Unmasking Societal Biases in Respiratory Support for ICU Patients through Social Determinants of Health Mira Moukheiber 1, Lama Moukheiber 1, Dana Moukheiber 1 and Hyung-Chul Lee 2, 1 Massachusetts Institute of Technology 2 Seoul National University College of Medicine, Seoul National University Hospital, Department of Anesthesiology and Pain Medicine vital@snu.ac.kr Abstract In critical care settings, where precise and timely interventions are crucial for health outcomes, evaluating disparities in patient outcomes is important. Current approaches often fall short in comprehensively understanding and evaluating the impact of respiratory support interventions on individuals affected by social determinants of health. Attributes such as gender, race, and age are commonly assessed and essential, but provide only a partial view of the complexities faced by diverse populations. In this study, we focus on two clinically motivated tasks: prolonged mechanical ventilation and successful weaning. We also perform fairness audits on the models' predictions across demographic groups and social determinants of health to better understand the health inequities in respiratory interventions in the intensive care unit. We also release a temporal benchmark dataset, verified by clinical experts, to enable benchmarking of clinical respiratory intervention tasks. 1 Introduction Critically-ill patients often find themselves in the intensive care unit (ICU) seeking specialized support for respiratory distress [ Doyle et al., 1995; Ware and Matthay, 2000 ] . Despite advances in supportive treatments, the in-hospital mortality rate remains 40% for conditions such as acute lung injury and acute respiratory distress syndrome [ Rubenfeld et al., 2005; Sweatt and Levitt, 2014 ] .

Rationing of healthcare resources is a challenging decision that policy makers and providers may be forced to make during a pandemic, natural disaster, or mass casualty event. Well-defined guidelines to triage scarce life-saving resources must be designed to promote transparency, trust, and consistency. To facilitate buy-in and use during high-stress situations, these guidelines need to be interpretable and operational. We propose a novel data-driven model to compute interpretable triage guidelines based on policies for Markov Decision Process that can be represented as simple sequences of decision trees ("tree policies"). In particular, we characterize the properties of optimal tree policies and present an algorithm based on dynamic programming recursions to compute good tree policies. We utilize this methodology to obtain simple, novel triage guidelines for ventilator allocations for COVID-19 patients, based on real patient data from Montefiore hospitals. We also compare the performance of our guidelines to the official New York State guidelines that were developed in 2015 (well before the COVID-19 pandemic). Our empirical study shows that the number of excess deaths associated with ventilator shortages could be reduced significantly using our policy. Our work highlights the limitations of the existing official triage guidelines, which need to be adapted specifically to COVID-19 before being successfully deployed.

Mechanical ventilation is a critical life-support intervention that uses a machine to deliver controlled air and oxygen to a patient's lungs, assisting or replacing spontaneous breathing. While several data-driven approaches have been proposed to optimize ventilator control strategies, they often lack interpretability and agreement with general domain knowledge. This paper proposes a methodology for interpretable reinforcement learning (RL) using decision trees for mechanical ventilation control. Using a causal, nonparametric model-based off-policy evaluation, we evaluate the policies in their ability to gain increases in SpO2 while avoiding aggressive ventilator settings which are known to cause ventilator induced lung injuries and other complications. Numerical experiments using MIMIC-III data on the stays of real patients' intensive care unit stays demonstrate that the decision tree policy outperforms the behavior cloning policy and is comparable to state-of-the-art RL policy. Future work concerns better aligning the cost function with medical objectives to generate deeper clinical insights.

Scarcity of health care resources could result in the unavoidable consequence of rationing. For example, ventilators are often limited in supply, especially during public health emergencies or in resource-constrained health care settings, such as amid the pandemic of COVID-19. Currently, there is no universally accepted standard for health care resource allocation protocols, resulting in different governments prioritizing patients based on various criteria and heuristic-based protocols. In this study, we investigate the use of reinforcement learning for critical care resource allocation policy optimization to fairly and effectively ration resources. We propose a transformer-based deep Q-network to integrate the disease progression of individual patients and the interaction effects among patients during the critical care resource allocation. We aim to improve both fairness of allocation and overall patient outcomes. Our experiments demonstrate that our method significantly reduces excess deaths and achieves a more equitable distribution under different levels of ventilator shortage, when compared to existing severity-based and comorbidity-based methods in use by different governments. Our source code is included in the supplement and will be released on Github upon publication.

