Many happy returns: machine learning to support platelet issuing and waste reduction in hospital blood banks

Efforts to reduce platelet wastage in hospital blood banks have focused on ordering policies, but the predominant practice of issuing the oldest unit first may not be optimal when some units are returned unused. We propose a novel, machine learning (ML)-guided issuing policy to increase the likelihood of returned units being reissued before expiration. Our ML model trained to predict returns on 17,297 requests for platelets gave AUROC 0.74 on 9,353 held-out requests. Prior to ML model development we built a simulation of the blood bank operation that incorporated returns to understand the scale of benefits of such a model. Using our trained model in the simulation gave an estimated reduction in wastage of 14%. Our partner hospital is considering adopting our approach, which would be particularly beneficial for hospitals with higher return rates and where units have a shorter remaining useful life on arrival.

Robust Real-Time Mortality Prediction in the Intensive Care Unit using Temporal Difference Learning

The task of predicting long-term patient outcomes using supervised machine learning is a challenging one, in part because of the high variance of each patient's trajectory, which can result in the model over-fitting to the training data. Temporal difference (TD) learning, a common reinforcement learning technique, may reduce variance by generalising learning to the pattern of state transitions rather than terminal outcomes. However, in healthcare this method requires several strong assumptions about patient states, and there appears to be limited literature evaluating the performance of TD learning against traditional supervised learning methods for long-term health outcome prediction tasks. In this study, we define a framework for applying TD learning to real-time irregularly sampled time series data using a Semi-Markov Reward Process. We evaluate the model framework in predicting intensive care mortality and show that TD learning under this framework can result in improved model robustness compared to standard supervised learning methods. and that this robustness is maintained even when validated on external datasets. This approach may offer a more reliable method when learning to predict patient outcomes using high-variance irregular time series data.

Multi-Continental Healthcare Modelling Using Blockchain-Enabled Federated Learning

One of the biggest challenges of building artificial intelligence (AI) model in healthcare area is the data sharing. Since healthcare data is private, sensitive, and heterogeneous, collecting sufficient data for modelling is exhausted, costly, and sometimes impossible. In this paper, we propose a framework for global healthcare modelling using datasets from multi-continents (Europe, North America and Asia) while without sharing the local datasets, and choose glucose management as a study model to verify its effectiveness. Technically, blockchain-enabled federated learning is implemented with adaption to make it meet with the privacy and safety requirements of healthcare data, meanwhile rewards honest participation and penalize malicious activities using its on-chain incentive mechanism. Experimental results show that the proposed framework is effective, efficient, and privacy preserved. Its prediction accuracy is much better than the models trained from limited personal data and is similar to, and even slightly better than, the results from a centralized dataset. This work paves the way for international collaborations on healthcare projects, where additional data is crucial for reducing bias and providing benefits to humanity.

Privacy Preserved Blood Glucose Level Cross-Prediction: An Asynchronous Decentralized Federated Learning Approach

Newly diagnosed Type 1 Diabetes (T1D) patients often struggle to obtain effective Blood Glucose (BG) prediction models due to the lack of sufficient BG data from Continuous Glucose Monitoring (CGM), presenting a significant "cold start" problem in patient care. Utilizing population models to address this challenge is a potential solution, but collecting patient data for training population models in a privacy-conscious manner is challenging, especially given that such data is often stored on personal devices. Considering the privacy protection and addressing the "cold start" problem in diabetes care, we propose "GluADFL", blood Glucose prediction by Asynchronous Decentralized Federated Learning. We compared GluADFL with eight baseline methods using four distinct T1D datasets, comprising 298 participants, which demonstrated its superior performance in accurately predicting BG levels for cross-patient analysis. Furthermore, patients' data might be stored and shared across various communication networks in GluADFL, ranging from highly interconnected (e.g., random, performs the best among others) to more structured topologies (e.g., cluster and ring), suitable for various social networks. The asynchronous training framework supports flexible participation. By adjusting the ratios of inactive participants, we found it remains stable if less than 70% are inactive. Our results confirm that GluADFL offers a practical, privacy-preserving solution for BG prediction in T1D, significantly enhancing the quality of diabetes management.

GARNN: An Interpretable Graph Attentive Recurrent Neural Network for Predicting Blood Glucose Levels via Multivariate Time Series

Accurate prediction of future blood glucose (BG) levels can effectively improve BG management for people living with diabetes, thereby reducing complications and improving quality of life. The state of the art of BG prediction has been achieved by leveraging advanced deep learning methods to model multi-modal data, i.e., sensor data and self-reported event data, organised as multi-variate time series (MTS). However, these methods are mostly regarded as ``black boxes'' and not entirely trusted by clinicians and patients. In this paper, we propose interpretable graph attentive recurrent neural networks (GARNNs) to model MTS, explaining variable contributions via summarizing variable importance and generating feature maps by graph attention mechanisms instead of post-hoc analysis. We evaluate GARNNs on four datasets, representing diverse clinical scenarios. Upon comparison with twelve well-established baseline methods, GARNNs not only achieve the best prediction accuracy but also provide high-quality temporal interpretability, in particular for postprandial glucose levels as a result of corresponding meal intake and insulin injection. These findings underline the potential of GARNN as a robust tool for improving diabetes care, bridging the gap between deep learning technology and real-world healthcare solutions.

