A Decision Tree-Initialised Neuro-fuzzy Approach for Clinical Decision Support

Exploring explainable AI features in the vocal biomarkers of lung disease

This review delves into the burgeoning field of explainable artificial intelligence (XAI) in the detection and analysis of lung diseases through vocal biomarkers. Lung diseases, often elusive in their early stages, pose a significant public health challenge. Recent advancements in AI have ushered in innovative methods for early detection, yet the black-box nature of many AI models limits their clinical applicability. XAI emerges as a pivotal tool, enhancing transparency and interpretability in AI-driven diagnostics. This review synthesizes current research on the application of XAI in analyzing vocal biomarkers for lung diseases, highlighting how these techniques elucidate the connections between specific vocal features and lung pathology. We critically examine the methodologies employed, the types of lung diseases studied, and the performance of various XAI models. The potential for XAI to aid in early detection, monitor disease progression, and personalize treatment strategies in pulmonary medicine is emphasized. Furthermore, this review identifies current challenges, including data heterogeneity and model generalizability, and proposes future directions for research. By offering a comprehensive analysis of explainable AI features in the context of lung disease detection, this review aims to bridge the gap between advanced computational approaches and clinical practice, paving the way for more transparent, reliable, and effective diagnostic tools.

BC-QNet: A quantum-infused ELM model for breast cancer diagnosis

The timely and accurate diagnosis of breast cancer is pivotal for effective treatment, but current automated mammography classification methods have their constraints. In this study, we introduce an innovative hybrid model that marries the power of the Extreme Learning Machine (ELM) with FuNet transfer learning, harnessing the potential of the MIAS dataset. This novel approach leverages an Enhanced Quantum-Genetic Binary Grey Wolf Optimizer (Q-GBGWO) within the ELM framework, elevating its performance. Our contributions are twofold: firstly, we employ a feature fusion strategy to optimize feature extraction, significantly enhancing breast cancer classification accuracy. The proposed methodological motivation stems from optimizing feature extraction for improved breast cancer classification accuracy. The Q-GBGWO optimizes ELM parameters, demonstrating its efficacy within the ELM classifier. This innovation marks a considerable advancement beyond traditional methods. Through comparative evaluations against various optimization techniques, the exceptional performance of our Q-GBGWO-ELM model becomes evident. The classification accuracy of the model is exceptionally high, with rates of 96.54 % for Normal, 97.24 % for Benign, and 98.01 % for Malignant classes. Additionally, the model demonstrates a high sensitivity with rates of 96.02 % for Normal, 96.54 % for Benign, and 97.75 % for Malignant classes, and it exhibits impressive specificity with rates of 96.69 % for Normal, 97.38 % for Benign, and 98.16 % for Malignant classes. These metrics are reflected in its ability to classify three different types of breast cancer accurately. Our approach highlights the innovative integration of image data, deep feature extraction, and optimized ELM classification, marking a transformative step in advancing early breast cancer detection and enhancing patient outcomes.

Breast cancer diagnosis using support vector machine optimized by improved quantum inspired grey wolf optimization

A prompt diagnosis of breast cancer in its earliest phases is necessary for effective treatment. While Computer-Aided Diagnosis systems play a crucial role in automated mammography image processing, interpretation, grading, and early detection of breast cancer, existing approaches face limitations in achieving optimal accuracy. This study addresses these limitations by hybridizing the improved quantum-inspired binary Grey Wolf Optimizer with the Support Vector Machines Radial Basis Function Kernel. This hybrid approach aims to enhance the accuracy of breast cancer classification by determining the optimal Support Vector Machine parameters. The motivation for this hybridization lies in the need for improved classification performance compared to existing optimizers such as Particle Swarm Optimization and Genetic Algorithm. Evaluate the efficacy of the proposed IQI-BGWO-SVM approach on the MIAS dataset, considering various metric parameters, including accuracy, sensitivity, and specificity. Furthermore, the application of IQI-BGWO-SVM for feature selection will be explored, and the results will be compared. Experimental findings demonstrate that the suggested IQI-BGWO-SVM technique outperforms state-of-the-art classification methods on the MIAS dataset, with a resulting mean accuracy, sensitivity, and specificity of 99.25%, 98.96%, and 100%, respectively, using a tenfold cross-validation datasets partition.

Taxonomy of hybrid architectures involving rule-based reasoning and machine learning in clinical decision systems: A scoping review

BACKGROUND

As the application of Artificial Intelligence (AI) technologies increases in the healthcare sector, the industry faces a need to combine medical knowledge, often expressed as clinical rules, with advances in machine learning (ML), which offer high prediction accuracy at the expense of transparency of decision making.

