Background Agitation and sedation management is critical in intensive care as it affects patient safety. Traditional nursing assessments suffer from low frequency and subjectivity. Automating these assessments can boost intensive care unit (ICU) efficiency, treatment capacity, and patient safety. Objectives The aim of this study was to develop a machine-learning based assessment of agitation and sedation. Methods Using data from the Taichung Veterans General Hospital ICU database (2020), an ensemble learning model was developed for classifying the levels of agitation and sedation. Different ensemble learning model sequences were compared. In addition, an interpretable artificial intelligence approach, SHAP (Shapley additive explanations), was employed for explanatory analysis. Results With 20 features and 121,303 data points, the random forest model achieved high area under the curve values across all models (sedation classification: 0.97; agitation classification: 0.88). The ensemble learning model enhanced agitation sensitivity (0.82) while maintaining high AUC values across all categories (all >0.82). The model explanations aligned with clinical experience. Conclusions This study proposes an ICU agitation-sedation assessment automation using machine learning, enhancing efficiency and safety. Ensemble learning improves agitation sensitivity while maintaining accuracy. Real-time monitoring and future digital integration have the potential for advancements in intensive care.

The accelerated digitization of documentation, including paper invoices and receipts, has mitigated the necessity for precise and expeditious information management. Nevertheless, it has become unfeasible for humans to manually capture data due to the laborious and time-consuming nature of the process. The paper proposed a low training cost, prompt-based applied key information extraction (applied KIE) pipeline of the information extraction approach with Amazon Textract and Automatic Prompt Engineer (APE) using large language models (LLMs). A series of experiments were conducted to evaluate the performance of the proposed approach, with the results indicating an average precision of 95.5% and document information extraction accuracy of 91.5% on the SROIE (a widely used English dataset), and an average precision of 97.15% and a document information extraction accuracy of 85.29% on the invoice dataset from a Taiwanese shipping company.

Industrial data processing and retrieval are necessary for adoption in Industry 5.0. Large Language Model (LLMs) revolutionize natural language process (NLP) but face challenges in domain-specific applications due to specialized terminology and context. Artificial Intelligence (AI) assistants for industrial-related work enquiry and customer support services are necessary for increasing demand and quality of service (QoS). Our research aims to design a novel customized model with a retrieval-augmented generation (RAG)-based LLM as a sustainable solution for industrial integration with AI. The goal is to provide an interactive industrial knowledge management (IIKM) system that can be applied to technical services: assisting technicians in the search for precise technical repair details and company internal regulation searches: personnel can easily inquire about regulations, such as business trips and leave requirements. The IIKM model architecture consists of BM25 and embedding sequence processing in the chroma database, where the top k-chunks are selected by the BAAI ranker to respond effectively to the queries. A group of documents of 234 MB size and pdf, pptx, docx, csv and txt formats are used for the experimental analysis. The designed interactive knowledge management system has a mean reciprocal rank (MRR) of 88 %, a recall of 85 % and a mean average precision (mAP) of 75 % in technical service. The internal regulatory documents have a generation-based retrieval evaluation prediction of recall of 91.62 %, MRR of 97.97 % and mAP of 91.12 %. We conclude with insights gained and experiences shared from IIKM deployment with Sakura incorporation, highlighting the importance of the hybrid approach integrating RAG-based generative pretrained transformer (GPT) models for customized solutions.

Objective To address the challenge of assessing sedation status in critically ill patients in the intensive care unit (ICU), we aimed to develop a non-contact automatic classifier of agitation using artificial intelligence and deep learning. Methods We collected the video recordings of ICU patients and cut them into 30-second (30-s) and 2-second (2-s) segments. All of the segments were annotated with the status of agitation as “Attention” and “Non-attention”. After transforming the video segments into movement quantification, we constructed the models of agitation classifiers with Threshold, Random Forest, and LSTM and evaluated their performances. Results The video recording segmentation yielded 427 30-s and 6405 2-s segments from 61 patients for model construction. The LSTM model achieved remarkable accuracy (ACC 0.92, AUC 0.91), outperforming other methods. Conclusion Our study proposes an advanced monitoring system combining LSTM and image processing to ensure mild patient sedation in ICU care. LSTM proves to be the optimal choice for accurate monitoring. Future efforts should prioritize expanding data collection and enhancing system integration for practical application.

