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Nicoleta Economou-Zavlanos

Nicoleta Economou-Zavlanos

Assistant Professor of Biostatistics & Bioinformatics
Biostatistics & Bioinformatics, Division of Translational Biomedical
nicoleta.economou@duke.edu
2424 Erwin Road, Room 9042, Durham, NC 27705

Selected Publications

Bridging the governance gap in health artificial intelligence: integrating nursing perspectives into the National Academy of Medicine Artificial Intelligence Code of Conduct.

Journal Article J Am Med Inform Assoc · May 1, 2026 BACKGROUND AND APPROACH: In 2025, the National Academy of Medicine released an Artificial Intelligence Code of Conduct (AICC). In this commentary, we examine how the AICC introduces governance mechanisms to oversee AI applications and how it can support th ... Full text Link to item Cite

Performance of PREVENT Cardiovascular Risk in Electronic Health Record-Based Clinical Practice.

Journal Article JAMA Netw Open · April 1, 2026 IMPORTANCE: In 2023, the American Heart Association Cardiovascular-Kidney-Metabolic Scientific Advisory Group introduced the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, a race-free, sex-specific model for cardiovascular disease (C ... Full text Link to item Cite

A federated learning framework for ethical dynamic treatment allocation across heterogeneous hospitals.

Journal Article J Biomed Inform · February 2026 OBJECTIVE: In this paper, we propose an adaptive federated learning framework to learn optimal treatments for individual hospitals that possibly serve different patient populations. The proposed framework can enable the design of more efficient treatment a ... Full text Link to item Cite

FairPOT: Balancing AUC Performance and Fairness with Proportional Optimal Transport.

Journal Article Proc AAAI ACM Conf AI Ethics Soc · October 2025 Fairness metrics utilizing the area under the receiver operator characteristic curve (AUC) have gained increasing attention in high-stakes domains such as healthcare, finance, and criminal justice. In these domains, fairness is often evaluated over risk sc ... Full text Open Access Link to item Cite

Algorithm-Based Clinical Decision Support: Evolving Regulatory Landscape and Best Practices for Local Oversight.

Journal Article Annu Rev Biomed Data Sci · August 2025 The potential of algorithm-based clinical decision support (CDS) in healthcare continues to increase with the growing field of artificial intelligence (AI)-enabled CDS. The use of these technologies to support clinicians, patients, and health systems is st ... Full text Link to item Cite

An evaluation framework for ambient digital scribing tools in clinical applications.

Journal Article NPJ Digit Med · June 13, 2025 Ambient digital scribing (ADS) tools alleviate clinician documentation burden, reducing burnout and enhancing efficiency. As AI-driven ADS tools integrate into clinical workflows, robust governance is essential for ethical and secure deployment. This study ... Full text Link to item Cite

Application of unified health large language model evaluation framework to In-Basket message replies: bridging qualitative and quantitative assessments.

Journal Article J Am Med Inform Assoc · April 1, 2025 OBJECTIVES: Large language models (LLMs) are increasingly utilized in healthcare, transforming medical practice through advanced language processing capabilities. However, the evaluation of LLMs predominantly relies on human qualitative assessment, which i ... Full text Link to item Cite

Empowering nurses to champion Health equity & BE FAIR: Bias elimination for fair and responsible AI in healthcare.

Journal Article J Nurs Scholarsh · January 2025 BACKGROUND: The concept of health equity by design encompasses a multifaceted approach that integrates actions aimed at eliminating biased, unjust, and correctable differences among groups of people as a fundamental element in the design of algorithms. As ... Full text Link to item Cite

A Clinician's Guide to Understanding Bias in Critical Clinical Prediction Models.

Journal Article Crit Care Clin · October 2024 This narrative review focuses on the role of clinical prediction models in supporting informed decision-making in critical care, emphasizing their 2 forms: traditional scores and artificial intelligence (AI)-based models. Acknowledging the potential for bo ... Full text Link to item Cite

Evaluating Factors Associated With Telehealth Appropriateness in Outpatient Rheumatoid Arthritis Encounters Using the Encounter Appropriateness Score for You (EASY).

