Background: Accurate prediction of surgical case duration underpins operating room (OR) scheduling, yet existing models often depend on site- or surgeon-specific inputs and rarely undergo external validation, limiting generalisability. Methods: We undertook a retrospective multicentre study using routinely collected perioperative data from two general hospitals in Japan (development: 1 January 2021-31 December 2023; temporal test: 1 January-31 December 2024). Elective weekday procedures with American Society of Anesthesiologists (ASA) Physical Status 1-4 were included. Pre-specified preoperative predictors comprised surgical context (year, month, weekday, scheduled duration, general anaesthesia indicator, body position) and patient factors (sex, age, body mass index, allergy, infection, comorbidity, ASA). Missing data were addressed by multiple imputation by chained equations. Four learners (elastic-net, generalised additive models, random forest, gradient-boosted trees) were tuned within internal-external cross-validation (IECV; leave-one-cluster-out by centre-year) and combined by stacked generalisation to predict log-transformed duration. Results: We analysed 63,206 procedures (development 45,647; temporal test 17,559). Cluster-specific and pooled errors and calibrations from IECV are provided with consistent performance across centres and years. In the 2024 temporal test cohort, calibration was good (intercept 0.423, 95%CI 0.372 to 0.474; slope 0.921, 95%CI 0.911 to 0.932). Conclusions: A stacked machine-learning model using only widely available preoperative variables achieved accurate, well-calibrated predictions in temporal external validation, supporting transportability across sites and over time. Such general-purpose tools may improve OR scheduling without relying on idiosyncratic inputs.

Parkinson's disease (PD) presents a growing global challenge, affecting over 10 million individuals, with prevalence expected to double by 2040. Early diagnosis remains difficult due to the late emergence of motor symptoms and limitations of traditional clinical assessments. In this study, we propose a novel pipeline that leverages keystroke dynamics as a non-invasive and scalable biomarker for remote PD screening and telemonitoring. Our methodology involves three main stages: (i) preprocessing of data from four distinct datasets, extracting four temporal signals and addressing class imbalance through the comparison of three methods; (ii) pre-training eight state-of-the-art deep-learning architectures on the two largest datasets, optimizing temporal windowing, stride, and other hyperparameters; (iii) fine-tuning on an intermediate-sized dataset and performing external validation on a fourth, independent cohort. Our results demonstrate that hybrid convolutional-recurrent and transformer-based models achieve strong external validation performance, with AUC-ROC scores exceeding 90% and F1-Score over 70%. Notably, a temporal convolutional model attains an AUC-ROC of 91.14% in external validation, outperforming existing methods that rely solely on internal validation. These findings underscore the potential of keystroke dynamics as a reliable digital biomarker for PD, offering a promising avenue for early detection and continuous monitoring.

Background: Cribriform morphology in prostate cancer is a histological feature that indicates poor prognosis and contraindicates active surveillance. However, it remains underreported and subject to significant interobserver variability amongst pathologists. We aimed to develop and validate an AI-based system to improve cribriform pattern detection. Methods: We created a deep learning model using an EfficientNetV2-S encoder with multiple instance learning for end-to-end whole-slide classification. The model was trained on 640 digitised prostate core needle biopsies from 430 patients, collected across three cohorts. It was validated internally (261 slides from 171 patients) and externally (266 slides, 104 patients from three independent cohorts). Internal validation cohorts included laboratories or scanners from the development set, while external cohorts used completely independent instruments and laboratories. Annotations were provided by three expert uropathologists with known high concordance. Additionally, we conducted an inter-rater analysis and compared the model's performance against nine expert uropathologists on 88 slides from the internal validation cohort. Results: The model showed strong internal validation performance (AUC: 0.97, 95% CI: 0.95-0.99; Cohen's kappa: 0.81, 95% CI: 0.72-0.89) and robust external validation (AUC: 0.90, 95% CI: 0.86-0.93; Cohen's kappa: 0.55, 95% CI: 0.45-0.64). In our inter-rater analysis, the model achieved the highest average agreement (Cohen's kappa: 0.66, 95% CI: 0.57-0.74), outperforming all nine pathologists whose Cohen's kappas ranged from 0.35 to 0.62. Conclusion: Our AI model demonstrates pathologist-level performance for cribriform morphology detection in prostate cancer. This approach could enhance diagnostic reliability, standardise reporting, and improve treatment decisions for prostate cancer patients.

Current methods for automated assessment of cognitive-linguistic impairment via picture description often neglect the visual narrative path - the sequence and locations of elements a speaker described in the picture. Analyses of spatio-semantic features capture this path using content information units (CIUs), but manual tagging or dictionary-based mapping is labor-intensive. This study proposes a BERT-based pipeline, fine tuned with binary cross-entropy and pairwise ranking loss, for automated CIU extraction and ordering from the Cookie Theft picture description. Evaluated by 5-fold cross-validation, it achieves 93% median precision, 96% median recall in CIU detection, and 24% sequence error rates. The proposed method extracts features that exhibit strong Pearson correlations with ground truth, surpassing the dictionary-based baseline in external validation. These features also perform comparably to those derived from manual annotations in evaluating group differences via ANCOVA. The pipeline is shown to effectively characterize visual narrative paths for cognitive impairment assessment, with the implementation and models open-sourced to public.

