A new study led by faculty at the University of Georgia demonstrates the potential of using artificial intelligence to transform tuberculosis treatment in low-resource communities. And while the study focused on TB patients, it has applications across the health care sector, freeing up health care workers to perform other necessary tasks. Growing evidence has demonstrated the potential for AI to increase productivity, reduce health care worker burnout, and improve quality of care in clinical settings. The study, which was published last month in the Journal of Medical Internet Research AI, pilots the use of AI to watch thousands of submitted videos of TB patients taking their medication. This application could automate the job of a health care worker watching a patient take their pill at a clinic, known as directly observed therapy (DOT).

Video bronchoscopy is routinely conducted for biopsies of lung tissue suspected for cancer, monitoring of COPD patients and clarification of acute respiratory problems at intensive care units. The navigation within complex bronchial trees is particularly challenging and physically demanding, requiring long-term experiences of physicians. This paper addresses the automatic segmentation of bronchial orifices in bronchoscopy videos. Deep learning-based approaches to this task are currently hampered due to the lack of readily-available ground truth segmentation data. Thus, we present a data-driven pipeline consisting of a k-means followed by a compact marker-based watershed algorithm which enables to generate airway instance segmentation maps from given depth images. In this way, these traditional algorithms serve as weak supervision for training a shallow CNN directly on RGB images solely based on a phantom dataset. We evaluate generalization capabilities of this model on two in-vivo datasets covering 250 frames on 21 different bronchoscopies. We demonstrate that its performance is comparable to those models being directly trained on in-vivo data, reaching an average error of 11 vs 5 pixels for the detected centers of the airway segmentation by an image resolution of 128x128. Our quantitative and qualitative results indicate that in the context of video bronchoscopy, phantom data and weak supervision using non-learning-based approaches enable to gain a semantic understanding of airway structures.

We present a new machine learning based bed-occupancy detection system that uses the accelerometer signal captured by a bed-attached consumer smartphone. Automatic bed-occupancy detection is necessary for automatic long-term cough monitoring, since the time which the monitored patient occupies the bed is required to accurately calculate a cough rate. Accelerometer measurements are more cost effective and less intrusive than alternatives such as video monitoring or pressure sensors. A 249-hour dataset of manually-labelled acceleration signals gathered from seven patients undergoing treatment for tuberculosis (TB) was compiled for experimentation. These signals are characterised by brief activity bursts interspersed with long periods of little or no activity, even when the bed is occupied. To process them effectively, we propose an architecture consisting of three interconnected components. An occupancy-change detector locates instances at which bed occupancy is likely to have changed, an occupancy-interval detector classifies periods between detected occupancy changes and an occupancy-state detector corrects falsely-identified occupancy changes. Using long short-term memory (LSTM) networks, this architecture was demonstrated to achieve an AUC of 0.94. When integrated into a complete cough monitoring system, the daily cough rate of a patient undergoing TB treatment was determined over a period of 14 days. As the colony forming unit (CFU) counts decreased and the time to positivity (TPP) increased, the measured cough rate decreased, indicating effective TB treatment. This provides a first indication that automatic cough monitoring based on bed-mounted accelerometer measurements may present a non-invasive, non-intrusive and cost-effective means of monitoring long-term recovery of TB patients.

A proof-of-concept study suggests that artificial intelligence (AI) may classify images captured during rapid onsite examination of endobronchial ultrasound guided transbronchial need aspiration (EBUS-TBNA) with high accuracy. The results of this study were published in the European Respiratory Journal. The use of AI in medicine has become more common in areas such as cervical cancer screening, which has led experts to question its potential in other fields of medicine. No data have been published on the application of AI during rapid on-site examination of EBUS-TBNA. A team of investigators "evaluated the performance of an AI model, consisting of an open-sounded convolutional neural network using transfer learning, for its ability to accurately classify images of [rapid onsite examination] of EBUS-TBNA smears in the bronchoscopy suite."

Restless Multi-Armed Bandits (RMABs) have been popularly used to model limited resource allocation problems. Recently, these have been employed for health monitoring and intervention planning problems. However, the existing approaches fail to account for the arrival of new patients and the departure of enrolled patients from a treatment program. To address this challenge, we formulate a streaming bandit (S-RMAB) framework, a generalization of RMABs where heterogeneous arms arrive and leave under possibly random streams. We propose a new and scalable approach to computing index-based solutions. We start by proving that index values decrease for short residual lifetimes, a phenomenon that we call index decay. We then provide algorithms designed to capture index decay without having to solve the costly finite horizon problem, thereby lowering the computational complexity compared to existing methods.We evaluate our approach via simulations run on real-world data obtained from a tuberculosis intervention planning task as well as multiple other synthetic domains. Our algorithms achieve an over 150x speed-up over existing methods in these tasks without loss in performance. These findings are robust across multiple domains.

Digital Adherence Technologies (DATs) are an increasingly popular method for verifying patient adherence to many medications. We analyze data from one city served by 99DOTS, a phone-call-based DAT deployed for Tuberculosis (TB) treatment in India where nearly 3 million people are afflicted with the disease each year. The data contains nearly 17,000 patients and 2.1M phone calls. We lay the groundwork for learning from this real-world data, including a method for avoiding the effects of unobserved interventions in training data used for machine learning. We then construct a deep learning model, demonstrate its interpretability, and show how it can be adapted and trained in three different clinical scenarios to better target and improve patient care. In the real-time risk prediction setting our model could be used to proactively intervene with 21% more patients and before 76% more missed doses than current heuristic baselines. For outcome prediction, our model performs 40% better than baseline methods, allowing cities to target more resources to clinics with a heavier burden of patients at risk of failure. Finally, we present a case study demonstrating how our model can be trained in an end-to-end decision focused learning setting to achieve 15% better solution quality in an example decision problem faced by health workers.