PURPOSE

This paper seeks to review the present literature, identify hybrid architecture patterns that incorporate rules and machine learning, and evaluate the rationale behind their selection to inform future development and research on the design of transparent and precise clinical decision systems.

METHODS

PubMed, IEEE Explore, and Google Scholar were queried in search for papers from 1992 to 2022, with the keywords: "clinical decision system", "hybrid clinical architecture", "machine learning and clinical rules". Excluded articles did not use both ML and rules or did not provide any explanation of employed architecture. A proposed taxonomy was used to organize the results, analyze them, and depict them in graphical and tabular form. Two researchers, one with expertise in rule-based systems and another in ML, reviewed identified papers and discussed the work to minimize bias, and the third one re-reviewed the work to ensure consistency of reporting.

RESULTS

The authors screened 957 papers and reviewed 71 that met their criteria. Five distinct architecture archetypes were determined: Rules are Embedded in ML architecture (REML) (most used), ML pre-processes input data for Rule-Based inference (MLRB), Rule-Based method pre-processes input data for ML prediction (RBML), Rules influence ML training (RMLT), Parallel Ensemble of Rules and ML (PERML), which was rarely observed in clinical contexts.

CONCLUSIONS

Most architectures in the reviewed literature prioritize prediction accuracy over explainability and trustworthiness, which has led to more complex embedded approaches. Alternatively, parallel (PERML) architectures may be employed, allowing for a more transparent system that is easier to explain to patients and clinicians. The potential of this approach warrants further research.

OTHER

A limitation of the study may be that it reviews scientific literature, while algorithms implemented in clinical practice may present different distributions of motivations and implementations of hybrid architectures.

Diagnosing attention-deficit hyperactivity disorder (ADHD) using artificial intelligence: a clinical study in the UK

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting a large percentage of the adult population. A series of ongoing efforts has led to the development of a hybrid AI algorithm (a combination of a machine learning model and a knowledge-based model) for assisting adult ADHD diagnosis, and its clinical trial currently operating in the largest National Health Service (NHS) for adults with ADHD in the UK. Most recently, more data was made available that has lead to a total collection of 501 anonymized records as of 2022 July. This prompted the ongoing research to carefully examine the model by retraining and optimizing the machine learning algorithm in order to update the model with better generalization capability. Based on the large data collection so far, this paper also pilots a study to examine the effectiveness of variables other than the Diagnostic Interview for ADHD in adults (DIVA) assessment, which adds considerable cost in the screenining process as it relies on specially trained senior clinicians. Results reported in this paper demonstrate that the newly trained machine learning model reaches an accuracy of 75.03% when all features are used; the hybrid model obtains an accuracy of 93.61%. Exceeding what clinical experts expected in the absence of DIVA, achieving an accuracy of 65.27% using a rule-based machine learning model alone encourages the development of a cost effective model in the future.

Develop and validate a radiomics space-time model to predict the pathological complete response in patients undergoing neoadjuvant treatment of rectal cancer: an artificial intelligence model study based on machine learning

OBJECTIVE

In this study, we aimed to investigate the predictive efficacy of magnetic resonance imaging (MRI) radiomics features at different time points of neoadjuvant therapy for rectal cancer in patients with pathological complete response (pCR). Furthermore, we aimed to develop and validate a radiomics space-time model (RSTM) using machine learning for artificial intelligence interventions in predicting pCR in patients.

METHODS

Clinical and imaging data of 83 rectal cancer patients were retrospectively analyzed, and the patients were classified as pCR and non-pCR patients according to their postoperative pathological results. All patients received one MRI examination before and after neoadjuvant therapy to extract radiomics features, including pre-treatment, post-treatment, and delta features. Delta features were defined by the ratio of the difference between the pre- and the post-treatment features to the pre-treatment feature. After feature dimensionality reduction based on the above three feature types, the RSTM was constructed using machine learning methods, and its performance was evaluated using the area under the curve (AUC).