Early detection of rapidly progressive kidney disease is key to improving the renal outcome and reducing complications in adult patients with type 2 diabetes mellitus (T2DM). We aimed to construct a 6-month machine learning (ML) predictive model for the risk of rapidly progressive kidney disease and the need for nephrology referral in adult patients with T2DM and an initial estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. We extracted patients and medical features from the electronic medical records (EMR), and the cohort was divided into a training/validation and testing data set to develop and validate the models on the basis of three algorithms: logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost). We also applied an ensemble approach using soft voting classifier to classify the referral group. We used the area under the receiver operating characteristic curve (AUROC), precision, recall, and accuracy as the metrics to evaluate the performance. Shapley additive explanations (SHAP) values were used to evaluate the feature importance. The XGB model had higher accuracy and relatively higher precision in the referral group as compared with the LR and RF models, but LR and RF models had higher recall in the referral group. In general, the ensemble voting classifier had relatively higher accuracy, higher AUROC, and higher recall in the referral group as compared with the other three models. In addition, we found a more specific definition of the target improved the model performance in our study. In conclusion, we built a 6-month ML predictive model for the risk of rapidly progressive kidney disease. Early detection and then nephrology referral may facilitate appropriate management.

The outreach of healthcare services is a challenge to remote areas with affected populations. Fortunately, remote health monitoring (RHM) has improved the hospital service quality and has proved its sustainable growth. However, the absence of security may breach the health insurance portability and accountability act (HIPAA), which has an exclusive set of rules for the privacy of medical data. Therefore, the goal of this work is to design and implement the adaptive Autonomous Protocol (AutoPro) on the patient’s remote healthcare (RHC) monitoring data for the hospital using fully homomorphic encryption (FHE). The aim is to perform adaptive autonomous FHE computations on recent RHM data for providing health status reporting and maintaining the confidentiality of every patient. The autonomous protocol works independently within the group of prime hospital servers without the dependency on the third-party system. The adaptiveness of the protocol modes is based on the patient’s affected level of slight, medium, and severe cases. Related applications are given as glucose monitoring for diabetes, digital blood pressure for stroke, pulse oximeter for COVID-19, electrocardiogram (ECG) for cardiac arrest, etc. The design for this work consists of an autonomous protocol, hospital servers combining multiple prime/local hospitals, and an algorithm based on fast fully homomorphic encryption over the torus (TFHE) library with a ring-variant by the Gentry, Sahai, and Waters (GSW) scheme. The concrete-ML model used within this work is trained using an open heart disease dataset from the UCI machine learning repository. Preprocessing is performed to recover the lost and incomplete data in the dataset. The concrete-ML model is evaluated both on the workstation and cloud server. Also, the FHE protocol is implemented on the AWS cloud network with performance details. The advantages entail providing confidentiality to the patient’s data/report while saving the travel and waiting time for the hospital services. The patient’s data will be completely confidential and can receive emergency services immediately. The FHE results show that the highest accuracy is achieved by support vector classification (SVC) of 88% and linear regression (LR) of 86% with the area under curve (AUC) of 91% and 90%, respectively. Ultimately, the FHE-based protocol presents a novel system that is successfully demonstrated on the cloud network.

