The United States opioid crisis contributed to 80,411 fatalities in 2021. It has strained hospitals, treatment facilities, and law enforcement agencies due to the enormous resources and procedures needed to respond to the crisis. As a result, many individuals who use opioids never receive or finish the treatment they need and instead have many interactions with hospitals or the criminal justice system. This paper introduces a discrete event simulation model that evaluates three opioid use disorder treatment policies: arrest diversion, re-entry case management, and overdose diversion. Publicly available data from 2011 to 2019 in Dane County, Wisconsin, was used to forecast opioid-related outcomes through 2032. Through analyzing a variety of policy-mix implementations, the study offers a versatile framework for evaluating policies at various implementation levels. The results demonstrate that treatment policies that create new pathways and programming by utilizing treatment services and successfully divert at least 20% of eligible individuals can lead to more opioid-resilient communities. The benefits increase when more policies are enacted and/or are offered to more individuals. We assume communities invest in increasing treatment capacity to meet increased treatment demand. In policy-mixes where societal savings from decreased opioid use, hospital encounters, and opioid-related arrests outweigh the costs of opioid use disorder treatment, the 2032 total savings range from $7.04 to $29.73 million. To reverse the opioid crisis within a community, treatment policies may need to be combined with other strategies, such as harm reduction, supply reduction, and use prevention.
Widespread adoption of AI for medical decision making is still hindered due to ethical and safety-related concerns. For AI-based decision support systems in healthcare settings it is paramount to be reliable and trustworthy. Common deep learning approaches, however, have the tendency towards overconfidence under data shift. Such inappropriate extrapolation beyond evidence-based scenarios may have dire consequences. This highlights the importance of reliable estimation of local uncertainty and its communication to the end user. While stochastic neural networks have been heralded as a potential solution to these issues, this study investigates their actual reliability in clinical applications. We centered our analysis on the exemplary use case of mortality prediction for ICU hospitalizations using EHR from MIMIC3 study. For predictions on the EHR time series, Encoder-Only Transformer models were employed. Stochasticity of model functions was achieved by incorporating common methods such as Bayesian neural network layers and model ensembles. Our models achieve state of the art performance in terms of discrimination performance (AUC ROC: 0.868+-0.011, AUC PR: 0.554+-0.034) and calibration on the mortality prediction benchmark. However, epistemic uncertainty is critically underestimated by the selected stochastic deep learning methods. A heuristic proof for the responsible collapse of the posterior distribution is provided. Our findings reveal the inadequacy of commonly used stochastic deep learning approaches to reliably recognize OoD samples. In both methods, unsubstantiated model confidence is not prevented due to strongly biased functional posteriors, rendering them inappropriate for reliable clinical decision support. This highlights the need for approaches with more strictly enforced or inherent distance-awareness to known data points, e.g., using kernel-based techniques.
Online hate speech proliferation has created a difficult problem for social media platforms. A particular challenge relates to the use of coded language by groups interested in both creating a sense of belonging for its users and evading detection. Coded language evolves quickly and its use varies over time. This paper proposes a methodology for detecting emerging coded hate-laden terminology. The methodology is tested in the context of online antisemitic discourse. The approach considers posts scraped from social media platforms, often used by extremist users. The posts are scraped using seed expressions related to previously known discourse of hatred towards Jews. The method begins by identifying the expressions most representative of each post and calculating their frequency in the whole corpus. It filters out grammatically incoherent expressions as well as previously encountered ones so as to focus on emergent well-formed terminology. This is followed by an assessment of semantic similarity to known antisemitic terminology using a fine-tuned large language model, and subsequent filtering out of the expressions that are too distant from known expressions of hatred. Emergent antisemitic expressions containing terms clearly relating to Jewish topics are then removed to return only coded expressions of hatred.
