Predicated on the increasing abundance of electronic health records, we investigate the problem of inferring individualized treatment effects using observational data. Stemming from the potential outcomes model, we propose a novel multi-task learning framework in which factual and counterfactual outcomes are modeled as the outputs of a function in a vector-valued reproducing kernel Hilbert space (vvRKHS). We develop a nonparametric Bayesian method for learning the treatment effects using a multi-task Gaussian process (GP) with a linear coregionalization kernel as a prior over the vvRKHS. The Bayesian approach allows us to compute individualized measures of confidence in our estimates via pointwise credible intervals, which are crucial for realizing the full potential of precision medicine. The impact of selection bias is alleviated via a risk-based empirical Bayes method for adapting the multi-task GP prior, which jointly minimizes the empirical error in factual outcomes and the uncertainty in (unobserved) counterfactual outcomes. We conduct experiments on observational datasets for an interventional social program applied to premature infants, and a left ventricular assist device applied to cardiac patients wait-listed for a heart transplant. In both experiments, we show that our method significantly outperforms the state-of-the-art.
Finite mixture model is an important branch of clustering methods and can be applied on data sets with mixed types of variables. However, challenges exist in its applications. First, it typically relies on the EM algorithm which could be sensitive to the choice of initial values. Second, biomarkers subject to limits of detection (LOD) are common to encounter in clinical data, which brings censored variables into finite mixture model. Additionally, researchers are recently getting more interest in variable importance due to the increasing number of variables that become available for clustering. To address these challenges, we propose a Bayesian finite mixture model to simultaneously conduct variable selection, account for biomarker LOD and obtain clustering results. We took a Bayesian approach to obtain parameter estimates and the cluster membership to bypass the limitation of the EM algorithm. To account for LOD, we added one more step in Gibbs sampling to iteratively fill in biomarker values below or above LODs. In addition, we put a spike-and-slab type of prior on each variable to obtain variable importance. Simulations across various scenarios were conducted to examine the performance of this method. Real data application on electronic health records was also conducted.
IBM Watson Health has formed a medical imaging collaborative with more than 15 leading healthcare organizations. The goal: To take on some of the most deadly diseases. The collaborative, which includes health systems, academic medical centers, ambulatory radiology providers and imaging technology companies, aims to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke. Watson will mine insights from what IBM calls previously invisible unstructured imaging data and combine it with a broad variety of data from other sources, such as data from electronic health records, radiology and pathology reports, lab results, doctors' progress notes, medical journals, clinical care guidelines and published outcomes studies. As the work of the collaborative evolves, Watson's rationale and insights will evolve, informed by the latest combined thinking of the participating organizations.
Health care executives from IBM Watson and Athenahealth athn debated that question onstage at Fortune's inaugural Brainstorm Health conference Tuesday. In addition to partnering with Celgene celg to better track negative drug side effects, IBM ibm is applying its cognitive computing AI technology to recommend cancer treatment in rural areas in the U.S., India, and China, where there is a dearth of oncologists, said Deborah DiSanzo, general manager for IBM Watson Health. For example, IBM Watson could read a patient's electronic medical record, analyze imagery of the cancer, and even look at gene sequencing of the tumor to figure out the optimal treatment plan for a particular person, she said. "That is the promise of AI--not that we are going to replace people, not that we're going to replace doctors, but that we really augment the intelligence and help," DiSanzo said. Athenahealth CEO Jonathan Bush, however, disagreed.
Xu, Zhenxing, Chou, Jingyuan, Zhang, Xi Sheryl, Luo, Yuan, Isakova, Tamara, Adekkanattu, Prakash, Ancker, Jessica S., Jiang, Guoqian, Kiefer, Richard C., Pacheco, Jennifer A., Rasmussen, Luke V., Pathak, Jyotishman, Wang, Fei
Acute Kidney Injury (AKI) is a common clinical syndrome characterized by the rapid loss of kidney excretory function, which aggravates the clinical severity of other diseases in a large number of hospitalized patients. Accurate early prediction of AKI can enable in-time interventions and treatments. However, AKI is highly heterogeneous, thus identification of AKI sub-phenotypes can lead to an improved understanding of the disease pathophysiology and development of more targeted clinical interventions. This study used a memory network-based deep learning approach to discover predictive AKI sub-phenotypes using structured and unstructured electronic health record (EHR) data of patients before AKI diagnosis. We leveraged a real world critical care EHR corpus including 37,486 ICU stays. Our approach identified three distinct sub-phenotypes: sub-phenotype I is with an average age of 63.03$ \pm 17.25 $ years, and is characterized by mild loss of kidney excretory function (Serum Creatinne (SCr) $1.55\pm 0.34$ mg/dL, estimated Glomerular Filtration Rate Test (eGFR) $107.65\pm 54.98$ mL/min/1.73$m^2$). These patients are more likely to develop stage I AKI. Sub-phenotype II is with average age 66.81$ \pm 10.43 $ years, and was characterized by severe loss of kidney excretory function (SCr $1.96\pm 0.49$ mg/dL, eGFR $82.19\pm 55.92$ mL/min/1.73$m^2$). These patients are more likely to develop stage III AKI. Sub-phenotype III is with average age 65.07$ \pm 11.32 $ years, and was characterized moderate loss of kidney excretory function and thus more likely to develop stage II AKI (SCr $1.69\pm 0.32$ mg/dL, eGFR $93.97\pm 56.53$ mL/min/1.73$m^2$). Both SCr and eGFR are significantly different across the three sub-phenotypes with statistical testing plus postdoc analysis, and the conclusion still holds after age adjustment.