Journal Article J Rheumatol · August 1, 2024 OBJECTIVE: Telehealth has been proposed as a safe and effective alternative to in-person care for rheumatoid arthritis (RA). The purpose of this study was to evaluate factors associated with telehealth appropriateness in outpatient RA encounters. METHODS: ... Full text Open Access Link to item Cite

BOLD: Blood-gas and Oximetry Linked Dataset.

Journal Article Sci Data · May 24, 2024 Pulse oximeters measure peripheral arterial oxygen saturation (SpO2) noninvasively, while the gold standard (SaO2) involves arterial blood gas measurement. There are known racial and ethnic disparities in their performance. BOLD is a dataset that aims to u ... Full text Link to item Cite

Use of artificial intelligence in critical care: opportunities and obstacles.

Journal Article Crit Care · April 8, 2024 BACKGROUND: Perhaps nowhere else in the healthcare system than in the intensive care unit environment are the challenges to create useful models with direct time-critical clinical applications more relevant and the obstacles to achieving those goals more m ... Full text Link to item Cite

Evaluating Provider Perceptions of Telehealth Utility in Outpatient Rheumatology Telehealth Encounters.

Journal Article J Clin Rheumatol · March 1, 2024 OBJECTIVE: This study aims to explore the factors associated with rheumatology providers' perceptions of telehealth utility in real-world telehealth encounters. METHODS: From September 14, 2020 to January 31, 2021, 6 providers at an academic medical center ... Full text Link to item Cite

Translating ethical and quality principles for the effective, safe and fair development, deployment and use of artificial intelligence technologies in healthcare.

Journal Article J Am Med Inform Assoc · February 16, 2024 OBJECTIVE: The complexity and rapid pace of development of algorithmic technologies pose challenges for their regulation and oversight in healthcare settings. We sought to improve our institution's approach to evaluation and governance of algorithmic techn ... Full text Link to item Cite

Distributionally Robust Clustered Federated Learning: A Case Study in Healthcare

Conference Proceedings of the IEEE Conference on Decision and Control · January 1, 2024 In this paper, we address the challenge of heterogeneous data distributions in cross-silo federated learning by introducing a novel algorithm, which we term Cross-silo Robust Clustered Federated Learning (CS-RCFL). Our approach leverages the Wasserstein di ... Full text Cite

Implementing quality management systems to close the AI translation gap and facilitate safe, ethical, and effective health AI solutions.

Journal Article NPJ Digit Med · November 25, 2023 The integration of Quality Management System (QMS) principles into the life cycle of development, deployment, and utilization of machine learning (ML) and artificial intelligence (AI) technologies within healthcare settings holds the potential to close the ... Full text Link to item Cite

Facilitating Harmonization of Variables in Framingham, MESA, ARIC, and REGARDS Studies Through a Metadata Repository.

Journal Article Circ Cardiovasc Qual Outcomes · November 2023 BACKGROUND: High-quality research in cardiovascular prevention, as in other fields, requires inclusion of a broad range of data sets from different sources. Integrating and harmonizing different data sources are essential to increase generalizability, samp ... Full text Link to item Cite

BOLD: Blood-gas and Oximetry Linked Dataset - Open Source Research.

Journal Article medRxiv · October 3, 2023 Pulse oximeters measure peripheral arterial oxygen saturation (SpO 2 ) noninvasively, while the gold standard (SaO 2 ) involves arterial blood gas measurement. There are known racial and ethnic disparities in their performance. BOLD is a new comprehensive ... Full text Link to item Cite

Mitigating Racial And Ethnic Bias And Advancing Health Equity In Clinical Algorithms: A Scoping Review.

Journal Article Health Aff (Millwood) · October 2023 In August 2022 the Department of Health and Human Services (HHS) issued a notice of proposed rulemaking prohibiting covered entities, which include health care providers and health plans, from discriminating against individuals when using clinical algorith ... Full text Link to item Cite

Predictive Modeling to Identify Children With Complex Health Needs At Risk for Hospitalization.

