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Since 2013, the Centers for Disease Control and Prevention (CDC) has hosted an annual influenza season forecasting challenge. The 2015–2016 challenge consisted of weekly probabilistic forecasts of multiple targets, including fourteen models submitted by eleven teams. Forecast skill was evaluated using a modified logarithmic score. We averaged submitted forecasts into a mean ensemble model and compared them against predictions based on historical trends. Forecast skill was highest for seasonal peak intensity and short-term forecasts, while forecast skill for timing of season onset and peak week was generally low. Higher forecast skill was associated with team participation in previous influenza forecasting challenges and utilization of ensemble forecasting techniques. The mean ensemble consistently performed well and outperformed historical trend predictions. CDC and contributing teams will continue to advance influenza forecasting and work to improve the accuracy and reliability of forecasts to facilitate increased incorporation into public health response efforts.

Continuous glucose monitoring (CGM) devices allow real-time glucose readings leading to improved glycemic control. However, glucose predictions in the lower (hypoglycemia) and higher (hyperglycemia) extremes, referred as glycemic excursions, remain challenging due to their rarity. Moreover, limited access to sensitive patient data hampers the development of robust machine learning models even with advanced deep learning algorithms available. We propose to simultaneously provide accurate glucose predictions in the excursion regions while addressing data privacy concerns. To tackle excursion prediction, we propose a novel Hypo-Hyper (HH) loss function that penalizes errors based on the underlying glycemic range with a higher penalty at the extremes over the normal glucose range. On the other hand, to address privacy concerns, we propose FedGlu, a machine learning model trained in a federated learning (FL) framework. FL allows collaborative learning without sharing sensitive data by training models locally and sharing only model parameters across other patients. The HH loss combined within FedGlu addresses both the challenges at the same time. The HH loss function demonstrates a 46% improvement over mean-squared error (MSE) loss across 125 patients. Compared to local models, FedGlu improved glycemic excursion detection by 35% compared to local models. This improvement translates to enhanced performance in predicting both, hypoglycemia and hyperglycemia, for 105 out of 125 patients. These results underscore the effectiveness of the proposed HH loss function in augmenting the predictive capabilities of glucose predictions. Moreover, implementing models within a federated learning framework not only ensures better predictive capabilities but also safeguards sensitive data concurrently.

Mosquitoes transmit several infectious diseases that pose significant threat to human health. Temperature along with other environmental factors at breeding and resting locations play a role in the organismal development and abundance of mosquitoes. Accurate analysis of mosquito population dynamics requires information on microclimatic conditions at breeding and resting locations. In this study, we develop a regression model to characterize microclimatic temperature based on ambient environmental conditions. Data were collected by placing sensor loggers at resting and breeding locations such as storm drains across Houston, TX. Corresponding weather data was obtained from National Oceanic and Atmospheric Administration website. Features extracted from these data sources along with contextual information on location were used to develop a Generalized Linear Model for predicting microclimate temperatures. We also analyzed mosquito population dynamics for Aedes albopictus under ambient and microclimatic conditions using system dynamic (SD) modelling to demonstrate the need for accurate microclimatic temperatures in population models. The microclimate prediction model had an R 2 value of ~ 95% and average prediction error of ~ 1.5 °C indicating that microclimate temperatures can be reliably estimated from the ambient environmental conditions. SD model analysis indicates that some microclimates in Texas could result in larger populations of juvenile and adult Aedes albopictus mosquitoes surviving the winter without requiring dormancy.

