Modeling patient disease progression using Electronic Health Records (EHRs) is critical to assist clinical decision making. Long-Short Term Memory (LSTM) is an effective model to handle sequential data, such as EHRs, but it encounters two major limitations when applied to EHRs: it is unable to interpret the prediction results and it ignores the irregular time intervals between consecutive events. To tackle these limitations, we propose an attention-based time-aware LSTM Networks (ATTAIN), to improve the interpretability of LSTM and to identify the critical previous events for current diagnosis by modeling the inherent time irregularity. We validate ATTAIN on modeling the progression of an extremely challenging disease, septic shock, by using real-world EHRs. Our results demonstrate that the proposed framework outperforms the state-of-the-art models such as RETAIN and T-LSTM. Also, the generated interpretative time-aware attention weights shed some lights on the progression behaviors of septic shock.
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Time-Aware Subgroup Matrix Decomposition: Imputing Missing Data Using Forecasting Events
Deep neural network models, especially Long Short Term Memory (LSTM), have shown great success in analyzing Electronic Health Records (EHRs) due to their ability to capture temporal dependencies in time series data. When applying the deep learning models to EHRs, we are generally confronted with two major challenges: high rate of missingness and time irregularity. Motivated by the original PACIFIER framework which utilized matrix decomposition for data imputation, we applied and further extended it by including three components: forecasting future events, a time-aware mechanism, and a subgroup basis approach. We evaluated the proposed framework with real-world EHRs which consists of 52,919 visits and 4,224,567 events on a task of early prediction of septic shock. We compared our work against multiple baselines including the original PACIFIER using both LSTM and Time-aware LSTM (T-LSTM). Experimental results showed that our proposed framework significantly outperformed all competitive baseline approaches. More importantly, the extracted interpretative latent patterns from subgroups could shed some lights for clinicians to discover the progression of septic shock patients.
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- Award ID(s):
- 1651909
- NSF-PAR ID:
- 10136459
- Date Published:
- Journal Name:
- IEEE International Conference on Big Data
- ISSN:
- 2639-1589
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Obeid, Iyad Selesnick (Ed.)Electroencephalography (EEG) is a popular clinical monitoring tool used for diagnosing brain-related disorders such as epilepsy [1]. As monitoring EEGs in a critical-care setting is an expensive and tedious task, there is a great interest in developing real-time EEG monitoring tools to improve patient care quality and efficiency [2]. However, clinicians require automatic seizure detection tools that provide decisions with at least 75% sensitivity and less than 1 false alarm (FA) per 24 hours [3]. Some commercial tools recently claim to reach such performance levels, including the Olympic Brainz Monitor [4] and Persyst 14 [5]. In this abstract, we describe our efforts to transform a high-performance offline seizure detection system [3] into a low latency real-time or online seizure detection system. An overview of the system is shown in Figure 1. The main difference between an online versus offline system is that an online system should always be causal and has minimum latency which is often defined by domain experts. The offline system, shown in Figure 2, uses two phases of deep learning models with postprocessing [3]. The channel-based long short term memory (LSTM) model (Phase 1 or P1) processes linear frequency cepstral coefficients (LFCC) [6] features from each EEG channel separately. We use the hypotheses generated by the P1 model and create additional features that carry information about the detected events and their confidence. The P2 model uses these additional features and the LFCC features to learn the temporal and spatial aspects of the EEG signals using a hybrid convolutional neural network (CNN) and LSTM model. Finally, Phase 3 aggregates the results from both P1 and P2 before applying a final postprocessing step. The online system implements Phase 1 by taking advantage of the Linux piping mechanism, multithreading techniques, and multi-core processors. To convert Phase 1 into an online system, we divide the system into five major modules: signal preprocessor, feature extractor, event decoder, postprocessor, and visualizer. The system reads 0.1-second frames from each EEG channel and sends them to the feature extractor and the visualizer. The feature extractor generates LFCC features in real time from the streaming EEG signal. Next, the system computes seizure and background probabilities