Background: Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. Methods: A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. Results: Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family’s preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient’s preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. Conclusion: Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family’s decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

The study aims to create a preoperative model from baseline demographic and health-related quality of life scores (HRQOL) to predict a good to excellent early clinical outcome using a machine learning (ML) approach. A single spine surgery center retrospective review of prospectively collected data from January 2016 to December 2020 from the institutional registry (SpineREG) was performed. The inclusion criteria were age ≥ 18 years, both sexes, lumbar arthrodesis procedure, a complete follow up assessment (Oswestry Disability Index—ODI, SF-36 and COMI back) and the capability to read and understand the Italian language. A delta of improvement of the ODI higher than 12.7/100 was considered a “good early outcome”. A combined target model of ODI (Δ ≥ 12.7/100), SF-36 PCS (Δ ≥ 6/100) and COMI back (Δ ≥ 2.2/10) was considered an “excellent early outcome”. The performance of the ML models was evaluated in terms of sensitivity, i.e., True Positive Rate (TPR), specificity, i.e., True Negative Rate (TNR), accuracy and area under the receiver operating characteristic curve (AUC ROC). A total of 1243 patients were included in this study. The model for predicting ODI at 6 months’ follow up showed a good balance between sensitivity (74.3%) and specificity (79.4%), while providing a good accuracy (75.8%) with ROC AUC = 0.842. The combined target model showed a sensitivity of 74.2% and specificity of 71.8%, with an accuracy of 72.8%, and an ROC AUC = 0.808. The results of our study suggest that a machine learning approach showed high performance in predicting early good to excellent clinical results.

Background: In Switzerland, Aedes albopictus is well established in Ticino, south of the Alps, where surveillance and control are implemented. The mosquito has also been observed in Swiss cities north of the Alps. Decision-making tools are urgently needed by the local authorities in order to optimize surveillance and control. Methods: A regularized logistic regression was used to link the long-term dataset of Ae. albopictus occurrence in Ticino with socioenvironmental predictors. The probability of establishment of Ae. albopictus was extrapolated to Switzerland and more finely to the cities of Basel and Zurich. Results: The model performed well, with an AUC of 0.86. Ten socio-environmental predictors were selected as informative, including the road-based distance in minutes of travel by car from the nearest cell established in the previous year. The risk maps showed high suitability for Ae. albopictus establishment in the Central Plateau, the area of Basel, and the lower Rhone Valley in the Canton of Valais. Conclusions: The areas identified as suitable for Ae. albopictus establishment are consistent with the actual current findings of tiger mosquito. Our approach provides a useful tool to prompt authorities’ intervention in the areas where there is higher risk of introduction and establishment of Ae. albopictus.

We address the problem of integrating data from multiple, possibly biased, observational and interventional studies, to eventually compute counterfactuals in structural causal models. We start from the case of a single observational dataset affected by a selection bias. We show that the likelihood of the available data has no local maxima. This enables us to use the causal expectation-maximisation scheme to compute approximate bounds for partially identifiable counterfactual queries, which are the focus of this paper. We then show how the same approach can solve the general case of multiple datasets, no matter whether interventional or observational, biased or unbiased, by remapping it into the former one via graphical transformations. Systematic numerical experiments and a case study on palliative care show the effectiveness and accuracy of our approach, while hinting at the benefits of integrating heterogeneous data to get informative bounds in case of partial identifiability.

Causal analysis may be affected by selection bias, which is defined as the systematic exclusion of data from a certain subpopulation. Previous work in this area focused on the derivation of identifiability conditions. We propose instead a first algorithm to address both identifiable and unidentifiable queries. We prove that, in spite of the missingness induced by the selection bias, the likelihood of the available data is unimodal. This enables us to use the causal expectation-maximisation scheme to obtain the values of causal queries in the identifiable case, and to compute bounds otherwise. Experiments demonstrate the approach to be practically viable. Theoretical convergence characterisations are provided.

We address the problem of integrating data from multiple, possibly biased, observational and interventional studies, to eventually compute counterfactuals in structural causal models. We start from the case of a single observational dataset affected by a selection bias. We show that the likelihood of the available data has no local maxima. This enables us to use the causal expectation-maximisation scheme to approximate the bounds for partially identifiable counterfactual queries, which are the focus of this paper. We then show how the same approach can address the general case of multiple datasets, no matter whether interventional or observational, biased or unbiased, by remapping it into the former one via graphical transformations. Systematic numerical experiments and a case study on palliative care show the effectiveness of our approach, while hinting at the benefits of fusing heterogeneous data sources to get informative outcomes in case of partial identifiability.