Going faster to see further: GPU-accelerated value iteration and simulation for perishable inventory control using JAX

Value iteration can find the optimal replenishment policy for a perishable inventory problem, but is computationally demanding due to the large state spaces that are required to represent the age profile of stock. The parallel processing capabilities of modern GPUs can reduce the wall time required to run value iteration by updating many states simultaneously. The adoption of GPU-accelerated approaches has been limited in operational research relative to other fields like machine learning, in which new software frameworks have made GPU programming widely accessible. We used the Python library JAX to implement value iteration and simulators of the underlying Markov decision processes in a high-level API, and relied on this library's function transformations and compiler to efficiently utilize GPU hardware. Our method can extend use of value iteration to settings that were previously considered infeasible or impractical. We demonstrate this on example scenarios from three recent studies which include problems with over 16 million states and additional problem features, such as substitution between products, that increase computational complexity. We compare the performance of the optimal replenishment policies to heuristic policies, fitted using simulation optimization in JAX which allowed the parallel evaluation of multiple candidate policy parameters on thousands of simulated years. The heuristic policies gave a maximum optimality gap of 2.49%. Our general approach may be applicable to a wide range of problems in operational research that would benefit from large-scale parallel computation on consumer-grade GPU hardware.

Basal Glucose Control in Type 1 Diabetes using Deep Reinforcement Learning: An In Silico Validation

People with Type 1 diabetes (T1D) require regular exogenous infusion of insulin to maintain their blood glucose concentration in a therapeutically adequate target range. Although the artificial pancreas and continuous glucose monitoring have been proven to be effective in achieving closed-loop control, significant challenges still remain due to the high complexity of glucose dynamics and limitations in the technology. In this work, we propose a novel deep reinforcement learning model for single-hormone (insulin) and dual-hormone (insulin and glucagon) delivery. In particular, the delivery strategies are developed by double Q-learning with dilated recurrent neural networks. For designing and testing purposes, the FDA-accepted UVA/Padova Type 1 simulator was employed. First, we performed long-term generalized training to obtain a population model. Then, this model was personalized with a small data-set of subject-specific data. In silico results show that the single and dual-hormone delivery strategies achieve good glucose control when compared to a standard basal-bolus therapy with low-glucose insulin suspension. Specifically, in the adult cohort (n=10), percentage time in target range [70, 180] mg/dL improved from 77.6% to 80.9% with single-hormone control, and to $85.6\%$ with dual-hormone control. In the adolescent cohort (n=10), percentage time in target range improved from 55.5% to 65.9% with single-hormone control, and to 78.8% with dual-hormone control. In all scenarios, a significant decrease in hypoglycemia was observed. These results show that the use of deep reinforcement learning is a viable approach for closed-loop glucose control in T1D.

A Dual-Hormone Closed-Loop Delivery System for Type 1 Diabetes Using Deep Reinforcement Learning

We propose a dual-hormone delivery strategy by exploiting deep reinforcement learning (RL) for people with Type 1 Diabetes (T1D). Specifically, double dilated recurrent neural networks (RNN) are used to learn the hormone delivery strategy, trained by a variant of Q-learning, whose inputs are raw data of glucose \& meal carbohydrate and outputs are dual-hormone (insulin and glucagon) delivery. Without prior knowledge of the glucose-insulin metabolism, we run the method on the UVA/Padova simulator. Hundreds days of self-play are performed to obtain a generalized model, then importance sampling is adopted to customize the model for personal use. \emph{In-silico} the proposed strategy achieves glucose time in target range (TIR) $93\%$ for adults and $83\%$ for adolescents given standard bolus, outperforming previous approaches significantly. The results indicate that deep RL is effective in building personalized hormone delivery strategy for people with T1D.

Convolutional Recurrent Neural Networks for Glucose Prediction

Control of blood glucose is essential for diabetes management. Current digital therapeutic approaches for subjects with Type 1 diabetes mellitus (T1DM) such as the artificial pancreas and insulin bolus calculators leverage machine learning techniques for predicting subcutaneous glucose for improved control. Deep learning has recently been applied in healthcare and medical research to achieve state-of-the-art results in a range of tasks including disease diagnosis, and patient state prediction among others. In this work, we present a deep learning model that is capable of predicting glucose levels over a 30-minute horizon with leading accuracy for simulated patient cases (RMSE = 9.38$\pm$0.71 [mg/dL] and MARD = 5.50$\pm$0.62\%) and real patient cases (RMSE = 21.13$\pm$1.23 [mg/dL] and MARD = 10.08$\pm$0.83\%). In addition, the model also provides competitive performance in forecasting adverse glycaemic events with minimal time lag both in a simulated patient dataset (MCC$_{hyper}$ = 0.83$\pm$0.05 and MCC$_{hypo}$ = 0.80$\pm$0.10) and in a real patient dataset (MCC$_{hyper}$ = 0.79$\pm$0.04 and MCC$_{hypo}$ = 0.38$\pm$0.10). This approach is evaluated on a dataset of 10 simulated cases generated from the UVa/Padova simulator and a clinical dataset of 5 real cases each containing glucose readings, insulin bolus, and meal (carbohydrate) data. Performance of the recurrent convolutional neural network is benchmarked against four algorithms. The prediction algorithm is implemented on an Android mobile phone, with an execution time of $6$ms on a phone compared to an execution time of $780$ms on a laptop in Python.

A Nonlinear Weighted Total Variation Image Reconstruction Algorithm for Electrical Capacitance Tomography

A new iterative image reconstruction algorithm for electrical capacitance tomography (ECT) is proposed that is based on iterative soft thresholding of a total variation penalty and adaptive reweighted compressive sensing. This algorithm encourages sharp changes in the ECT image and overcomes the disadvantage of the $l_1$ minimization by equipping the total variation with an adaptive weighting depending on the reconstructed image. Moreover, the non-linear effect is also partially reduced due to the adoption of an updated sensitivity matrix. Simulation results show that the proposed algorithm recovers ECT images more precisely than existing state-of-the-art algorithms and therefore is suitable for the imaging of multiphase systems in industrial or medical applications.