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      Artificial intelligence in clinical and translational science: Successes, challenges and opportunities

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          Abstract

          Artificial intelligence (AI) is transforming many domains, including finance, agriculture, defense, and biomedicine. In this paper, we focus on the role of AI in clinical and translational research (CTR), including preclinical research (T1), clinical research (T2), clinical implementation (T3), and public (or population) health (T4). Given the rapid evolution of AI in CTR, we present three complementary perspectives: (1) scoping literature review, (2) survey, and (3) analysis of federally funded projects. For each CTR phase, we addressed challenges, successes, failures, and opportunities for AI. We surveyed Clinical and Translational Science Award (CTSA) hubs regarding AI projects at their institutions. Nineteen of 63 CTSA hubs (30%) responded to the survey. The most common funding source (48.5%) was the federal government. The most common translational phase was T2 (clinical research, 40.2%). Clinicians were the intended users in 44.6% of projects and researchers in 32.3% of projects. The most common computational approaches were supervised machine learning (38.6%) and deep learning (34.2%). The number of projects steadily increased from 2012 to 2020. Finally, we analyzed 2604 AI projects at CTSA hubs using the National Institutes of Health Research Portfolio Online Reporting Tools (RePORTER) database for 2011–2019. We mapped available abstracts to medical subject headings and found that nervous system (16.3%) and mental disorders (16.2) were the most common topics addressed. From a computational perspective, big data (32.3%) and deep learning (30.0%) were most common. This work represents a snapshot in time of the role of AI in the CTSA program.

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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            Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

            Background Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate. Results Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions. Conclusions Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.
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              Dermatologist-level classification of skin cancer with deep neural networks

              Skin cancer, the most common human malignancy, is primarily diagnosed visually, beginning with an initial clinical screening and followed potentially by dermoscopic analysis, a biopsy and histopathological examination. Automated classification of skin lesions using images is a challenging task owing to the fine-grained variability in the appearance of skin lesions. Deep convolutional neural networks (CNNs) show potential for general and highly variable tasks across many fine-grained object categories. Here we demonstrate classification of skin lesions using a single CNN, trained end-to-end from images directly, using only pixels and disease labels as inputs. We train a CNN using a dataset of 129,450 clinical images—two orders of magnitude larger than previous datasets—consisting of 2,032 different diseases. We test its performance against 21 board-certified dermatologists on biopsy-proven clinical images with two critical binary classification use cases: keratinocyte carcinomas versus benign seborrheic keratoses; and malignant melanomas versus benign nevi. The first case represents the identification of the most common cancers, the second represents the identification of the deadliest skin cancer. The CNN achieves performance on par with all tested experts across both tasks, demonstrating an artificial intelligence capable of classifying skin cancer with a level of competence comparable to dermatologists. Outfitted with deep neural networks, mobile devices can potentially extend the reach of dermatologists outside of the clinic. It is projected that 6.3 billion smartphone subscriptions will exist by the year 2021 (ref. 13) and can therefore potentially provide low-cost universal access to vital diagnostic care.
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                Author and article information

                Journal
                Clin Transl Sci
                Clin Transl Sci
                10.1111/(ISSN)1752-8062
                CTS
                Clinical and Translational Science
                John Wiley and Sons Inc. (Hoboken )
                1752-8054
                1752-8062
                30 October 2021
                February 2022
                : 15
                : 2 ( doiID: 10.1111/cts.v15.2 )
                : 309-321
                Affiliations
                [ 1 ] School of Biomedical Informatics The University of Texas Health Science Center at Houston Houston Texas USA
                [ 2 ] Division of General Internal Medicine Department of Internal Medicine McGovern Medical School The University of Texas Health Science Center at Houston Houston Texas USA
                [ 3 ] Departments of Surgery and Microbiology Immunology & Molecular Genetics University of Texas Health San Antonio San Antonio Texas USA
                [ 4 ] University Health San Antonio Texas USA
                [ 5 ] South Texas Veterans Health Care System San Antonio Texas USA
                [ 6 ] Department of Investigational Cancer Therapeutics The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 7 ] Division of Clinical Research Informatics Department of Population Health Sciences University of Texas Health San Antonio San Antonio Texas USA
                [ 8 ] Department of Pathology University of Texas Health San Antonio San Antonio Texas USA
                [ 9 ] Department of Population Health Sciences University of Texas Health San Antonio San Antonio Texas USA
                [ 10 ] Department of Biomedical Informatics University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
                Author notes
                [*] Correspondence

                Elmer V. Bernstam, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St., Suite 600, Houston, Texas 77030, USA.

                Email: Elmer.V.Bernstam@ 123456uth.tmc.edu

                Author information
                https://orcid.org/0000-0002-9332-1684
                Article
                CTS13175
                10.1111/cts.13175
                8841416
                34706145
                3d8f7a05-8f71-4812-bfcc-1807b515de6f
                © 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 10 August 2021
                : 01 October 2021
                Page count
                Figures: 5, Tables: 0, Pages: 13, Words: 8664
                Funding
                Funded by: National Center for Advancing Translational Sciences , doi 10.13039/100006108;
                Award ID: UL1 TR000371
                Award ID: UL1 TR001857
                Award ID: UL1 TR002645
                Funded by: NIH , doi 10.13039/100000002;
                Award ID: U01 TR002393
                Funded by: National Library of Medicine
                Award ID: R01 LM011829
                Award ID: K99 LM013383
                Funded by: National Institute of Aging
                Award ID: P30 AG044271
                Categories
                Review
                Reviews
                Reviews
                Custom metadata
                2.0
                February 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.1 mode:remove_FC converted:13.02.2022

                Medicine
                artificial intelligence,machine learning,translational medical research
                Medicine
                artificial intelligence, machine learning, translational medical research

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