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BackgroundAlthough conventional prediction models for surgical patients often ignore intraoperative time-series data, deep learning approaches are well-suited to incorporate time-varying and non-linear data with complex interactions. Blood lactate concentration is one important clinical marker that can reflect the adequacy of systemic perfusion during cardiac surgery. During cardiac surgery and cardiopulmonary bypass, minute-level data is available on key parameters that affect perfusion. The goal of this study was to use machine learning and deep learning approaches to predict maximum blood lactate concentrations after cardiac surgery. We hypothesized that models using minute-level intraoperative data as inputs would have the best predictive performance. MethodsAdults who underwent cardiac surgery with cardiopulmonary bypass were eligible. The primary outcome was maximum lactate concentration within 24 h postoperatively. We considered three classes of predictive models, using the performance metric of mean absolute error across testing folds: (1) static models using baseline preoperative variables, (2) augmentation of the static models with intraoperative statistics, and (3) a dynamic approach that integrates preoperative variables with intraoperative time series data. Results2,187 patients were included. For three models that only used baseline characteristics (linear regression, random forest, artificial neural network) to predict maximum postoperative lactate concentration, the prediction error ranged from a median of 2.52 mmol/L (IQR 2.46, 2.56) to 2.58 mmol/L (IQR 2.54, 2.60). The inclusion of intraoperative summary statistics (including intraoperative lactate concentration) improved model performance, with the prediction error ranging from a median of 2.09 mmol/L (IQR 2.04, 2.14) to 2.12 mmol/L (IQR 2.06, 2.16). For two modelling approaches (recurrent neural network, transformer) that can utilize intraoperative time-series data, the lowest prediction error was obtained with a range of median 1.96 mmol/L (IQR 1.87, 2.05) to 1.97 mmol/L (IQR 1.92, 2.05). Intraoperative lactate concentration was the most important predictive feature based on Shapley additive values. Anemia and weight were also important predictors, but there was heterogeneity in the importance of other features. ConclusionPostoperative lactate concentrations can be predicted using baseline and intraoperative data with moderate accuracy. These results reflect the value of intraoperative data in the prediction of clinically relevant outcomes to guide perioperative management.
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Cloud-Based Single-Frequency Snapshot RTK Positioning
With great potential for being applied to Internet of Things (IoT) applications, the concept of cloud-based Snapshot Real Time Kinematics (SRTK) was proposed and its feasibility under zero-baseline configuration was confirmed recently by the authors. This article first introduces the general workflow of the SRTK engine, as well as a discussion on the challenges of achieving an SRTK fix using actual snapshot data. This work also describes a novel solution to ensure a nanosecond level absolute timing accuracy in order to compute highly precise satellite coordinates, which is required for SRTK. Parameters such as signal bandwidth, integration time and baseline distances have an impact on the SRTK performance. To characterize this impact, different combinations of these settings are analyzed through experimental tests. The results show that the use of higher signal bandwidths and longer integration times result in higher SRTK fix rates, while the more significant impact on the performance comes from the baseline distance. The results also show that the SRTK fix rate can reach more than 93% by using snapshots with a data size as small as 255 kB. The positioning accuracy is at centimeter level when phase ambiguities are resolved at a baseline distance less or equal to 15 km.
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- PAR ID:
- 10340039
- Date Published:
- Journal Name:
- Sensors
- Volume:
- 21
- Issue:
- 11
- ISSN:
- 1424-8220
- Page Range / eLocation ID:
- 3688
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3390/s21113688
