Interpretable Machine Learning Model for Clinical Decision Making

Despite machine learning models being increasingly used in medical decision-making and meeting classification predictive accuracy standards, they remain untrusted black-boxes due to decision-makers\u27 lack of insight into their complex logic. Therefore, it is necessary to develop interpretable machine learning models that will engender trust in the knowledge they generate and contribute to clinical decision-makers intention to adopt them in the field. The goal of this dissertation was to systematically investigate the applicability of interpretable model-agnostic methods to explain predictions of black-box machine learning models for medical decision-making. As proof of concept, this study addressed the problem of predicting the risk of emergency readmissions within 30 days of being discharged for heart failure patients. Using a benchmark data set, supervised classification models of differing complexity were trained to perform the prediction task. More specifically, Logistic Regression (LR), Random Forests (RF), Decision Trees (DT), and Gradient Boosting Machines (GBM) models were constructed using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD). The precision, recall, area under the ROC curve for each model were used to measure predictive accuracy. Local Interpretable Model-Agnostic Explanations (LIME) was used to generate explanations from the underlying trained models. LIME explanations were empirically evaluated using explanation stability and local fit (R2). The results demonstrated that local explanations generated by LIME created better estimates for Decision Trees (DT) classifiers

POKES, PRODS, AND PUSHES: INFORMATION AVAILABILITY AND DECISION MAKING IN AMBIGUOUS ENVIRONMENTS

In this dissertation I investigate how changes in the availability of information influences decision making in inherently ambiguous environments. As the Internet has not only fostered connectivity, but also catalyzed information generation on an unprecedented scale, my objective is to revisit the concept of information availability and salience in the digital age. I conduct my empirical analysis in the contexts of entrepreneurship and healthcare, which are significant both theoretically as well as in terms of economic and public welfare. In essay one, I examine how rising perceptions of fashion, viz., increased media coverage and herding, influence the willingness of venture capitalists to fund non-co-located entrepreneurs. This essay contributes to extant theory on entrepreneur-VC co-location by identifying the effect that social trends, as opposed to factors which are native only to the focal entrepreneur, can have on the willingness to venture capitalists to fund non-co-located entrepreneurs. In essay two, I explore the interplay between the broadcast and social media, as well as the ability of these media to incentivize firm formation on the part of nascent entrepreneurs. Applying the lens of agenda setting theory I demonstrate that the social media will moderate the impact of the broadcast media when entrepreneurs and financiers seek to found and fund new ventures. This study augments existing literature by considering not only the intensity of non-novel information, but also how participation will impact decision making. The third essay investigates a persistent puzzle in the medical literature: how different physicians react to medical guideline release (i.e. the release of new and novel information) which call into question the efficacy of long standing treatment options. Situating this essay within two theoretical tensions in the literature, the trade-off between agility and routines and the debate between costless and costly information assimilation, I find that while physicians are discerning in their reaction to new information their reactions are not quick, creating significant public welfare deficits. Moreover, I find that physician characteristics, such as tenure, board certification, and freelancer status, significantly moderate physician response to new guidelines. Taken together these essays contribute to the literature on Information Systems and Strategic Management by augmenting understanding of the construct of information availability, and how it affects decision makers in ambiguous environments

Data Science in Healthcare

Data science is an interdisciplinary field that applies numerous techniques, such as machine learning, neural networks, and deep learning, to create value based on extracting knowledge and insights from available data. Advances in data science have a significant impact on healthcare. While advances in the sharing of medical information result in better and earlier diagnoses as well as more patient-tailored treatments, information management is also affected by trends such as increased patient centricity (with shared decision making), self-care (e.g., using wearables), and integrated care delivery. The delivery of health services is being revolutionized through the sharing and integration of health data across organizational boundaries. Via data science, researchers can deliver new approaches to merge, analyze, and process complex data and gain more actionable insights, understanding, and knowledge at the individual and population levels. This Special Issue focuses on how data science is used in healthcare (e.g., through predictive modeling) and on related topics, such as data sharing and data management

Thirty-second Annual Symposium of Trinity College Undergraduate Research

2019 annual volume of abstracts for science research projects conducted by students at Trinity College

PROMOTING BREAKTHROUGH MEDICAL INNOVATION: INSIGHTS FROM AN ANALYSIS OF RECENT TRANSFORMATIVE DRUGS, BIOLOGICS AND MEDICAL DEVICES

Given the recent concern from multiple healthcare stakeholders that the pipeline of medical innovation is slowing, this thesis provides insights on how to spur breakthrough medical innovation in present day. The findings and recommendations are derived from one of the largest collections of interview transcripts from biomedical innovators (n=143) responsible for developing critical devices, drugs and diagnostics used in medicine today. An exemplary case (coronary artery stent) was selected for an in-depth analysis, which included a detailed recounting of stent development and an exhaustive analysis of the patent literature. External factors either catalyzed (e.g., supportive institutions, strong underlying science and collaboration) or hindered (e.g., technology transfer challenges, lack of funding and onerous conflict of interest rules) the development process. Strategies aimed towards promoting transformative medical innovation should focus on institutional-level policies targeting early stages of innovation. This includes providing individuals with unique expertise with the capacity to pursue innovative work. Technology transfer processes should be simplified to enable collaboration for individuals between institutions with disparate expertise. Policymakers should continue to support basic science research, which underlies future innovations. In contrast, policies that increase reimbursement or reduce taxes for industry or extend patent terms are less likely to impact transformative innovation