Open-box models in the medical domain have high acceptance and demand by many medical examiners. Even though the accuracy predicted by most of convolutional neural network (CNN) models is high, it is still not convincing as the detailed discussion regarding the outcome is semi-transparent in the functioning process. Pneumonia is known as one of the top contagious infections that makes most of the population affected due to low immunity. Therefore, the goal of this paper is to implement an interpretable classification of pneumonia infection using eXplainable AI (XAI-ICP). Thus, XAI-ICP is the highly efficient system designed to solve this challenge by adapting to the recent population health conditions. The aim is to design an interpretable deep classification and transfer learning based evaluation for pneumonia infection classification. The model is primarily pre-trained using the open Chest X-Ray (CXR) dataset from National Institutes of Health (NIH). Whereas, the training input and testing given to this system is Taichung Veterans General Hospital (TCVGH) for independent learning, Taiwan + VinDr open dataset for transfer learning of pneumonia affected patients with labeled CXR images possessing three features of infiltrate, cardiomegaly and effusion. The data labeling is performed by the medical examiners with the XAI human-in-the-loop approach. XAI-ICP demonstrates the XAI based reconfigurable DCNN with human-in-the-loop as a novel approach. The interpretable deep classification provides detailed transparency analysis and transfer learning for competitive accuracy. The purpose of this work, to design a re-configurable model that can continuously improve itself by using a feedback system and provide feasibility for the model deployment across multiple countries to provide an efficient system for the pneumonia infection classification. The designed model then provides detailed decisions taken at each step as transparency and features used within the algorithm for the pneumonia classification during the hospitalization. Thus, the scope can be given as explainable AI usage for the diagnosis classification using data preprocessing and interpretable deep convolutional neural network by the CXR evaluation. The accuracy achieved by using independent learning classification is 92.14% and is further improved based on successive transfer learning based evaluation is 93.29%. The XAI-ICP model adapts to the different populations by using transfer learning, while providing competitive results to the affected conditions.

Abstract Background: Intensive care units (ICUs) are crucial in healthcare, but internal factors, like patient agitation due to delirium, treatment discomfort, and the ICU environment, can compromise care and lead to safety issues. In Taiwan, the Richmond Agitation–Sedation Scale (RASS) is used for agitation assessment, but it has limitations, including subjectivity and infrequent assessments. Methods: To enhance ICU care, we developed a machine learning-based patient agitation and sedation assessment tool. We used an ensemble learning model, combining two machine learning models to classify patients into three categories: oversedation, optimal sedation, and agitation. Results: The RandomForest model achieved the highest average accuracy for sedation (ACC = 0.92, AUC = 0.97), while addressing class imbalance increased agitation classification accuracy (ACC = 0.77, AUC = 0.88). The model's results, based on key features identified, can guide sedative dosage adjustments, enabling more precise patient care. Conclusions: Our study demonstrated the effectiveness of machine learning in classifying patient agitation and sedation. We recommend incorporating image-based features in patient agitation assessment. Our classification system can assist medical professionals in RASS assessments, mitigating safety risks related to patient agitation in ICUs and improving overall ICU capacity. Trial Registration: We obtained access to the critical care database (AI-111010) of the AI Center of Taichung Veterans General Hospital (TCVGH) from the Institutional Review Board (approval number: CE22484A), retrospectively registered.

Objective The aim of this study was to develop an artificial intelligence–based model to detect the presence of acute respiratory distress syndrome (ARDS) using clinical data and chest X-ray (CXR) data. Method The transfer learning method was used to train a convolutional neural network (CNN) model with an external image dataset to extract the image features. Then, the last layer of the model was fine-tuned to determine the probability of ARDS. The clinical data were trained using three machine learning algorithms—eXtreme Gradient Boosting (XGB), random forest (RF), and logistic regression (LR)—to estimate the probability of ARDS. Finally, ensemble-weighted methods were proposed that combined the image model and the clinical data model to estimate the probability of ARDS. An analysis of the importance of clinical features was performed to explore the most important features in detecting ARDS. A gradient-weighted class activation mapping (Grad-CAM) model was used to explain what our CNN sees and understands when making a decision. Results The proposed ensemble-weighted methods improved the performances of the ARDS classifiers (XGB + CNN, area under the curve [AUC] = 0.916; RF + CNN, AUC = 0.920; LR + CNN, AUC = 0.920; XGB + RF + LR + CNN, AUC = 0.925). In addition, the ML model using clinical data to present the top 15 important features to identify the risk factors of ARDS. Conclusion This study developed combined machine learning models with clinical data and CXR images to detect ARDS. According to the results of the Shapley Additive exPlanations values and the Grad-CAM techniques, an explicable ARDS diagnosis model is suitable for a real-life scenario.

