A Process Mining Approach to Statistical Analysis: Application to a Real-World Advanced Melanoma Dataset

AbstractThanks to its ability to offer a time-oriented perspective on the clinical events that define the patient's path of care, Process Mining (PM) is assuming an emerging role in clinical data analytics. PM's ability to exploit time-series data and to build processes without any a priori knowledge suggests interesting synergies with the most common statistical analyses in healthcare, in particular survival analysis. In this work we demonstrate contributions of our process-oriented approach in analyzing a real-world retrospective dataset of patients treated for advanced melanoma at the Lausanne University Hospital. Addressing the clinical questions raised by our oncologists, we integrated PM in almost all the steps of a common statistical analysis. We show: (1) how PM can be leveraged to improve the quality of the data (data cleaning/pre-processing), (2) how PM can provide efficient data visualizations that support and/or suggest clinical hypotheses, also allowing to check the consistency between real and expected processes (descriptive statistics), and (3) how PM can assist in querying or re-expressing the data in terms of pre-defined reference workflows for testing survival differences among sub-cohorts (statistical inference). We exploit a rich set of PM tools for querying the event logs, inspecting the processes using statistical hypothesis testing, and performing conformance checking analyses to identify patterns in patient clinical paths and study the effects of different treatment sequences in our cohort

Multilingual RECIST classification of radiology reports using supervised learning.

OBJECTIVES The objective of this study is the exploration of Artificial Intelligence and Natural Language Processing techniques to support the automatic assignment of the four Response Evaluation Criteria in Solid Tumors (RECIST) scales based on radiology reports. We also aim at evaluating how languages and institutional specificities of Swiss teaching hospitals are likely to affect the quality of the classification in French and German languages. METHODS In our approach, 7 machine learning methods were evaluated to establish a strong baseline. Then, robust models were built, fine-tuned according to the language (French and German), and compared with the expert annotation. RESULTS The best strategies yield average F1-scores of 90% and 86% respectively for the 2-classes (Progressive/Non-progressive) and the 4-classes (Progressive Disease, Stable Disease, Partial Response, Complete Response) RECIST classification tasks. CONCLUSIONS These results are competitive with the manual labeling as measured by Matthew's correlation coefficient and Cohen's Kappa (79% and 76%). On this basis, we confirm the capacity of specific models to generalize on new unseen data and we assess the impact of using Pre-trained Language Models (PLMs) on the accuracy of the classifiers

The role of diabetes in metastatic melanoma patients treated with nivolumab plus relatlimab

Background The combination of nivolumab + relatlimab is superior to nivolumab alone in the treatment of naive patients and has activity in PD-1 refractory melanoma. We had previously observed a reduced expression of LAG3 in melanoma tissue from patients with type 2 diabetes. Method To evaluate the impact of diabetes on oncological outcomes of patients with advanced melanoma treated with nivolumab plus the LAG3 inhibitor relatlimab we performed a retrospective multicenter study. Results Overall, 129 patients were included: 88 without diabetes before the treatment, 37 who were diagnosed with type 2 diabetes before the start of treatment, and 4 without diabetes before treatment who developed immune checkpoint inhibitor-induced diabetes (ICI-DM). PFS was 21.71 months (95% CI: 15.61–27.81) in patients without diabetes, 10.23 months (95% CI: 5.81–14.66) in patients with type 2 diabetes, and 50.85 months (95% CI: 23.04–78.65) in patients who developed ICI-DM. OS was 37.94 months (95% CI: 31.02–44.85) in patients without diabetes, 22.12 months (95% CI: 14.41–29.85) in those with type 2 diabetes and 57.64 months (95% CI: 42.29–72.99) in those who developed ICI-DM. Multivariate analysis showed that the presence of diabetes and LDH was correlated with OS and PFS. The mean OS was 64.63 months in subjects with low levels of glucose ( 1.5) had a worse prognosis than those whose glucose level had not increased. This result was observed also in subgroups treated either in first line or further lines. Patients who developed ICI-DM during the study period had better outcomes than the overall population and patients without diabetes. Conclusions LAG3 inhibition for treating metastatic or unresectable melanoma has a reduced efficacy in patients with type 2 diabetes, possibly due to a low expression of LAG3 in tumor tissue. Higher level evidence should be obtained

