Establishing an MSU service in a medium-sized German urban area — clinical and economic considerations

Background and purpose: Mobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service. Methods: Local stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed. Results: Median time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%. Conclusion: This analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources

Investigating the importance of demographic features for EDM-predictions

Demographic features are commonly used in Educational Data Mining (EDM) research to predict at-risk students. Yet, the practice of using demographic features has to be considered extremely problematic due to the data’s sensitive nature, but also because (historic and representation) biases likely exist in the training data, which leads to strong fairness concerns. At the same time and despite the frequent use, the value of demographic features for prediction accuracy remains unclear. In this paper, we systematically investigate the importance of demographic features for at-risk prediction using several publicly available datasets from different countries. We find strong evidence that including demographic features does not lead to better-performing models as long as some study-related features exist, such as performance or activity data. Additionally, we show that models, nonetheless, place importance on these features when they are included in the data – although this is not necessary for accuracy. These findings, together with our discussion, strongly suggest that at-risk prediction should not include demographic features. Our code is available at: https://anonymous.4open.science/r/edm-F7D1

Explaining Neural Networks without Access to Training Data

We consider generating explanations for neural networks in cases where the network's training data is not accessible, for instance due to privacy or safety issues. Recently, $\mathcal{I}$-Nets have been proposed as a sample-free approach to post-hoc, global model interpretability that does not require access to training data. They formulate interpretation as a machine learning task that maps network representations (parameters) to a representation of an interpretable function. In this paper, we extend the $\mathcal{I}$-Net framework to the cases of standard and soft decision trees as surrogate models. We propose a suitable decision tree representation and design of the corresponding $\mathcal{I}$-Net output layers. Furthermore, we make $\mathcal{I}$-Nets applicable to real-world tasks by considering more realistic distributions when generating the $\mathcal{I}$-Net's training data. We empirically evaluate our approach against traditional global, post-hoc interpretability approaches and show that it achieves superior results when the training data is not accessible

Explaining neural networks without access to training data

We consider generating explanations for neural networks in cases where the network's training data is not accessible, for instance due to privacy or safety issues. Recently, Interpretation Nets (I-Nets) have been proposed as a sample-free approach to post-hoc, global model interpretability that does not require access to training data. They formulate interpretation as a machine learning task that maps network representations (parameters) to a representation of an interpretable function. In this paper, we extend the I-Net framework to the cases of standard and soft decision trees as surrogate models. We propose a suitable decision tree representation and design of the corresponding I-Net output layers. Furthermore, we make I-Nets applicable to real-world tasks by considering more realistic distributions when generating the I-Net's training data. We empirically evaluate our approach against traditional global, post-hoc interpretability approaches and show that it achieves superior results when the training data is not accessible

Enabling mixed effects neural networks for diverse, clustered data using Monte Carlo methods

Neural networks often assume independence among input data samples, disregarding correlations arising from inherent clustering patterns in real-world datasets (e.g., due to different sites or repeated measurements). Recently, mixed effects neural networks (MENNs) which separate cluster-specific 'random effects' from cluster-invariant 'fixed effects' have been proposed to improve generalization and interpretability for clustered data. However, existing methods only allow for approximate quantification of cluster effects and are limited to regression and binary targets with only one clustering feature. We present MC-GMENN, a novel approach employing Monte Carlo methods to train Generalized Mixed Effects Neural Networks. We empirically demonstrate that MC-GMENN outperforms existing mixed effects deep learning models in terms of generalization performance, time complexity, and quantification of inter-cluster variance. Additionally, MC-GMENN is applicable to a wide range of datasets, including multi-class classification tasks with multiple high-cardinality categorical features. For these datasets, we show that MC-GMENN outperforms conventional encoding and embedding methods, simultaneously offering a principled methodology for interpreting the effects of clustering patterns

Data_Sheet_1_Establishing an MSU service in a medium-sized German urban area—clinical and economic considerations.docx

Background and purposeMobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service.MethodsLocal stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed.ResultsMedian time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%.ConclusionThis analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources.</p