Intraoperative hypotension (IOH) is strongly associated with postoperative complications, including postoperative delirium and increased mortality, making its early prediction crucial in perioperative care. While several artificial intelligence-based models have been developed to provide IOH warnings, existing methods face limitations in incorporating both time and frequency domain information, capturing short- and long-term dependencies, and handling noise sensitivity in biosignal data. To address these challenges, we propose a novel Self-Adaptive Frequency Domain Network (SAFDNet). Specifically, SAFDNet integrates an adaptive spectral block, which leverages Fourier analysis to extract frequency-domain features and employs self-adaptive thresholding to mitigate noise. Additionally, an interactive attention block is introduced to capture both long-term and short-term dependencies in the data. Extensive internal and external validations on two large-scale real-world datasets demonstrate that SAFDNet achieves up to 97.3\% AUROC in IOH early warning, outperforming state-of-the-art models. Furthermore, SAFDNet exhibits robust predictive performance and low sensitivity to noise, making it well-suited for practical clinical applications.

Survival analysis is central to clinical research, informing patient prognoses, guiding treatment decisions, and optimising resource allocation. Accurate time-to-event predictions not only improve quality of life but also reveal risk factors that shape clinical practice. For these models to be relevant in healthcare, interpretability is critical: predictions must be traceable to patient-specific characteristics, and risk factors should be identifiable to generate actionable insights for both clinicians and researchers. Traditional survival models often fail to capture non-linear interactions, while modern deep learning approaches, though powerful, are limited by poor interpretability. We propose a Pipeline for Interpretable Survival Analysis (PISA) - a pipeline that provides multiple survival analysis models that trade off complexity and performance. Using multiple-feature, multi-objective feature engineering, PISA transforms patient characteristics and time-to-event data into multiple survival analysis models, providing valuable insights into the survival prediction task. Crucially, every model is converted into simple patient stratification flowcharts supported by Kaplan-Meier curves, whilst not compromising on performance. While PISA is model-agnostic, we illustrate its flexibility through applications of Cox regression and shallow survival trees, the latter avoiding proportional hazards assumptions. Applied to two clinical benchmark datasets, PISA produced interpretable survival models and intuitive stratification flowcharts whilst achieving state-of-the-art performances. Revisiting a prior departmental study further demonstrated its capacity to automate survival analysis workflows in real-world clinical research.

The intensive care unit (ICU) manages critically ill patients, many of whom face a high risk of mortality. Early and accurate prediction of in-hospital mortality within the first 24 hours of ICU admission is crucial for timely clinical interventions, resource optimization, and improved patient outcomes. Traditional scoring systems, while useful, often have limitations in predictive accuracy and adaptability. Objective: This review aims to systematically evaluate and benchmark innovative methodologies that leverage data available within the first day of ICU admission for predicting in-hospital mortality. We focus on advancements in machine learning, novel biomarker applications, and the integration of diverse data types.

Accurately and efficiently diagnosing Post-Acute Sequelae of COVID-19 (PASC) remains challenging due to its myriad symptoms that evolve over long- and variable-time intervals. To address this issue, we developed a hybrid natural language processing pipeline that integrates rule-based named entity recognition with BERT-based assertion detection modules for PASC-symptom extraction and assertion detection from clinical notes. We developed a comprehensive PASC lexicon with clinical specialists. From 11 health systems of the RECOVER initiative network across the U.S., we curated 160 intake progress notes for model development and evaluation, and collected 47,654 progress notes for a population-level prevalence study. We achieved an average F1 score of 0.82 in one-site internal validation and 0.76 in 10-site external validation for assertion detection. Our pipeline processed each note at $2.448\pm 0.812$ seconds on average. Spearman correlation tests showed $ρ>0.83$ for positive mentions and $ρ>0.72$ for negative ones, both with $P <0.0001$. These demonstrate the effectiveness and efficiency of our models and their potential for improving PASC diagnosis.

Electronic health record (EHR) foundation models have been an area ripe for exploration with their improved performance in various medical tasks. Despite the rapid advances, there exists a fundamental limitation: Processing unseen medical codes out of vocabulary. This problem limits the generalizability of EHR foundation models and the integration of models trained with different vocabularies. To alleviate this problem, we propose a set of novel medical concept representations (MedRep) for EHR foundation models based on the observational medical outcome partnership (OMOP) common data model (CDM). For concept representation learning, we enrich the information of each concept with a minimal definition through large language model (LLM) prompts and complement the text-based representations through the graph ontology of OMOP vocabulary. Our approach outperforms the vanilla EHR foundation model and the model with a previously introduced medical code tokenizer in diverse prediction tasks. We also demonstrate the generalizability of MedRep through external validation.

Blood pressure (BP) monitoring is critical in in tensive care units (ICUs) where hemodynamic instability can rapidly progress to cardiovascular collapse. Current machine learning (ML) approaches suffer from three limitations: lack of external validation, absence of uncertainty quantification, and inadequate data leakage prevention. This study presents the first comprehensive framework with novel algorithmic leakage prevention, uncertainty quantification, and cross-institutional validation for electronic health records (EHRs) based BP pre dictions. Our methodology implemented systematic data leakage prevention, uncertainty quantification through quantile regres sion, and external validation between the MIMIC-III and eICU databases. An ensemble framework combines Gradient Boosting, Random Forest, and XGBoost with 74 features across five physiological domains. Internal validation achieved a clinically acceptable performance (for SBP: R^2 = 0.86, RMSE = 6.03 mmHg; DBP: R^2 = 0.49, RMSE = 7.13 mmHg), meeting AAMI standards. External validation showed 30% degradation with critical limitations in patients with hypotensive. Uncertainty quantification generated valid prediction intervals (80.3% SBP and 79.9% DBP coverage), enabling risk-stratified protocols with narrow intervals (< 15 mmHg) for standard monitoring and wide intervals (> 30 mmHg) for manual verification. This framework provides realistic deployment expectations for cross institutional AI-assisted BP monitoring in critical care settings. The source code is publicly available at https://github.com/ mdbasit897/clinical-bp-prediction-ehr.