Using the hidden Markov model to capture quality of care in Lombardy geriatric wards

Quality of care is an important aspect of healthcare monitoring, which is used to ensure that the healthcare system is delivering care of the highest standard. With populations growing older there is an increased urgency in making sure that the healthcare delivered is of the highest standard. Healthcare providers are under increased pressure to ensure that this is the case with public and government demand expecting a healthcare system of the highest quality. Modelling quality of care is difficult to measure due to the many ways of defining it. This paper introduces a potential model which could be used to take quality of care into account when modelling length of stay. The Coxian phase-type distribution is used to model length of stay and the associated quality of care incorporated into the Coxian using a Hidden Markov model. Covariates are also introduced to determine their impact on the hidden level to find out what potentially can affect quality of care. This model is applied to geriatic patient data from the Lombardy region of Italy. The results obtained highlighted that bed numbers and the type of hospital (public or private) can have an effect on the quality of care delivered.

Using a Discrete Hidden Markov Model Kernel for lip-based biometric identification

In this paper, a novel and effective lip-based biometric identification approach with the Discrete Hidden Markov Model Kernel (DHMMK) is developed. Lips are described by shape features (both geometrical and sequential) on two different grid layouts: rectangular and polar. These features are then specifically modeled by a DHMMK, and learnt by a support vector machine classifier. Our experiments are carried out in a ten-fold cross validation fashion on three different datasets, GPDS-ULPGC Face Dataset, PIE Face Dataset and RaFD Face Dataset. Results show that our approach has achieved an average classification accuracy of 99.8%, 97.13%, and 98.10%, using only two training images per class, on these three datasets, respectively. Our comparative studies further show that the DHMMK achieved a 53% improvement against the baseline HMM approach. The comparative ROC curves also confirm the efficacy of the proposed lip contour based biometrics learned by DHMMK. We also show that the performance of linear and RBF SVM is comparable under the frame work of DHMMK.

Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model.

INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

Model estimation of cerebral hemodynamics between blood flow and volume changes: A data-based modeling approach

It is well known that there is a dynamic relationship between cerebral blood flow (CBF) and cerebral blood volume (CBV). With increasing applications of functional MRI, where the blood oxygen-level-dependent signals are recorded, the understanding and accurate modeling of the hemodynamic relationship between CBF and CBV becomes increasingly important. This study presents an empirical and data-based modeling framework for model identification from CBF and CBV experimental data. It is shown that the relationship between the changes in CBF and CBV can be described using a parsimonious autoregressive with exogenous input model structure. It is observed that neither the ordinary least-squares (LS) method nor the classical total least-squares (TLS) method can produce accurate estimates from the original noisy CBF and CBV data. A regularized total least-squares (RTLS) method is thus introduced and extended to solve such an error-in-the-variables problem. Quantitative results show that the RTLS method works very well on the noisy CBF and CBV data. Finally, a combination of RTLS with a filtering method can lead to a parsimonious but very effective model that can characterize the relationship between the changes in CBF and CBV.

Benchmarks and the accuracy of GARCH model estimation

This paper reviews nine software packages with particular reference to their GARCH model estimation accuracy when judged against a respected benchmark. We consider the numerical consistency of GARCH and EGARCH estimation and forecasting. Our results have a number of implications for published research and future software development. Finally, we argue that the establishment of benchmarks for other standard non-linear models is long overdue.

