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Stepwise Fine and Gray: Subject-Specific Variable Selection Shows When Hemodynamic Data Improves Prognostication of Comatose Post-Cardiac Arrest Patients
Shen, Xiaobin, Elmer, Jonathan, Chen, George H.
Prognostication for comatose post-cardiac arrest patients is a critical challenge that directly impacts clinical decision-making in the ICU. Clinical information that informs prognostication is collected serially over time. Shortly after cardiac arrest, various time-invariant baseline features are collected (e.g., demographics, cardiac arrest characteristics). After ICU admission, additional features are gathered, including time-varying hemodynamic data (e.g., blood pressure, doses of vasopressor medications). We view these as two phases in which we collect new features. In this study, we propose a novel stepwise dynamic competing risks model that improves the prediction of neurological outcomes by automatically determining when to take advantage of time-invariant features (first phase) and time-varying features (second phase). Notably, our model finds patients for whom this second phase (time-varying hemodynamic) information is beneficial for prognostication and also when this information is beneficial (as we collect more hemodynamic data for a patient over time, how important these data are for prognostication varies). Our approach extends the standard Fine and Gray model to explicitly model the two phases and to incorporate neural networks to flexibly capture complex nonlinear feature relationships. Evaluated on a retrospective cohort of 2,278 comatose post-arrest patients, our model demonstrates robust discriminative performance for the competing outcomes of awakening, withdrawal of life-sustaining therapy, and death despite maximal support. Our approach generalizes to more than two phases in which new features are collected and could be used in other dynamic prediction tasks, where it may be helpful to know when and for whom newly collected features significantly improve prediction.
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Continuously Updating Digital Twins using Large Language Models
Amad, Harry, Astorga, Nicolás, van der Schaar, Mihaela
Digital twins are models of real-world systems that can simulate their dynamics in response to potential actions. In complex settings, the state and action variables, and available data and knowledge relevant to a system can constantly change, requiring digital twins to continuously update with these changes to remain relevant. Current approaches struggle in this regard, as they require fixed, well-defined modelling environments, and they cannot adapt to novel variables without re-designs, or incorporate new information without re-training. To address this, we frame digital twinning as an in-context learning problem using large language models, enabling seamless updates to the twin at inference time. We develop CALM-DT, a Context-Adaptive Language Model-based Digital Twin that can accurately simulate across diverse state-action spaces using in-context learning alone by utilising fine-tuned encoders for sample retrieval. We empirically demonstrate CALM-DT's competitive performance with existing digital twin approaches, and its unique ability to adapt to changes in its modelling environment without parameter updates.
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Development of an Autonomous Mobile Robotic System for Efficient and Precise Disinfection
Ou, Ting-Wei, Jiang, Jia-Hao, Huang, Guan-Lin, Young, Kuu-Young
The COVID-19 pandemic has severely affected public health, healthcare systems, and daily life, especially amid resource shortages and limited workers. This crisis has underscored the urgent need for automation in hospital environments, particularly disinfection, which is crucial to controlling virus transmission and improving the safety of healthcare personnel and patients. Ultraviolet (UV) light disinfection, known for its high efficiency, has been widely adopted in hospital settings. However, most existing research focuses on maximizing UV coverage while paying little attention to the impact of human activity on virus distribution. To address this issue, we propose a mobile robotic system for UV disinfection focusing on the virus hotspot. The system prioritizes disinfection in high-risk areas and employs an approach for optimized UV dosage to ensure that all surfaces receive an adequate level of UV exposure while significantly reducing disinfection time. It not only improves disinfection efficiency but also minimizes unnecessary exposure in low-risk areas. In two representative hospital scenarios, our method achieves the same disinfection effectiveness while reducing disinfection time by 30.7% and 31.9%, respectively. The video of the experiment is available at: https://youtu.be/wHcWzOcoMPM.