Diabetes is a large healthcare burden worldwide. There is substantial evidence that lifestyle modifications and drug intervention can prevent diabetes, therefore, an early identification of high risk individuals is important to design targeted prevention strategies. In this paper, we present an automatic tool that uses machine learning techniques to predict the development of type 2 diabetes mellitus (T2DM). Data generated from an oral glucose tolerance test (OGTT) was used to develop a predictive model based on the support vector machine (SVM). We trained and validated the models using the OGTT and demographic data of 1,492 healthy individuals collected during the San Antonio Heart Study. This study collected plasma glucose and insulin concentrations before glucose intake and at three time-points thereafter (30, 60 and 120 min). Furthermore, personal information such as age, ethnicity and body-mass index was also a part of the data-set. Using 11 OGTT measurements, we have deduced 61 features, which are then assigned a rank and the top ten features are shortlisted using minimum redundancy maximum relevance feature selection algorithm. All possible combinations of the 10 best ranked features were used to generate SVM based prediction models. This research shows that an individual's plasma glucose levels, and the information derived therefrom have the strongest predictive performance for the future development of T2DM. Significantly, insulin and demographic features do not provide additional performance improvement for diabetes prediction. The results of this work identify the parsimonious clinical data needed to be collected for an efficient prediction of T2DM. Our approach shows an average accuracy of 96.80% and a sensitivity of 80.09% obtained on a holdout set.

The COVID-19 disease spreads swiftly, and nearly three months after the first positive case was confirmed in China, Coronavirus started to spread all over the United States. Some states and counties reported high number of positive cases and deaths, while some reported lower COVID-19 related cases and death. In this paper, the factors that could affect the risk of COVID-19 infection and death were analyzed in county level. An innovative method by using K-means clustering and several classification models is utilized to determine the most critical factors. Results showed that longitudinal coordinate and population density, latitudinal coordinate, percentage of non-white people, percentage of uninsured people, percent of people below poverty, percentage of Elderly people, number of ICU beds per 10,000 people, percentage of smokers were the most significant attributes.

Many commercial wearable sensor systems typically rely on a single continuous cardiorespiratory sensing modality, photoplethysmography (PPG), which suffers from inherent biases (i.e., differences in skin tone) and noise (e.g., motion and pressure artifacts). In this research, we present a wearable device that provides robust estimates of cardiorespiratory variables by combining three physiological signals from the upper arm: multiwavelength PPG, single-sided electrocardiography (SS-ECG), and bioimpedance plethysmography (BioZ), along with an inertial measurement unit (IMU) providing 3-axis accelerometry and gyroscope information. We evaluated the multimodal device on 16 subjects by its ability to estimate heart rate (HR) and breathing rate (BR) in the presence of various static and dynamic noise sources (e.g., skin tone and motion). We proposed a hierarchical approach that considers the subject’s skin tone and signal quality to select the optimal sensing modality for estimating HR and BR. Our results indicate that, when estimating HR, there is a trade-off between accuracy and robustness, with SS-ECG providing the highest accuracy (low mean absolute error; MAE) but low reliability (higher rates of sensor failure), and PPG/BioZ having lower accuracy but higher reliability. When estimating BR, we find that fusing estimates from multiple modalities via ensemble bagged tree regression outperforms single-modality estimates. These results indicate that multimodal approaches to cardiorespiratory monitoring can overcome the accuracy–robustness trade-off that occurs when using single-modality approaches.

The increasing range of Aedes aegypti, vector for Zika, dengue, chikungunya, and other viruses, has brought attention to the need to understand the population and transmission dynamics of this mosquito. It is well understood that environmental factors and breeding site characteristics play a role in organismal development and the potential to transmit pathogens. In this study, we observe the impact of larval density in combination with diurnal temperature on the time to pupation, emergence, and mortality of Aedes aegypti. Experiments were conducted at two diurnal temperature ranges based on 10 years of historical temperatures of Houston, Texas (21-32°C and 26.5-37.5°C). Experiments at constant temperatures (26.5°C, 32°C) were also conducted for comparison. At each temperature setting, five larval densities were observed (0.2, 1, 2, 4, 5 larvae per mL of water). Data collected shows significant differences in time to first pupation, time of first emergence, maximum rate of pupation, time of maximum rate of pupation, maximum rate of emergence, time of maximum rate of emergence, final average proportion of adult emergence, and average proportion of larval mortality. Further, data indicates a significant interactive effect between temperature fluctuation and larval density on these measures. Thus, wild population estimates should account for temperature fluctuations, larval density, and their interaction in low-volume containers.

