A Learning Health System for Radiation Oncology

The proposed research aims to address the challenges faced by clinical data science researchers in radiation oncology accessing, integrating, and analyzing heterogeneous data from various sources. The research presents a scalable intelligent infrastructure, called the Health Information Gateway and Exchange (HINGE), which captures and structures data from multiple sources into a knowledge base with semantically interlinked entities. This infrastructure enables researchers to mine novel associations and gather relevant knowledge for personalized clinical outcomes. The dissertation discusses the design framework and implementation of HINGE, which abstracts structured data from treatment planning systems, treatment management systems, and electronic health records. It utilizes disease-specific smart templates for capturing clinical information in a discrete manner. HINGE performs data extraction, aggregation, and quality and outcome assessment functions automatically, connecting seamlessly with local IT/medical infrastructure. Furthermore, the research presents a knowledge graph-based approach to map radiotherapy data to an ontology-based data repository using FAIR (Findable, Accessible, Interoperable, Reusable) concepts. This approach ensures that the data is easily discoverable and accessible for clinical decision support systems. The dissertation explores the ETL (Extract, Transform, Load) process, data model frameworks, ontologies, and provides a real-world clinical use case for this data mapping. To improve the efficiency of retrieving information from large clinical datasets, a search engine based on ontology-based keyword searching and synonym-based term matching tool was developed. The hierarchical nature of ontologies is leveraged to retrieve patient records based on parent and children classes. Additionally, patient similarity analysis is conducted using vector embedding models (Word2Vec, Doc2Vec, GloVe, and FastText) to identify similar patients based on text corpus creation methods. Results from the analysis using these models are presented. The implementation of a learning health system for predicting radiation pneumonitis following stereotactic body radiotherapy is also discussed. 3D convolutional neural networks (CNNs) are utilized with radiographic and dosimetric datasets to predict the likelihood of radiation pneumonitis. DenseNet-121 and ResNet-50 models are employed for this study, along with integrated gradient techniques to identify salient regions within the input 3D image dataset. The predictive performance of the 3D CNN models is evaluated based on clinical outcomes. Overall, the proposed Learning Health System provides a comprehensive solution for capturing, integrating, and analyzing heterogeneous data in a knowledge base. It offers researchers the ability to extract valuable insights and associations from diverse sources, ultimately leading to improved clinical outcomes. This work can serve as a model for implementing LHS in other medical specialties, advancing personalized and data-driven medicine

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

Predictive Modelling Approach to Data-Driven Computational Preventive Medicine

This thesis contributes novel predictive modelling approaches to data-driven computational preventive medicine and offers an alternative framework to statistical analysis in preventive medicine research. In the early parts of this research, this thesis presents research by proposing a synergy of machine learning methods for detecting patterns and developing inexpensive predictive models from healthcare data to classify the potential occurrence of adverse health events. In particular, the data-driven methodology is founded upon a heuristic-systematic assessment of several machine-learning methods, data preprocessing techniques, models’ training estimation and optimisation, and performance evaluation, yielding a novel computational data-driven framework, Octopus. Midway through this research, this thesis advances research in preventive medicine and data mining by proposing several new extensions in data preparation and preprocessing. It offers new recommendations for data quality assessment checks, a novel multimethod imputation (MMI) process for missing data mitigation, a novel imbalanced resampling approach, and minority pattern reconstruction (MPR) led by information theory. This thesis also extends the area of model performance evaluation with a novel classification performance ranking metric called XDistance. In particular, the experimental results show that building predictive models with the methods guided by our new framework (Octopus) yields domain experts' approval of the new reliable models’ performance. Also, performing the data quality checks and applying the MMI process led healthcare practitioners to outweigh predictive reliability over interpretability. The application of MPR and its hybrid resampling strategies led to better performances in line with experts' success criteria than the traditional imbalanced data resampling techniques. Finally, the use of the XDistance performance ranking metric was found to be more effective in ranking several classifiers' performances while offering an indication of class bias, unlike existing performance metrics The overall contributions of this thesis can be summarised as follow. First, several data mining techniques were thoroughly assessed to formulate the new Octopus framework to produce new reliable classifiers. In addition, we offer a further understanding of the impact of newly engineered features, the physical activity index (PAI) and biological effective dose (BED). Second, the newly developed methods within the new framework. Finally, the newly accepted developed predictive models help detect adverse health events, namely, visceral fat-associated diseases and advanced breast cancer radiotherapy toxicity side effects. These contributions could be used to guide future theories, experiments and healthcare interventions in preventive medicine and data mining

Digital early warning scores in cardiac care settings: Mixed-methods research

The broad adoption of the National Early Warning Score (NEWS2) was formally endorsed for prediction of early deterioration across all settings. With current digitalisation of the Early Warning Score (EWS) through electronic health records (EHR) and automated patient monitoring, there is an excellent opportunity for facilitating and evaluating NEWS2 implementation. However, no evidence yet shows the success of such standardisation or digitalisation of EWS in cardiac care settings. Individuals with cardiovascular disease (CVD) have a significant risk of developing critical events, and CVD-related morbidity is a critical burden for health and social care. However, there is a gap in research evaluating the performance and implementation of EWS in cardiac settings and the role of digital solutions in the implementation and performance of EWS and clinicians' practice. This PhD aims to provide high-quality evidence on the effectiveness of NEWS2 in predicting worsening events in patients with CVD, the implementation of the digital NEWS2 in two healthcare settings, the experience of escalation of care during the COVID-19 pandemic, and the evaluation of EHR-integrated dashboard for auditing NEWS2 and clinicians' performance