Researchers are often interested in estimating the effect of sustained use of a treatment on a health outcome. However, adherence to strict treatment protocols can be challenging for individuals in practice and, when non-adherence is expected, estimates of the effect of sustained use may not be useful for decision making. As an alternative, more relaxed treatment protocols which allow for periods of time off treatment (i.e. grace periods) have been considered in pragmatic randomized trials and observational studies. In this article, we consider the interpretation, identification, and estimation of treatment strategies which include grace periods. We contrast natural grace period strategies which allow individuals the flexibility to take treatment as they would naturally do, with stochastic grace period strategies in which the investigator specifies the distribution of treatment utilization. We estimate the effect of initiation of a thiazide diuretic or an angiotensin-converting enzyme inhibitor in hypertensive individuals under various strategies which include grace periods.
Background: Pain assessment in individuals with neurological conditions, especially those with limited self-report ability and altered facial expressions, presents challenges. Existing measures, relying on direct observation by caregivers, lack sensitivity and specificity. In cerebral palsy, pain is a common comorbidity and a reliable evaluation protocol is crucial. Thus, having an automatic system that recognizes facial expressions could be of enormous help when diagnosing pain in this type of patient. Objectives: 1) to build a dataset of facial pain expressions in individuals with cerebral palsy, and 2) to develop an automated facial recognition system based on deep learning for pain assessment addressed to this population. Methods: Ten neural networks were trained on three pain image databases, including the UNBC-McMaster Shoulder Pain Expression Archive Database, the Multimodal Intensity Pain Dataset, and the Delaware Pain Database. Additionally, a curated dataset (CPPAIN) was created, consisting of 109 preprocessed facial pain expression images from individuals with cerebral palsy, categorized by two physiotherapists using the Facial Action Coding System observational scale. Results: InceptionV3 exhibited promising performance on the CP-PAIN dataset, achieving an accuracy of 62.67% and an F1 score of 61.12%. Explainable artificial intelligence techniques revealed consistent essential features for pain identification across models. Conclusion: This study demonstrates the potential of deep learning models for robust pain detection in populations with neurological conditions and communication disabilities. The creation of a larger dataset specific to cerebral palsy would further enhance model accuracy, offering a valuable tool for discerning subtle and idiosyncratic pain expressions. The insights gained could extend to other complex neurological conditions.
In this work some advances in the theory of curvature of two-dimensional probability manifolds corresponding to families of distributions are proposed. It is proved that location-scale distributions are hyperbolic in the Information Geometry sense even when the generatrix is non-even or non-smooth. A novel formula is obtained for the computation of curvature in the case of exponential families: this formula implies some new flatness criteria in dimension 2. Finally, it is observed that many two parameter distributions, widely used in applications, are locally hyperbolic, which highlights the role of hyperbolic geometry in the study of commonly employed probability manifolds. These results have benefited from the use of explainable computational tools, which can substantially boost scientific productivity.
Methods for estimating heterogeneous treatment effects (HTE) from observational data have largely focused on continuous or binary outcomes, with less attention paid to survival outcomes and almost none to settings with competing risks. In this work, we develop censoring unbiased transformations (CUTs) for survival outcomes both with and without competing risks.After converting time-to-event outcomes using these CUTs, direct application of HTE learners for continuous outcomes yields consistent estimates of heterogeneous cumulative incidence effects, total effects, and separable direct effects. Our CUTs enable application of a much larger set of state of the art HTE learners for censored outcomes than had previously been available, especially in competing risks settings. We provide generic model-free learner-specific oracle inequalities bounding the finite-sample excess risk. The oracle efficiency results depend on the oracle selector and estimated nuisance functions from all steps involved in the transformation. We demonstrate the empirical performance of the proposed methods in simulation studies.
Online hate speech proliferation has created a difficult problem for social media platforms. A particular challenge relates to the use of coded language by groups interested in both creating a sense of belonging for its users and evading detection. Coded language evolves quickly and its use varies over time. This paper proposes a methodology for detecting emerging coded hate-laden terminology. The methodology is tested in the context of online antisemitic discourse. The approach considers posts scraped from social media platforms, often used by extremist users. The posts are scraped using seed expressions related to previously known discourse of hatred towards Jews. The method begins by identifying the expressions most representative of each post and calculating their frequency in the whole corpus. It filters out grammatically incoherent expressions as well as previously encountered ones so as to focus on emergent well-formed terminology. This is followed by an assessment of semantic similarity to known antisemitic terminology using a fine-tuned large language model, and subsequent filtering out of the expressions that are too distant from known expressions of hatred. Emergent antisemitic expressions containing terms clearly relating to Jewish topics are then removed to return only coded expressions of hatred.
