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In the context of clinical and biomedical studies, joint frailty models have been developed to study the joint temporal evolution of recurrent and terminal events, capturing both the heterogeneous susceptibility to experiencing a new episode and the dependence between the two processes. While discretely-distributed frailty is usually more exploitable by clinicians and healthcare providers, existing literature on joint frailty models predominantly assumes continuous distributions for the random effects. In this article, we present a novel joint frailty model that assumes bivariate discretely-distributed non-parametric frailties, with an unknown finite number of mass points. This approach facilitates the identification of latent structures among subjects, grouping them into sub-populations defined by a shared frailty value. We propose an estimation routine via Expectation-Maximization algorithm, which not only estimates the number of subgroups but also serves as an unsupervised classification tool. This work is motivated by a study of patients with Heart Failure (HF) receiving ACE inhibitors treatment in the Lombardia region of Italy. Recurrent events of interest are hospitalizations due to HF and terminal event is death for any cause.

In biomedical applications it is often necessary to estimate a physiological response to a treatment consisting of multiple components, and learn the separate effects of the components in addition to the joint effect. Here, we extend existing probabilistic nonparametric approaches to explicitly address this problem. We also develop a new convolution-based model for composite treatment-response curves that is more biologically interpretable. We validate our models by estimating the impact of carbohydrate and fat in meals on blood glucose. By differentiating treatment components, incorporating their dosages, and sharing statistical information across patients via a hierarchical multi-output Gaussian process, our method improves prediction accuracy over existing approaches, and allows us to interpret the different effects of carbohydrates and fat on the overall glucose response.

Due to the high heterogeneity and clinical characteristics of cancer, there are significant differences in multi-omics data and clinical features among subtypes of different cancers. Therefore, the identification and discovery of cancer subtypes are crucial for the diagnosis, treatment, and prognosis of cancer. In this study, we proposed a generalization framework based on attention mechanisms for unsupervised contrastive learning to analyze cancer multi-omics data for the identification and characterization of cancer subtypes. The framework contains a symmetric unsupervised multi-head attention encoder, which can deeply extract contextual features and long-range dependencies of multi-omics data, reducing the impact of noise in multi-omics data. Importantly, the proposed framework includes a decoupled contrastive learning model (DEDUCE) based on a multi-head attention mechanism to learn multi-omics data features and clustering and identify cancer subtypes. This method clusters subtypes by calculating the similarity between samples in the feature space and sample space of multi-omics data. The basic idea is to decouple different attributes of multi-omics data features and learn them as contrasting terms. Construct a contrastive loss function to measure the difference between positive examples and negative examples, and minimize this difference, thereby encouraging the model to learn better feature representation. The DEDUCE model conducts large-scale experiments on simulated multi-omics data sets, single-cell multi-omics data sets and cancer multi-omics data sets, and the results are better than 10 deep learning models. Finally, we used the DEDUCE model to reveal six cancer subtypes of AML. By analyzing GO functional enrichment, subtype-specific biological functions and GSEA of AML,

3D mesh segmentation is an important task with many biomedical applications. The human body has bilateral symmetry and some variations in organ positions. It allows us to expect a positive effect of rotation and inversion invariant layers in convolutional neural networks that perform biomedical segmentations. In this study, we show the impact of weight symmetry in neural networks that perform 3D mesh segmentation. We analyze the problem of 3D mesh segmentation for pathological vessel structures (aneurysms) and conventional anatomical structures (endocardium and epicardium of ventricles). Local geometrical features are encoded as sampling from the signed distance function, and the neural network performs prediction for each mesh node. We show that weight symmetry gains from 1 to 3% of additional accuracy and allows decreasing the number of trainable parameters up to 8 times without suffering the performance loss if neural networks have at least three convolutional layers. This also works for very small training sets.

We demonstrate a validity problem of machine learning in the vital application area of disease diagnosis in medicine. It arises when target labels in training data are determined by an indirect measurement, and the fundamental measurements needed to determine this indirect measurement are included in the input data representation. Machine learning models trained on this data will learn nothing else but to exactly reconstruct the known target definition. Such models show perfect performance on similarly constructed test data but will fail catastrophically on real-world examples where the defining fundamental measurements are not or only incompletely available. We present a general procedure allowing identification of problematic datasets and black-box machine learning models trained on them, and exemplify our detection procedure on the task of early prediction of sepsis.

