array:24 [
  "pii" => "S2173572723000759"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2023.06.004"
  "estado" => "S300"
  "fechaPublicacion" => "2023-10-01"
  "aid" => "1890"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Intensiva. 2023;47:616"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569123001213"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2023.05.005"
      "estado" => "S300"
      "fechaPublicacion" => "2023-10-01"
      "aid" => "1890"
      "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Intensiva. 2023;47:616"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">CARTA AL EDITOR</span>"
        "titulo" => "La medicina es frecuentemente desequilibrada"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "616"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Medicine is often imbalanced"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Valiente Fern&#225;ndez"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Valiente Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572723000759"
          "doi" => "10.1016/j.medine.2023.06.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000759?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123001213?idApp=WMIE"
      "url" => "/02105691/0000004700000010/v3_202402090611/S0210569123001213/v3_202402090611/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S217357272300125X"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2023.07.004"
    "estado" => "S300"
    "fechaPublicacion" => "2023-10-01"
    "aid" => "1902"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Intensiva. 2023;47:617"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Reply to&#58; &#8220;Artificial intelligence in scientific publishing&#58; Embracing change and addressing&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "617"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Respuesta a&#58; &#171;Inteligencia artificialen las publicaciones cient&#237;ficas&#58; abrazar el cambio y abordar susconsideraciones &#233;ticas&#187;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "EdgarJos&#233; Marcano-Mill&#225;n, Federico Gordo, F&#233;lix Mart&#237;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "EdgarJos&#233;"
              "apellidos" => "Marcano-Mill&#225;n"
            ]
            1 => array:2 [
              "nombre" => "Federico"
              "apellidos" => "Gordo"
            ]
            2 => array:2 [
              "nombre" => "F&#233;lix"
              "apellidos" => "Mart&#237;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569123002036"
        "doi" => "10.1016/j.medin.2023.06.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123002036?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357272300125X?idApp=WMIE"
    "url" => "/21735727/0000004700000010/v3_202311091840/S217357272300125X/v3_202311091840/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173572723000826"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2023.05.018"
    "estado" => "S300"
    "fechaPublicacion" => "2023-10-01"
    "aid" => "1894"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Intensiva. 2023;47:603-15"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Update in intensive care medicine&#58; ultrasound in the critically ill patient&#46; Clinical applications</span>"
      "titulo" => "Selective decontamination of the digestive tract&#58; concept and application"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "603"
          "paginaFinal" => "615"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Descontaminaci&#243;n digestiva del tracto digestivo&#58; concepto y aplicaci&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1407
              "Ancho" => 3264
              "Tamanyo" => 98382
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0035"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of endogenous infections in the critical patient&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Eva Esther Tejerina-&#193;lvarez, Miguel &#193;ngel de la Cal L&#243;pez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Eva Esther"
              "apellidos" => "Tejerina-&#193;lvarez"
            ]
            1 => array:2 [
              "nombre" => "Miguel &#193;ngel"
              "apellidos" => "de la Cal L&#243;pez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569123001250"
        "doi" => "10.1016/j.medin.2023.05.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123001250?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000826?idApp=WMIE"
    "url" => "/21735727/0000004700000010/v3_202311091840/S2173572723000826/v3_202311091840/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Medicine is often imbalanced"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#58;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "616"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Marcos Valiente Fern&#225;ndez"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Marcos"
            "apellidos" => "Valiente Fern&#225;ndez"
            "email" => array:1 [
