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      Artificial intelligence in public health: the potential of epidemic early warning systems

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          Abstract

          The use of artificial intelligence (AI) to generate automated early warnings in epidemic surveillance by harnessing vast open-source data with minimal human intervention has the potential to be both revolutionary and highly sustainable. AI can overcome the challenges faced by weak health systems by detecting epidemic signals much earlier than traditional surveillance. AI-based digital surveillance is an adjunct to—not a replacement of—traditional surveillance and can trigger early investigation, diagnostics and responses at the regional level. This narrative review focuses on the role of AI in epidemic surveillance and summarises several current epidemic intelligence systems including ProMED-mail, HealthMap, Epidemic Intelligence from Open Sources, BlueDot, Metabiota, the Global Biosurveillance Portal, Epitweetr and EPIWATCH. Not all of these systems are AI-based, and some are only accessible to paid users. Most systems have large volumes of unfiltered data; only a few can sort and filter data to provide users with curated intelligence. However, uptake of these systems by public health authorities, who have been slower to embrace AI than their clinical counterparts, is low. The widespread adoption of digital open-source surveillance and AI technology is needed for the prevention of serious epidemics.

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          Most cited references73

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          BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding

          We introduce a new language representation model called BERT, which stands for Bidirectional Encoder Representations from Transformers. Unlike recent language representation models, BERT is designed to pre-train deep bidirectional representations from unlabeled text by jointly conditioning on both left and right context in all layers. As a result, the pre-trained BERT model can be fine-tuned with just one additional output layer to create state-of-the-art models for a wide range of tasks, such as question answering and language inference, without substantial task-specific architecture modifications. BERT is conceptually simple and empirically powerful. It obtains new state-of-the-art results on eleven natural language processing tasks, including pushing the GLUE score to 80.5% (7.7% point absolute improvement), MultiNLI accuracy to 86.7% (4.6% absolute improvement), SQuAD v1.1 question answering Test F1 to 93.2 (1.5 point absolute improvement) and SQuAD v2.0 Test F1 to 83.1 (5.1 point absolute improvement).
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            AI in health and medicine

            Artificial intelligence (AI) is poised to broadly reshape medicine, potentially improving the experiences of both clinicians and patients. We discuss key findings from a 2-year weekly effort to track and share key developments in medical AI. We cover prospective studies and advances in medical image analysis, which have reduced the gap between research and deployment. We also address several promising avenues for novel medical AI research, including non-image data sources, unconventional problem formulations and human-AI collaboration. Finally, we consider serious technical and ethical challenges in issues spanning from data scarcity to racial bias. As these challenges are addressed, AI's potential may be realized, making healthcare more accurate, efficient and accessible for patients worldwide.
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              Is Open Access

              Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

              Pulse oximetry is routinely used to non-invasively monitor oxygen saturation levels. A low oxygen level in the blood means low oxygen in the tissues, which can ultimately lead to organ failure. Yet, contrary to heart rate variability measures, a field which has seen the development of stable standards and advanced toolboxes and software, no such standards and open tools exist for continuous oxygen saturation time series variability analysis. The primary objective of this research was to identify, implement and validate key digital oximetry biomarkers (OBMs) for the purpose of creating a standard and associated reference toolbox for continuous oximetry time series analysis. We review the sleep medicine literature to identify clinically relevant OBMs. We implement these biomarkers and demonstrate their clinical value within the context of obstructive sleep apnea (OSA) diagnosis on a total of n = 3806 individual polysomnography recordings totaling 26,686 h of continuous data. A total of 44 digital oximetry biomarkers were implemented. Reference ranges for each biomarker are provided for individuals with mild, moderate, and severe OSA and for non-OSA recordings. Linear regression analysis between biomarkers and the apnea hypopnea index (AHI) showed a high correlation, which reached \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overline R ^2 = 0.82$$\end{document} R ¯ 2 = 0.82 . The resulting python OBM toolbox, denoted “pobm”, was contributed to the open software PhysioZoo (physiozoo.org). Studying the variability of the continuous oxygen saturation time series using pbom may provide information on the underlying physiological control systems and enhance our understanding of the manifestations and etiology of diseases, with emphasis on respiratory diseases.
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                Author and article information

                Journal
                J Int Med Res
                J Int Med Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                March 2023
                26 March 2023
                : 51
                : 3
                : 03000605231159335
                Affiliations
                [1 ]Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
                [2 ]College of Public Service & Community Solutions, Arizona State University, Tempe, United States
                [3 ]School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
                [4 ]School of Computer Science and Engineering, Faulty of Engineering, University of New South Wales, Sydney, Australia
                [5 ]School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
                [6 ]William Harvey Research Institute, Queen Mary University of London, United Kingdom
                Author notes
                [*]Xin Chen, Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia. Email: jessie@ 123456epiwatch.org
                Author information
                https://orcid.org/0000-0002-9905-2307
                https://orcid.org/0000-0001-9838-8960
                Article
                10.1177_03000605231159335
                10.1177/03000605231159335
                10052500
                36967669
                b7c80b90-2c5c-487b-96b0-8972740e505d
                © The Author(s) 2023

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 23 June 2022
                : 3 February 2023
                Funding
                Funded by: National Health and Medical Research Council, FundRef https://doi.org/10.13039/501100000925;
                Award ID: Principal Research Fellowship, grant number 113758
                Funded by: MRFF 2021 Frontier Health and Medical Research Grant, Department of Health, the Australian Government.;
                Award ID: ID RFRHPI000280
                Categories
                Review
                Custom metadata
                ts2

                artificial intelligence,public health,epidemic intelligence,pandemic,early warning system,digital surveillance

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