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Cardiovascular diseases represent the leading global cause of death, typically diagnosed and addressed through electrocardiograms (ECG), which record the heart's electrical activity. In recent years, there has been a notable surge in ECG recordings, driven by the widespread use of wearable devices. However, the limited availability of medical experts to analyze these recordings underscores the necessity for automated ECG analysis using computer-aided methods. In this study, we introduced 3DECG-Net, a deep learning model designed to detect and classify seven distinct heart states through the analysis of data fusion from 12-lead ECG in a multi-label framework. Our model leverages a residual architecture with a multi-head attention mechanism, undergoing training within a five-fold cross-validation scheme. By transforming 12-lead ECG signals into 3D data with the help of Recurrent Plot technique, 3DECG-Net achieves a noteworthy micro F1-score of 80.3 %, surpassing the performance of other state-of-the-art deep learning models developed for this specific task. Also, we present an ECG preprocessing framework to generate compact, high-quality ECG signals for potential application in future studies within this domain. We conduct an explainable AI experiment using Local Interpretable Model-agnostic Explanations (LIME) to elucidate the significance of each lead in accurately diagnosing specific arrhythmias, ensuring the logical processing of ECG data by 3DECG-Net. The findings of this study suggest that the proposed model is trustworthy and has the potential to be used as an effective diagnostic toolset for identifying heart arrhythmias. Its effectiveness can improve the diagnostic process, facilitate early treatment, and enhance overall efficiency in medical settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Early and reliable prognostication in post-cardiac arrest patients remains challenging, with various factors linked to return of spontaneous circulation (ROSC), survival, and neurological results. Machine learning and deep learning models show promise in improving these predictions. This systematic review and meta-analysis evaluates how effective these approaches are in predicting clinical outcomes at different time points using structured data., Methods: This study followed PRISMA guidelines, involving a comprehensive search across PubMed, Scopus, and Web of Science databases until March 2024. Studies aimed at predicting ROSC, survival (or mortality), and neurological outcomes after cardiac arrest through the application of machine learning or deep learning techniques with structured data were included. Data extraction followed the guidelines of the CHARMS checklist, and the bias risk was evaluated using PROBAST tool. Models reporting the AUC metric with 95 % confidence intervals were incorporated into the quantitative synthesis and meta-analysis., Results: After extracting 2,753 initial records, 41 studies met the inclusion criteria, yielding 97 machine learning and 16 deep learning models. The pooled AUC for predicting favorable neurological outcomes (CPC 1 or 2) at hospital discharge was 0.871 (95 % CI: 0.813 - 0.928) for machine learning models and 0.877 (95 % CI: 0.831-0.924) across deep learning algorithms. For survival prediction, this value was found to be 0.837 (95 % CI: 0.757-0.916). Considerable heterogeneity and high risk of bias were observed, mainly attributable to inadequate management of missing data and the absence of calibration plots. Most studies focused on pre-hospital factors, with age, sex, and initial arrest rhythm being the most frequent features., Conclusion: Predictive models utilizing AI-based approaches, including machine and deep learning models exhibit enhanced effectiveness compared to previous regression algorithms, but significant heterogeneity and high risk of bias limit their dependability. Evaluating state-of-the-art deep learning models tailored for tabular data and their clinical generalizability can enhance outcome prediction after cardiac arrest., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The COVID-19 pandemic triggered an unprecedented level of restrictive measures globally. Most countries resorted to lockdowns at some point to buy the much-needed time for flattening the curve and scaling up vaccination and treatment capacity. Although lockdowns, social distancing and business closures generally slowed the case growth, there is a growing concern about these restrictions' social, economic and psychological impact, especially on the disadvantaged and poorer segments of society. While we are all in this together, these segments often take the heavier toll of the pandemic and face harsher restrictions or get blamed for community transmission. This study proposes a road-network-based networked approach to model mobility patterns between localities during lockdown stages. It utilises a panel regression method to analyse the effects of mobility in transmitting COVID-19 in an Australian context, together with a close look at a suburban population's characteristics like their age, income and education. Firstly, we attempt to model how the local road networks between the neighbouring suburbs (i.e., neighbourhood measure) and current infection count affect the case growth and how they differ between delta and omicron variants. We use a geographic information system, population and infection data to measure road connections, mobility and transmission probability across the suburbs. We then looked at three socio-demographic variables: age, education and income and explored how they moderate independent and dependent variables (infection rates and neighbourhood measures). The result shows strong model performance to predict infection rate based on neighbourhood road connection. However, apart from age in the delta variant context, the other variables (income and education level) do not seem to moderate the relationship between infection rate and neighbourhood measure. The results indicate that suburbs with a more socio-economically disadvantaged population do not necessarily contribute to more community transmission. The study findings could be potentially helpful for stakeholders in tailoring any health decision for future pandemics., (© 2024. The Author(s).)

