Assessing the pre-operative risk of lymph node metastases in endometrial cancer patients is a complex and challenging task. In principle, machine learning and deep learning models are flexible and expressive enough to capture the dynamics of clinical risk assessment. However, in this setting we are limited to observational data with quality issues, missing values, small sample size and high dimensionality: we cannot reliably learn such models from limited observational data with these sources of bias. Instead, we choose to learn a causal Bayesian network to mitigate the issues above and to leverage the prior knowledge on endometrial cancer available from clinicians and physicians. We introduce a causal discovery algorithm for causal Bayesian networks based on bootstrap resampling, as opposed to the single imputation used in related works. Moreover, we include a context variable to evaluate whether selection bias results in learning spurious associations. Finally, we discuss the strengths and limitations of our findings in light of the presence of missing data that may be missing-not-at-random, which is common in real-world clinical settings.
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Prior probabilities of clinical hypotheses are not systematically used for clinical trial design yet, due to a concern that poor priors may lead to poor decisions. To address this concern, a conservative approach to Bayesian trial design is illustrated here, requiring that the operational characteristics of the primary trial outcome are stronger than the prior. This approach is complementary to current Bayesian design methods, in that it insures against prior-data conflict by defining a sample size commensurate to a fixed design prior. This approach is ethical, in that it requires designs appropriate to achieving pre-specified levels of clinical equipoise imbalance. Practical examples are discussed, illustrating design of trials with binary or time to event endpoints. Moderate increases in phase II study sample size are shown to deliver strong levels of overall evidence for go/no-go clinical development decisions. Levels of negative evidence provided by group sequential confirmatory designs are found negligible, highlighting the importance of complementing efficacy boundaries with non-binding futility criteria.
The limited ability of Convolutional Neural Networks to generalize to images from previously unseen domains is a major limitation, in particular, for safety-critical clinical tasks such as dermoscopic skin cancer classification. In order to translate CNN-based applications into the clinic, it is essential that they are able to adapt to domain shifts. Such new conditions can arise through the use of different image acquisition systems or varying lighting conditions. In dermoscopy, shifts can also occur as a change in patient age or occurence of rare lesion localizations (e.g. palms). These are not prominently represented in most training datasets and can therefore lead to a decrease in performance. In order to verify the generalizability of classification models in real world clinical settings it is crucial to have access to data which mimics such domain shifts. To our knowledge no dermoscopic image dataset exists where such domain shifts are properly described and quantified. We therefore grouped publicly available images from ISIC archive based on their metadata (e.g. acquisition location, lesion localization, patient age) to generate meaningful domains. To verify that these domains are in fact distinct, we used multiple quantification measures to estimate the presence and intensity of domain shifts. Additionally, we analyzed the performance on these domains with and without an unsupervised domain adaptation technique. We observed that in most of our grouped domains, domain shifts in fact exist. Based on our results, we believe these datasets to be helpful for testing the generalization capabilities of dermoscopic skin cancer classifiers.
Many anomaly detection approaches, especially deep learning methods, have been recently developed to identify abnormal image morphology by only employing normal images during training. Unfortunately, many prior anomaly detection methods were optimized for a specific "known" abnormality (e.g., brain tumor, bone fraction, cell types). Moreover, even though only the normal images were used in the training process, the abnormal images were oftenly employed during the validation process (e.g., epoch selection, hyper-parameter tuning), which might leak the supposed ``unknown" abnormality unintentionally. In this study, we investigated these two essential aspects regarding universal anomaly detection in medical images by (1) comparing various anomaly detection methods across four medical datasets, (2) investigating the inevitable but often neglected issues on how to unbiasedly select the optimal anomaly detection model during the validation phase using only normal images, and (3) proposing a simple decision-level ensemble method to leverage the advantage of different kinds of anomaly detection without knowing the abnormality. The results of our experiments indicate that none of the evaluated methods consistently achieved the best performance across all datasets. Our proposed method enhanced the robustness of performance in general (average AUC 0.956).
Difference-in-differences (DiD) is a popular method to evaluate treatment effects of real-world policy interventions. Several approaches have previously developed under alternative identifying assumptions in settings where pre- and post-treatment outcome measurements are available. However, these approaches suffer from several limitations, either (i) they only apply to continuous outcomes and the average treatment effect on the treated, or (ii) they depend on the scale of outcome, or (iii) they assume the absence of unmeasured confounding given pre-treatment covariate and outcome measurements, or (iv) they lack semiparametric efficiency theory. In this paper, we develop a new framework for causal identification and inference in DiD settings that satisfies (i)-(iv), making it universally applicable, unlike existing DiD methods. Key to our framework is an odds ratio equi-confounding (OREC) assumption, which states that the generalized odds ratio relating treatment and treatment-free potential outcome is stable across pre- and post-treatment periods. Under the OREC assumption, we establish nonparametric identification for any potential treatment effect on the treated in view, which in principle would be identifiable under the stronger assumption of no unmeasured confounding. Moreover, we develop a consistent, asymptotically linear, and semiparametric efficient estimator of treatment effects on the treated by leveraging recent learning theory. We illustrate our framework with extensive simulation studies and two well-established real-world applications in labor economics and traffic safety evaluation.
