.3:1. Median age was 39 years. Age ranged from <1 year to 90 years. Overall STS rates increased with age. The most common histological types were liposarcoma (19%), rhabdomyosarcoma (17%) and leiomyosarcoma (10%). The most common anatomic location was the extremity (40.1%), followed by the trunk (14.7%), then head and neck (10.8%). Conclusion: STSs are rare in North Jordan. A slight increase in their incidence was identified during the study period similar to global trends. The collection of relevant data on established risk factors along with a broader scale evaluation of the epidemiology of STS in the Middle East region is recommended to better evaluate disease burden and trends.

An explainable machine learning framework for lung cancer hospital length of stay prediction.

This work introduces a predictive Length of Stay (LOS) framework for lung cancer patients using machine learning (ML) models. The framework proposed to deal with imbalanced datasets for classification-based approaches using electronic healthcare records (EHR). We have utilized supervised ML methods to predict lung cancer inpatients LOS during ICU hospitalization using the MIMIC-III dataset. Random Forest (RF) Model outperformed other models and achieved predicted results during the three framework phases. With clinical significance features selection, over-sampling methods (SMOTE and ADASYN) achieved the highest AUC results (98% with CI 95%: 95.3-100%, and 100% respectively). The combination of Over-sampling and under-sampling achieved the second-highest AUC results (98%, with CI 95%: 95.3-100%, and 97%, CI 95%: 93.7-100% SMOTE-Tomek, and SMOTE-ENN respectively). Under-sampling methods reported the least important AUC results (50%, with CI 95%: 40.2-59.8%) for both (ENN and Tomek- Links). Using ML explainable technique called SHAP, we explained the outcome of the predictive model (RF) with SMOTE class balancing technique to understand the most significant clinical features that contributed to predicting lung cancer LOS with the RF model. Our promising framework allows us to employ ML techniques in-hospital clinical information systems to predict lung cancer admissions into ICU.

Exploring serious games for stroke rehabilitation: a scoping review.

AIMS AND OBJECTIVES: Stroke is the main cause of long-term disability and happens mostly in the older population. Stroke affected patients experience either of the cognitive, visual or motor losses and recovery requires time and patience as they have to do physical exercises every day and at times repetitively. There are various types of stroke rehabilitation exercises focussing on technological solutions that include therapies performed using games. Motion-based games are popular in encouraging participants to perform repetitive tasks without being getting bored. Therefore, in this study, we have explored studies that included the use of games for stroke rehabilitation to understand the design principles and characteristics of the games used for these purposes. METHOD: A number of medical respositories were searched for relevant articles in a window of 2008-2018. 18 studies were chosen for the scoping review depending on the inclusion criteria, and design principles used in these studies are analysed and evaluated. RESULTS AND CONCLUSION: We present main findings from our review concerning the attributes of existing games for stroke rehabilitation such as meaningful play, handling of failures, emphasising challenge, and the value of feedback. We conclude with a list of design recommendations that future serious game developers can consider while designing interfaces for stroke patients.Implications for RehabilitationThis review exhibits that the usage of gaming technologies is a very effective interactive mechanism for stroke based rehabilitation.Further our review also shows that serious games provide an avenue and opportunity for customized and highly contextualized gameplayOur review also suggests that effective features to incorporate into serious games for rehabilitation includes; facilitating challenge and recovery from errors.

A simulated measurement for COVID-19 pandemic using the effective reproductive number on an empirical portion of population: epidemiological models.

COVID-19 as a global pandemic has had an unprecedented impact on the entire world. Projecting the future spread of the virus in relation to its characteristics for a specific suite of countries against a temporal trend can provide public health guidance to governments and organizations. Therefore, this paper presented an epidemiological comparison of the traditional SEIR model with an extended and modified version of the same model by splitting the infected compartment into asymptomatic mild and symptomatic severe. We then exposed our derived layered model into two distinct case studies with variations in mitigation strategies and non-pharmaceutical interventions (NPIs) as a matter of benchmarking and comparison. We focused on exploring the United Arab Emirates (a small yet urban centre (where clear sequential stages NPIs were implemented). Further, we concentrated on extending the models by utilizing the effective reproductive number (R t) estimated against time, a more realistic than the static R 0, to assess the potential impact of NPIs within each case study. Compared to the traditional SEIR model, the results supported the modified model as being more sensitive in terms of peaks of simulated cases and flattening determinations.

A State-of-the-Art Survey on Artificial Intelligence to Fight COVID-19.

