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BACKGROUND: Intensivists target different blood pressure component values to manage intensive care unit (ICU) patients with sepsis. We aimed to evaluate the relationship between individual blood pressure components and organ dysfunction in critically ill septic patients. METHODS: In this retrospective observational study, we evaluated 77,328 septic patients in 364 ICUs in the eICU Research Institute database. Primary exposure was the lowest cumulative value of each component; mean, systolic, diastolic, and pulse pressure, sustained for at least 120 min during ICU stay. Primary outcome was ICU mortality and secondary outcomes were composite outcomes of acute kidney injury or death and myocardial injury or death during ICU stay. Multivariable logistic regression spline and threshold regression adjusting for potential confounders were conducted to evaluate associations between exposures and outcomes. Sensitivity analysis was conducted in 4211 patients with septic shock. RESULTS: Lower values of all blood pressures components were associated with a higher risk of ICU mortality. Estimated change-points for the risk of ICU mortality were 69 mmHg for mean, 100 mmHg for systolic, 60 mmHg for diastolic, and 57 mmHg for pulse pressure. The strength of association between blood pressure components and ICU mortality as determined by slopes of threshold regression were mean (- 0.13), systolic (- 0.11), diastolic (- 0.09), and pulse pressure (- 0.05). Equivalent non-linear associations between blood pressure components and ICU mortality were confirmed in septic shock patients. We observed a similar relationship between blood pressure components and secondary outcomes. CONCLUSION: Blood pressure component association with ICU mortality is the strongest for mean followed by systolic, diastolic, and weakest for pulse pressure. Critical care teams should continue to follow MAP-based resuscitation, though exploratory analysis focusing on blood pressure components in different sepsis phenotypes in critically ill ICU patients is needed.

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OBJECTIVE: To develop machine learning models predicting extubation failure in low birthweight neonates using large amounts of clinical data. STUDY DESIGN: Retrospective cohort study using MIMIC-III, a large single-center, open-source clinical dataset. Logistic regression and boosted-tree (XGBoost) models using demographics, medications, and vital sign and ventilatory data were developed to predict extubation failure, defined as reintubation within 7 days. RESULTS: 1348 low birthweight (≤2500 g) neonates who received mechanical ventilation within the first 7 days were included, of which 350 (26%) failed a trial of extubation. The best-performing model was a boosted-tree model incorporating demographics, vital signs, ventilator parameters, and medications (AUROC 0.82). The most important features were birthweight, last FiO2, average mean airway pressure, caffeine use, and gestational age. CONCLUSIONS: Machine learning models identified low birthweight ventilated neonates at risk for extubation failure. These models will need to be validated across multiple centers to determine generalizability of this tool.

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BACKGROUND: Timely recognition of hemodynamic instability in critically ill patients enables increased vigilance and early treatment opportunities. We develop the Hemodynamic Stability Index (HSI), which highlights situational awareness of possible hemodynamic instability occurring at the bedside and to prompt assessment for potential hemodynamic interventions. METHODS: We used an ensemble of decision trees to obtain a real-time risk score that predicts the initiation of hemodynamic interventions an hour into the future. We developed the model using the eICU Research Institute (eRI) database, based on adult ICU admissions from 2012 to 2016. A total of 208,375 ICU stays met the inclusion criteria, with 32,896 patients (prevalence = 18%) experiencing at least one instability event where they received one of the interventions during their stay. Predictors included vital signs, laboratory measurements, and ventilation settings. RESULTS: HSI showed significantly better performance compared to single parameters like systolic blood pressure and shock index (heart rate/systolic blood pressure) and showed good generalization across patient subgroups. HSI AUC was 0.82 and predicted 52% of all hemodynamic interventions with a lead time of 1-h with a specificity of 92%. In addition to predicting future hemodynamic interventions, our model provides confidence intervals and a ranked list of clinical features that contribute to each prediction. Importantly, HSI can use a sparse set of physiologic variables and abstains from making a prediction when the confidence is below an acceptable threshold. CONCLUSIONS: The HSI algorithm provides a single score that summarizes hemodynamic status in real time using multiple physiologic parameters in patient monitors and electronic medical records (EMR). Importantly, HSI is designed for real-world deployment, demonstrating generalizability, strong performance under different data availability conditions, and providing model explanation in the form of feature importance and prediction confidence.