Dynamical systems across the sciences, from electrical circuits to ecological networks, undergo qualitative and often catastrophic changes in behavior, called bifurcations, when their underlying parameters cross a threshold. Existing methods predict oncoming catastrophes in individual systems but are primarily time-series-based and struggle both to categorize qualitative dynamical regimes across diverse systems and to generalize to real data. To address this challenge, we propose a data-driven, physically-informed deep-learning framework for classifying dynamical regimes and characterizing bifurcation boundaries based on the extraction of topologically invariant features. We focus on the paradigmatic case of the supercritical Hopf bifurcation, which is used to model periodic dynamics across a wide range of applications. Our convolutional attention method is trained with data augmentations that encourage the learning of topological invariants which can be used to detect bifurcation boundaries in unseen systems and to design models of biological systems like oscillatory gene regulatory networks. We further demonstrate our method's use in analyzing real data by recovering distinct proliferation and differentiation dynamics along pancreatic endocrinogenesis trajectory in gene expression space based on single-cell data. Our method provides valuable insights into the qualitative, long-term behavior of a wide range of dynamical systems, and can detect bifurcations or catastrophic transitions in large-scale physical and biological systems.
Women with an increased life-time risk of breast cancer undergo supplemental annual screening MRI. We propose to predict the risk of developing breast cancer within one year based on the current MRI, with the objective of reducing screening burden and facilitating early detection. An AI algorithm was developed on 53,858 breasts from 12,694 patients who underwent screening or diagnostic MRI and accrued over 12 years, with 2,331 confirmed cancers. A first U-Net was trained to segment lesions and identify regions of concern. A second convolutional network was trained to detect malignant cancer using features extracted by the U-Net. This network was then fine-tuned to estimate the risk of developing cancer within a year in cases that radiologists considered normal or likely benign. Risk predictions from this AI were evaluated with a retrospective analysis of 9,183 breasts from a high-risk screening cohort, which were not used for training. Statistical analysis focused on the tradeoff between number of omitted exams versus negative predictive value, and number of potential early detections versus positive predictive value. The AI algorithm identified regions of concern that coincided with future tumors in 52% of screen-detected cancers. Upon directed review, a radiologist found that 71.3% of cancers had a visible correlate on the MRI prior to diagnosis, 65% of these correlates were identified by the AI model. Reevaluating these regions in 10% of all cases with higher AI-predicted risk could have resulted in up to 33% early detections by a radiologist. Additionally, screening burden could have been reduced in 16% of lower-risk cases by recommending a later follow-up without compromising current interval cancer rate. With increasing datasets and improving image quality we expect this new AI-aided, adaptive screening to meaningfully reduce screening burden and improve early detection.
Breast cancer remains a global challenge, causing over 1 million deaths globally in 2018. To achieve earlier breast cancer detection, screening x-ray mammography is recommended by health organizations worldwide and has been estimated to decrease breast cancer mortality by 20-40%. Nevertheless, significant false positive and false negative rates, as well as high interpretation costs, leave opportunities for improving quality and access. To address these limitations, there has been much recent interest in applying deep learning to mammography; however, obtaining large amounts of annotated data poses a challenge for training deep learning models for this purpose, as does ensuring generalization beyond the populations represented in the training dataset. Here, we present an annotation-efficient deep learning approach that 1) achieves state-of-the-art performance in mammogram classification, 2) successfully extends to digital breast tomosynthesis (DBT; "3D mammography"), 3) detects cancers in clinically-negative prior mammograms of cancer patients, 4) generalizes well to a population with low screening rates, and 5) outperforms five-out-of-five full-time breast imaging specialists by improving absolute sensitivity by an average of 14%. Our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.