RESULTS

The AUC values of the individual basic models constructed by pre-treatment, post-treatment, and delta features were 0.771, 0.681, and 0.871, respectively. Their sensitivity values were 0.727, 0.864, and 0.909, respectively, and their specificity values were 0.803, 0.492, and 0.656, respectively. The AUC, sensitivity, and specificity values of the combined basic model constructed by combining pre-treatment, post-treatment, and delta features were 0.901, 0.909, and 0.803, respectively. The AUC, sensitivity, and specificity values of the RSTM constructed using the K-Nearest Neighbor (KNN) classifier on the basis of the combined basic model were 0.944, 0.871, and 0.983, respectively. The Delong test showed that the performance of RSTM was significantly different from that of pre-treatment, post-treatment, and delta models (P < 0.05) but not significantly different from the combined basic model of the three (P > 0.05).

CONCLUSIONS

The RSTM constructed using the KNN classifier based on the combined features of before and after neoadjuvant therapy and delta features had the best predictive efficacy for pCR of neoadjuvant therapy. It may emerge as a new clinical tool to assist with individualized management of rectal cancer patients.

A hybrid interpretable deep structure based on adaptive neuro-fuzzy inference system, decision tree, and K-means for intrusion detection

For generating an interpretable deep architecture for identifying deep intrusion patterns, this study proposes an approach that combines ANFIS (Adaptive Network-based Fuzzy Inference System) and DT (Decision Tree) for interpreting the deep pattern of intrusion detection. Meanwhile, for improving the efficiency of training and predicting, Pearson Correlation analysis, standard deviation, and a new adaptive K-means are used to select attributes and make fuzzy interval decisions. The proposed algorithm was trained, validated, and tested on the NSL-KDD (National security lab-knowledge discovery and data mining) dataset. Using 22 attributes that highly related to the target, the performance of the proposed method achieves a 99.86% detection rate and 0.14% false alarm rate on the KDDTrain+ dataset, a 77.46% detection rate on the KDDTest+ dataset, which is better than many classifiers. Besides, the interpretable model can help us demonstrate the complex and overlapped pattern of intrusions and analyze the pattern of various intrusions.

Artificial intelligence and IoT based prediction of Covid-19 using chest X-ray images

Coronavirus illness (COVID-19), discovered in late 2019, has spread rapidly worldwide, resulting in significant mortality. This study analyzed the performance of studies that employed machines and DL on chest X-ray pictures and CT scans for COVID-19 diagnosis. ML approaches on CT and X-ray images aided incorrectly in identifying COVID-19. The fast spread of COVID-19 worldwide and the growing number of deaths necessitates an immediate response from all sectors. Authorities will be able to deal with the effects more efficiently if such illnesses can be predicted in the future. Furthermore, it is crucial to maintain track of the number of infected persons through regular check-ups, and it is frequently required to confine affected people and implement medical treatments. In addition, various additional elements, such as environmental influences and commonalities among the most afflicted places, should be considered to slow the spread of COVID-19, and precautions should be taken. AI-based approaches for the prediction and diagnosis of COVID-19 were suggested in this paper. This Review Article discusses current advances in AI technology and its biological applications, particularly the coronavirus.

Wireless IoT and Cyber-Physical System for Health Monitoring Using Honey Badger Optimized Least-Squares Support-Vector Machine

Health monitoring is a prominent factor in a person's daily life. Healthcare for the elderly is becoming increasingly important as the population ages and grows. The health of an Elderly patient needs frequent examination because the health deteriorates with an increasing age profile. IoT is utilized everywhere in the health industry to identify and communicate with the patients by the professional. A cyber-physical system (CPS) is used to combine physical processes with communication and computation. CPS and IoT are both wirelessly connected via information and communication technologies. The novelty of the research lies in the Honey Badger (HB) algorithm optimized Least-squares Support-Vector Machine (LS-SVM) architecture proposed in this paper for monitoring multi parameters to categorize and determine the abnormal patient details present in the dataset. Since the performance of the LS-SVM is highly dependent on the width coefficient and regularization factor, the HB algorithm is employed in this study to optimize both parameters. The HB algorithm is capable of solving the medical problem that has a complex search space and it also improves the convergence performance of the LS-SVM classifier by achieving a tradeoff between the exploration and exploitation phases. The HB optimized LS-SVM classifier predicts the patients with deteriorating health conditions and evaluates the accuracy of the results obtained. In the end, the statistical data is provided to the caretaker via a smartphone application as a monthly statistical report. The proposed model offers a Positive Predictive Value (PPV), Negative Predictive Value (NPV), and an Area Under the Curve (AUC) score of 0.9478, 0.9587, and 0.9617 respectively which is relatively higher than the conventional techniques such as Decision tree, Random Forest, and Support Vector Machine (SVM) classifier. The simulation results demonstrate that the proposed model efficiently models the sensor parameters and offers timely support to elderly patients.