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Mobile health research on illicit drug use detection typically involves a two-stage study design where data to learn detectors is first collected in lab-based trials, followed by a deployment to subjects in a free-living environment to assess detector performance. While recent work has demonstrated the feasibility of wearable sensors for illicit drug use detection in the lab setting, several key problems can limit lab-to-field generalization performance. For example, lab-based data collection often has low ecological validity, the ground-truth event labels collected in the lab may not be available at the same level of temporal granularity in the field, and there can be significant variability between subjects. In this paper, we present domain adaptation methods for assessing and mitigating potential sources of performance loss in lab-to-field generalization and apply them to the problem of cocaine use detection from wearable electrocardiogram sensor data.

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The ability to assess a user's emotional reaction from biometrics has applications in personalization, recommendation, and enhancing user experiences, among other areas. Unfortunately, understanding the connection between biometric signals and user reactions has previously focused on black box techniques that are opaque to the underlying physiology of the user. In this paper, we explore a novel user study connecting biometric reaction to external stimuli and changes in the user's autonomic nervous system. Specifically, we focus on two competing responses, namely the sympathetic and parasympathetic nervous system, and how differing activations are related to different user responses. Our experiments demonstrate how prior psychophysiological research distinguishing this activation can be replicated using biometric data collected from wearables. The insights from this work have applications in better understanding emotional state from biometric sensors.

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Thanks to advances in mobile sensing technologies, it has recently become practical to deploy wireless electrocardiograph sensors for continuous recording of ECG signals. This capability has diverse applications in the study of human health and behavior, but to realize its full potential, new computational tools are required to effectively deal with the uncertainty that results from the noisy and highly non-stationary signals collected using these devices. In this work, we present a novel approach to the problem of extracting the morphological structure of ECG signals based on the use of dynamically structured conditional random field (CRF) models. We apply this framework to the problem of extracting morphological structure from wireless ECG sensor data collected in a lab-based study of habituated cocaine users. Our results show that the proposed CRF-based approach significantly out-performs independent prediction models using the same features, as well as a widely cited open source toolkit.

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Using the think/no-think paradigm (Anderson & Green, 2001), researchers have found that suppressing retrieval of a memory (in the presence of a strong retrieval cue) can make it harder to retrieve that memory on a subsequent test. This effect has been replicated numerous times, but the size of the effect is highly variable. Also, it is unclear from a neural mechanistic standpoint why preventing recall of a memory now should impair your ability to recall that memory later. Here, we address both of these puzzles using the idea, derived from computational modeling and studies of synaptic plasticity, that the function relating memory activation to learning is U-shaped, such that moderate levels of memory activation lead to weakening of the memory and higher levels of activation lead to strengthening. According to this view, forgetting effects in the think/no-think paradigm occur when the suppressed item activates moderately during the suppression attempt, leading to weakening; the effect is variable because sometimes the suppressed item activates strongly (leading to strengthening) and sometimes it does not activate at all (in which case no learning takes place). To test this hypothesis, we ran a think/no-think experiment where participants learned word-picture pairs; we used pattern classifiers, applied to fMRI data, to measure how strongly the picture associates were activating when participants were trying not to retrieve these associates, and we used a novel Bayesian curve-fitting procedure to relate this covert neural measure of retrieval to performance on a later memory test. In keeping with our hypothesis, the curve-fitting procedure revealed a nonmonotonic relationship between memory activation (as measured by the classifier) and subsequent memory, whereby moderate levels of activation of the to-be-suppressed item led to diminished performance on the final memory test, and higher levels of activation led to enhanced performance on the final test.

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Eleven channels of EEG were recorded from a subject performing four mental tasks. A time-embedded representation of the untransformed EEG samples was constructed. Classification of the time-embedded samples was performed by linear and quadratic discriminant analysis and by an artificial neural network. A classifier's output for consecutive samples is combined to increase reliability. A new performance measure is defined as the number of correct selections that would be made by a brain-computer interface (BCI) user of the system, accounting for the need for an incorrect selection to be followed by a correct one to 'delete' the previous selection. A best result of 0.32 correct selections s(-1) (about 3 s per BCI decision) was obtained with a neural network using a time-embedding dimension of 50.

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