Artificial intelligence (AI) has shown immense potential to fight COVID-19 in many ways. This paper focuses primarily on AI's role in managing COVID-19 using digital images, clinical and laboratory data analysis, and a summary of the most recent articles published last year. We surveyed the use of AI for COVID-19 detection, screening, diagnosis, the progression of severity, mortality, drug repurposing, and other tasks. We started with the technical overview of all models used to fight the COVID-19 pandemic and ended with a brief statement of the current state-of-the-art, limitations, and challenges.

Application of Artificial Intelligence in COVID-19 Pandemic: Bibliometric Analysis.

The application of artificial intelligence (AI) to health has increased, including to COVID-19. This study aimed to provide a clear overview of COVID-19-related AI publication trends using longitudinal bibliometric analysis. A systematic literature search was conducted on the Web of Science for English language peer-reviewed articles related to AI application to COVID-19. A search strategy was developed to collect relevant articles and extracted bibliographic information (e.g., country, research area, sources, and author). VOSviewer (Leiden University) and Bibliometrix (R package) were used to visualize the co-occurrence networks of authors, sources, countries, institutions, global collaborations, citations, co-citations, and keywords. We included 729 research articles on the application of AI to COVID-19 published between 2020 and 2021. PLOS One (33/729, 4.52%), Chaos Solution Fractals (29/729, 3.97%), and Journal of Medical Internet Research (29/729, 3.97%) were the most common journals publishing these articles. The Republic of China (190/729, 26.06%), the USA (173/729, 23.73%), and India (92/729, 12.62%) were the most prolific countries of origin. The Huazhong University of Science and Technology, Wuhan University, and the Chinese Academy of Sciences were the most productive institutions. This is the first study to show a comprehensive picture of the global efforts to address COVID-19 using AI. The findings of this study also provide insights and research directions for academic researchers, policymakers, and healthcare practitioners who wish to collaborate in these domains in the future.

Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis.

BACKGROUND: The COVID-19 outbreak has spread rapidly and hospitals are overwhelmed with COVID-19 patients. While analysis of nasal and throat swabs from patients is the main way to detect COVID-19, analyzing chest images could offer an alternative method to hospitals, where health care personnel and testing kits are scarce. Deep learning (DL), in particular, has shown impressive levels of performance when analyzing medical images, including those related to COVID-19 pneumonia. OBJECTIVE: The goal of this study was to perform a systematic review with a meta-analysis of relevant studies to quantify the performance of DL algorithms in the automatic stratification of COVID-19 patients using chest images. METHODS: A search strategy for use in PubMed, Scopus, Google Scholar, and Web of Science was developed, where we searched for articles published between January 1 and April 25, 2020. We used the key terms "COVID-19," or "coronavirus," or "SARS-CoV-2," or "novel corona," or "2019-ncov," and "deep learning," or "artificial intelligence," or "automatic detection." Two authors independently extracted data on study characteristics, methods, risk of bias, and outcomes. Any disagreement between them was resolved by consensus. RESULTS: A total of 16 studies were included in the meta-analysis, which included 5896 chest images from COVID-19 patients. The pooled sensitivity and specificity of the DL models in detecting COVID-19 were 0.95 (95% CI 0.94-0.95) and 0.96 (95% CI 0.96-0.97), respectively, with an area under the receiver operating characteristic curve of 0.98. The positive likelihood, negative likelihood, and diagnostic odds ratio were 19.02 (95% CI 12.83-28.19), 0.06 (95% CI 0.04-0.10), and 368.07 (95% CI 162.30-834.75), respectively. The pooled sensitivity and specificity for distinguishing other types of pneumonia from COVID-19 were 0.93 (95% CI 0.92-0.94) and 0.95 (95% CI 0.94-0.95), respectively. The performance of radiologists in detecting COVID-19 was lower than that of the DL models; however, the performance of junior radiologists was improved when they used DL-based prediction tools. CONCLUSIONS: Our study findings show that DL models have immense potential in accurately stratifying COVID-19 patients and in correctly differentiating them from patients with other types of pneumonia and normal patients. Implementation of DL-based tools can assist radiologists in correctly and quickly detecting COVID-19 and, consequently, in combating the COVID-19 pandemic.

Technology, Privacy, and User Opinions of COVID-19 Mobile Apps for Contact Tracing: Systematic Search and Content Analysis.