COVID-19 is a highly communicable respiratory illness caused by the novel coronavirus SARS-CoV-2, which has had a significant impact on global public health and the economy. Detecting COVID-19 patients during a pandemic with limited medical facilities can be challenging, resulting in errors and further complications. Therefore, this study aims to develop deep learning models to facilitate automated diagnosis of COVID-19 from CT scan records of patients. The study also introduced COVID-MAH-CT, a new dataset that contains 4442 CT scan images from 133 COVID-19 patients, as well as 133 CT scan 3D volumes. We proposed and evaluated six different transfer learning models for slide-level analysis that are responsible for detecting COVID-19 in multi-slice spiral CT. Additionally, multi-head attention squeeze and excitation residual (MASERes) neural network, a novel 3D deep model was developed for patient-level analysis, which analyzes all the CT slides of a given patient as a whole and can accurately diagnose COVID-19. The codes and dataset developed in this study are available at https://github.com/alrzsdgh/COVID . The proposed transfer learning models for slide-level analysis were able to detect COVID-19 CT slides with an accuracy of more than 99%, while MASERes was able to detect COVID-19 patients from 3D CT volumes with an accuracy of 100%. These achievements demonstrate that the proposed models in this study can be useful for automatically detecting COVID-19 in both slide-level and patient-level from patients' CT scan records, and can be applied for real-world utilization, particularly in diagnosing COVID-19 cases in areas with limited medical facilities., (© 2024. The Author(s).)

The presence or absence of spontaneous retinal venous pulsations (SVP) provides clinically significant insight into the hemodynamic status of the optic nerve head. Reduced SVP amplitudes have been linked to increased intracranial pressure and glaucoma progression. Currently, monitoring for the presence or absence of SVPs is performed subjectively and is highly dependent on trained clinicians. In this study, we developed a novel end-to-end deep model, called U3D-Net, to objectively classify SVPs as present or absent based on retinal fundus videos. The U3D-Net architecture consists of two distinct modules: an optic disc localizer and a classifier. First, a fast attention recurrent residual U-Net model is applied as the optic disc localizer. Then, the localized optic discs are passed on to a deep convolutional network for SVP classification. We trained and tested various time-series classifiers including 3D Inception, 3D Dense-ResNet, 3D ResNet, Long-term Recurrent Convolutional Network, and ConvLSTM. The optic disc localizer achieved a dice score of 95% for locating the optic disc in 30 milliseconds. Amongst the different tested models, the 3D Inception model achieved an accuracy, sensitivity, and F1-Score of 84 ± 5%, 90 ± 8%, and 81 ± 6% respectively, outperforming the other tested models in classifying SVPs. To the best of our knowledge, this research is the first study that utilizes a deep neural network for an autonomous and objective classification of SVPs using retinal fundus videos., (© 2023. Springer Nature Limited.)

Machine learning models are used to create and enhance various disease prediction frameworks. Ensemble learning is a machine learning technique that combines multiple classifiers to improve performance by making more accurate predictions than a single classifier. Although numerous studies have employed ensemble approaches for disease prediction, there is a lack of thorough assessment of commonly used ensemble approaches against highly researched diseases. Consequently, this study aims to identify significant trends in the performance accuracies of ensemble techniques (i.e., bagging, boosting, stacking, and voting) against five hugely researched diseases (i.e., diabetes, skin disease, kidney disease, liver disease, and heart conditions). Using a well-defined search strategy, we first identified 45 articles from the current literature that applied two or more of the four ensemble approaches to any of these five diseases and were published in 2016-2023. Although stacking has been used the fewest number of times (23) compared with bagging (41) and boosting (37), it showed the most accurate performance the most times (19 out of 23). The voting approach is the second-best ensemble approach, as revealed in this review. Stacking always revealed the most accurate performance in the reviewed articles for skin disease and diabetes. Bagging demonstrated the best performance for kidney disease (five out of six times) and boosting for liver and diabetes (four out of six times). The results show that stacking has demonstrated greater accuracy in disease prediction than the other three candidate algorithms. Our study also demonstrates variability in the perceived performance of different ensemble approaches against frequently used disease datasets. The findings of this work will assist researchers in better understanding current trends and hotspots in disease prediction models that employ ensemble learning, as well as in determining a more suitable ensemble model for predictive disease analytics. This article also discusses variability in the perceived performance of different ensemble approaches against frequently used disease datasets.

