Effectively handling the limited number of surgery operating rooms equipped with expensive equipment is a challenging task for hospital management such as reducing the case-time duration and reducing idle time. Improving the efficiency of operating room usage via reducing the idle time with better scheduling would rely on accurate estimation of surgery duration. Our model can achieve a good prediction result on surgery duration with a dozen of features. We have found the result of our best performing department-specific XGBoost model with the values 31.6 min, 18.71 min, 0.71, 28% and 27% for the metrics of root-mean-square error (RMSE), mean absolute error (MAE), coefficient of determination (R2), mean absolute percentage error (MAPE) and proportion of estimated result within 10% variation, respectively. We have presented each department-specific result with our estimated results between 5 and 10 min deviation would be more informative to the users in the real application. Our study shows comparable performance with previous studies, and the machine learning methods use fewer features that are better suited for universal usability.
Previous non-invasive Diabetes Mellitus (DM) prediction methods for rapid screening suffered from the trade-off between speed and accuracy. The accurate results of questionnaires rely on long and detailed questions thus sacrifice speed, meanwhile, photoplethysmography (PPG) offers convenient and fast testing but lacking accuracy. In this work, we developed a 5-grade model to accurately screen out non-DM subjects (low prediction grades) via one-minute PPG measurement. This efficient and effective rapid screening will practically reduce the loading for further invasive verification on the remaining DM-grade subjects. A total of 2538 subjects are recruited (DM: 1310, non-DM: 1228) with two 1-minute PPG samples taken from each subject. The model includes 8 features: 3 autonomic-and 3 vascular-related PPG features, heart rate, and waist circumference. All 8 features monotonically alter with increased DM prediction grade. The model provides users 5 DM risk grades. While defined grade 1 and grade 2 as non-DM grades, the prediction result shows a low false-negative rate of 13%. If only considering grade 1 as non-DM, the false-negative rate will be significantly reduced to 1.3%. Thus subjects predicted as grades 1 and 2 are substantially away from DM. The remaining subjects with higher DM risk grades such as grades 3, 4, and 5 (or unlikely grade 2) are recommended to take clinical-standard invasive DM test for corresponding therapeutic treatment. A table for assessing the risk index for each feature is also compiled. We have experimentally demonstrated a 1-minute pulsation measurement with PPG-based device (SpO 2 oximeter, smartphone, or wearable device) can be an efficient/effective DM rapid screening technique to filter out non-DM subjects. The resulted high-risk feature indexes also pose as warning signs of the degradation of either autonomic or vascular functions for personal healthcare management. The fast and convenient execution and useful results suggest that our approach is very simple and informative for quick DM risk assessment.
Previously published photoplethysmography-(PPG) based non-invasive blood glucose (NIBG) measurements have not yet been validated over 500 subjects. As illustrated in this work, we increased the number subjects recruited to 2538 and found that the prediction accuracy (the ratio in zone A of Clarke’s error grid) reduced to undesirable 60.6%. We suspect the low prediction accuracy induced by larger sample size might arise from the physiological diversity of subjects, and one possibility is that the diversity might originate from medication. Therefore, we split the subjects into two cohorts for deep learning: with and without medication (1682 and 856 recruited subjects, respectively). In comparison, the cohort training for subjects without any medication had approximately 30% higher prediction accuracy over the cohort training for those with medication. Furthermore, by adding quarterly (every 3 months) measured glycohemoglobin (HbA1c), we were able to significantly boost the prediction accuracy by approximately 10%. For subjects without medication, the best performing model with quarterly measured HbA1c achieved 94.3% prediction accuracy, RMSE of 12.4 mg/dL, MAE of 8.9 mg/dL, and MAPE of 0.08, which demonstrates a very promising solution for NIBG prediction via deep learning. Regarding subjects with medication, a personalized model could be a viable means of further investigation.
Personalized modeling has long been anticipated to approach precise noninvasive blood glucose measurements, but challenged by limited data for training personal model and its unavoidable outlier predictions. To overcome these long-standing problems, we largely enhanced the training efficiency with the limited personal data by an innovative Deduction Learning (DL), instead of the conventional Induction Learning (IL). The domain theory of our deductive method, DL, made use of accumulated comparison of paired inputs leading to corrections to preceded measured blood glucose to construct our deep neural network architecture. DL method involves the use of paired adjacent rounds of finger pulsation Photoplethysmography signal recordings as the input to a convolutional-neural-network (CNN) based deep learning model. Our study reveals that CNN filters of DL model generated extra and non-uniform feature patterns than that of IL models, which suggests DL is superior to IL in terms of learning efficiency under limited training data. Among 30 diabetic patients as our recruited volunteers, DL model achieved 80% of test prediction in zone A of Clarke Error Grid (CEG) for model training with 12 rounds of data, which was 20% improvement over IL method. Furthermore, we developed an automatic screening algorithm to delete low confidence outlier predictions. With only a dozen rounds of training data, DL with automatic screening achieved a correlation coefficient ($${R}_{P}$$ R P ) of 0.81, an accuracy score ($${R}_{A}$$ R A ) of 93.5, a root mean squared error of 13.93 mg/dl, a mean absolute error of 12.07 mg/dl, and 100% predictions in zone A of CEG. The nonparametric Wilcoxon paired test on $${R}_{A}$$ R A for DL versus IL revealed near significant difference with p-value 0.06. These significant improvements indicate that a very simple and precise noninvasive measurement of blood glucose concentration is achievable.
Atrial fibrillation (AFib) is a common type of arrhythmia that is often clinically asymptomatic, which increases the risk of stroke significantly but can be prevented with anticoagulation. The photoplethysmogram (PPG) has recently attracted a lot of attention as a surrogate for electrocardiography (ECG) on atrial fibrillation (AFib) detection, with its out-of-hospital usability for rapid screening or long-term monitoring. Previous studies on AFib detection via PPG signals have achieved good results, but were short of intuitive criteria like ECG p-wave absence or not, especially while using interval randomness to detect AFib suffering from conjunction with premature contractions (PAC/PVC). In this study, we newly developed a PPG flux (pulse amplitude) and interval plots-based methodology, simply comprising an irregularity index threshold of 20 and regression error threshold of 0.06 for the precise automatic detection of AFib. The proposed method with automated detection on AFib shows a combined sensitivity, specificity, accuracy, and precision of 1, 0.995, 0.995, and 0.952 across the 460 samples. Furthermore, the flux-interval plot configuration also acts as a very intuitive tool for visual reassessment to confirm the automatic detection of AFib by its distinctive plot pattern compared to other cardiac rhythms. The study demonstrated that exclusive 2 false-positive cases could be corrected after the reassessment. With the methodology’s background theory well established, the detection process automated and visualized, and the PPG sensors already extensively used, this technology is very user-friendly and convincing for promoted to in-house AFib diagnostics.
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