BACKGROUND: Many countries across the globe have released their own COVID-19 contact tracing apps. This has resulted in the proliferation of several apps that used a variety of technologies. With the absence of a standardized approach used by the authorities, policy makers, and developers, many of these apps were unique. Therefore, they varied by function and the underlying technology used for contact tracing and infection reporting. OBJECTIVE: The goal of this study was to analyze most of the COVID-19 contact tracing apps in use today. Beyond investigating the privacy features, design, and implications of these apps, this research examined the underlying technologies used in contact tracing apps. It also attempted to provide some insights into their level of penetration and to gauge their public reception. This research also investigated the data collection, reporting, retention, and destruction procedures used by each of the apps under review. METHODS: This research study evaluated 13 apps corresponding to 10 countries based on the underlying technology used. The inclusion criteria ensured that most COVID-19-declared epicenters (ie, countries) were included in the sample, such as Italy. The evaluated apps also included countries that did relatively well in controlling the outbreak of COVID-19, such as Singapore. Informational and unofficial contact tracing apps were excluded from this study. A total of 30,000 reviews corresponding to the 13 apps were scraped from app store webpages and analyzed. RESULTS: This study identified seven distinct technologies used by COVID-19 tracing apps and 13 distinct apps. The United States was reported to have released the most contact tracing apps, followed by Italy. Bluetooth was the most frequently used underlying technology, employed by seven apps, whereas three apps used GPS. The Norwegian, Singaporean, Georgian, and New Zealand apps were among those that collected the most personal information from users, whereas some apps, such as the Swiss app and the Italian (Immuni) app, did not collect any user information. The observed minimum amount of time implemented for most of the apps with regard to data destruction was 14 days, while the Georgian app retained records for 3 years. No significant battery drainage issue was reported for most of the apps. Interestingly, only about 2% of the reviewers expressed concerns about their privacy across all apps. The number and frequency of technical issues reported on the Apple App Store were significantly more than those reported on Google Play; the highest was with the New Zealand app, with 27% of the reviewers reporting technical difficulties (ie, 10% out of 27% scraped reviews reported that the app did not work). The Norwegian, Swiss, and US (PathCheck) apps had the least reported technical issues, sitting at just below 10%. In terms of usability, many apps, such as those from Singapore, Australia, and Switzerland, did not provide the users with an option to sign out from their apps. CONCLUSIONS: This article highlighted the fact that COVID-19 contact tracing apps are still facing many obstacles toward their widespread and public acceptance. The main challenges are related to the technical, usability, and privacy issues or to the requirements reported by some users.

Predicting Length of Stay for Cardiovascular Hospitalizations in the Intensive Care Unit: Machine Learning Approach.

Predicting Cardiovascular Length of stay based hospitalization at the time of patients' admitting to the coronary care unit (CCU) or (cardiac intensive care units CICU) is deemed as a challenging task to hospital management systems globally. Recently, few studies examined the length of stay (LOS) predictive analytics for cardiovascular inpatients in ICU. However, there are almost scarcely real attempts utilized machine learning models to predict the likelihood of heart failure patients length of stay in ICU hospitalization. This paper introduces a predictive research architecture to predict Length of Stay (LOS) for heart failure diagnoses from electronic medical records using the state-of-art- machine learning models, in particular, the ensembles regressors and deep learning regression models. Our results showed that the gradient boosting regressor (GBR) outweighed the other proposed models in this study. The GBR reported higher R-squared value followed by the proposed method in this study called Staking Regressor. Additionally, The Random forest Regressor (RFR) was the fastest model to train. Our outcomes suggested that deep learning-based regressor did not achieve better results than the traditional regression model in this study. This work contributes to the field of predictive modelling for electronic medical records for hospital management systems.

The Effect of Strict State Measures on the Epidemiologic Curve of COVID-19 Infection in the Context of a Developing Country: A Simulation from Jordan.