Evaluating several vital signs and chest X-ray (CXR) reports regularly to determine the recovery of the pneumonia patients at general wards is a challenge for doctors. A recent study shows the identification of pneumonia by the history of symptoms and signs including vital signs, CXR, and other clinical parameters, but they lack predicting the recovery status after starting treatment. The goal of this paper is to provide a pneumonia status prediction system for the early affected patient’s discharge from the hospital within 7 days or late discharge more than 7 days. This paper aims to design a multimodal data analysis for pneumonia status prediction using deep learning classification (MDA-PSP). We have developed a system that takes an input of vital signs and CXR images of the affected patient with pneumonia from admission day 1 to day 3. The deep learning then classifies the health status improvement or deterioration for predicting the possible discharge state. Therefore, the scope is to provide a highly accurate prediction of the pneumonia recovery on the 7th day after 3-day treatment by the SHAP (SHapley Additive exPlanation), imputation, adaptive imputation-based preprocessing of the vital signs, and CXR image feature extraction using deep learning based on dense layers-batch normalization (BN) with class weights for the first 7 days’ general ward patient in MDA-PSP. A total of 3972 patients with pneumonia were enrolled by de-identification with an adult age of 71 mean ± 17 sd and 64% of them were male. After analyzing the data behavior, appropriate improvement measures are taken by data preprocessing and feature vectorization algorithm. The deep learning method of Dense-BN with SHAP features has an accuracy of 0.77 for vital signs, 0.92 for CXR, and 0.75 for the combined model with class weights. The MDA-PSP hybrid method-based experiments are proven to demonstrate higher prediction accuracy of 0.75 for pneumonia patient status. Henceforth, the hybrid methods of machine and deep learning for pneumonia patient discharge are concluded to be a better approach.

The wood-based furniture manufacturing industries prioritize quality of production to meet higher market demands. Identifying various types of edge-glued wooden panel defects are a challenge for a human worker or a camera. Several studies have shown that the detection of edge-glued defects with low, high, normal, overlong, short is identified but detection of residue and bluntness is highly challenging. Thus, the present model identifies defects of low, high, normal, overlong, short by computer vision and/or deep learning, whereas defects of residue and bluntness by deep learning based decide by pass for having better performance. The goal of this paper is to provide an improved defect detection solution for wood-based furniture manufacturing industries by process automation. Therefore, a system was designed that takes defect input images from a camera as raw image and laser-aligned image for defect detection of the edge-glued wooden panel. The process automation then performs computer vision-based image features extraction with deep learning for defect detection. The aim of this paper is to solve edge-glued defect detection problems by using design and implementation of edge-glued wooden defect detection, that can be stated as edge-glued wooden panel defect detection using deep learning (WDD-DL) for process automation by artificial intelligence and Automated Optical Inspection (AOI) consolidation. Possibly there exist several types of defects on the edges while edge-banding on the wooden panel in furniture manufacturing. Therefore, the scope is to achieve higher accuracy by raw image and laser-aligned image feature extraction using deep learning algorithms for final result defect classification in WDD-DL by AOI. The WDD-DL system uses Gabor, Harris corner, morphology, structured light detection and curvature calculation for pre-processing and InceptionResnetV2 Convolutional Neural Network algorithm to attain the best results. The applications of this work can be found in quality control of the furniture manufacturing industry for an edge, corner, joint defect detection of the wooden panels. The WDD-DL achieves best results as the precision, recall and F1 score are 0.97, 0.90 and 0.92, respectively. The experiments demonstrate higher accuracy achievement as compared to other methods with overkill and escape rate analysis. Ultimately, the discussion section provides an interesting experience sharing about the necessary factors for implementing the WDD-DL in real-time industrial operations.

A distinct security protocol is necessary for the exponential growth in intelligent edge devices. In particular, the autonomous devices need to address significant security concern to function smoothly in the high market demand. Nevertheless, exponential increase in the connected devices has made cloud networks more complex and suffer from information processing delay. Therefore, the goal of this work is to design a novel server-less mutual authentication protocol for the edge networks. The aim is to demonstrate an autonomous mutual authentication amongst the connected smart devices within the edge networks. The solution addresses applications of autonomous cars, smart things, and Internet of Things (IoT) devices in the edge or wireless sensor networks (WSN), etc. In this paper, the design proposes use of a public-key system, octet-based balanced-tree transitions, challenge–response mechanism, device unique ID (UID), pseudo-random number generator (PRNG), time-stamps, and event specific session keys. Ultimately, server-less design requires less infrastructure and avoids several types of network-based communication attacks, e.g., impersonating, Man in the middle (MITM), IoT-DDOS, etc. Additionally, the system overhead is eliminated by no secret key requirements. The results provide sufficient evidence about the protocol market competitiveness and demonstrate better benchmark comparison results.