La sémiologie des odeurs au XIXe siècle : du savoir médical à la norme sociale

Parmi toutes les caractéristiques auxquelles Lavater suggérait de porter attention dans l’étude d’un sujet, l’odeur corporelle est peut-être celle qui a le moins retenu l’attention des physiognomonistes. Si de nombreux médecins appuyaient encore au XVIIIe siècle leurs diagnostiques sur les odeurs émanant de leurs patients, celles-ci ont progressivement disparu, chassées par le grand mouvement hygiéniste à l’œuvre au XIXe siècle à l’issue duquel, désormais, c’était l’absence d’odeurs qui garantissait non seulement le statut social du sujet, mais aussi sa bonne moralité. C’est en observant l’instauration de normes, désodorisation des corps et usages des parfums, qui jalonnent ce cheminement entre le discours médical et le discours social que cet article fait apparaître l’évolution des conceptions et des interprétations de l’identité olfactive au cours du siècle.While many doctors in the 18th century still based their diagnoses on odours emanating from their patients, this reliance on odours gradually disappeared in the 19th century, thanks to the hygienist movement which lent credence to the absence of odours as assurance not only of social status but also the person’s moral character. By observing the development of standards that linked medical and social discourses, such as odour control and use of perfumes, this paper traces the evolution and interpretations of identity olfactory throughout the century

Médialité des odeurs

International audienceThe study of scents and all things olfactory is thriving, a sign of the great interest that our information-based society feels for a sense that seems to offer a direct and immediate experience of reality. But smells resist description and representation, especially given that they are closely linked to individual personal experience, and their perception has changed through time and space in a myriad of ways. This volume aims to contribute to the flourishing multidisciplinary exchanges around smells by examining the question of their mediality, focusing on the mechanisms by which the olfactory experience, as well as the scents themselves, circulate and are diffused, but also by exploring the modes of smell as a medium in itself. Drawing on a wide variety of approaches, cultural zones, and historical periods, this volume gathers the contributions of twenty-one researchers who specialize in this field in order to explore the multiple aspects of olfactory culture, which characterizes and shapes our relations to smells.La richesse de l’actualité en matière d’odeurs et d’odorat témoigne du vif intérêt de nos sociétés de l’information pour un sens qui semble offrir une saisie directe et immédiate du réel. Circulant de manière très variable à travers le temps et l’espace, les odeurs font l’objet d’une perception qui résiste d’autant plus à la description et à la représentation qu’elle reste individuelle et liée à l’histoire personnelle. Ce volume vise à contribuer aux échanges interdisciplinaires sur l’olfaction à travers la question de la médialité, en s’interrogeant sur les mécanismes par lesquels l’expérience olfactive et les odeurs sont transmises et diffusées, mais aussi en explorant les modalités de l’odeur comme médium. Proposant une diversité d’approches, d’aires culturelles et de périodes, ce volume rassemble les contributions de vingt-et-un spécialistes qui étudient comment la culture olfactive caractérise et construit nos rapports aux odeurs

Sociabilités du parfum (XVIIIe – XIXe siècles)

Numéro thématique de la Revue littératureInternational audienc

Introduction: Olfactive culture and mediality of smells

International audienc

Médialité des odeurs

International audienceThe study of scents and all things olfactory is thriving, a sign of the great interest that our information-based society feels for a sense that seems to offer a direct and immediate experience of reality. But smells resist description and representation, especially given that they are closely linked to individual personal experience, and their perception has changed through time and space in a myriad of ways. This volume aims to contribute to the flourishing multidisciplinary exchanges around smells by examining the question of their mediality, focusing on the mechanisms by which the olfactory experience, as well as the scents themselves, circulate and are diffused, but also by exploring the modes of smell as a medium in itself. Drawing on a wide variety of approaches, cultural zones, and historical periods, this volume gathers the contributions of twenty-one researchers who specialize in this field in order to explore the multiple aspects of olfactory culture, which characterizes and shapes our relations to smells.La richesse de l’actualité en matière d’odeurs et d’odorat témoigne du vif intérêt de nos sociétés de l’information pour un sens qui semble offrir une saisie directe et immédiate du réel. Circulant de manière très variable à travers le temps et l’espace, les odeurs font l’objet d’une perception qui résiste d’autant plus à la description et à la représentation qu’elle reste individuelle et liée à l’histoire personnelle. Ce volume vise à contribuer aux échanges interdisciplinaires sur l’olfaction à travers la question de la médialité, en s’interrogeant sur les mécanismes par lesquels l’expérience olfactive et les odeurs sont transmises et diffusées, mais aussi en explorant les modalités de l’odeur comme médium. Proposant une diversité d’approches, d’aires culturelles et de périodes, ce volume rassemble les contributions de vingt-et-un spécialistes qui étudient comment la culture olfactive caractérise et construit nos rapports aux odeurs

Introduction : Culture olfactive et médialité des odeurs

International audienc

Présentation : Littérature et parfum : des affinités électives

International audienceLe parfum se distingue de l’odeur en ce qu’il est nécessairement agréable. Dès lors, il relève d’une construction sociale : soit parce qu’il est volontairement extrait ou composé dans le but de flatter l’odorat, soit parce que l’appréciation d’une odeur est toujours socialement déterminée. Il peut ainsi constituer un facteur de représentation sociale, lié à la constitution artificielle de la présence..