Mental health is vital in all human life stages, and managing mental healthcare service resources is crucial for providers. This paper presents a new method, called Extended Inter-Spike Interval (EISI), on identifying the patients with a similar utilisation of mental health services and medications. The EISI measures the distance between the utilisation patterns of the patients. Then, the pairwise distances are given to a developed split-and-merge Partitioning Around Medoids (PAM) clustering algorithm to identify the patients with similar utilisation patterns. To evaluate the proposed method, we use two years (2013-2014) of the 10% publicly available sample of the Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) administrative data. Results show that mental health patients can be grouped into ten clusters with distinct and interpretable utilisations patterns. The largest cluster comprises individuals who only visit general practitioners and take psycholeptics medications for a short time. The smallest group contains occasional visits with general practitioners and regularly utilises psycholeptics and psychoanaleptics medications over long periods. The proposed method provides insights on whom to target and how to structure services for different groups of individuals with mental health conditions., Competing Interests: Declaration of Competing interests None declared., (Copyright © 2022 IPEM. Published by Elsevier Ltd. All rights reserved.)

COVID-19 and swine-origin influenza A (H1N1) are both pandemics that sparked significant concern worldwide. Since these two diseases have common symptoms, a fast COVID-19 versus H1N1 screening helps better manage patients at healthcare facilities. We present a novel deep model, called Optimized Parallel Inception, for fast screening of COVID-19 and H1N1 patients. We also present a Semi-supervised Generative Adversarial Network (SGAN) to address the problem related to the smaller size of the COVID-19 and H1N1 research data. To evaluate the proposed models, we have merged two separate COVID-19 and H1N1 data from different sources to build a new dataset. The created dataset includes 4,383 positive COVID-19 cases, 989 positive H1N1 cases, and 1,059 negative cases. We applied SGAN on this dataset to remove issues related to unequal class densities. The experimental results show that the proposed model's screening accuracy is 99.2% and 99.6% for COVID-19 and H1N1, respectively. According to our analysis, the most significant symptoms and underlying chronic diseases for COVID-19 versus H1N1 screening are dry cough, breathing problems, diabetes, and gastrointestinal., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Ltd. All rights reserved.)

COVID-19 and swine-origin influenza A (H1N1) are both pandemics that sparked significant concern worldwide. These two viruses have the same symptoms and occur at a collision timeline. Optimized Parallel Inception (OPI) presents a new strategy to screen the COVID-19 from H1N1 with use of only symptoms. In this paper, the process of preprocessing, screening, and specifying feature importance by OPI and particle swarm optimization is presented. Experimental results indicate 98.88 accuracy for screening COVID-19, H1N1, and Neither COVID-19 Nor H1N1., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