              0 => "mvalientefernandez@gmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario 12 de Octubre&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La medicina es&#44; frecuentemente&#44; desequilibrada"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the article authored by H&#46; Lozano G&#243;mez et al&#46; entitled &#8220;Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#8221; the authors aim to create an algorithm to detect mortality in a highly relevant condition such as acute coronary syndrome&#46; Firstly&#44; I would like to acknowledge the value of their work considering the inherent complexity of the database they dealt with&#44; and the innovative methodology used&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; I would like to emphasize an aspect that I believe has not been adequately addressed in the study limitations section&#46; The database is highly complex due to its imbalance since the event of interest &#40;mortality&#41; has a very low prevalence &#40;&#60;5&#37;&#41;&#46; This causes various problems that I intend to discuss&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evaluation metrics used in models are important because they guide the selection of the best possible model&#46; If guidance is not accurate&#44; then the selected model will not provide the results we&#8217;re looking for&#46; The metric used in the study was the area under the receiver operating characteristic &#40;ROC&#41; curve&#44; which tends to be particularly optimistic in imbalanced datasets&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Maybe that is why&#44; in the validation dataset&#44; a 12&#37; sensitivity rate and a 48&#37; positive predictive value were reported&#46; These values are likely far from the target set by the algorithm&#46; However&#44; it is often difficult to use a different metric &#40;even if suboptimal&#41; to maintain comparative power with other studies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The problem of imbalance and the metric may have been more serious due to the algorithm chosen &#40;Multilayer perceptron&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Algorithms tend to optimize the overall result&#44; and their internal optimization is often impacted by the dominant class &#40;in the current problem&#44; &#8220;alive&#8221;&#41;&#46; Technically&#44; the vector of the dominant class of the variable of interest &#40;alive&#41; is more &#8220;powerful&#8221; during the <span class="elsevierStyleItalic">gradient descent</span> obtained during optimization through back propagation&#46; As a result&#44; in imbalanced databases&#44; the algorithm tends to optimize the proper classification of the dominant class in the event of interest &#40;alive&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To address these problems&#44; different methods have been proposed that act on both the database and the algorithms themselves&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the dataset&#58; sampling techniques are suggested for a better balance of the sample whether by increasing the number of cases of interest &#40;deaths&#41;&#44; decreasing the number of non-interest cases &#40;alive&#41; or both at the same time&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the algorithm&#58; using boosting-based algorithms&#44; adopting algorithms with cost functions&#44; and using threshold methods &#40;which were used in the article but seemingly did not achieve the desired effect&#41;&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; extreme imbalance poses complex statistical problems that are difficult to solve&#46; The commonly used ROC curve can yield &#8220;misleading&#8221; results&#44; and in this context&#44; further reflection and consideration are required regarding data preprocessing and the algorithm of choice&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">None whatsoever&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Funding"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Conflicts of interest"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Lozano G&#243;mez H&#44; Rodr&#237;guez Garc&#237;a A&#44; Rodr&#237;guez Esteban M&#193;&#44; L&#243;pez Ferraz C&#44; Murcia Hern&#225;ndez MDP&#44; Fern&#225;ndez Zapata A&#44; et al&#46; Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit&#46; Medicina intensiva&#46; S2173-5727&#40;23&#41;00028-0&#46; Advance online publication&#46; <a target="_blank" href="https://doi.org/10.1016/j.medine.2023.03.008">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medine&#46;2023&#46;03&#46;008</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Branco P&#44; Torgo L&#44; Ribeiro RP&#46; A survey of predictive modelling under imbalanced distributions&#46; Available from&#58; Q5arXiv&#58;1505&#46;01658&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of imbalanced data&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Sun"
                            1 => "A&#46;K&#46;C&#46; Wong"
                            2 => "M&#46;S&#46; Kamel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Pattern Recognit Artif Intell"
                        "fecha" => "2009"
                        "volumen" => "23"
                        "paginaInicial" => "687"
                        "paginaFinal" => "719"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004700000010/v3_202311091840/S2173572723000759/v3_202311091840/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "64604"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004700000010/v3_202311091840/S2173572723000759/v3_202311091840/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000759?idApp=WMIE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Letter to the Editor
Medicine is often imbalanced
La medicina es, frecuentemente, desequilibrada
Marcos Valiente Fernández
Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
Read
821
Times
was read the article
364
Total PDF
457
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173572723000759"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2023.06.004"