Decomposition of surface electromyographic signal using Hidden Markov Model

The detection of physiological signals from the motor system (electromyographic signals) is being utilized in the practice clinic to guide the therapist in a more precise and accurate diagnosis of motor disorders. In this context, the process of decomposition of EMG (electromyographic) signals that includes the identification and classification of MUAP (Motor Unit Action Potential) of a EMG signal, is very important to help the therapist in the evaluation of motor disorders. The EMG decomposition is a complex task due to EMG features depend on the electrode type (needle or surface), its placement related to the muscle, the contraction level and the health of the Neuromuscular System. To date, the majority of researches on EMG decomposition utilize EMG signals acquired by needle electrodes, due to their advantages in processing this type of signal. However, relatively few researches have been conducted using surface EMG signals. Thus, this article aims to contribute to the clinical practice by presenting a technique that permit the decomposition of surface EMG signal via the use of Hidden Markov Models. This process is supported by the use of differential evolution and spectral clustering techniques. The developed system presented coherent results in: (1) identification of the number of Motor Units actives in the EMG signal; (2) presentation of the morphological patterns of MUAPs in the EMG signal; (3) identification of the firing sequence of the Motor Units. The model proposed in this work is an advance in the research area of decomposition of surface EMG signals.

An evaluation of contemporary hidden Markov model genefinders with a predicted exon taxonomy

We present an independent evaluation of six recent hidden Markov model (HMM) genefinders. Each was tested on the new dataset (FSH298), the results of which showed no dramatic improvement over the genefinders tested five years ago. In addition, we introduce a comprehensive taxonomy of predicted exons and classify each resulting exon accordingly. These results are useful in measuring (with finer granularity) the effects of changes in a genefinder. We present an analysis of these results and identify four patterns of inaccuracy common in all HMM-based results.

Policy recognition in the Abstract Hidden Markov Model

In this paper, we present a method for recognising an agent's behaviour in dynamic, noisy, uncertain domains, and across multiple levels of abstraction. We term this problem on-line plan recognition under uncertainty and view it generally as probabilistic inference on the stochastic process representing the execution of the agent's plan. Our contributions in this paper are twofold. In terms of probabilistic inference, we introduce the Abstract Hidden Markov Model (AHMM), a novel type of stochastic processes, provide its dynamic Bayesian network (DBN) structure and analyse the properties of this network. We then describe an application of the Rao-Blackwellised Particle Filter to the AHMM which allows us to construct an efficient, hybrid inference method for this model. In terms of plan recognition, we propose a novel plan recognition framework based on the AHMM as the plan execution model. The Rao-Blackwellised hybrid inference for AHMM can take advantage of the independence properties inherent in a model of plan execution, leading to an algorithm for online probabilistic plan recognition that scales well with the number of levels in the plan hierarchy. This illustrates that while stochastic models for plan execution can be complex, they exhibit special structures which, if exploited, can lead to efficient plan recognition algorithms. We demonstrate the usefulness of the AHMM framework via a behaviour recognition system in a complex spatial environment using distributed video surveillance data.

Tracking and surveillance in wide-area spatial environments using the abstract hidden markov model.

In this paper, we consider the problem of tracking an object and predicting the object's future trajectory in a wide-area environment, with complex spatial layout and the use of multiple sensors/cameras. To solve this problem, there is a need for representing the dynamic and noisy data in the tracking tasks, and dealing with them at different levels of detail. We employ the Abstract Hidden Markov Models (AHMM), an extension of the well-known Hidden Markov Model (HMM) and a special type of Dynamic Probabilistic Network (DPN), as our underlying representation framework. The AHMM allows us to explicitly encode the hierarchy of connected spatial locations, making it scalable to the size of the environment being modeled. We describe an application for tracking human movement in an office-like spatial layout where the AHMM is used to track and predict the evolution of object trajectories at different levels of detail.

Human behavior recognition with generic exponential family duration modeling in the hidden semi-Markov model

The ability to learn and recognize human activities of daily living (ADLs) is important in building pervasive and smart environments. In this paper, we tackle this problem using the hidden semi-Markov model. We discuss the state-of-the-art duration modeling choices and then address a large class of exponential family distributions to model state durations. Inference and learning are efficiently addressed by providing a graphical representation for the model in terms of a dynamic Bayesian network (DBN). We investigate both discrete and continuous distributions from the exponential family (Poisson and Inverse Gaussian respectively) for the problem of learning and recognizing ADLs. A full comparison between the exponential family duration models and other existing models including the traditional multinomial and the new Coxian are also presented. Our work thus completes a thorough investigation into the aspect of duration modeling and its application to human activities recognition in a real-world smart home surveillance scenario.

