SUBIC: A Supervised Bi-Clustering Approach for Precision Medicine

Traditional medicine typically applies one-size-fits-all treatment for the entire patient population whereas precision medicine develops tailored treatment schemes for different patient subgroups. The fact that some factors may be more significant for a specific patient subgroup motivates clinicians and medical researchers to develop new approaches to subgroup detection and analysis, which is an effective strategy to personalize treatment. In this study, we propose a novel patient subgroup detection method, called Supervised Biclustring (SUBIC) using convex optimization and apply our approach to detect patient subgroups and prioritize risk factors for hypertension (HTN) in a vulnerable demographic subgroup (African-American). Our approach not only finds patient subgroups with guidance of a clinically relevant target variable but also identifies and prioritizes risk factors by pursuing sparsity of the input variables and encouraging similarity among the input variables and between the input and target variable

A concave pairwise fusion approach to subgroup analysis

An important step in developing individualized treatment strategies is to correctly identify subgroups of a heterogeneous population, so that specific treatment can be given to each subgroup. In this paper, we consider the situation with samples drawn from a population consisting of subgroups with different means, along with certain covariates. We propose a penalized approach for subgroup analysis based on a regression model, in which heterogeneity is driven by unobserved latent factors and thus can be represented by using subject-specific intercepts. We apply concave penalty functions to pairwise differences of the intercepts. This procedure automatically divides the observations into subgroups. We develop an alternating direction method of multipliers algorithm with concave penalties to implement the proposed approach and demonstrate its convergence. We also establish the theoretical properties of our proposed estimator and determine the order requirement of the minimal difference of signals between groups in order to recover them. These results provide a sound basis for making statistical inference in subgroup analysis. Our proposed method is further illustrated by simulation studies and analysis of the Cleveland heart disease dataset

Data-Driven Modeling For Decision Support Systems And Treatment Management In Personalized Healthcare

Massive amount of electronic medical records (EMRs) accumulating from patients and populations motivates clinicians and data scientists to collaborate for the advanced analytics to create knowledge that is essential to address the extensive personalized insights needed for patients, clinicians, providers, scientists, and health policy makers. Learning from large and complicated data is using extensively in marketing and commercial enterprises to generate personalized recommendations. Recently the medical research community focuses to take the benefits of big data analytic approaches and moves to personalized (precision) medicine. So, it is a significant period in healthcare and medicine for transferring to a new paradigm. There is a noticeable opportunity to implement a learning health care system and data-driven healthcare to make better medical decisions, better personalized predictions; and more precise discovering of risk factors and their interactions. In this research we focus on data-driven approaches for personalized medicine. We propose a research framework which emphasizes on three main phases: 1) Predictive modeling, 2) Patient subgroup analysis and 3) Treatment recommendation. Our goal is to develop novel methods for each phase and apply them in real-world applications. In the fist phase, we develop a new predictive approach based on feature representation using deep feature learning and word embedding techniques. Our method uses different deep architectures (Stacked autoencoders, Deep belief network and Variational autoencoders) for feature representation in higher-level abstractions to obtain effective and more robust features from EMRs, and then build prediction models on the top of them. Our approach is particularly useful when the unlabeled data is abundant whereas labeled one is scarce. We investigate the performance of representation learning through a supervised approach. We perform our method on different small and large datasets. Finally we provide a comparative study and show that our predictive approach leads to better results in comparison with others. In the second phase, we propose a novel patient subgroup detection method, called Supervised Biclustring (SUBIC) using convex optimization and apply our approach to detect patient subgroups and prioritize risk factors for hypertension (HTN) in a vulnerable demographic subgroup (African-American). Our approach not only finds patient subgroups with guidance of a clinically relevant target variable but also identifies and prioritizes risk factors by pursuing sparsity of the input variables and encouraging similarity among the input variables and between the input and target variables. Finally, in the third phase, we introduce a new survival analysis framework using deep learning and active learning with a novel sampling strategy. First, our approach provides better representation with lower dimensions from clinical features using labeled (time-to-event) and unlabeled (censored) instances and then actively trains the survival model by labeling the censored data using an oracle. As a clinical assistive tool, we propose a simple yet effective treatment recommendation approach based on our survival model. In the experimental study, we apply our approach on SEER-Medicare data related to prostate cancer among African-Americans and white patients. The results indicate that our approach outperforms significantly than baseline models

Application and Extension of Weighted Quantile Sum Regression for the Development of a Clinical Risk Prediction Tool

In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient’s health and the overall function of different organs. In this dissertation, we develop and validate a weighted composite index that aggregates the information from a variety of health biomarkers covering multiple organ systems. The index can be used for predicting all-cause mortality and could also be used as a holistic measure of overall physiological health status. We refer to it as the Health Status Metric (HSM). Validation analysis shows that the HSM is predictive of long-term mortality risk and exhibits a robust association with concurrent chronic conditions, recent hospital utilization, and self-rated health. We develop the HSM using Weighted Quantile Sum (WQS) regression (Gennings et al., 2013; Carrico, 2013), a novel penalized regression technique that imposes nonnegativity and unit-sum constraints on the coefficients used to weight index components. In this dissertation, we develop a number of extensions to the WQS regression technique and apply them to the construction of the HSM. We introduce a new guided approach for the standardization of index components which accounts for potential nonlinear relationships with the outcome of interest. An extended version of the WQS that accommodates interaction effects among index components is also developed and implemented. In addition, we demonstrate that ensemble learning methods borrowed from the field of machine learning can be used to improve the predictive power of the WQS index. Specifically, we show that the use of techniques such as weighted bagging, the random subspace method and stacked generalization in conjunction with the WQS model can produce an index with substantially enhanced predictive accuracy. Finally, practical applications of the HSM are explored. A comparative study is performed to evaluate the feasibility and effectiveness of a number of ‘real-time’ imputation strategies in potential software applications for computing the HSM. In addition, the efficacy of the HSM as a predictor of hospital readmission is assessed in a cohort of emergency department patients