Clinical trials (CTs) often fail due to inadequate patient recruitment. This paper tackles the challenges of CT retrieval by presenting an approach that addresses the patient-to-trials paradigm. Our approach involves two key components in a pipeline-based model: (i) a data enrichment technique for enhancing both queries and documents during the first retrieval stage, and (ii) a novel re-ranking schema that uses a Transformer network in a setup adapted to this task by leveraging the structure of the CT documents. We use named entity recognition and negation detection in both patient description and the eligibility section of CTs. We further classify patient descriptions and CT eligibility criteria into current, past, and family medical conditions. This extracted information is used to boost the importance of disease and drug mentions in both query and index for lexical retrieval. Furthermore, we propose a two-step training schema for the Transformer network used to re-rank the results from the lexical retrieval. The first step focuses on matching patient information with the descriptive sections of trials, while the second step aims to determine eligibility by matching patient information with the criteria section. Our findings indicate that the inclusion criteria section of the CT has a great influence on the relevance score in lexical models, and that the enrichment techniques for queries and documents improve the retrieval of relevant trials. The re-ranking strategy, based on our training schema, consistently enhances CT retrieval and shows improved performance by 15\% in terms of precision at retrieving eligible trials. The results of our experiments suggest the benefit of making use of extracted entities. Moreover, our proposed re-ranking schema shows promising effectiveness compared to larger neural models, even with limited training data.
Randomized controlled trials (RCTs) are the gold standard for causal inference, but they are often powered only for average effects, making estimation of heterogeneous treatment effects (HTEs) challenging. Conversely, large-scale observational studies (OS) offer a wealth of data but suffer from confounding bias. Our paper presents a novel framework to leverage OS data for enhancing the efficiency in estimating conditional average treatment effects (CATEs) from RCTs while mitigating common biases. We propose an innovative approach to combine RCTs and OS data, expanding the traditionally used control arms from external sources. The framework relaxes the typical assumption of CATE invariance across populations, acknowledging the often unaccounted systematic differences between RCT and OS participants. We demonstrate this through the special case of a linear outcome model, where the CATE is sparsely different between the two populations. The core of our framework relies on learning potential outcome means from OS data and using them as a nuisance parameter in CATE estimation from RCT data. We further illustrate through experiments that using OS findings reduces the variance of the estimated CATE from RCTs and can decrease the required sample size for detecting HTEs.
Along with the increasing availability of health data has come the rise of data-driven models to inform decision-making and policy. These models have the potential to benefit both patients and health care providers but can also exacerbate health inequities. Existing "algorithmic fairness" methods for measuring and correcting model bias fall short of what is needed for health policy in two key ways. First, methods typically focus on a single grouping along which discrimination may occur rather than considering multiple, intersecting groups. Second, in clinical applications, risk prediction is typically used to guide treatment, creating distinct statistical issues that invalidate most existing techniques. We present summary unfairness metrics that build on existing techniques in "counterfactual fairness" to address both challenges. We also develop a complete framework of estimation and inference tools for our metrics, including the unfairness value ("u-value"), used to determine the relative extremity of unfairness, and standard errors and confidence intervals employing an alternative to the standard bootstrap. We demonstrate application of our framework to a COVID-19 risk prediction model deployed in a major Midwestern health system.
A fundamental goal of scientific research is to learn about causal relationships. However, despite its critical role in the life and social sciences, causality has not had the same importance in Natural Language Processing (NLP), which has traditionally placed more emphasis on predictive tasks. This distinction is beginning to fade, with an emerging area of interdisciplinary research at the convergence of causal inference and language processing. Still, research on causality in NLP remains scattered across domains without unified definitions, benchmark datasets and clear articulations of the remaining challenges. In this survey, we consolidate research across academic areas and situate it in the broader NLP landscape. We introduce the statistical challenge of estimating causal effects, encompassing settings where text is used as an outcome, treatment, or as a means to address confounding. In addition, we explore potential uses of causal inference to improve the performance, robustness, fairness, and interpretability of NLP models. We thus provide a unified overview of causal inference for the computational linguistics community.
Evaluating the quality of learned representations without relying on a downstream task remains one of the challenges in representation learning. In this work, we present Geometric Component Analysis (GeomCA) algorithm that evaluates representation spaces based on their geometric and topological properties. GeomCA can be applied to representations of any dimension, independently of the model that generated them. We demonstrate its applicability by analyzing representations obtained from a variety of scenarios, such as contrastive learning models, generative models and supervised learning models.
This paper focuses on the expected difference in borrower's repayment when there is a change in the lender's credit decisions. Classical estimators overlook the confounding effects and hence the estimation error can be magnificent. As such, we propose another approach to construct the estimators such that the error can be greatly reduced. The proposed estimators are shown to be unbiased, consistent, and robust through a combination of theoretical analysis and numerical testing. Moreover, we compare the power of estimating the causal quantities between the classical estimators and the proposed estimators. The comparison is tested across a wide range of models, including linear regression models, tree-based models, and neural network-based models, under different simulated datasets that exhibit different levels of causality, different degrees of nonlinearity, and different distributional properties. Most importantly, we apply our approaches to a large observational dataset provided by a global technology firm that operates in both the e-commerce and the lending business. We find that the relative reduction of estimation error is strikingly substantial if the causal effects are accounted for correctly.
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