using a channel-based LSTM model and applies a postprocessor to aggregate the detected events across channels. The system then displays the EEG signal and the decisions simultaneously using a visualization module. The online system uses C++, Python, TensorFlow, and PyQtGraph in its implementation. The online system accepts streamed EEG data sampled at 250 Hz as input. The system begins processing the EEG signal by applying a TCP montage [8]. Depending on the type of the montage, the EEG signal can have either 22 or 20 channels. To enable the online operation, we send 0.1-second (25 samples) length frames from each channel of the streamed EEG signal to the feature extractor and the visualizer. Feature extraction is performed sequentially on each channel. The signal preprocessor writes the sample frames into two streams to facilitate these modules. In the first stream, the feature extractor receives the signals using stdin. In parallel, as a second stream, the visualizer shares a user-defined file with the signal preprocessor. This user-defined file holds raw signal information as a buffer for the visualizer. The signal preprocessor writes into the file while the visualizer reads from it. Reading and writing into the same file poses a challenge. The visualizer can start reading while the signal preprocessor is writing into it. 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The user can plot the signal and decisions using the signal and HYP files with only the visualizer by enabling appropriate options. For comparing the performance of different stages of development, we used the test set of TUSZ v1.2.1 database. It contains 1015 EEG records of varying duration. The any-overlap performance [12] of the overall system shown in Figure 2 is 40.29% sensitivity with 5.77 FAs per 24 hours. For comparison, the previous state-of-the-art model developed on this database performed at 30.71% sensitivity with 6.77 FAs per 24 hours [3]. The individual performances of the deep learning phases are as follows: Phase 1’s (P1) performance is 39.46% sensitivity and 11.62 FAs per 24 hours, and Phase 2 detects seizures with 41.16% sensitivity and 11.69 FAs per 24 hours. We trained an LSTM model with the delayed features and the window-based normalization technique for developing the online system. Using the offline decoder and postprocessor, the model performed at 36.23% sensitivity with 9.52 FAs per 24 hours. The trained model was then evaluated with the online modules. The current performance of the overall online system is 45.80% sensitivity with 28.14 FAs per 24 hours. Table 2 summarizes the performances of these systems. The performance of the online system deviates from the offline P1 model because the online postprocessor fails to combine the events as the seizure probability fluctuates during an event. The modules in the online system add a total of 11.1 seconds of delay for processing each second of the data, as shown in Figure 3. In practice, we also count the time for loading the model and starting the visualizer block. When we consider these facts, the system consumes 15 seconds to display the first hypothesis. The system detects seizure onsets with an average latency of 15 seconds. Implementing an automatic seizure detection model in real time is not trivial. We used a variety of techniques such as the file locking mechanism, multithreading, circular buffers, real-time event decoding, and signal-decision plotting to realize the system. A video demonstrating the system is available at: https://www.isip.piconepress.com/projects/nsf_pfi_tt/resources/videos/realtime_eeg_analysis/v2.5.1/video_2.5.1.mp4. The final conference submission will include a more detailed analysis of the online performance of each module. ACKNOWLEDGMENTS Research reported in this publication was most recently supported by the National Science Foundation Partnership for Innovation award number IIP-1827565 and the Pennsylvania Commonwealth Universal Research Enhancement Program (PA CURE). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the official views of any of these organizations. REFERENCES [1] A. Craik, Y. He, and J. L. Contreras-Vidal, “Deep learning for electroencephalogram (EEG) classification tasks: a review,” J. Neural Eng., vol. 16, no. 3, p. 031001, 2019. https://doi.org/10.1088/1741-2552/ab0ab5. [2] A. C. Bridi, T. Q. Louro, and R. C. L. Da Silva, “Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients,” Rev. Lat. Am. Enfermagem, vol. 22, no. 6, p. 1034, 2014. https://doi.org/10.1590/0104-1169.3488.2513. [3] M. Golmohammadi, V. Shah, I. Obeid, and J. Picone, “Deep Learning Approaches for Automatic Seizure Detection from Scalp Electroencephalograms,” in Signal Processing in Medicine and Biology: Emerging Trends in Research and Applications, 1st ed., I. Obeid, I. Selesnick, and J. Picone, Eds. New York, New York, USA: Springer, 2020, pp. 233–274. https://doi.org/10.1007/978-3-030-36844-9_8. [4] “CFM