To find the gold standard out of three pre-established routine slow freezing (SF) methods, ovarian cortex tissues of nine transsexual individuals were cryopreserved and compared to each other, as well as the control (fresh) samples. Histological, genomic, and endocrinological effects of the SFs were assessed post-thawing and after a seven-day culture period. SF1 included 10% dimethyl-sulfoxide (Me2SO) in the base medium (BM), SF2 had 1.5 M/L ethylene-glycol (EG) and 0.1 M/L sucrose in the BM, and SF3 consisted of 6% Me2SO, 6% EG and 0.15 M/L sucrose in the BM. The cortical tissue strips went under a programmed cooling process and were stored in liquid nitrogen. Histological criteria (tissue damage and follicular quality), as well as gene expression levels, were assessed in the thawed and control tissues. Half of the thawed and control tissues were cultured for seven days and their histology, genetic profile, and hormonal status were examined as the reflection of the avascular tension effect. Post-thawing tissue damage was similar between all groups but significantly increased post-culture (P < 0.05). The percentages of high-quality follicles diminished in all SFs after thawing and culture (P < 0.05) except for the similarity of post-thawing SF3, compared to control. The genetic profile of the tissue after thawing and culture suggested quiescence/activation balance in SF1 and 2 and significant down-regulation in SF3, compared to the control specimens (P < 0.05). Post-thawing BAX:BCL2 was higher than control in SF1 and SF3 (P < 0.05), while this ratio in SF2 was similar to the control. However, after culture this ratio was similar to that of control in SF3 and diminished in SF1 and 2 (P < 0.05). The expression levels of gap-junction genes showed dramatic pre- and post-thawing fluctuations in all groups. After culture, estradiol in SF3 was significantly higher than SF1 and 2 (P < 0.05). In addition, progesterone in SF3 was similar to control but significantly lower in SF1 and 2 (P < 0.05). In conclusion, all SFs showed advantages and disadvantages, and the follicular quality and its function depend on the type of cryoprotectant and the speed of thawing. The effects of freezing/thawing continue to appear during the seven days of culture. According to the results of this study, SF3 seems to be more promising in keeping the follicles functional and safe from cell damage during culture., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Sepsis is a life-threatening condition that occurs due to the body's reaction to infections, and it is a leading cause of morbidity and mortality in hospitals. Early prediction of sepsis onset facilitates early interventions that promote the survival of suspected patients. However, reliable and intelligent systems for predicting sepsis are scarce., Methods: This paper presents a novel technique called Smart Sepsis Predictor (SSP) to predict sepsis onset in patients admitted to an intensive care unit (ICU). SSP is a deep neural network architecture that encompasses long short-term memory (LSTM), convolutional, and fully connected layers to achieve early prediction of sepsis. SSP can work in two modes; Mode 1 uses demographic data and vital signs, and Mode 2 uses laboratory test results in addition to demographic data and vital signs. To evaluate SSP, we have used the 2019 PhysioNet/CinC Challenge dataset, which includes the records of 40,366 patients admitted to the ICU., Results: To compare SSP with existing state-of-the-art methods, we have measured the accuracy of the SSP in 4-, 8-, and 12-h prediction windows using publicly available data. Our results show that the SSP performance in Mode 1 and Mode 2 is much higher than existing methods, achieving an area under the receiver operating characteristic curve (AUROC) of 0.89 and 0.92, 0.88 and 0.87, and 0.86 and 0.84 for 4 h, 8 h, and 12 h before sepsis onset, respectively., Conclusions: Using ICU data, sepsis onset can be predicted up to 12 h in advance. Our findings offer an early solution for mitigating the risk of sepsis onset., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: The first line of treatment for people with Diabetes mellitus is metformin. However, over the course of the disease metformin may fail to achieve appropriate glycemic control, and a second-line therapy may become necessary. In this paper we introduce Tangle, a time span-guided neural attention model that can accurately and timely predict the upcoming need for a second-line diabetes therapy from administrative data in the Australian adult population. The method is suitable for designing automatic therapy review recommendations for patients and their providers without the need to collect clinical measures., Data: We analyzed seven years of de-identified records (2008-2014) of the 10% publicly available linked sample of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia., Methods: By design, Tangle inherits the representational power of pre-trained word embedding, such as GloVe, to encode sequences of claims with the related MBS codes. Moreover, the proposed attention mechanism natively exploits the information hidden in the time span between two successive claims (measured in number of days). We compared the proposed method against state-of-the-art sequence classification methods., Results: Tangle outperforms state-of-the-art recurrent neural networks, including attention-based models. In particular, when the proposed time span-guided attention strategy is coupled with pre-trained embedding methods, the model performance reaches an Area Under the ROC Curve of 90%, an improvement of almost 10 percentage points over an attentionless recurrent architecture., Implementation: Tangle is implemented in Python using Keras and it is hosted on GitHub at https://github.com/samuelefiorini/tangle., Competing Interests: The authors have declared that no competing interests exist.

Objectives: We examine the extent to which the adult Australian population on lipid-lowering medications receives the level of high-density lipoprotein cholesterol (HDL-C) testing recommended by national guidelines., Data: We analysed records from 7 years (2008-2014) of the 10% publicly available sample of deidentified, individual level, linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia., Methods: The PBS data were used to identify individuals on stable prescriptions of lipid-lowering treatment. The MBS data were used to estimate the annual frequency of HDL-C testing. We developed a methodology to address the issue of 'episode coning' in the MBS data, which causes an undercounting of pathology tests. We used a published figure on the proportion of unreported HDL-C tests to correct for the undercounting and estimate the probability that an HDL-C test was performed. We judged appropriateness of testing frequency by comparing the HDL-C testing rate to guidelines' recommendations of annual testing for people at high risk for cardiovascular disease., Results: We estimated that approximately 49% of the population on stable lipid-lowering treatment did not receive any HDL-C test in a given year. We also found that approximately 19% of the same population received two or more HDL-C tests within the year. These levels of underutilisation and overutilisation have been changing at an average rate of 2% and -4% a year, respectively, since 2009. The yearly expenditure associated with test overutilisation was approximately $A4.3 million during the study period, while the cost averted because of test underutilisation was approximately $A11.3 million a year., Conclusions: We found that approximately half of Australians on stable lipid-lowering treatment may be having fewer HDL-C testing than recommended by national guidelines, while nearly one-fifth are having more tests than recommended., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)