AI Health

Friday Roundup

The AI Health Friday Roundup highlights the week’s news and publications related to artificial intelligence, data science, public health, and clinical research.

January 22, 2022

In today’s AI Health Roundup: Black patients more likely to have stigmatizing descriptions in EHR notes; Office of the National Coordinator debuts Trusted Exchange Framework; global toll of COVID likely undercounts deaths; impact of “nocebo effect” on reported adverse events in COVID trials; world’s children still face dire health impacts from lead; trash piles up as Omicron spreads among sanitation workers; links between eviction and Medicaid disenrollment, much more:

Deep Breaths

“The Parker spacecraft left Earth in 2018, and is traveling on a long loop around our star, making periodic visits. The spacecraft, built by the Johns Hopkins University Applied Physics Laboratory in Maryland, is designed to withstand the extremes of flying so close to our wonderful, scorching ball of nuclear fusion and dipping into its atmosphere, for a few hours, at least, to swim through sizzling matter.” If January’s grey chill has got you feeling down, Marina Koren’s Atlantic profile of the Parker solar observatory mission may be the (very intense) ray of sunshine you need.

AI, STATISTICS & DATA SCIENCE

“…we found that Black patients had 2.54 times the odds of being described with one or more negative descriptors in the history and physical notes of their EHRs, even after we adjusted for their sociodemographic and health characteristics. Our findings suggest disproportionate use of negative patient descriptors for Black patients compared with their White counterparts, which raises concerns about racial bias and possible transmission of stigma in the medical record.” A remarkable machine-learning analysis by Sun and colleagues published in Health Affairs finds that negative or stigmatizing descriptions of patients occured significantly more often in the electronic health records of Black patients. (At STAT News, Elizabeth Preston reports on the study and talks further with Sun about the findings.)
“A deep learning system applied to single-lead ECGs acquired during a routine examination with an ECG-enabled stethoscope can detect LVEF of 40% or lower. These findings highlight the potential for inexpensive, non-invasive, workflow-adapted, point-of-care screening, for earlier diagnosis and prognostically beneficial treatment.” A paper published by Bachtiger and colleagues in Lancet Digital Health reports results from an observational study of a convolutional neural network that was used to interpret ECG findings at point-of-care and identify patients with a left ventricular ejection fraction of 40% or less.
Courtesy of a 2017 article by Andrew Tch at Towards Data Science comes this “mostly complete” chart (along with succinct explanations) of the different kinds of neural networks (H/T @MIT_CSAIL).
“Across all test sets, we find that the Tempo policy combined with an image-based artificial intelligence (AI) risk model is significantly more efficient than current regimens used in clinical practice in terms of simulated early detection per screen frequency.” A research article published in Nature Medicine by Yala and colleagues describes findings from a study that paired risk-based personalized breast cancer screening policies with reinforcement learning approach (H/T @STATNews).
A handy resource curated by Radiology: Artificial Intelligence provides a compact library (“the Magician’s Corner”) of introductory materials for understanding the workings and application of different kinds of artificial intelligence in the clinical setting.
“To raise awareness of the prevalence of biased datasets The Lancet Digital Health editors are requesting demographics of population cohorts, including ethnicity and race, to be reported in research papers. Even if these data are not available, the implications of the absence of representation must be discussed, including the future work needed to ensure that benefits of the reported research reach the widest range of people and do not exacerbate existing inequalities.” An editorial in Lancet Digital Health addresses the need for renewed efforts to address issues of equity in medical research and practice – particularly as data-driven algorithmic tools are entering the picture.
A press release from the Office of the National Coordinator announces the publication of the Office’s Trusted Exchange Framework and the Common Agreement (TEFCA) which will allow the creation of health information exchange networks consisting of vetted, qualified members. A blog post at Health IT Buzz authored by Micky Tripathi and Mariann Yeager provides some additional details and explanation.

