Analyzing and Forecasting Pediatric Fever Clinic Visits in High Frequency Using Ensemble Time-Series Methods After the COVID-19 Pandemic in Hangzhou, China: Retrospective Study.

BACKGROUND: The COVID-19 pandemic has significantly altered the global health and medical landscape. In response to the outbreak, Chinese hospitals have established 24-hour fever clinics to serve patients with COVID-19. The emergence of these clinics and the impact of successive epidemics have led to a surge in visits, placing pressure on hospital resource allocation and scheduling. Therefore, accurate prediction of outpatient visits is essential for informed decision-making in hospital management. OBJECTIVE: Hourly visits to fever clinics can be characterized as a long-sequence time series in high frequency, which also exhibits distinct patterns due to the particularity of pediatric treatment behavior in an epidemic context. This study aimed to build models to forecast fever clinic visit with outstanding prediction accuracy and robust generalization in forecast horizons. In addition, this study hopes to provide a research paradigm for time-series forecasting problems, which involves an exploratory analysis revealing data patterns before model development. METHODS: An exploratory analysis, including graphical analysis, autocorrelation analysis, and seasonal-trend decomposition, was conducted to reveal the seasonality and structural patterns of the retrospective fever clinic visit data. The data were found to exhibit multiseasonality and nonlinearity. On the basis of these results, an ensemble of time-series analysis methods, including individual models and their combinations, was validated on the data set. Root mean square error and mean absolute error were used as accuracy metrics, with the cross-validation of rolling forecasting origin conducted across different forecast horizons. RESULTS: Hybrid models generally outperformed individual models across most forecast horizons. A novel model combination, the hybrid neural network autoregressive (NNAR)-seasonal and trend decomposition using Loess forecasting (STLF), was identified as the optimal model for our forecasting task, with the best performance in all accuracy metrics (root mean square error=20.1, mean absolute error=14.3) for the 15-days-ahead forecasts and an overall advantage for forecast horizons that were 1 to 30 days ahead. CONCLUSIONS: Although forecast accuracy tends to decline with an increasing forecast horizon, the hybrid NNAR-STLF model is applicable for short-, medium-, and long-term forecasts owing to its ability to fit multiseasonality (captured by the STLF component) and nonlinearity (captured by the NNAR component). The model identified in this study is also applicable to hospitals in other regions with similar epidemic outpatient configurations or forecasting tasks whose data conform to long-sequence time series in high frequency exhibiting multiseasonal and nonlinear patterns. However, as external variables and disruptive events were not accounted for, the model performance declined slightly following changes in the COVID-19 containment policy in China. Future work may seek to improve accuracy by incorporating external variables that characterize moving events or other factors as well as by adding data from different organizations to enhance algorithm generalization.

[Development and Application of Medical Imaging Analysis Platform Based on Radiomics and Machine Learning Technologies].

OBJECTIVE: In order to solve the technical problems, clinical researchers face the process of medical imaging analysis such as data labeling, feature extraction and algorithm selection, a medical imaging oriented multi-disease research platform based on radiomics and machine learning technology was designed and constructed. METHODS: Five aspects including data acquisition, data management, data analysis, modeling and data management were considered. This platform provides comprehensive functions such as data retrieve and data annotation, image feature extraction and dimension reduction, machine learning model running, results validation, visual analysis and automatic generation of analysis reports, thus an integrated solution for the whole process of radiomics analysis has been generated. RESULTS: Clinical researchers can use this platform for the whole process of radiomics and machine learning analysis for medical images, and quickly produce research results. CONCLUSIONS: This platform greatly shortens the time for medical image analysis research, decreasing the work difficulty of clinical researchers, as well as significantly promoting their working efficiency.

An improved joint non-negative matrix factorization for identifying surgical treatment timing of neonatal necrotizing enterocolitis.

Neonatal necrotizing enterocolitis is a severe neonatal intestinal disease. Timely identification of surgical indications is essential for newborns in order to seek the best time for treatment and improve prognosis. This paper attempts to establish an algorithm model based on multimodal clinical data to determine the features of surgical indications and construct an auxiliary diagnosis model. The proposed algorithm adds hypergraph constraints on the two modal data based on Joint Nonnegative Matrix Factorization (JNMF), aiming to mine the higher-order correlations of the two data features. In addition, the adjacency matrix of the two kinds of data is used as a network regularization constraint to prevent overfitting. Orthogonal and L1-norm regulations were introduced to avoid feature redundancy and perform feature selection, respectively, and confirmed 14 clinical features. Finally, we used three classifiers, random forest, support vector machine, and logistic regression, to perform binary classification of patients requiring surgery. The results show that when the features selected by the proposed algorithm model are classified by random forest, the area under the ROC curve is 0.8, which has high prediction accuracy.

Patterns of Pediatric and Adolescent Gynecologic Problems in China: A Hospital-Based Retrospective Study of 97,252 Patients.

