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Predicting readmission risk for diabetic patients: Make artificial intelligence work in real life with interpretable machine learning
No full textBackground: The expenditures of healthcare services associated with unplanned readmissions are enormous. Recognising the reasons that contribute to readmission and identifying at-risk patients are the essential steps to reduce such readmissions. Artificial intelligence is changing the practice of healthcare. It has enabled medical practitioners to provide high-quality treatments to reduce readmissions. While it is essential to employ such solutions, making them transparent to medical experts is more critical.Aims: Apparently, healthcare stakeholders do not have a strong data science background. Doctors consider the cause of a prognosis rather than the binary outcome from the machine learning methods. Most of the previous work presented predictions, but they did not explain the models. Treating these models as “black boxes” diminishes confidence in their predictions. This study aims to report high-performing predictive models for readmission along with transparent interpretations. Methods: Six machine learning applications are employed in predicting 30-day readmission after hospitalisation for diabetic patients. This study also utilised the white-box machine learning framework by exploring Shapley Additive Explanations and Local Interpretable Model-agnostic Explanations.Results: Results show that the CatBoost had the best performance with a higher area under the receiver operating characteristic curve than other models. Prior readmission, discharged at home, the number of emergencies and age were strong predictors. To demonstrated explainability at the individual level, we interpreted the relative variable influence of patient observations.Conclusions: The findings could be helpful in medical practice and provide valuable recommendations to stakeholders for minimising readmission and reducing public healthcare costs in the future
The health digital twin model to tackle cardiovascular disease: mapping an emerging interdisciplinary field
No full textPrecision or personalised medicine seeks to manage the differences between patients with the same condition, using tailored diagnostics and treatment. Potential benefits in cardiovascular disease (CVD) include optimising risk stratification and treatment selection using multiple clinical, imaging, molecular, and other variables. An approach to realising this potential is the concept of the digital twin, whereby a virtual patient receives real-time updates of a range of data variables in order to predict disease and improve treatment selection in the real-life patient. Here we explore the concepts and challenges within this emerging field, and identify digital twin applications in CVD. A modified mapping review was undertaken, using a systematic search strategy from multiple data sources. The review found that digital twin research for CVD and other conditions is established globally. CVD applications were generally more-traditional simulation models, although some precursor models exist for the real-time cyber-physical system characteristic of a true digital twin. Key challenges in digital twin science concern computational power needs, cybersecurity, data sharing issues, ethical constraints, and potential clinician barriers to adoption of decision tools derived from artificial intelligence systems
Exploring the early-phase implementation of digital health solutions to improve access and treatment outcomes of eating disorders within in rural and regional health services
No full textBackground: Anorexia Nervosa (AN) is a complex eating disorder with severe implications, carrying the highest mortality rate of all psychiatric illnesses. Fortunately, there are efficacious treatments available, with Family-Based Treatment (FBT) recommended as the outpatient intervention of choice for young people with AN. Treatment to protocol has relied on face-to-face delivery within specialist settings. FBT is subject to geographic, temporal, and human factors, rendering it susceptible to inequities and disruption, resulting in poorer service provision. Telehealth offers a potential solution to this problem. However, the barriers, facilitators, acceptability and effectiveness of the digital translation of evidence-based treatments from the ‘ivory tower’ of specialist clinics to ‘real world’ community health services remains unknown. Aims: The aim of the presentation is to discuss the barriers and facilitators of implementing telehealth-delivered FBT into the rural and regional mental health system. Methods: Implementation data (qualitative and quantitative) will be analysed to understand the barriers and facilitators of the early-implementation phase. Results: This presentation will discuss the barriers and facilitators during the early implementation of telehealth-delivered FBT within rural health services. Conclusions: If digitally delivered treatments are clinically effective, economically feasible, and embedded within health servicepathways, then access and treatment inequalities for geographically dispersed individuals may well be minimized. Further, the health system will be better positioned in the face of future service disruptions, such as those experienced in 2020-21.
Student-led Journal Club with a Technology for Asynchronous Discussions In-line with Content.