BACKGROUND:Antinuclear antibody pattern recognition is vital for autoimmune disease diagnosis but labor-intensive for manual interpretation. To develop an automated pattern recognition system, we established machine learning models based on the International Consensus on Antinuclear Antibody Patterns (ICAP) at a competent level, mixed patterns recognition, and evaluated their consistency with human reading.METHODS:51,694 human epithelial cells (HEp-2) cell images with patterns assigned by experienced medical technologists collected in a medical center were used to train six machine learning algorithms and were compared by their performance. Next, we choose the best performing model to test the consistency with five experienced readers and two beginners.RESULTS:The mean F1 score in each classification of the best performing model was 0.86 evaluated by Testing Data 1. For the inter-observer agreement test on Testing Data 2, the average agreement was 0.849 (κ) among five experienced readers, 0.844 between the best performing model and experienced readers, 0.528 between experienced readers and beginners. The results indicate that the proposed model outperformed beginners and achieved an excellent agreement with experienced readers.CONCLUSIONS:This study demonstrated that the developed model could reach an excellent agreement with experienced human readers using machine learning methods.

Sheet metal-based products serve as a major portion of the furniture market and maintain higher quality standards by being competitive. During industrial processes, while converting a sheet metal to an end product, new defects are observed and thus need to be identified carefully. Recent studies have shown scratches, bumps, and pollution/dust are identified, but orange peel defects present overall a new challenge. So our model identifies scratches, bumps, and dust by using computer vision algorithms, whereas orange peel defect detection with deep learning have a better performance. The goal of this paper was to resolve artificial intelligence (AI) as an AI landing challenge faced in identifying various kinds of sheet metal-based product defects by ALDB-DL process automation. Therefore, our system model consists of multiple cameras from two different angles to capture the defects of the sheet metal-based drawer box. The aim of this paper was to solve multiple defects detection as design and implementation of Industrial process integration with AI by Automated Optical Inspection (AOI) for sheet metal-based drawer box defect detection, stated as AI Landing for sheet metal-based Drawer Box defect detection using Deep Learning (ALDB-DL). Therefore, the scope was given as achieving higher accuracy using multi-camera-based image feature extraction using computer vision and deep learning algorithm for defect classification in AOI. We used SHapley Additive exPlanations (SHAP) values for pre-processing, LeNet with a (1 × 1) convolution filter, and a Global Average Pooling (GAP) Convolutional Neural Network (CNN) algorithm to achieve the best results. It has applications for sheet metal-based product industries with improvised quality control for edge and surface detection. The results were competitive as the precision, recall, and area under the curve were 1.00, 0.99, and 0.98, respectively. Successively, the discussion section presents a detailed insight view about the industrial functioning with ALDB-DL experience sharing.

In this paper, we proposed a method for accelerating the transmission of a series of streaming files for multi-session file delivery scenarios. When streaming files are transmitted, the throughput of data transmission can be increased and the out of order problem of file reception (i.e., file reception delay) can also be reduced at the same time. This is achieved by using a repair file generation mechanism based on AL-FEC, which is triggered while an empty file transmission session appears but there are still uncompleted files waiting to be delivered. Performance evaluation results shows that the file transmission throughput of the proposed method are 28% to 44% higher than the throughput of a traditional file transmission method that is designed for reducing file reception delay. However, the file reception delay is the same as the above-mentioned traditional method.