A Predictive Analysis of Heart Rates Using Machine Learning Techniques

Heart disease, caused by low heart rate, is one of the most significant causes of mortality in the world today. Therefore, it is critical to monitor heart health by identifying the deviation in the heart rate very early, which makes it easier to detect and manage the heart’s function irregularities at a very early stage. The fast-growing use of advanced technology such as the Internet of Things (IoT), wearable monitoring systems and artificial intelligence (AI) in the healthcare systems has continued to play a vital role in the analysis of huge amounts of health-based data for early and accurate disease detection and diagnosis for personalized treatment and prognosis evaluation. It is then important to analyze the effectiveness of using data analytics and machine learning to monitor and predict heart rates using wearable device (accelerometer)-generated data. Hence, in this study, we explored a number of powerful data-driven models including the autoregressive integrated moving average (ARIMA) model, linear regression, support vector regression (SVR), k-nearest neighbor (KNN) regressor, decision tree regressor, random forest regressor and long short-term memory (LSTM) recurrent neural network algorithm for the analysis of accelerometer data to make future HR predictions from the accelerometer’s univariant HR time-series data from healthy people. The performances of the models were evaluated under different durations. Evaluated on a very recently created data set, our experimental results demonstrate the effectiveness of using an ARIMA model with a walk-forward validation and linear regression for predicting heart rate under all durations and other models for durations longer than 1 min. The results of this study show that employing these data analytics techniques can be used to predict future HR more accurately using accelerometers.

A new approach for interpretability and reliability in clinical risk prediction: Acute coronary syndrome scenario

INTRODUCTION

The risk prediction of the occurrence of a clinical event is often based on conventional statistical procedures, through the implementation of risk score models. Recently, approaches based on more complex machine learning (ML) methods have been developed. Despite the latter usually have a better predictive performance, they obtain little approval from the physicians, as they lack interpretability and, therefore, clinical confidence. One clinical issue where both types of models have received great attention is the mortality risk prediction after acute coronary syndromes (ACS).

OBJECTIVE

We intend to create a new risk assessment methodology that combines the best characteristics of both risk score and ML models. More specifically, we aim to develop a method that, besides having a good performance, offers a personalized model and outcome for each patient, presents high interpretability, and incorporates an estimation of the prediction reliability which is not usually available. By combining these features in the same approach we expect that it can boost the confidence of physicians to use such a tool in their daily activity.

METHODS

In order to achieve the mentioned goals, a three-step methodology was developed: several rules were created by dichotomizing risk factors; such rules were trained with a machine learning classifier to predict the acceptance degree of each rule (the probability that the rule is correct) for each patient; that information was combined and used to compute the risk of mortality and the reliability of such prediction. The methodology was applied to a dataset of 1111 patients admitted with any type of ACS (myocardial infarction and unstable angina) in two Portuguese hospitals, to assess the 30-days all-cause mortality risk, being validated through a Monte-Carlo cross-validation technique. The performance was compared with state-of-the-art approaches: logistic regression (LR), artificial neural network (ANN), and clinical risk score model (namely the Global Registry of Acute Coronary Events - GRACE).

RESULTS

For the scenario being analyzed, the performance of the proposed approach and the comparison models was assessed through discrimination and calibration. The ability to rank the patients was evaluated through the area under the ROC curve (AUC), and the ability to stratify the patients into low or high-risk groups was determined using the geometric mean (GM) of specificity and sensitivity, the negative predictive value (NPV) and the positive predictive value (PPV). The validation calibration curves were also inspected. The proposed approach (AUC = 81%, GM = 74%, PPV = 17%, NPV = 99%) achieved testing results identical to the standard LR model (AUC = 83%, GM = 73%, PPV = 16%, NPV=99%), but offers superior interpretability and personalization; it also significantly outperforms the GRACE risk model (AUC = 79%, GM = 47%, PPV = 13%, NPV = 98%) and the standard ANN model (AUC = 78%, GM = 70%, PPV = 13%, NPV = 98%). The calibration curve also suggests a very good generalization ability of the obtained model as it approaches the ideal curve (slope = 0.96). Finally, the reliability estimation of individual predictions presented a great correlation with the misclassifications rate.

CONCLUSION

We developed and described a new tool that showed great potential to guide the clinical staff in the risk assessment and decision-making process, and to obtain their wide acceptance due to its interpretability and reliability estimation properties. The methodology presented a good performance when applied to ACS events, but those properties may have a beneficial application in other clinical scenarios as well.