Journal Article Hosp Pediatr · May 1, 2023 BACKGROUND: Identifying children at high risk with complex health needs (CCHN) who have intersecting medical and social needs is challenging. This study's objectives were to (1) develop and evaluate an electronic health record (EHR)-based clinical predicti ... Full text Link to item Cite

Telehealth Made EASY: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters.

Journal Article ACR Open Rheumatol · October 2022 OBJECTIVE: The purpose of this study was to evaluate a novel scoring system, the Encounter Appropriateness Score for You (EASY), to assess provider perceptions of telehealth appropriateness in rheumatology encounters. METHODS: The EASY scoring system promp ... Full text Open Access Link to item Cite

A framework for the oversight and local deployment of safe and high-quality prediction models.

Journal Article J Am Med Inform Assoc · August 16, 2022 Artificial intelligence/machine learning models are being rapidly developed and used in clinical practice. However, many models are deployed without a clear understanding of clinical or operational impact and frequently lack monitoring plans that can detec ... Full text Open Access Link to item Cite

Provider Assessment of Telehealth Utility During COVID-19

Conference ARTHRITIS & RHEUMATOLOGY · September 2021 Link to item Cite

Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care.

Journal Article Am Heart J · January 2021 BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic brought about abrupt changes in the way health care is delivered, and the impact of transitioning outpatient clinic visits to telehealth visits on processes of care and outcomes is unclear. METHO ... Full text Link to item Cite

Enzymatic basis of "hybridity" in thiomarinol biosynthesis.

Journal Article Angew Chem Int Ed Engl · April 20, 2015 Thiomarinol is a naturally occurring double-headed antibiotic that is highly potent against methicillin-resistant Staphylococcus aureus. Its structure comprises two antimicrobial subcomponents, pseudomonic acid analogue and holothin, linked by an amide bon ... Full text Link to item Cite

The high resolution structure of tyrocidine A reveals an amphipathic dimer.

Journal Article Biochim Biophys Acta · May 2014 Tyrocidine A, one of the first antibiotics ever to be discovered, is a cyclic decapeptide that binds to membranes of target bacteria, disrupting their integrity. It is active against a broad spectrum of Gram-positive organisms, and has recently engendered ... Full text Link to item Cite

High-resolution crystal structure reveals molecular details of target recognition by bacitracin.

Journal Article Proc Natl Acad Sci U S A · August 27, 2013 Bacitracin is a metalloantibiotic agent that is widely used as a medicine and feed additive. It interferes with bacterial cell-wall biosynthesis by binding undecaprenyl-pyrophosphate, a lipid carrier that serves as a critical intermediate in cell wall prod ... Full text Link to item Cite

Structure of the complex between teicoplanin and a bacterial cell-wall peptide: use of a carrier-protein approach.

Journal Article Acta Crystallogr D Biol Crystallogr · April 2013 Multidrug-resistant bacterial infections are commonly treated with glycopeptide antibiotics such as teicoplanin. This drug inhibits bacterial cell-wall biosynthesis by binding and sequestering a cell-wall precursor: a D-alanine-containing peptide. A carrie ... Full text Link to item Cite

A carrier protein strategy yields the structure of dalbavancin.

Journal Article J Am Chem Soc · March 14, 2012 Many large natural product antibiotics act by specifically binding and sequestering target molecules found on bacterial cells. We have developed a new strategy to expedite the structural analysis of such antibiotic-target complexes, in which we covalently ... Full text Link to item Cite

A protein engineering approach differentiates the functional importance of carbohydrate moieties of interleukin-5 receptor α.

Journal Article Biochemistry · September 6, 2011 Human interleukin-5 receptor α (IL5Rα) is a glycoprotein that contains four N-glycosylation sites in the extracellular region. Previously, we found that enzymatic deglycosylation of IL5Rα resulted in complete loss of IL5 binding. To localize the functional ... Full text Link to item Cite

A unitary anesthetic binding site at high resolution.

Journal Article J Biol Chem · September 4, 2009 Propofol is the most widely used injectable general anesthetic. Its targets include ligand-gated ion channels such as the GABA(A) receptor, but such receptor-channel complexes remain challenging to study at atomic resolution. Until structural biology metho ... Full text Link to item Cite