Orhun Vural

Objectives: This study analyzes factors influencing Emergency Department (ED) overcrowding by examining the impacts of operational, environmental, and external variables, including weather conditions and football games. Materials and Methods: This retrospective observational study analyzed emergency department (ED) tracking and hospital census data from a southeastern U.S. academic medical center covering 2019–2023. These data were merged with corresponding weather, football event, and federal holiday data. The dependent variable was the hourly waiting count in the ED, our operational measure of overcrowding. Seven regression models were developed to assess different predictors across various timestamps. Results: Weather conditions were significantly correlated with increased ED waiting count in the Baseline Model, while federal holidays and weekends were consistently correlated with reduced waiting counts. Boarding count was positively correlated with ED waiting count when concurrent, but boarding counts 3 h and 6 h before showed significant negative correlations. Hospital census showed a negative correlation in the Baseline Model but shifted to a positive effect in other models, reflecting its time-dependent influence on ED operations. Football games 12 h before significantly correlated with increased waiting counts, while games 12 and 24 h after had no significant effects. Discussion: While existing research typically focuses on limited variables and narrow timeframes, the temporal relationships between operational and non-operational factors affecting ED overcrowding remain understudied, particularly the delayed impacts of external events and environmental conditions. Conclusions: This study emphasizes the importance of incorporating both operational and non-operational factors to understand ED patient flow. Identifying robust predictors such as weather conditions, federal holidays, boarding count, and hospital census can inform dynamic resource allocation strategies to mitigate ED overcrowding effectively.

Background: Emergency department (ED) overcrowding remains a critical challenge, leading to delays in patient care and increased operational strain. Current hospital management strategies often rely on reactive decision-making, addressing congestion only after it occurs. However, effective patient flow management requires early identification of overcrowding risks to allow timely interventions. Machine learning (ML)–based predictive modeling offers a solution by forecasting key patient flow measures, such as waiting count, enabling proactive resource allocation and improved hospital efficiency. Objective: The aim of this study is to develop ML models that predict ED waiting room occupancy (waiting count) at 2 temporal resolutions. The first approach is the hourly prediction model, which estimates the waiting count exactly 6 hours ahead at each prediction time (eg, a 1 PM prediction forecasts 7 PM). The second approach is the daily prediction model, which forecasts the average waiting count for the next 24-hour period (eg, a 5 PM prediction estimates the following day’s average). These predictive tools support resource allocation and help mitigate overcrowding by enabling proactive interventions before congestion occurs. Methods: Data from a partner hospital’s ED in the southeastern United States were used, integrating internal and external sources. Eleven different ML algorithms, ranging from traditional approaches to deep learning architectures, were systematically trained and evaluated on both hourly and daily predictions to determine the models that achieved the lowest prediction error. Experiments optimized feature combinations, and the best models were tested under high patient volume and across different hours to assess temporal accuracy. Results: The best hourly prediction performance was achieved by time series vision transformer plus (TSiTPlus) with a mean absolute error (MAE) of 4.19 and a mean squared error (MSE) of 29.36. The overall hourly waiting count had a mean of 18.11 and a SD (σ) of 9.77. Prediction accuracy varied by time of day, with the lowest MAE at 11 PM (2.45) and the highest at 8 PM (5.45). Extreme case analysis at (mean + 1σ), (mean + 2σ), and (mean + 3σ) resulted in MAEs of 6.16, 10.16, and 15.59, respectively. For daily predictions, an explainable convolutional neural network plus (XCMPlus) achieved the best results with an MAE of 2.00 and a MSE of 6.64. The daily waiting count had a mean of 18.11 and a SD of 4.51. Both models outperformed traditional forecasting approaches across multiple evaluation metrics. Conclusions: The proposed prediction models effectively forecast ED waiting count at both hourly and daily intervals. The results demonstrate the value of integrating diverse data sources and applying advanced modeling techniques to support proactive resource allocation decisions. The implementation of these forecasting tools within hospital management systems has the potential to improve patient flow and reduce overcrowding in emergency care settings. The code is available in our GitHub repository.

Emergency department (ED) overcrowding remains a major challenge for hospitals, resulting in worse outcomes, longer waits, elevated hospital operating costs, and greater strain on staff. Boarding count, the number of patients who have been admitted to an inpatient unit but are still in the ED waiting for transfer, is a key patient flow metric that affects overall ED operations. This study presents a deep learning-based approach to forecasting ED boarding counts using only operational and contextual features—derived from hourly ED tracking, inpatient census, weather, holiday, and local event data—without patient-level clinical information. Different deep learning algorithms were tested, including convolutional and transformer-based time-series models, and the best-performing model, Time Series Transformer Plus (TSTPlus), achieved strong performance at the 6-h prediction horizon, with a mean absolute error of 4.30 and an R² score of 0.79. After identifying TSTPlus as the best-performing model, its performance was further evaluated at additional horizons of 8, 10, and 12 h. The model was also evaluated under extreme operational conditions, demonstrating robust and accurate forecasts. These findings highlight the potential of the proposed forecasting approach to support proactive operational planning and reduce ED overcrowding.