Parens Patriae 2.0: Invoking the Superior Courts' Protective Jurisdiction to Help Lonely Older Men Age-in-Place

Loneliness is associated with paradoxically self defeating behaviour, in which social contact is simultaneously desired and rejected. This behaviour can manifest in various ways. Lonely people may, for example, unwittingly decline objectively needed services such as home care. For several reasons, lonely older men may be particularly prone to rejecting offers of support. While refusals are often seen as a win for the right to live at risk, the victory can be hollow when it does not translate into a better quality of life. Often an older man can be persuaded to accept services, but sometimes these efforts fail. In such situations, our traditional understanding of the law leaves concerned third parties with two undesirable options: take no further action or categorise the person as incapable to override his decision making rights. This dilemma is a sad consequence of overcorrecting the medically-dominated approach to elder care with a highly libertarian perspective that lets individuals needlessly suffer. In our pursuit of unfettered individualism, the law has given insufficient weight to internal constraints such as loneliness which affect one’s exercise of free choice, yet keep them below the incapacity threshold. Therefore, in this thesis, I propose an intervention approach to loneliness that is not paralysed by the legal fiction of capacity: invoking a superior court’s protective jurisdiction. Through a therapeutic jurisprudence lens, I draw on the evolution of the parens patriae jurisdiction in Canada and a recent line of English case law to argue that a superior court’s protective jurisdiction may be used to help lonely older men age-in-place. I then propose a framework for invoking the jurisdiction. Specifically, I outline the general circumstances in which a court may be justified in exercising the jurisdiction, and I suggest that dignity ought to serve as the guiding principle. Then using B.C.’s laws as a point of reference, I identify the legislative gap which exists in adult guardianship/protection and mental health laws. Next I propose that the jurisdiction ought to be exercised in the most effective, less intrusive manner. I conclude with a discussion of some practical challenges of using the jurisdiction

Perceptions of Service Quality: Evidence for the Validity and Inseparability of Customer Reported Experiences and True Quality

<p>Marketing researchers have long relied on customer perceptions of service encounters to represent the "true" underlying quality. Researchers and practitioners in healthcare, on the other hand, have long dismissed customer perceptions as a credible measure of service quality. We built a quality framework designed to address this fundamental question: are customer perceptions of service encounters unique, redundant, or wholly flawed measures of actual service quality?</p><p>We consistently show customer perspectives reflect a measure of service quality that is both unique from, and complimentary to, the competence with which a service is provided. In fact, we found the explanatory power of either single dimension of process care is completely dependent on the state of the other as they relate to service encounter outcomes. This latter finding may require both management and policy makers to rethink how they approach managing and incenting a balanced approach to investments in improving process care dimensions.</p><p>Our research also provides evidence of factors both within, and indirectly outside, the control of management in improving healthcare service quality. In addition, government administrators face a particularly challenging roll in the system; their own policies - whether too punitive or too generous - have the potential to institutionalize lower quality healthcare for the very populations they are most trying to protect.</p>Dissertatio

The Impact of ‘Non-Clinical’ Patient Factors (NCpF) on Clinical Decision-making: Uncovering the Impact on Mental Health

This thesis aimed to understand the influence of non-clinical patient factors on mental health-related diagnostic, treatment, and referral decisions. Non-clinical patient factors are characteristics of the patient that are not known to be relevant for the clinical diagnosis or prognosis. Examples of non-clinical patient factors in mental health care include gender, age, and socioeconomic status. Focus groups were conducted to understand the perceptions of patient’s mental health care experiences and identify any NCpF that varied from past literature. Then, using the Secure Anonymised Information Linkage Databank, administrative data for participants with a gold standard indicator of mental health were linked with their healthcare records to determine associations between NCpF and being diagnosed, treated, or referred for mental health-related conditions. Finally, an experimental clinical vignette study was conducted. General practitioners were invited to answer clinical decisions based on the clinical vignettes which depicted patients with bulimia, anxiety, and bipolar disorder. All participants saw one of each disorder, however they were randomly allocated to either male, female or a control condition for bulimia, young, old or control condition for age, or high- or low- socioeconomic status or no reference for bipolar disorder. Utilising a combined methodological approach, gender, age and socioeconomic status were found to impact the clinical decision-making process. The effect of this influence varied depending on the clinical decision and disorder type. This thesis demonstrated the feasibility of using administrative and health care records to study mental health-related clinical decision-making

Disclosure of inside information within the belgian biotech industry: a quantitative and qualitative analysis

As investing in biotech companies is subject to high risk and the information within this industry is often technical, it is important for investors that this information is disclosed in a comprehensible manner. This research investigates how the FSMA could improve the disclosure practices of inside information by Belgian biotech companies with respect to the FSMA Opinion, that sets out guidelines in this regard.1 Therefore, press releases published by both Belgian and foreign biotech companies are analysed. This analysis is complemented by a study on US case law and regulatory insights from Japan and Australia. Last, data of Belgian press releases is analysed in order to map the Belgian biotech companies’ labelling practices.FSM