  "estado" => "S300"
  "fechaPublicacion" => "2023-10-01"
  "aid" => "1890"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Intensiva. 2023;47:616"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569123001213"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2023.05.005"
      "estado" => "S300"
      "fechaPublicacion" => "2023-10-01"
      "aid" => "1890"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Intensiva. 2023;47:616"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">CARTA AL EDITOR</span>"
        "titulo" => "La medicina es frecuentemente desequilibrada"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "616"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Medicine is often imbalanced"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Valiente Fern&#225;ndez"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Valiente Fern&#225;ndez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572723000759"
          "doi" => "10.1016/j.medine.2023.06.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000759?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123001213?idApp=WMIE"
      "url" => "/02105691/0000004700000010/v3_202402090611/S0210569123001213/v3_202402090611/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S217357272300125X"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2023.07.004"
    "estado" => "S300"
    "fechaPublicacion" => "2023-10-01"
    "aid" => "1902"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Intensiva. 2023;47:617"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Reply to&#58; &#8220;Artificial intelligence in scientific publishing&#58; Embracing change and addressing&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "617"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Respuesta a&#58; &#171;Inteligencia artificialen las publicaciones cient&#237;ficas&#58; abrazar el cambio y abordar susconsideraciones &#233;ticas&#187;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "EdgarJos&#233; Marcano-Mill&#225;n, Federico Gordo, F&#233;lix Mart&#237;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "EdgarJos&#233;"
              "apellidos" => "Marcano-Mill&#225;n"
            ]
            1 => array:2 [
              "nombre" => "Federico"
              "apellidos" => "Gordo"
            ]
            2 => array:2 [
              "nombre" => "F&#233;lix"
              "apellidos" => "Mart&#237;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569123002036"
        "doi" => "10.1016/j.medin.2023.06.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123002036?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357272300125X?idApp=WMIE"
    "url" => "/21735727/0000004700000010/v3_202311091840/S217357272300125X/v3_202311091840/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173572723000826"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2023.05.018"
    "estado" => "S300"
    "fechaPublicacion" => "2023-10-01"
    "aid" => "1894"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Intensiva. 2023;47:603-15"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Update in intensive care medicine&#58; ultrasound in the critically ill patient&#46; Clinical applications</span>"
      "titulo" => "Selective decontamination of the digestive tract&#58; concept and application"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "603"
          "paginaFinal" => "615"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Descontaminaci&#243;n digestiva del tracto digestivo&#58; concepto y aplicaci&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1407
              "Ancho" => 3264
              "Tamanyo" => 98382
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0035"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathogenesis of endogenous infections in the critical patient&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Eva Esther Tejerina-&#193;lvarez, Miguel &#193;ngel de la Cal L&#243;pez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Eva Esther"
              "apellidos" => "Tejerina-&#193;lvarez"
            ]
            1 => array:2 [
              "nombre" => "Miguel &#193;ngel"
              "apellidos" => "de la Cal L&#243;pez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569123001250"
        "doi" => "10.1016/j.medin.2023.05.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123001250?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000826?idApp=WMIE"
    "url" => "/21735727/0000004700000010/v3_202311091840/S2173572723000826/v3_202311091840/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Medicine is often imbalanced"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#58;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "616"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Marcos Valiente Fern&#225;ndez"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Marcos"
            "apellidos" => "Valiente Fern&#225;ndez"
            "email" => array:1 [
