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      AI in Health: State of the Art, Challenges, and Future Directions

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          Summary

          Introduction : Artificial intelligence (AI) technologies continue to attract interest from a broad range of disciplines in recent years, including health. The increase in computer hardware and software applications in medicine, as well as digitization of health-related data together fuel progress in the development and use of AI in medicine. This progress provides new opportunities and challenges, as well as directions for the future of AI in health.

          Objective : The goals of this survey are to review the current state of AI in health, along with opportunities, challenges, and practical implications. This review highlights recent developments over the past five years and directions for the future.

          Methods : Publications over the past five years reporting the use of AI in health in clinical and biomedical informatics journals, as well as computer science conferences, were selected according to Google Scholar citations. Publications were then categorized into five different classes, according to the type of data analyzed. Results: The major data types identified were multi-omics, clinical, behavioral, environmental and pharmaceutical research and development (R&D) data. The current state of AI related to each data type is described, followed by associated challenges and practical implications that have emerged over the last several years. Opportunities and future directions based on these advances are discussed.

          Conclusion : Technologies have enabled the development of AI-assisted approaches to healthcare. However, there remain challenges. Work is currently underway to address multi-modal data integration, balancing quantitative algorithm performance and qualitative model interpretability, protection of model security, federated learning, and model bias.

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          Most cited references72

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          Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network

          Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow1. Widely available digital ECG data and the algorithmic paradigm of deep learning2 present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F1 score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.
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            Deep learning with convolutional neural networks for EEG decoding and visualization

            Abstract Deep learning with convolutional neural networks (deep ConvNets) has revolutionized computer vision through end‐to‐end learning, that is, learning from the raw data. There is increasing interest in using deep ConvNets for end‐to‐end EEG analysis, but a better understanding of how to design and train ConvNets for end‐to‐end EEG decoding and how to visualize the informative EEG features the ConvNets learn is still needed. Here, we studied deep ConvNets with a range of different architectures, designed for decoding imagined or executed tasks from raw EEG. Our results show that recent advances from the machine learning field, including batch normalization and exponential linear units, together with a cropped training strategy, boosted the deep ConvNets decoding performance, reaching at least as good performance as the widely used filter bank common spatial patterns (FBCSP) algorithm (mean decoding accuracies 82.1% FBCSP, 84.0% deep ConvNets). While FBCSP is designed to use spectral power modulations, the features used by ConvNets are not fixed a priori. Our novel methods for visualizing the learned features demonstrated that ConvNets indeed learned to use spectral power modulations in the alpha, beta, and high gamma frequencies, and proved useful for spatially mapping the learned features by revealing the topography of the causal contributions of features in different frequency bands to the decoding decision. Our study thus shows how to design and train ConvNets to decode task‐related information from the raw EEG without handcrafted features and highlights the potential of deep ConvNets combined with advanced visualization techniques for EEG‐based brain mapping. Hum Brain Mapp 38:5391–5420, 2017. © 2017 Wiley Periodicals, Inc.
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              Data Mining of the Public Version of the FDA Adverse Event Reporting System

              The US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS, formerly AERS) is a database that contains information on adverse event and medication error reports submitted to the FDA. Besides those from manufacturers, reports can be submitted from health care professionals and the public. The original system was started in 1969, but since the last major revision in 1997, reporting has markedly increased. Data mining algorithms have been developed for the quantitative detection of signals from such a large database, where a signal means a statistical association between a drug and an adverse event or a drug-associated adverse event, including the proportional reporting ratio (PRR), the reporting odds ratio (ROR), the information component (IC), and the empirical Bayes geometric mean (EBGM). A survey of our previous reports suggested that the ROR provided the highest number of signals, and the EBGM the lowest. Additionally, an analysis of warfarin-, aspirin- and clopidogrel-associated adverse events suggested that all EBGM-based signals were included in the PRR-based signals, and also in the IC- or ROR-based ones, and that the PRR- and IC-based signals were in the ROR-based ones. In this article, the latest information on this area is summarized for future pharmacoepidemiological studies and/or pharmacovigilance analyses.
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                Author and article information

                Journal
                Yearb Med Inform
                Yearb Med Inform
                10.1055/s-00034612
                Yearbook of Medical Informatics
                Georg Thieme Verlag KG (Stuttgart )
                0943-4747
                2364-0502
                August 2019
                16 August 2019
                : 28
                : 1
                : 16-26
                Affiliations
                [1 ]Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, NY, USA
                [2 ]IBM Watson Health, Cambridge, MA, USA
                Author notes
                Correspondence to: Fei Wang, PhD, Associate Professor Division of Health Informatics, Department of Healthcare Policy and Research Weill Cornell Medicine, Cornell University, 425 East 61 Street, New York. NY 10065, USA few2001@ 123456med.cornell.edu
                Article
                wang
                10.1055/s-0039-1677908
                6697503
                31419814
                b496ec97-1197-465a-9259-b7ca2e3a1ffc

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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                Categories
                Special Section: Artificial Intelligence in Health: New Opportunities, Challenges, and Practical Implications
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                ai,health,deep learning,machine learning,natural language processing,federated learning

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