BASIC SCIENCE, CLINICAL RESEARCH & PUBLIC HEALTH

“…approximately one-third of placebo recipients in COVID-19 vaccine randomized clinical trials reported at least 1 systemic AE after both the first and the second dose, with headache and fatigue being the most common. This nocebo response accounted for 76.0% of systemic AEs after the first dose of COVID-19 vaccine, and for 51.8% after the second dose.” A paper by Haas and colleagues published in JAMA Network Open reports findings from a systematic review and meta-analysis of adverse events recorded on the placebo arms of COVID vaccine trials (H/T @chrishendel).
“The scramble to calculate a global death toll while the pandemic continues is an exercise that combines sophisticated statistical modelling with rapid-fire data gathering. Everyone involved knows any answer they provide will be provisional and imprecise. But they feel it is important to try.” In a news feature at Nature, David Adam reports on the evidence that current official death tolls from COVID around the world most likely represent a substantial undercount of the actual mortality.
“…it’s unclear at this point whether swapping out the original strain of the virus and replacing it one that targets the Omicron variant would be the right approach to take. This extraordinary wave of the pandemic could end in record time; Omicron could remain the dominant strain or could be replaced in the near term by something else.” STAT News’ Helen Branswell reports on the complexities of whether and how to adopt a global approach to an “updated” COVID vaccine that would encompass the Omicron variant.
“The lead problem is global. It’s catastrophic in scope and hurting children’s ability to learn, earn a living when they grow up, and function in society. Yet lead has gotten comparatively little attention in the global public health space. Charities globally are spending a total of just $6 million to $10 million a year trying to fight it.” An article by Dylan Matthews at Vox reveals that lead exposure remains a significant global health threat, particularly for children – yet it has gotten scant attention, and efforts to counter lead exposure receive a relative pittance in terms of resources (H/T @DukeNews).
“We’re still in the middle of this major eruptive sequence and many aspects remain unclear, partly because the island is currently obscured by ash clouds….The latest eruption has stepped up the scale in terms of violence. The ash plume is already about 20km high.” At the Conversation (via Scientific American) Shane Cronin explains the extraordinary violence of the recent Hunga Hapai Hunga-Tonga volcanic eruption.
“…the fact that the process was so hard for a journalist whose job it is to understand how Paxlovid gets delivered is not encouraging. I worry that many patients or their family would give up when told “no” as many times as I was….I was also reminded that even a “free” treatment can come with significant costs.” The New York Times’ Rebecca Robbins shares her Kafka-esque experiences of trying to secure antiviral COVID treatments, authorized for use by the FDA, for a family member with a COVID infection.

COMMUNICATIONS & DIGITAL SOCIETY

“The highly contagious variant hit just when Americans were generating a lot of trash — over the Christmas holidays. Combine that with a relatively low vaccination level among front-line sanitation workers and you have a ‘perfect storm for delayed collection,’ the association’s executive director, David Biderman, said this week.” Writing for the Associated Press, Travis Loller reports on how the spread of COVID through the ranks of sanitation workers has slowed or halted trash and recycling pickup for some neighborhoods.
“…those arguing against the status quo pointed out that the explosion of published systematic reviews has saturated the academic literature with studies that add little to no value – an enormous waste of resources . There is no incentive to stop publishing systematic reviews. Instead, tremendous incentives exist to publish them.” An article at Retraction Watch by Michelle Ghert and Aaron Gazendam reports on an academic debate that questioned the wisdom of the relatively common practice of tasking medical residents and fellows with conducting systematic reviews and meta-analyses.
“To thrive, cities must lean into nature. That means having open green spaces and interconnected waterways to prevent floods; green roofs and walls that reduce temperatures and produce food; and forests planted as green belts to oxygenate urban areas and regenerate ecosystems….But cities are doing little of this.” A perspective piece in Nature by Akanksha Khatri urges civic leaders to invest in ecological, as well as technological, infrastructure.
“…the work reviewed here suggests echo chambers are much less widespread than is commonly assumed, finds no support for the filter bubble hypothesis and offers a very mixed picture on polarisation and the role of news and media use in contributing to polarisation.” A literature review by Arguedas and colleagues, available from Oxford’s Reuters Institute for the Study of Journalism, finds little support for the hypothesis that political polarization is being driven by the existence of “echo chambers” or algorithmically mediated “filter bubbles” – and that the picture may different outside of the United States (H/T @brossardd).

POLICY

“Results suggest that eviction drives increased healthcare spending while disrupting healthcare access. Given previous research that Medicaid expansion lowered eviction rates, eviction and Medicaid disenrollment may operate cyclically, accumulating disadvantage.” A research article by Schwartz and colleagues published in the American Journal of Preventive Medicine explores the links between eviction and Medicaid disenrollment in New York City. (See also this paper by Leifheit and colleagues, published in December in the American Journal of Epidemiology, that examined associations between the expiration of eviction moratoria and COVID mortality.)
“The Centers for Disease Control and Prevention on Friday clarified its stance on various kinds of masks, acknowledging that the cloth masks frequently worn by Americans do not offer as much protection as surgical masks or respirators….While this disparity is widely known to the general public, the update marks the first time the C.D.C. has explicitly addressed the differences.” The New York Times’ Apoorva Mandavilli reports on the CDC’s updated guidance on mask wearing.
“If the clinical and translational research enterprise is to help resolve health crises and ensure that all people in the United States have the opportunity to live healthy lives, it must shift paradigms and begin to center equity, diversity, and inclusion in its work.” A perspective article by Boulware and colleagues, published this week in the New England Journal of Medicine, examines ways to overcome structural inequities in medical research.