Emergency department (ED) overcrowding remains a major challenge for hospitals, resulting in worse outcomes, longer waits, higher costs, and greater strain on staff. Boarding count—the number of admitted patients waiting for a bed—is a key patient flow metric that affects overall ED operations. This study presents a deep learning-based approach to forecast ED boarding counts six hours in advance using only operational and contextual features, without patient-level clinical data. Hourly data from ED tracking, inpatient census, weather, holidays, and local events were merged and preprocessed for model training. Multiple time series deep learning models were evaluated, including the CNN-based ResNetPlus and two transformer-based models, TSTPlus and TSiTPlus, with hyperparameters optimized using Optuna. TSTPlus achieved the best performance, with a mean absolute error of 4.30, mean squared error of 29.47, root mean squared error of 5.43, and an R² score of 0.79. Model explainability was analyzed to interpret the influence of different input features on predictions. The models were also tested under extreme scenarios, demonstrating accurate forecasts even in challenging conditions. Results show the models are effective for six-hour-ahead boarding count prediction, aiding proactive planning to reduce ED overcrowding. The source code and model implementation are available at https://github.com/drorhunvural/ED_OverCrowding_Predictions.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Emergency department (ED) overcrowding remains a critical challenge, leading to delays in patient care and increased operational strain. Current hospital management strategies often rely on reactive decision-making, addressing congestion only after it occurs. However, effective patient flow management requires early identification of overcrowding risks to allow timely interventions. Machine learning (ML)–based predictive modeling offers a solution by forecasting key patient flow measures, such as waiting count, enabling proactive resource allocation and improved hospital efficiency. Objective: The aim of this study is to develop ML models that predict ED waiting room occupancy (waiting count) at 2 temporal resolutions. The first approach is the hourly prediction model, which estimates the waiting count exactly 6 hours ahead at each prediction time (eg, a 1 PM prediction forecasts 7 PM). The second approach is the daily prediction model, which forecasts the average waiting count for the next 24-hour period (eg, a 5 PM prediction estimates the following day’s average). These predictive tools support resource allocation and help mitigate overcrowding by enabling proactive interventions before congestion occurs. Methods: Data from a partner hospital’s ED in the southeastern United States were used, integrating internal and external sources. Eleven different ML algorithms, ranging from traditional approaches to deep learning architectures, were systematically trained and evaluated on both hourly and daily predictions to determine the models that achieved the lowest prediction error. Experiments optimized feature combinations, and the best models were tested under high patient volume and across different hours to assess temporal accuracy. Results: The best hourly prediction performance was achieved by time series vision transformer plus (TSiTPlus) with a mean absolute error (MAE) of 4.19 and a mean squared error (MSE) of 29.36. The overall hourly waiting count had a mean of 18.11 and a SD (σ) of 9.77. Prediction accuracy varied by time of day, with the lowest MAE at 11 PM (2.45) and the highest at 8 PM (5.45). Extreme case analysis at (mean + 1σ), (mean + 2σ), and (mean + 3σ) resulted in MAEs of 6.16, 10.16, and 15.59, respectively. For daily predictions, an explainable convolutional neural network plus (XCMPlus) achieved the best results with an MAE of 2.00 and a MSE of 6.64. The daily waiting count had a mean of 18.11 and a SD of 4.51. Both models outperformed traditional forecasting approaches across multiple evaluation metrics. Conclusions: The proposed prediction models effectively forecast ED waiting count at both hourly and daily intervals. The results demonstrate the value of integrating diverse data sources and applying advanced modeling techniques to support proactive resource allocation decisions. The implementation of these forecasting tools within hospital management systems has the potential to improve patient flow and reduce overcrowding in emergency care settings. The code is available in our GitHub repository. Trial Registration:

Proteins, composed of amino acids, are crucial for a wide range of biological functions. Proteins have various interaction sites, one of which is the protein-ligand binding site, essential for molecular interactions and biochemical reactions. These sites enable proteins to bind with other molecules, facilitating key biological functions. Accurate prediction of these binding sites is pivotal in computational drug discovery, helping to identify therapeutic targets and facilitate treatment development. Machine learning has made significant contributions to this field by improving the prediction of protein-ligand interactions. This paper reviews studies that use machine learning to predict protein-ligand binding sites from sequence data, focusing on recent advancements. The review examines various embedding methods and machine learning architectures, addressing current challenges and the ongoing debates in the field. Additionally, research gaps in the existing literature are highlighted, and potential future directions for advancing the field are discussed. This study provides a thorough overview of sequence-based approaches for predicting protein-ligand binding sites, offering insights into the current state of research and future possibilities.

The analysis of protein-ligand binding sites plays a crucial role in the initial stages of drug discovery. Accurately predicting the ligand types that are likely to bind to protein-ligand binding sites enables more informed decision making in drug design. Our study, DeepLigType, determines protein-ligand binding sites using Fpocket and then predicts the ligand type of these pockets with the deep learning model, Convolutional Block Attention Module (CBAM) with ResNet. CBAM-ResNet has been trained to accurately predict five distinct ligand types. We classified protein-ligand binding sites into five different categories according to the type of response ligands cause when they bind to their target proteins, which are antagonist, agonist, activator, inhibitor, and others. We created a novel dataset, referred to as LigType5, from the widely recognized PDBbind and scPDB dataset for training and testing our model. While the literature mostly focuses on the specificity and characteristic analysis of protein binding sites by experimental (laboratory-based) methods, we propose a computational method with the DeepLigType architecture. DeepLigType demonstrated an accuracy of 74.30% and an AUC of 0.83 in ligand type prediction on a novel test dataset using the CBAM-ResNet deep learning model. For access to the code implementation of this research, please visit our GitHub repository at https://github.com/drorhunvural/DeepLigType