The use of the non-parametric Restricted Mean Survival Time endpoint (RMST) has grown in popularity as trialists look to analyse time-to-event outcomes without the restrictions of the proportional hazards assumption. In this paper, we evaluate the power and type I error rate of the parametric and non-parametric RMST estimators when treatment effect is explained by multiple covariates, including an interaction term. Utilising the RMST estimator in this way allows the combined treatment effect to be summarised as a one-dimensional estimator, which is evaluated using a one-sided hypothesis Z-test. The estimators are either fully specified or misspecified, both in terms of unaccounted covariates or misspecified knot points (where trials exhibit crossing survival curves). A placebo-controlled trial of Gamma interferon is used as a motivating example to simulate associated survival times. When correctly specified, the parametric RMST estimator has the greatest power, regardless of the time of analysis. The misspecified RMST estimator generally performs similarly when covariates mirror those of the fitted case study dataset. However, as the magnitude of the unaccounted covariate increases, the associated power of the estimator decreases. In all cases, the non-parametric RMST estimator has the lowest power, and power remains very reliant on the time of analysis (with a later analysis time correlated with greater power).

In prediction settings where data are collected over time, it is often of interest to understand both the importance of variables for predicting the response at each time point and the importance summarized over the time series. Building on recent advances in estimation and inference for variable importance measures, we define summaries of variable importance trajectories. These measures can be estimated and the same approaches for inference can be applied regardless of the choice of the algorithm(s) used to estimate the prediction function. We propose a nonparametric efficient estimation and inference procedure as well as a null hypothesis testing procedure that are valid even when complex machine learning tools are used for prediction. Through simulations, we demonstrate that our proposed procedures have good operating characteristics, and we illustrate their use by investigating the longitudinal importance of risk factors for suicide attempt.

Individualized treatment rules (ITRs) for treatment recommendation is an important topic for precision medicine as not all beneficial treatments work well for all individuals. Interpretability is a desirable property of ITRs, as it helps practitioners make sense of treatment decisions, yet there is a need for ITRs to be flexible to effectively model complex biomedical data for treatment decision making. Many ITR approaches either focus on linear ITRs, which may perform poorly when true optimal ITRs are nonlinear, or black-box nonlinear ITRs, which may be hard to interpret and can be overly complex. This dilemma indicates a tension between interpretability and accuracy of treatment decisions. Here we propose an additive model-based nonlinear ITR learning method that balances interpretability and flexibility of the ITR. Our approach aims to strike this balance by allowing both linear and nonlinear terms of the covariates in the final ITR. Our approach is parsimonious in that the nonlinear term is included in the final ITR only when it substantially improves the ITR performance. To prevent overfitting, we combine cross-fitting and a specialized information criterion for model selection. Through extensive simulations, we show that our methods are data-adaptive to the degree of nonlinearity and can favorably balance ITR interpretability and flexibility. We further demonstrate the robust performance of our methods with an application to a cancer drug sensitive study.

Evidence of a global trend in dose-response dependencies is commonly used in bio-medicine and epidemiology, especially because this represents a causality criterion. However, conventional trend tests indicate a significant trend even when dependence is in the opposite direction for low doses when the high dose alone has a superior effect. Here we present a trend test for a strictly monotonic increasing (or decreasing) trend, evaluate selected sample data for it, and provide corresponding R code using CRAN packages.

Breast cancer remains a global challenge, causing over 1 million deaths globally in 2018. To achieve earlier breast cancer detection, screening x-ray mammography is recommended by health organizations worldwide and has been estimated to decrease breast cancer mortality by 20-40%. Nevertheless, significant false positive and false negative rates, as well as high interpretation costs, leave opportunities for improving quality and access. To address these limitations, there has been much recent interest in applying deep learning to mammography; however, obtaining large amounts of annotated data poses a challenge for training deep learning models for this purpose, as does ensuring generalization beyond the populations represented in the training dataset. Here, we present an annotation-efficient deep learning approach that 1) achieves state-of-the-art performance in mammogram classification, 2) successfully extends to digital breast tomosynthesis (DBT; "3D mammography"), 3) detects cancers in clinically-negative prior mammograms of cancer patients, 4) generalizes well to a population with low screening rates, and 5) outperforms five-out-of-five full-time breast imaging specialists by improving absolute sensitivity by an average of 14%. Our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.