Hripcsak, G. | bioRxiv Science

bioRxiv2020

Delay-Induced Uncertainty in Physiological Systems

AO_SCPLOWBSTRACTC_SCPLOWMedical practice in the intensive care unit is based on the supposition that physiological systems such as the human glucose-insulin system are reliabile. Reliability of dynamical systems refers to response to perturbation: A dynamical system is reliable if it behaves predictably following a perturbation. Here, we demonstrate that reliability fails for an archetypal physiological model, the Ultradian glucose-insulin model. Reliability failure arises because of the presence of delay. Using the theory of rank one maps from smooth dynamical systems, we precisely explain the nature of the resulting delay-induced uncertainty (DIU). We develop a recipe one may use to diagnose DIU in a general dynamical system. Guided by this recipe, we analyze DIU emergence first in a classical linear shear flow model and then in the Ultradian model. Our results potentially apply to a broad class of physiological systems that involve delay.

physiology↗

bioRxiv2019

Development and Validation of Phenotype Classifiers across Multiple Sites in the Observational Health Sciences and Informatics (OHDSI) Network

ObjectiveAccurate electronic phenotyping is essential to support collaborative observational research. Supervised machine learning methods can be used to train phenotype classifiers in a high-throughput manner using imperfectly labeled data. We developed ten phenotype classifiers using this approach and evaluated performance across multiple sites within the Observational Health Sciences and Informatics (OHDSI) network.\n\nMaterials and MethodsWe constructed classifiers using the Automated PHenotype Routine for Observational Definition, Identification, Training and Evaluation (APHRODITE) R-package, an open-source framework for learning phenotype classifiers using datasets in the OMOP CDM. We labeled training data based on the presence of multiple mentions of disease-specific codes. Performance was evaluated on cohorts derived using rule-based definitions and real-world disease prevalence. Classifiers were developed and evaluated across three medical centers, including one international site.\n\nResultsCompared to the multiple mentions labeling heuristic, classifiers showed a mean recall boost of 0.43 with a mean precision loss of 0.17. Performance decreased slightly when classifiers were shared across medical centers, with mean recall and precision decreasing by 0.08 and 0.01, respectively, at a site within the USA, and by 0.18 and 0.10, respectively, at an international site.\n\nDiscussion and ConclusionWe demonstrate a high-throughput pipeline for constructing and sharing phenotype classifiers across multiple sites within the OHDSI network using APHRODITE. Classifiers exhibit good portability between sites within the USA, however limited portability internationally, indicating that classifier generalizability may have geographic limitations, and consequently, sharing the classifier-building recipe, rather than the pre-trained classifiers, may be more useful for facilitating collaborative observational research.

bioinformatics↗