              0 => "mvalientefernandez@gmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario 12 de Octubre&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La medicina es&#44; frecuentemente&#44; desequilibrada"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the article authored by H&#46; Lozano G&#243;mez et al&#46; entitled &#8220;Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#8221; the authors aim to create an algorithm to detect mortality in a highly relevant condition such as acute coronary syndrome&#46; Firstly&#44; I would like to acknowledge the value of their work considering the inherent complexity of the database they dealt with&#44; and the innovative methodology used&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; I would like to emphasize an aspect that I believe has not been adequately addressed in the study limitations section&#46; The database is highly complex due to its imbalance since the event of interest &#40;mortality&#41; has a very low prevalence &#40;&#60;5&#37;&#41;&#46; This causes various problems that I intend to discuss&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evaluation metrics used in models are important because they guide the selection of the best possible model&#46; If guidance is not accurate&#44; then the selected model will not provide the results we&#8217;re looking for&#46; The metric used in the study was the area under the receiver operating characteristic &#40;ROC&#41; curve&#44; which tends to be particularly optimistic in imbalanced datasets&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Maybe that is why&#44; in the validation dataset&#44; a 12&#37; sensitivity rate and a 48&#37; positive predictive value were reported&#46; These values are likely far from the target set by the algorithm&#46; However&#44; it is often difficult to use a different metric &#40;even if suboptimal&#41; to maintain comparative power with other studies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The problem of imbalance and the metric may have been more serious due to the algorithm chosen &#40;Multilayer perceptron&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Algorithms tend to optimize the overall result&#44; and their internal optimization is often impacted by the dominant class &#40;in the current problem&#44; &#8220;alive&#8221;&#41;&#46; Technically&#44; the vector of the dominant class of the variable of interest &#40;alive&#41; is more &#8220;powerful&#8221; during the <span class="elsevierStyleItalic">gradient descent</span> obtained during optimization through back propagation&#46; As a result&#44; in imbalanced databases&#44; the algorithm tends to optimize the proper classification of the dominant class in the event of interest &#40;alive&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To address these problems&#44; different methods have been proposed that act on both the database and the algorithms themselves&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the dataset&#58; sampling techniques are suggested for a better balance of the sample whether by increasing the number of cases of interest &#40;deaths&#41;&#44; decreasing the number of non-interest cases &#40;alive&#41; or both at the same time&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the algorithm&#58; using boosting-based algorithms&#44; adopting algorithms with cost functions&#44; and using threshold methods &#40;which were used in the article but seemingly did not achieve the desired effect&#41;&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; extreme imbalance poses complex statistical problems that are difficult to solve&#46; The commonly used ROC curve can yield &#8220;misleading&#8221; results&#44; and in this context&#44; further reflection and consideration are required regarding data preprocessing and the algorithm of choice&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">None whatsoever&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Funding"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Conflicts of interest"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Lozano G&#243;mez H&#44; Rodr&#237;guez Garc&#237;a A&#44; Rodr&#237;guez Esteban M&#193;&#44; L&#243;pez Ferraz C&#44; Murcia Hern&#225;ndez MDP&#44; Fern&#225;ndez Zapata A&#44; et al&#46; Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit&#46; Medicina intensiva&#46; S2173-5727&#40;23&#41;00028-0&#46; Advance online publication&#46; <a target="_blank" href="https://doi.org/10.1016/j.medine.2023.03.008">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medine&#46;2023&#46;03&#46;008</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Branco P&#44; Torgo L&#44; Ribeiro RP&#46; A survey of predictive modelling under imbalanced distributions&#46; Available from&#58; Q5arXiv&#58;1505&#46;01658&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of imbalanced data&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Sun"
                            1 => "A&#46;K&#46;C&#46; Wong"
                            2 => "M&#46;S&#46; Kamel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Pattern Recognit Artif Intell"
                        "fecha" => "2009"
                        "volumen" => "23"
                        "paginaInicial" => "687"
                        "paginaFinal" => "719"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004700000010/v3_202311091840/S2173572723000759/v3_202311091840/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "64604"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004700000010/v3_202311091840/S2173572723000759/v3_202311091840/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000759?idApp=WMIE"
]
Article information
ISSN: 21735727
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 5 10
2024 October 46 48 94
2024 September 58 29 87
2024 August 47 40 87
2024 July 40 33 73
2024 June 32 36 68
2024 May 46 26 72
2024 April 35 31 66
2024 March 49 25 74
2024 February 43 39 82
2024 January 52 48 100
2023 December 3 2 5
2023 October 1 2 3
Show all

Follow this link to access the full text of the article

Idiomas
Medicina Intensiva (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?