Timely and reliable evaluation of the effects of interventions: a framework for adaptive meta-analysis (FAME)

Most systematic reviews are retrospective and use aggregate data AD) from publications, meaning they can be unreliable, lag behind therapeutic developments and fail to influence ongoing or new trials. Commonly, the potential influence of unpublished or ongoing trials is overlooked when interpreting results, or determining the value of updating the meta-analysis or need to collect individual participant data (IPD). Therefore, we developed a Framework for Adaptive Metaanalysis (FAME) to determine prospectively the earliest opportunity for reliable AD meta-analysis. We illustrate FAME using two systematic reviews in men with metastatic (M1) and non-metastatic (M0)hormone-sensitive prostate cancer (HSPC)

HOW CAN ADVERSE EVENTS INFORMATION BE USED TO MORE EFFECTIVELY INFORM CANCER PATIENT CARE?

Due to advances in screening and therapy design, cancer patients are living longer while on or following therapy. Therapy-related adverse events (AEs) are an unintended, but not infrequent, outcome of these treatments. AEs can impact quality of life, adherence to therapy, economic status, and treatment decision-making. This novel qualitative study is the first to undertake a multi-stakeholder evaluation of the impact of AE information on informing cancer patient care in the context of extended survival. The evaluation focuses on a growing subset of cancer patients – those receiving adjuvant therapy. Adjuvant therapies, used to manage many common cancers, lower the risk that the cancer will return. In this setting, mediating the impact of potential acute or delayed adjuvant treatment-related AEs relative to an uncertain potential for tumor recurrence presents important challenges in balancing risks versus benefits. Stakeholder perspectives on generating, disseminating, and/or adjuvant treatment-related AE information were elicited via key informant interviews with patient advocacy, clinical care, regulatory, drug development, and healthcare payer representatives. The stakeholders identified future needs in four key areas: 1) information resources, 2) information integration and implementation, 3) value systems and culture, and 4) alignment and ownership of collective efforts to improve the use of AE information in the adjuvant setting. This study revealed the following novel insights: 1) there is cross-stakeholder agreement that change is needed to improve the use of AE information in the adjuvant setting to improve patient outcome, 2) the directionality of needed changes are similar across stakeholders, although specific priorities varied, and 3) the potential to realize broad systemic progress in the use of adjuvant-related AE information is a challenge that lacks clear ownership. This lack of ownership has adversely impacted resourcing, efficiency, and collective progress and is likely to be a progress-limiting factor in realizing transformational change. To address the system-limiting challenges identified in this research, a proposed approach to incentivize and support stakeholders in forward action is offered. The proposal offers an infrastructure to promote collaborative and independent efforts in fulfillment of the many scientific, economic, communication, social, and implementation challenges identified in this research study.Doctor of Public Healt

QSAR model development for early stage screening of monoclonal antibody therapeutics to facilitate rapid developability

PhD ThesisMonoclonal antibodies (mAbs) and related therapeutics are highly desirable from a biopharmaceutical perspective as they are highly target specific and well tolerated within the human system. Nevertheless, several mAbs have been discontinued or withdrawn based either on their inability to demonstrate efficacy and/or due to adverse effects. With nearly 80% of drugs failing in clinical development mainly due to lack of efficacy and safety there arises an urgent need for better understanding of biological activity, affinity, pharmacology, toxicity, immunogenicity etc. thus leading to early prediction of success/failure. In this study a hybrid modelling framework was developed that enabled early stage screening of mAbs. The applicability of the experimental methods was first tested on chemical compounds to assess the assay quality following which they were used to assess potential off target adverse effects of mAbs. Furthermore, hypersensitivity reactions were assessed using Skimune™, a non-artificial human skin explants based assay for safety and efficacy assessment of novel compounds and drugs, developed by Alcyomics Ltd. The suitability of Skimune™ for assessing the immune related adverse effects of aggregated mAbs was studied where aggregation was induced using a heat stress protocol. The aggregates were characterised by protein analysis techniques such as analytical ultra-centrifugation following which the immunogenicity tested using Skimune™ assay. Numerical features (descriptors) of mAbs were identified and generated using ProtDCal, EMBOSS Pepstat software as well as amino acid scales for different. Five independent and novel X block datasets consisting of these descriptors were generated based on the physicochemical, electronic, thermodynamic, electronic and topological properties of amino acids: Domain, Window, Substructure, Single Amino Acid, and Running Sum. This study describes the development of a hybrid QSAR based model with a structured workflow and clear evaluation metrics, with several optimisation steps, that could be beneficial for broader and more generic PLS modelling. Based on the results and observation from this study, it was demonstrated incremental improvement via selection of datasets and variables help in further optimisation of these hybrid models. Furthermore, using hypersensitivity and cross reactivity as responses and physicochemical characteristics of mAbs as descriptors, the QSAR models generated for different applicability domains allow for rapid early stage screening and developability. These models were validated with external test set comprising of proprietary compounds from industrial partners, thus paving way for enhanced developability that tackles manufacturing failures as well as attrition rates.European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie actions grant agreemen