Foresight-England: Development of a National-Scale Generative AI Model of Electronic Health Records for Medical Event Prediction across the COVID-19 Pandemic

Foresight-England (Foresight-E) is the first national-scale generative foundation model of electronic health records (EHRs), developed as a research pilot strictly for COVID-19 research. We evaluated its ability to model the direct and indirect effects of the pandemic. Trained from scratch entirely within the NHS England Secure Data Environment, Foresight-E is a 243-million-parameter transformer decoder. It was trained and evaluated on de-identified, longitudinal EHRs of approximately 61 million individuals, integrating primary/secondary care, death registrations, and COVID-19 data. Training and validation used a 90% subset (54.9 million) spanning November 2018 to December 2022; the remaining 10% (6.1 million) was held out for evaluation. Foresight-E models patient timelines autoregressively, predicting the next medical event given their prior history. At inference, it operates zero-shot, predicting any concept in its ~40,000-code vocabulary without task-specific training. Our tokenisation scheme retains the clinical granularity of ICD-10, OPCS-4, and SNOMED CT codes, jointly representing absolute and relative timing. We designed an evaluation framework for 30-day COVID-19 hospitalisation and mortality, including subgroup analyses by demographic factors and vaccination status. To assess generalisation to unseen future data and the pandemic's indirect effects, we tested the model on medical events from 2023 (beyond its training period), benchmarking against logistic regression and XGBoost. As detailed in the Project Status section, NHS England has paused access to data for the Foresight-E project, meaning quantitative results are currently unavailable. Instead, we share our strategy for tokenisation, architecture, training, inference, and evaluation as a methodological template and case study in the challenges of building population-scale EHR foundation models.

Machine Learning and ARIMA Model Averaging for Adaptive Public Health Forecasting: Comparative Evaluation and an Ontario COVID-19 Case Study

Public health forecasts must respond to abrupt changes in surveillance data without over-extrapolating noise, reporting artifacts, or temporary trends. We evaluated autoregressive integrated moving average (ARIMA), random forest, and extreme gradient boosting (XGBoost) models using 190 weekly observations of publicly available Ontario COVID-19 case counts from January 2020 to October 2023. Rolling-origin time-series cross-validation preserved temporal order during model tuning and evaluation. Performance was assessed across three operating dimensions: responsiveness following selected turning points, forecast horizons of one to six weeks, and the amount of historical training data. We also developed Machine Learning and ARIMA Model Averaging (MLAMA), a non-negative performance-weighted ensemble with weights that vary by forecast horizon and responsiveness setting. Retrospective comparisons showed that ARIMA adapted rapidly after turning points but its normalized error increased at longer horizons. Random forest and XGBoost were less responsive initially but maintained more stable normalized error over longer horizons. For two-week forecasts at the end of the study period, training on the most recent data outperformed using longer historical periods, particularly for XGBoost. MLAMA achieved the lowest normalized mean absolute percentage error across most forecast horizons and ranked among the best-performing methods across responsiveness settings. These findings support selecting forecasting models according to operating conditions rather than relying on a single universally preferred approach. MLAMA provides a practical framework for combining complementary statistical and machine-learning forecasts. The accompanying Python package is currently maintained in a private repository while software validation and reproducibility testing are completed.

EpiFlow: A framework for improving the utility of wastewater signals for disease forecasting

Wastewater-based surveillance is an effective tool for disease monitoring and can provide early warning of outbreaks. Although wastewater viral loads (WVL) correlate with disease burden, their utility for improving real-time forecasting remains under investigation. During the early phases of an epidemic, many indicators can effectively monitor disease spread, but their reliability may decline because of reporting fatigue and low prevalence. Hospital burden can vary substantially even during low-prevalence periods, making accurate forecasting of burden indicators essential for minimizing disease impacts. In this paper, we present principled approaches for processing wastewater data, characterizing its relationship with burden indicators, and generating real-time forecasts. We assess the predictability of WVL using entropy measures. We analyze the relationship between WVL and burden indicators using causality tests that capture temporal dynamics and the leading-indicator behavior of WVL. We incorporate these insights into a time-varying forecasting model that accounts for the evolving relationship between the signals. We also evaluate the effects of delays in WVL reporting through simulations. We test the utility of our methods by forecasting COVID-19 hospital admissions across Virginia and its health regions during periods of varying disease prevalence. Incorporating WVL improves forecast accuracy relative to baseline models, particularly during critical epidemic phases, and results in a 20 percentage point improvement in forecast coverage. Our results demonstrate that WVL signals can improve infectious disease forecasting even under conditions of low prevalence or delayed reporting.