Background A common challenge with all opioid use disorder treatment paths is withdrawal management. When withdrawal symptoms are not effectively monitored and managed, they lead to relapse which often leads to deadly overdose. A prerequisite for effective opioid withdrawal management is early identification and assessment of withdrawal symptoms. Objective The objective of this research was to describe the type and content of opioid withdrawal monitoring methods, including surveys, scales and technology, to identify gaps in research and practice that could inform the design and development of novel withdrawal management technologies. Methods A scoping review of literature was conducted. PubMed, EMBASE and Google Scholar were searched using a combination of search terms. Results Withdrawal scales are the main method of assessing and quantifying opioid withdrawal intensity. The search yielded 18 different opioid withdrawal scales used within the last 80 years. While traditional opioid withdrawal scales for patient monitoring are commonly used, most scales rely heavily on patients’ self-report and frequent observations, and generally suffer from lack of consensus on the criteria used for evaluation, mode of administration, type of reporting (e.g., scales used), frequency of administration, and assessment window. Conclusions It is timely to investigate how opioid withdrawal scales can be complemented or replaced with reliable monitoring technologies. Use of noninvasive wearable sensors to continuously monitor physiologic changes associated with opioid withdrawal represents a potential to extend monitoring outside clinical setting.

Fatigue is defined as “a loss of force-generating capacity” in a muscle that can intensify tremor. Tremor quantification can facilitate early detection of fatigue onset so that preventative or corrective controls can be taken to minimize work-related injuries and improve the performance of tasks that require high-levels of accuracy. We focused on developing a system that recognizes and classifies voluntary effort and detects phases of fatigue. The experiment was designed to extract and evaluate hand-tremor data during the performance of both rest and effort tasks. The data were collected from the wrist and finger of the participant’s dominant hand. To investigate tremor, time, frequency domain features were extracted from the accelerometer signal for segments of 45 and 90 samples/window. Analysis using advanced signal processing and machine-learning techniques such as decision tree, k-nearest neighbor, support vector machine, and ensemble classifiers were applied to discover models to classify rest and effort tasks and the phases of fatigue. Evaluation of the classifier’s performance was assessed based on various metrics using 5-fold cross-validation. The recognition of rest and effort tasks using an ensemble classifier based on the random subspace and window length of 45 samples was deemed to be the most accurate (96.1%). The highest accuracy (~98%) that distinguished between early and late fatigue phases was achieved using the same classifier and window length.

 With 425 million individuals globally living with diabetes, it is critical to support the self-management of this life-threatening condition. However, adherence and engagement with existing technologies are inadequate and need further research.  The objective of our study was to develop an integrated belief model that helps identify the significant constructs in predicting intention to use a diabetes self-management device for the detection of hypoglycemia.  Adults with type 1 diabetes living in the United States were recruited through Qualtrics to take a web-based questionnaire that assessed their preferences for a device that monitors their tremors and alerts them of the onset of hypoglycemia. As part of this questionnaire, a section focused on eliciting their response to behavioral constructs from the Health Belief Model, Technology Acceptance Model, and others.  A total of 212 eligible participants responded to the Qualtrics survey. Intention to use a device for the self-management of diabetes was well predicted (R =0.65; F =27.19; P<.001) by 4 main constructs. The most significant constructs were perceived usefulness (β=.33; P<.001) and perceived health threat (β=.55; P<.001) followed by cues to action (β=.17; P<.001) and a negative effect from resistance to change (β=-.19; P<.001). Older age (β=.025; P<.001) led to an increase in their perceived health threat. For individuals to use such a device, they need to perceive it as useful, perceive diabetes as life-threatening, regularly remember to perform actions to manage their condition, and exhibit less resistance to change. The model predicted the intention to use a diabetes self-management device as well, with several constructs found to be significant. This mental modeling approach can be complemented in future work by field-testing with physical prototype devices and assessing their interaction with the device longitudinally.