In recent years, word embedding models receive tremendous research attentions due to their capability of capturing textual semantics. This study investigates the issue of employing word embedding models into storage-constrained edge devices for personalized item-of-interest recommendation in a smart store. The challenge lies in that the existing embedding models are often too large to fit into a storage-constrained edge device. One naive idea is to reside the word embedding model in a secondary storage and process recommendation with that storage. However, this idea suffers from the burden of additional traffics. To this end, we propose a framework called Word Embedding Quantization (WEQ) which constructs an index upon a given word embedding model and stores the index in the primary storage to enable the use of the word embedding model by edge devices. One challenge for using the index is that the exact user profile is no longer ensured. However, we find that there are opportunities for computing the correct recommendation results by knowing only an inexact user profile. In this paper, we propose a series of techniques that leverage the opportunities for computing candidates with the goal of minimizing the accessing cost to a secondary storage in edge devices. Experiments are performed to verify the efficiency of the proposed techniques, demonstrating the feasibility of the proposed framework.

Acute kidney injury (AKI) refers to rapid decline of kidney function and is manifested by decreasing urine output or abnormal blood test (elevated serum creatinine). Electronic health records (EHRs) is fundamental for clinicians and machine learning algorithms to predict the clinical outcome of patients in the Intensive Care Unit (ICU). Early prediction of AKI could automatically warn the clinicians to review the possible risk factors and act in advance to prevent it. However, the enormous amount of patient data usually consists of a relatively incomplete data set and is very challenging for supervised machine learning process. In this paper, we propose an entropy-based feature engineering framework for vital signs based on their frequency of records. In particular, we address the missing at random (MAR) and missing not at random (MNAR) types of missing data according to different clinical scenarios. Regarding its applicability, we applied it to establish a prediction model for future AKI in ICU patients using 4278 ICU admissions from a tertiary hospital. Our result shows that the proposed entropy-based features are feasible to be used in the AKI prediction model and its performance improves as the data availability increases. In addition, we study the performance of AKI prediction model by comparing different time gaps and feature windows with the proposed vital sign entropy features. This work could be used as a guidance for feature windows selection and missing data processing during the development of a prediction model in ICU.

Video surveillance systems are deployed at many places such as airports, train stations, and malls for security and monitoring purposes. However, it is laborious to search for and retrieve persons in multicamera surveillance systems, especially with cluttered backgrounds and appearance variations among multiple cameras. To solve these problems, this paper proposes a person retrieval method that extracts the attributes of a masked image using an instance segmentation module for each object of interest. It uses attributes such as color and type of clothes to describe a person. The proposed person retrieval system involves four steps: (1) using the YOLACT++ model to perform pixelwise person segmentation, (2) conducting appearance-based attribute feature extraction using a multiple convolutional neural network classifier, (3) employing a search engine with a fundamental attribute matching approach, and (4) implementing a video summarization technique to produce a temporal abstraction of retrieved objects. Experimental results show that the proposed retrieval system can achieve effective retrieval performance and provide a quick overview of retrieved content for multicamera surveillance systems.

This study aimed to develop an early prediction model for identifying patients with bloodstream infections. The data resource was taken from 2015 to 2019 at Taichung Veterans General Hospital, and a total of 1647 bloodstream infection episodes and 3552 non-bloodstream infection episodes in the intensive care unit (ICU) were included in the model development and evaluation. During the data analysis, 30 clinical variables were selected, including patients’ basic characteristics, vital signs, laboratory data, and clinical information. Five machine learning algorithms were applied to examine the prediction model performance. The findings indicated that the area under the receiver operating characteristic curve (AUROC) of the prediction performance of the XGBoost model was 0.825 for the validation dataset and 0.821 for the testing dataset. The random forest model also presented higher values for the AUROC on the validation dataset and testing dataset, which were 0.855 and 0.851, respectively. The tree-based ensemble learning model enabled high detection ability for patients with bloodstream infections in the ICU. Additionally, the analysis of importance of features revealed that alkaline phosphatase (ALKP) and the period of the central venous catheter are the most important predictors for bloodstream infections. We further explored the relationship between features and the risk of bloodstream infection by using the Shapley Additive exPlanations (SHAP) visualized method. The results showed that a higher prothrombin time is more prominent in a bloodstream infection. Additionally, the impact of a lower platelet count and albumin was more prominent in a bloodstream infection. Our results provide additional clinical information for cut-off laboratory values to assist clinical decision-making in bloodstream infection diagnostics.