Olympic Brainz Monitor.” [Online]. Available: https://newborncare.natus.com/products-services/newborn-care-products/newborn-brain-injury/cfm-olympic-brainz-monitor. [Accessed: 17-Jul-2020]. [5] M. L. Scheuer, S. B. Wilson, A. Antony, G. Ghearing, A. Urban, and A. I. Bagic, “Seizure Detection: Interreader Agreement and Detection Algorithm Assessments Using a Large Dataset,” J. Clin. Neurophysiol., 2020. https://doi.org/10.1097/WNP.0000000000000709. [6] A. Harati, M. Golmohammadi, S. Lopez, I. Obeid, and J. Picone, “Improved EEG Event Classification Using Differential Energy,” in Proceedings of the IEEE Signal Processing in Medicine and Biology Symposium, 2015, pp. 1–4. https://doi.org/10.1109/SPMB.2015.7405421. [7] V. Shah, C. Campbell, I. Obeid, and J. Picone, “Improved Spatio-Temporal Modeling in Automated Seizure Detection using Channel-Dependent Posteriors,” Neurocomputing, 2021. [8] W. Tatum, A. Husain, S. Benbadis, and P. Kaplan, Handbook of EEG Interpretation. New York City, New York, USA: Demos Medical Publishing, 2007. [9] D. P. Bovet and C. Marco, Understanding the Linux Kernel, 3rd ed. O’Reilly Media, Inc., 2005. https://www.oreilly.com/library/view/understanding-the-linux/0596005652/. [10] V. Shah et al., “The Temple University Hospital Seizure Detection Corpus,” Front. Neuroinform., vol. 12, pp. 1–6, 2018. https://doi.org/10.3389/fninf.2018.00083. [11] F. Pedregosa et al., “Scikit-learn: Machine Learning in Python,” J. Mach. Learn. Res., vol. 12, pp. 2825–2830, 2011. https://dl.acm.org/doi/10.5555/1953048.2078195. [12] J. Gotman, D. Flanagan, J. Zhang, and B. Rosenblatt, “Automatic seizure detection in the newborn: Methods and initial evaluation,” Electroencephalogr. Clin. Neurophysiol., vol. 103, no. 3, pp. 356–362, 1997. https://doi.org/10.1016/S0013-4694(97)00003-9.more » « less
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Abstract Advances in visual perceptual tasks have been mainly driven by the amount, and types, of annotations of large-scale datasets. Researchers have focused on fully-supervised settings to train models using offline epoch-based schemes. Despite the evident advancements, limitations and cost of manually annotated datasets have hindered further development for event perceptual tasks, such as detection and localization of objects and events in videos. The problem is more apparent in zoological applications due to the scarcity of annotations and length of videos-most videos are at most ten minutes long. Inspired by cognitive theories, we present a self-supervised perceptual prediction framework to tackle the problem of temporal event segmentation by building a stable representation of event-related objects. The approach is simple but effective. We rely on LSTM predictions of high-level features computed by a standard deep learning backbone. For spatial segmentation, the stable representation of the object is used by an attention mechanism to filter the input features before the prediction step. The self-learned attention maps effectively localize the object as a side effect of perceptual prediction. We demonstrate our approach on long videos from continuous wildlife video monitoring, spanning multiple days at 25 FPS. We aim to facilitate automated ethogramming by detecting and localizing events without the need for labels. Our approach is trained in an online manner on streaming input and requires only a single pass through the video, with no separate training set. Given the lack of long and realistic (includes real-world challenges) datasets, we introduce a new wildlife video dataset–nest monitoring of the Kagu (a flightless bird from New Caledonia)–to benchmark our approach. Our dataset features a video from 10 days (over 23 million frames) of continuous monitoring of the Kagu in its natural habitat. We annotate every frame with bounding boxes and event labels. Additionally, each frame is annotated with time-of-day and illumination conditions. We will make the dataset, which is the first of its kind, and the code available to the research community. We find that the approach significantly outperforms other self-supervised, traditional (e.g., Optical Flow, Background Subtraction) and NN-based (e.g., PA-DPC, DINO, iBOT), baselines and performs on par with supervised boundary detection approaches (i.e., PC). At a recall rate of 80%, our best performing model detects one false positive activity every 50 min of training. On average, we at least double the performance of self-supervised approaches for spatial segmentation. Additionally, we show that our approach is robust to various environmental conditions (e.g., moving shadows). We also benchmark the framework on other datasets (i.e., Kinetics-GEBD, TAPOS) from different domains to demonstrate its generalizability. The data and code are available on our project page:
https://aix.eng.usf.edu/research_automated_ethogramming.html
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