COVID-19 has posed an unprecedented global public health threat and caused a significant number of severe cases that necessitated long hospitalization and overwhelmed health services in the most affected countries. In response, governments initiated a series of non-pharmaceutical interventions (NPIs) that led to severe economic and social impacts. The effect of these intervention measures on the spread of the COVID-19 pandemic are not well investigated within developing country settings. This study simulated the trajectories of the COVID-19 pandemic curve in Jordan between February and May and assessed the effect of Jordan's strict NPI measures on the spread of COVID-19. A modified susceptible, exposed, infected, and recovered (SEIR) epidemic model was utilized. The compartments in the proposed model categorized the Jordanian population into six deterministic compartments: suspected, exposed, infectious pre-symptomatic, infectious with mild symptoms, infectious with moderate to severe symptoms, and recovered. The GLEAMviz client simulator was used to run the simulation model. Epidemic curves were plotted for estimated COVID-19 cases in the simulation model, and compared against the reported cases. The simulation model estimated the highest number of total daily new COVID-19 cases, in the pre-symptomatic compartmental state, to be 65 cases, with an epidemic curve growing to its peak in 49 days and terminating in a duration of 83 days, and a total simulated cumulative case count of 1048 cases. The curve representing the number of actual reported cases in Jordan showed a good pattern compatibility to that in the mild and moderate to severe compartmental states. The reproduction number under the NPIs was reduced from 5.6 to less than one. NPIs in Jordan seem to be effective in controlling the COVID-19 epidemic and reducing the reproduction rate. Early strict intervention measures showed evidence of containing and suppressing the disease.

Measurement Method for Evaluating the Lockdown Policies during the COVID-19 Pandemic.

Coronavirus Disease 2019 (COVID-19) has affected day to day life and slowed down the global economy. Most countries are enforcing strict quarantine to control the havoc of this highly contagious disease. Since the outbreak of COVID-19, many data analyses have been done to provide close support to decision-makers. We propose a method comprising data analytics and machine learning classification for evaluating the effectiveness of lockdown regulations. Lockdown regulations should be reviewed on a regular basis by governments, to enable reasonable control over the outbreak. The model aims to measure the efficiency of lockdown procedures for various countries. The model shows a direct correlation between lockdown procedures and the infection rate. Lockdown efficiency is measured by finding a correlation coefficient between lockdown attributes and the infection rate. The lockdown attributes include retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, residential, and schools. Our results show that combining all the independent attributes in our study resulted in a higher correlation (0.68) to the dependent value Interquartile 3 (Q3). Mean Absolute Error (MAE) was found to be the least value when combining all attributes.

COVID-19 Global Risk: Expectation vs. Reality.

Background and Objective: COVID-19 has engulfed the entire world, with many countries struggling to contain the pandemic. In order to understand how each country is impacted by the virus compared with what would have been expected prior to the pandemic and the mortality risk on a global scale, a multi-factor weighted spatial analysis is presented. Method: A number of key developmental indicators across three main categories of demographics, economy, and health infrastructure were used, supplemented with a range of dynamic indicators associated with COVID-19 as independent variables. Using normalised COVID-19 mortality on 13 May 2020 as a dependent variable, a linear regression (N = 153 countries) was performed to assess the predictive power of the various indicators. Results: The results of the assessment show that when in combination, dynamic and static indicators have higher predictive power to explain risk variation in COVID-19 mortality compared with static indicators alone. Furthermore, as of 13 May 2020 most countries were at a similar or lower risk level than what would have been expected pre-COVID, with only 44/153 countries experiencing a more than 20% increase in mortality risk. The ratio of elderly emerges as a strong predictor but it would be worthwhile to consider it in light of the family makeup of individual countries. Conclusion: In conclusion, future avenues of data acquisition related to COVID-19 are suggested. The paper concludes by discussing the ability of various factors to explain COVID-19 mortality risk. The ratio of elderly in combination with the dynamic variables associated with COVID-19 emerge as more significant risk predictors in comparison to socio-economic and demographic indicators.

Global and Temporal COVID-19 Risk Evaluation.

The COVID-19 pandemic has caused unprecedented crisis across the world, with many countries struggling with the pandemic. In order to understand how each country is impacted by the virus and assess the risk on a global scale we present a regression based analysis using two pre-existing indexes, namely the Inform and Infectious Disease Vulnerability Index, in conjunction with the number of elderly living in the population. Further we introduce a temporal layer in our modeling by incorporating the stringency level employed by each country over a period of 6 time intervals. Our results show that the indexes and level of stringency are not ideally suited for explaining variation in COVID-19 risk, however the ratio of elderly in the population is a stand out indicator in terms of its predictive power for mortality risk. In conclusion, we discuss how such modeling approaches can assist public health policy.

Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review.

Background and Objective: Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19. Methods: We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19. Results: Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25-40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19. Conclusions: Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.

Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients' Rehabilitation: Systematic Review.

BACKGROUND: Robot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications. OBJECTIVE: The goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors. METHODS: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct & The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients' condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients. RESULTS: Thirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. CONCLUSIONS: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies.

Passive RFID Localisation Framework in Smart Homes Healthcare Settings.

In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using battery-enabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes healthcare.