Activity recognition and abnormality detection with the switching hidden semi-Markov model

This paper addresses the problem of learning and recognizing human activities of daily living (ADL), which is an important research issue in building a pervasive and smart environment. In dealing with ADL, we argue that it is beneficial to exploit both the inherent hierarchical organization of the activities and their typical duration. To this end, we introduce the Switching Hidden Semi-Markov Model (S-HSMM), a two-layered extension of the hidden semi-Markov model (HSMM) for the modeling task. Activities are modeled in the S-HSMM in two ways: the bottom layer represents atomic activities and their duration using HSMMs; the top layer represents a sequence of high-level activities where each high-level activity is made of a sequence of atomic activities. We consider two methods for modeling duration: the classic explicit duration model using multinomial distribution, and the novel use of the discrete Coxian distribution. In addition, we propose an effective scheme to detect abnormality without the need for training on abnormal data. Experimental results show that the S-HSMM performs better than existing models including the flat HSMM and the hierarchical hidden Markov model in both classification and abnormality detection tasks, alleviating the need for presegmented training data. Furthermore, our discrete Coxian duration model yields better computation time and generalization error than the classic explicit duration model.

Polymorphic malware detection using Hierarchical Hidden Markov Model

Binary signatures have been widely used to detect malicious software on the current Internet. However, this approach is unable to achieve the accurate identification of polymorphic malware variants, which can be easily generated by the malware authors using code generation engines. Code generation engines randomly produce varying code sequences but perform the same desired malicious functions. Previous research used flow graph and signature tree to identify polymorphic malware families. The key difficulty of previous research is the generation of precisely defined state machine models from polymorphic variants. This paper proposes a novel approach, using Hierarchical Hidden Markov Model (HHMM), to provide accurate inductive inference of the malware family. This model can capture the features of self-similar and hierarchical structure of polymorphic malware family signature sequences. To demonstrate the effectiveness and efficiency of this approach, we evaluate it with real malware samples. Using more than 15,000 real malware, we find our approach can achieve high true positives, low false positives, and low computational cost.

Discovery of activity structures using the hierarchical hidden Markov model

In building a surveillance system for monitoring people behaviours, it is important to understand the typical patterns of people's movement in the environment. This task is difficult when dealing with high-level behaviours. The flat model such as the hidden Markov model (HMM) is inefficient in differentiating between signatures of such behaviours. This paper examines structure learning for high-level behaviours using the hierarchical hidden Markov model (HHMM).We propose a two-phase learning algorithm in which the parameters of the behaviours at low levels are estimated first and then the structures and parameters of the behaviours at high levels are learned from multi-camera training data. Our algorithm is then evaluated using data from a real environment, demonstrating the robustness of the learned structure in recognising people's behaviour.

Efficient Coxian duration modelling for activity recognition in smart environment with the hidden semi-Markov model

In this paper, we exploit the discrete Coxian distribution and propose a novel form of stochastic model, termed as the Coxian hidden semi-Makov model (Cox-HSMM), and apply it to the task of recognising activities of daily living (ADLs) in a smart house environment. The use of the Coxian has several advantages over traditional parameterization (e.g. multinomial or continuous distributions) including the low number of free parameters needed, its computational efficiency, and the existing of closed-form solution. To further enrich the model in real-world applications, we also address the problem of handling missing observation for the proposed Cox-HSMM. In the domain of ADLs, we emphasize the importance of the duration information and model it via the Cox-HSMM. Our experimental results have shown the superiority of the Cox-HSMM in all cases when compared with the standard HMM. Our results have further shown that outstanding recognition accuracy can be achieved with relatively low number of phases required in the Coxian, thus making the Cox-HSMM particularly suitable in recognizing ADLs whose movement trajectories are typically very long in nature.