STUDY OBJECTIVE: To describe the pattern and population characteristics of pediatric and adolescent gynecologic (PAG) problems in China DESIGN: A clinic-based retrospective study of gynecologic patients (aged 0-18 years) over a period of 13 years SETTING: Department of PAG in the Children's Hospital, Zhejiang University School of Medicine PARTICIPANT: The final analyses included 97,252 patients with gynecologic problems. INTERVENTIONS/METHODS: Descriptive analysis was conducted to evaluate the pattern of PAG problems. MAIN OUTCOME MEASURES: Spectrum of PAG problems RESULTS AND CONCLUSIONS: The number of first-visit PAG patients increased from 4,582 to 11,876 from 2006 to 2018. Overall, genital inflammation was the most common presentation (57.0%), followed by precocious puberty (18.2%). The disease pattern varied across age groups; the most common problems were genital inflammation for age 0-6 years, genital inflammation and precocious puberty for age 7-9 years, and consultation, genital inflammation, and menstrual disorders for age 10-18 years. Overall, genital inflammation, precocious puberty, consultation, and menstrual disorders were common issues for pediatric and adolescent patients with gynecologic problems in China.

Identification of pediatric respiratory diseases using a fine-grained diagnosis system.

Respiratory diseases, including asthma, bronchitis, pneumonia, and upper respiratory tract infection (RTI), are among the most common diseases in clinics. The similarities among the symptoms of these diseases precludes prompt diagnosis upon the patients' arrival. In pediatrics, the patients' limited ability in expressing their situation makes precise diagnosis even harder. This becomes worse in primary hospitals, where the lack of medical imaging devices and the doctors' limited experience further increase the difficulty of distinguishing among similar diseases. In this paper, a pediatric fine-grained diagnosis-assistant system is proposed to provide prompt and precise diagnosis using solely clinical notes upon admission, which would assist clinicians without changing the diagnostic process. The proposed system consists of two stages: a test result structuralization stage and a disease identification stage. The first stage structuralizes test results by extracting relevant numerical values from clinical notes, and the disease identification stage provides a diagnosis based on text-form clinical notes and the structured data obtained from the first stage. A novel deep learning algorithm was developed for the disease identification stage, where techniques including adaptive feature infusion and multi-modal attentive fusion were introduced to fuse structured and text data together. Clinical notes from over 12000 patients with respiratory diseases were used to train a deep learning model, and clinical notes from a non-overlapping set of about 1800 patients were used to evaluate the performance of the trained model. The average precisions (AP) for pneumonia, RTI, bronchitis and asthma are 0.878, 0.857, 0.714, and 0.825, respectively, achieving a mean AP (mAP) of 0.819. These results demonstrate that our proposed fine-grained diagnosis-assistant system provides precise identification of the diseases.

Adversarial active learning for the identification of medical concepts and annotation inconsistency.

OBJECTIVE: Named entity recognition (NER) is a principal task in the biomedical field and deep learning-based algorithms have been widely applied to biomedical NER. However, all of these methods that are applied to biomedical corpora use only annotated samples to maximize their performances. Thus, (1) large numbers of unannotated samples are relinquished and their values are overlooked. (2) Compared with other types of active learning (AL) algorithms, generative adversarial learning (GAN)-based AL methods have developed slowly. Furthermore, current diversity-based AL methods only compute similarities between a pair of sentences and cannot evaluate distribution similarities between groups of sentences. Annotation inconsistency is one of the significant challenges in the biomedical annotation field. Most existing methods for addressing this challenge are statistics-based or rule-based methods. (3) They require sufficient expert knowledge and complex designs. To address challenges (1), (2), and (3) simultaneously, we propose innovative algorithms. METHODS: GAN is introduced in this paper, and we propose the GAN-bidirectional long short-term memory-conditional random field (GAN-BiLSTM-CRF) and the GAN-bidirectional encoder representations from transformers-conditional random field (GAN-BERT-CRF) models, which can be considered an NER model, an AL model, and a model identifying error labels. BiLSTM-CRF or BERT-CRF is defined as the generator and a convolutional neural network (CNN)-based network is considered the discriminator. (1) The generator employs unannotated samples in addition to annotated samples to maximize NER performance. (2) The outputs of the CRF layer and the discriminator are used to select unlabeled samples for the AL task. (3) The discriminator discriminates the distribution of error labels from that of correct labels, identify error labels, and address the annotation inconsistency challenge. RESULTS: The corpus from the 2010 i2b2/VA NLP challenge and the Chinese CCKS-2017 Task 2 dataset are adopted for experiments. Compared to the baseline BiLSTM-CRF and BERT-CRF, the GAN-BiLSTM-CRF and GAN-BERT-CRF models achieved significant improvements on the precision, recall, and F1 scores in terms of NER performance. Learning curves in AL experiments show the comparative results of the proposed models. Furthermore, the trained discriminator can identify samples with incorrect medical labels in both simulation and real-word experimental environments. CONCLUSION: The idea of introducing GAN contributes significant results in terms of NER, active learning, and the ability to identify incorrect annotated samples. The benefits of GAN will be further studied.