The COVID-19 pandemic has a devastating impact globally, claiming millions of lives and causing significant social and economic disruptions. In order to optimize decision-making and allocate limited resources, it is essential to identify COVID-19 symptoms and determine the severity of each case. Machine learning algorithms offer a potent tool in the medical field, particularly in mining clinical datasets for useful information and guiding scientific decisions. Association rule mining is a machine learning technique for extracting hidden patterns from data. This paper presents an application of association rule mining based Apriori algorithm to discover symptom patterns from COVID-19 patients. The study, using 2875 patient's records, identified the most common signs and symptoms as apnea (72%), cough (64%), fever (59%), weakness (18%), myalgia (14.5%), and sore throat (12%). The proposed method provides clinicians with valuable insight into disease that can assist them in managing and treating it effectively.

Technological evolution in the field of robotics is emerging with major breakthroughs in recent years. This was especially fostered by revolutionary new software applications leading to humanoid robots. Humanoids are being envisioned for manufacturing applications to form human-robot teams. But their implication in manufacturing practices especially for industrial safety standards and lean manufacturing practices have been minimally addressed. Humanoids will also be competing with conventional robotic arms and effective methods to assess their return on investment are needed. To study the next generation of industrial automation, we used the case context of the Tesla humanoid robot. The company has recently unveiled its project on an intelligent humanoid robot named Optimus to achieve an increased level of manufacturing automation. This article proposes a framework to integrate humanoids for manufacturing automation and also presents the significance of safety standards of human-robot collaboration. A case of lean assembly cell for the manufacturing of an open-source medical ventilator was used for human-humanoid automation. Simulation results indicate that humanoids can increase the level of manufacturing automation. Managerial and research implications are presented.

A ventilator simulation system can make mechanical ventilation easier and more effective. As a result, predicting a patient's ventilator pressure is essential when designing a simulation ventilator. We suggested a hybrid deep learning-based approach to forecast required ventilator pressure for patients. This system is made up of Bi-LSTM and Bi-GRU networks. The SELU activation function was used in our proposed model. MAE and MSE were used to examine the accuracy of the proposed model so that our proposed methodology can be applied to real-world problems. The model performed well against test data and created far too few losses. Major parts of our research were data collection, data analysis, data cleaning, building hybrid Bi-LSTM and Bi-GRU model, training the model, model evaluation, and result analysis. We compared the results of our research with some contemporary works, and our proposed model performed better than those models.

Picture this: As a Covid-19 patient fights for her life on a ventilator, software powered by artificial intelligence analyzes her vital signs and sends her care providers drug-dosing recommendations -- even as the same software simultaneously analyzes in real time the vital signs of thousands of other ventilated patients across the country to learn more about how the dosage affects their care and automatically implements improvements to its drug-dosing algorithm. When an algorithm encounters a real-world clinical setting, adaptive AI might allow it to learn from these new data and incorporate clinician feedback to optimize its performance. Instead of being unleashed, artificial self-control lets a manufacturer put adaptive AI on a longer leash, allowing the algorithm to explore within a defined space to find the optimal operating point. When the algorithm is ready to incorporate what it has learned from real-world data about how drug-dosing information has affected other patients on ventilators, it first goes through a controlled revalidation process, automatically testing its performance on a random sample from a large representative test dataset in the cloud, a dataset that has been carefully curated by the manufacturer to ensure it is representative of the overall population and has high quality information about drug-dosing and patient outcomes. The test is logged, and each data point used in the test is carefully controlled to ensure that the algorithm is not simply getting better and better at predicting the answer in a small test set (a common problem in machine learning called overfitting) but is instead truly improving its performance.

The Afghan Girls Robotics Team works on their robot at a 2017 competition in Washington. The Afghan Girls Robotics Team works on their robot at a 2017 competition in Washington. The Afghan Girls Robotics Team made headlines in 2017 when they came to Washington for an international competition just a few blocks from the White House. Most members of the team were born after the Taliban were ousted from power in 2001, symbolizing a new Afghanistan where girls were free to go to school and women were getting at least some opportunities that had been long denied. But with the Taliban back, the future of these girls -- some of them now young women -- has turned precarious.

In his early twenties, Lee Nam-hyun was an avid swimmer. But in 2004 he broke his neck in a pool, which left him paralyzed from the shoulders down. Recovery from his injuries required years of rehabilitation. The accident also temporarily halted his lifelong passion for singing. Opera and K-pop songs are his favorites, and being able to sing again became one of his top goals in recovery.