While the opportunities of ML and AI in healthcare are promising, the growth of complex data-driven prediction models requires careful quality and applicability assessment before they are applied and disseminated in daily practice. This scoping review aimed to identify actionable guidance for those closely involved in AI-based prediction model (AIPM) development, evaluation and implementation including software engineers, data scientists, and healthcare professionals and to identify potential gaps in this guidance. We performed a scoping review of the relevant literature providing guidance or quality criteria regarding the development, evaluation, and implementation of AIPMs using a comprehensive multi-stage screening strategy. PubMed, Web of Science, and the ACM Digital Library were searched, and AI experts were consulted. Topics were extracted from the identified literature and summarized across the six phases at the core of this review: (1) data preparation, (2) AIPM development, (3) AIPM validation, (4) software development, (5) AIPM impact assessment, and (6) AIPM implementation into daily healthcare practice. From 2683 unique hits, 72 relevant guidance documents were identified. Substantial guidance was found for data preparation, AIPM development and AIPM validation (phases 1–3), while later phases clearly have received less attention (software development, impact assessment and implementation) in the scientific literature. The six phases of the AIPM development, evaluation and implementation cycle provide a framework for responsible introduction of AI-based prediction models in healthcare. Additional domain and technology specific research may be necessary and more practical experience with implementing AIPMs is needed to support further guidance.

Missing data is a common problem during the development, evaluation, and implementation of prediction models. Although machine learning (ML) methods are often said to be capable of circumventing missing data, it is unclear how these methods are used in medical research. We aim to find out if and how well prediction model studies using machine learning report on their handling of missing data. We systematically searched the literature on published papers between 2018 and 2019 about primary studies developing and/or validating clinical prediction models using any supervised ML methodology across medical fields. From the retrieved studies information about the amount and nature (e.g. missing completely at random, potential reasons for missingness) of missing data and the way they were handled were extracted. We identified 152 machine learning-based clinical prediction model studies. A substantial amount of these 152 papers did not report anything on missing data (n = 56/152). A majority (n = 96/152) reported details on the handling of missing data (e.g., methods used), though many of these (n = 46/96) did not report the amount of the missingness in the data. In these 96 papers the authors only sometimes reported possible reasons for missingness (n = 7/96) and information about missing data mechanisms (n = 8/96). The most common approach for handling missing data was deletion (n = 65/96), mostly via complete-case analysis (CCA) (n = 43/96). Very few studies used multiple imputation (n = 8/96) or built-in mechanisms such as surrogate splits (n = 7/96) that directly address missing data during the development, validation, or implementation of the prediction model. Though missing values are highly common in any type of medical research and certainly in the research based on routine healthcare data, a majority of the prediction model studies using machine learning does not report sufficient information on the presence and handling of missing data. Strategies in which patient data are simply omitted are unfortunately the most often used methods, even though it is generally advised against and well known that it likely causes bias and loss of analytical power in prediction model development and in the predictive accuracy estimates. Prediction model researchers should be much more aware of alternative methodologies to address missing data.

Background: Clinical prediction models are developed widely across medical disciplines. When predictors in such models are highly collinear, unexpected or spurious predictor-outcome associations may occur, thereby potentially reducing face-validity of the prediction model. Collinearity can be dealt with by exclusion of collinear predictors, but when there is no a priori motivation (besides collinearity) to include or exclude specific predictors, such an approach is arbitrary and possibly inappropriate.Methods: We compare different methods to address collinearity, including shrinkage, dimensionality reduction, and constrained optimization. The effectiveness of these methods is illustrated via simulations.Results: In the conducted simulations, no effect of collinearity was observed on predictive outcomes (AUC,R², Intercept, Slope) across methods. However, a negative effect of collinearity on the stability of predictor selection was found, affecting all compared methods, but in particular methods that perform strong predictor selection (e.g., Lasso). Methods for which the included set of predictors remained most stable under increased collinearity were Ridge, PCLR, LAELR, and Dropout.Conclusions: Based on the results, we would recommend refraining from data-driven predictor selection approaches in the presence of high collinearity, because of the increased instability of predictor selection, even in relatively high events-per-variable settings. The selection of certain predictors over others may disproportionally give the impression that included predictors have a stronger association with the outcome than excluded predictors.

Time is deeply woven into how people perceive, and communicate about the world. Almost unconsciously, we provide our language utterances with temporal cues, like verb tenses, and we can hardly produce sentences without such cues. Extracting temporal cues from text, and constructing a global temporal view about the order of described events is a major challenge of automatic natural language understanding. Temporal reasoning, the process of combining different temporal cues into a coherent temporal view, plays a central role in temporal information extraction. This article presents a comprehensive survey of the research from the past decades on temporal reasoning for automatic temporal information extraction from text, providing a case study on how combining symbolic reasoning with machine learning-based information extraction systems can improve performance. It gives a clear overview of the used methodologies for temporal reasoning, and explains how temporal reasoning can be, and has been successfully integrated into temporal information extraction systems. Based on the distillation of existing work, this survey also suggests currently unexplored research areas. We argue that the level of temporal reasoning that current systems use is still incomplete for the full task of temporal information extraction, and that a deeper understanding of how the various types of temporal information can be integrated into temporal reasoning is required to drive future research in this area.

In this paper we present a novel approach to minimally supervised synonym extraction. The approach is based on the word embeddings and aims at presenting a method for synonym extraction that is extensible to various languages. We report experiments with word vectors trained by using both the continuous bag-of-words model (CBoW) and the skip-gram model (SG) investigating the effects of different settings with respect to the contextual window size, the number of dimensions and the type of word vectors. We analyze the word categories that are (cosine) similar in the vector space, showing that cosine similarity on its own is a bad indicator to determine if two words are synonymous. In this context, we propose a new measure, relative cosine similarity, for calculating similarity relative to other cosine-similar words in the corpus. We show that calculating similarity relative to other words boosts the precision of the extraction. We also experiment with combining similarity scores from differently-trained vectors and explore the advantages of using a part-of-speech tagger as a way of introducing some light supervision, thus aiding extraction. We perform both intrinsic and extrinsic evaluation on our final system: intrinsic evaluation is carried out manually by two human evaluators and we use the output of our system in a machine translation task for extrinsic evaluation, showing that the extracted synonyms improve the evaluation metric.