No full textBackground: Online journal club was begun in Feb 2014 in response to reducing online engagement by postgraduate doctors.Aim: To assess the impact of experiential based online discussions for postgraduate students enrolled in Master of Medicine (Ophthalmic Science) degree collaboratively run by the Universities of Sydney and Otago.Methods: This assignment was instituted in 3 units of study: Ophthalmic Physiology, Ophthalmic Anatomy and Optics. Students were assigned weekly discussion topics and encouraged to select a clinically relevant peer reviewed journal article related to the week’s lectures. 1-2 students developed summaries and the clinical implications of the basic sciences lectures discussed inside OB3 - a technology for asynchronous discussions in-line with content. Fellow students had 7 days to discuss and expand on these ideas and build a collaborative online document analyzing scientific evidence, other articles, relevance to basic sciences and future directions of research.Results: This online collaboration works very well as an assessment activity with the goal of showing students the relevance of basic science in clinical practice. Students are comfortable discussing papers that marry science and practice together because this is day-to-day work for them. OB3 has allowed us to provide a network within the course to discuss and monitor an article each week. A significant increase in discussions posts and access to journal pages was noticed over 12 months. This has been sustained over the last 7 years.Conclusion: Experiential online learning via a journal club in basic science units of study increase educational engagement of medical professionals enrolled in postgraduate degrees
‘I’ll Tell My Mother’: Dorothy Hewett and Literary Feminism after #Metoo
Get PDFIn the middle of 2018, which for me was also the mid-point in writing the biography of major Australian literary figure Dorothy Hewett, her daughters - writers Kate Lilley and Rosanna Lilley - each published a book revealing their parents’ complicity in their sexual abuse as teenagers in the 1970s. As they both acknowledge, their experiences were never secret, at least not to the people involved, not to some who knew them well from that period and not to those who know them well now. And their testimonies were already part of my research for the biography. The revelations provoked a full-blown press scandal, however, and became a key #MeToo moment in Australia, in which the betrayals of sexual liberation and second wave literary feminism have been held up for new scrutiny.This paper seeks to re-read Hewett’s poetry through her daughters’ works, understood as examples of what Leigh Gilmore identifies as MeTooLit, to examine the contrary rhetorical work of shame and what we may call freedom – both sexual liberation and the freedom to speak – in the thickly populous intertexts of rape culture that surround Hewett’s biography
Teaching and practicing group-work for social justice: A critical reflection on power and process
Get PDFIn this paper, we argue that groups and group-work practice are potential sites for working towards social justice. This demands a robust understanding and critique of power, reflexively applied into group-work practice. The attainment of social justice presupposes group-work practice that is emancipatory, action orientated, and imbued with individual and collective accountabilities towards understanding privilege and inequalities in power. By way of example, we illustrate our argument by critically examining group-work practice in relation to power and social justice considerations, particularly focusing on clinical, educative, and peer facilitated lived experience groups. Our aim is to teach group-work and apply group-work in our practices in a manner that is transformative, emancipatory, self-empowering and aligned with social justice agendas. Here we explore key themes and principles of group-work theory and practice, through practice reflections to illustrate the potential for groups as a vehicle for social justice praxis
Working towards cultural responsiveness and inclusion in Australia: The re-Indigenization of social work education
Get PDFThe scope of Australian social work education, training and practice models retain many of the Western components from which they were initially derived. Indigenization is concerned with the use of appropriate First Nation theories and practice methods that can transform the entrenched and sometimes enforced Westernised values, norms, and philosophies. This paper argues that social work education should prepare social workers to work with ethnic and culturally diverse populations and more safely with Indigenous peoples. The issues and challenges concerned with re-Indigenization and how social work education and practice should adapt are explored
Christos Tsiolkas's Style
Get PDFThis article takes up a specific feature of Christos Tsiolkas's writing, his style. Focusing on Tsiolkas's fourth novel, The Slap, this article argues that Tsiolkas’s style is an inarticulate style: a style that does not always use the right word at the right moment, that employs language for narrative utility rather than its own sake, and that sporadically departs from standard usage and correctness in ways that do not appear artistically motivated. My argument is that The Slap is notable among contemporary fiction in that what I consider to be Tsiolkas’s worst sentences are the most revealing of his inclinations as a novelist. Consequently, I depart from what has become a standard formula in Tsiolkas's reception, that where Tsiolkas succeeds as a writer he succeeds in spite of his style. Finally, this article also contributes to recent debates about the purpose and vocabulary of Australian literary discussion: how critics debate the work of a prize-winning author, how criticism and praise operate in critical judgements, and the significance of style in evaluations of literature
