Prediction of emergency department revisits among child and youth mental health outpatients using deep learning techniques

BACKGROUND

The proportion of Canadian youth seeking mental health support from an emergency department (ED) has risen in recent years. As EDs typically address urgent mental health crises, revisiting an ED may represent unmet mental health needs. Accurate ED revisit prediction could aid early intervention and ensure efficient healthcare resource allocation. We examine the potential increased accuracy and performance of graph neural network (GNN) machine learning models compared to recurrent neural network (RNN), and baseline conventional machine learning and regression models for predicting ED revisit in electronic health record (EHR) data.

METHODS

This study used EHR data for children and youth aged 4-17 seeking services at McMaster Children's Hospital's Child and Youth Mental Health Program outpatient service to develop and evaluate GNN and RNN models to predict whether a child/youth with an ED visit had an ED revisit within 30 days. GNN and RNN models were developed and compared against conventional baseline models. Model performance for GNN, RNN, XGBoost, decision tree and logistic regression models was evaluated using F1 scores.

RESULTS

The GNN model outperformed the RNN model by an F1-score increase of 0.0511 and the best performing conventional machine learning model by an F1-score increase of 0.0470. Precision, recall, receiver operating characteristic (ROC) curves, and positive and negative predictive values showed that the GNN model performed the best, and the RNN model performed similarly to the XGBoost model. Performance increases were most noticeable for recall and negative predictive value than for precision and positive predictive value.

CONCLUSIONS

This study demonstrates the improved accuracy and potential utility of GNN models in predicting ED revisits among children and youth, although model performance may not be sufficient for clinical implementation. Given the improvements in recall and negative predictive value, GNN models should be further explored to develop algorithms that can inform clinical decision-making in ways that facilitate targeted interventions, optimize resource allocation, and improve outcomes for children and youth.

Data-driven approach to quantify trust in medical devices using Bayesian networks

Bayesian networks are increasingly used to quantify the uncertainty of subjective and stochastic concepts such as trust. In this article, we propose a data-driven approach to estimate Bayesian parameters in the domain of wearable medical devices. Our approach extracts the probability of a trust factor being in a specific state directly from the devices (e.g. sensor quality). The strength of the relationship between related factors is defined by expert knowledge and incorporated into the model. We use propagation rules from requirements engineering to estimate how much each trust factor contributes to the related intermediate nodes in the network and ultimately compute the trust score. The trust score is a relative measure of trustworthiness when different devices are evaluated in the same test conditions and using the same Bayesian structure. To evaluate our approach, we developed Bayesian networks for the trust quantification of similar wearable devices from two manufacturers under identical test conditions and noise levels. The results demonstrated the learnability and generalizability of our approach.

Evaluation methodology for deep learning imputation models

There is growing interest in imputing missing data in tabular datasets using deep learning. Existing deep learning-based imputation models have been commonly evaluated using root mean square error (RMSE) as the predictive accuracy metric. In this article, we investigate the limitations of assessing deep learning-based imputation models by conducting a comparative analysis between RMSE and alternative metrics in the statistical literature including qualitative, predictive accuracy, statistical distance, and descriptive statistics. We design a new aggregated metric, called reconstruction loss (RL), to evaluate deep learning-based imputation models. We also develop and evaluate a novel imputation evaluation methodology based on RL. To minimize model and dataset biases, we use a regression imputation model and two different deep learning imputation models: denoising autoencoders and generative adversarial nets. We also use two tabular datasets from different industry sectors: health care and financial. Our results show that the proposed methodology is effective in evaluating multiple properties of the deep learning-based imputation model's reconstruction performance.

An Environmental Scan of the National and Provincial Diagnostic Reference Levels in Canada for Common Adult Computed Tomography Scans

Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization.

Exploring PSI-MI XML Collections Using DescribeX

PSI-MI has been endorsed by the protein informatics community as a standard XML data exchange format for protein-protein interaction datasets. While many public databases support the standard, there is a degree of heterogeneity in the way the proposed XML schema is interpreted and instantiated by different data providers. Analysis of schema instantiation in large collections of XML data is a challenging task that is unsupported by existing tools.

In this study we use DescribeX, a novel visualization technique of (semi-)structured XML formats, to quantitatively and qualitatively analyze PSI-MI XML collections at the instance level with the goal of gaining insights about schema usage and to study specific questions such as: adequacy of controlled vocabularies, detection of common instance patterns, and evolution of different data collections. Our analysis shows DescribeX enhances understanding the instance-level structure of PSI-MI data sources and is a useful tool for standards designers, software developers, and PSI-MI data providers.