Classification of COVID-19 cases from chest CT volumes using hybrid model of 3D CNN and 3D MLP-Mixer

This paper proposes an automated classification method of COVID-19 chest CT volumes using improved 3D MLP-Mixer. Novel coronavirus disease 2019 (COVID-19) spreads over the world, causing a large number of infected patients and deaths. Sudden increase in the number of COVID-19 patients causes a manpower shortage in medical institutions. Computer-aided diagnosis (CAD) system provides quick and quantitative diagnosis results. CAD system for COVID-19 enables efficient diagnosis workflow and contributes to reduce such manpower shortage. In image-based diagnosis of viral pneumonia cases including COVID-19, both local and global image features are important because viral pneumonia cause many ground glass opacities and consolidations in large areas in the lung. This paper proposes an automated classification method of chest CT volumes for COVID-19 diagnosis assistance. MLP-Mixer is a recent method of image classification using Vision Transformer-like architecture. It performs classification using both local and global image features. To classify 3D CT volumes, we developed a hybrid classification model that consists of both a 3D convolutional neural network (CNN) and a 3D version of the MLP-Mixer. Classification accuracy of the proposed method was evaluated using a dataset that contains 1205 CT volumes and obtained 79.5% of classification accuracy. The accuracy was higher than that of conventional 3D CNN models consists of 3D CNN layers and simple MLP layers.

Who Became Financially Vulnerable After COVID-19? A Population-Level Machine Learning Analysis Using MEPS Data

The cost of healthcare remains a concern in the United States and may have been influenced by disruptions associated with the COVID-19 pandemic. This study examines healthcare financial vulnerability before and after the pandemic using Medical Expenditure Panel Survey (MEPS) data from 2019 and 2021. High financial burden was defined as out-of-pocket healthcare expenditures exceeding 10% of family income. Survey-weighted subgroup analyses were performed to obtain nationally representative estimates across demographic and socioeconomic groups. Descriptive analyses were complemented by interpretable logistic regression and machine learning models. Logistic regression was used to estimate adjusted odds ratios, while random forest and gradient boosting models were used to evaluate predictive performance. Temporal generalization assessed whether models trained on pre-pandemic data remained predictive when applied to post-pandemic observations. Financial vulnerability was strongly associated with poverty status, insurance coverage, and prescription drug spending. Subgroup analyses indicated persistent disparities across population groups, with some evidence of increased burden among vulnerable populations in 2021. Despite these differences, models trained on pre-pandemic data exhibited only modest reductions in predictive performance when evaluated on post-pandemic data, suggesting that the principal predictors of healthcare financial vulnerability remained relatively stable over time. These findings provide a population-level assessment of healthcare financial vulnerability during the COVID-19 period and demonstrate the value of combining interpretable statistical modeling with machine learning for population health research. The results may support future population health surveillance, risk stratification, and healthcare policy research aimed at reducing financial barriers to care.

Accurate Recognition of Pneumonia and COVID-19 by Geometric Shape Normalization of Lung Region using Automatic Landmark Detection and Piecewise Affine Warping

This paper presents an automatic system for recognizing pulmonary diseases in chest X-rays using geometric normalization of the lung region. The method combines three modules: (1) a ResNet-18 landmark detector with coordinate attention that predicts 15 lung-contour landmarks, achieving a mean localization error of 3.61 pixels through an ensemble of four models with test-time augmentation; (2) a geometric normalizer based on Generalized Procrustes Analysis, Delaunay triangulation, and piecewise affine warping to map each lung region to a standardized shape; and (3) a ResNet-18 classifier with transfer learning and SAHS contrast enhancement to classify images as COVID-19, Viral Pneumonia, or Normal. On the COVID-19 Radiography Database, the normalized-image classifier achieved 98.60+/-0.26% accuracy and 98.00% F1-Macro using five-fold cross-validation. Although original images produced slightly higher raw accuracy, Grad-CAM and cropping experiments suggest that this advantage is partly influenced by acquisition artifacts. In contrast, geometrically normalized images outperformed artifact-masked/cropped unaligned images on both the COVID-19 Radiography Database (98.60% vs. 96.24%) and a balanced adult-pediatric mixed dataset including pediatric cases from the Kermany dataset (94.67% vs. 94.17%). These results suggest that anatomical alignment can provide a more controlled and artifact-resistant representation for pulmonary disease recognition.