BACKGROUND: Current clinical decision support systems (DSS) are trained and validated on observational data from the clinic in which the DSS is going to be applied. This is problematic for treatments that have already been validated in a randomized clinical trial (RCT), but have not yet been introduced in any clinic. In this work, we report on a method for training and validating the DSS core before introduction to a clinic, using the RCT data themselves. The key challenges we address are of missingness, foremost: missing rationale when assigning a treatment to a patient (the assignment is at random), and missing verification evidence, since the effectiveness of a treatment for a patient can only be verified (ground truth) if the treatment was indeed assigned to the patient - but then the assignment was at random. MATERIALS: We use the data of a multi-armed clinical trial that investigated the effectiveness of single treatments and combination treatments for 240+ tinnitus patients recruited and treated in 5 clinical centres. METHODS: To deal with the 'missing rationale for treatment assignment' challenge, we re-model the target variable that measures the outcome of interest, in order to suppress the effect of the individual treatment, which was at random, and control on the effect of treatment in general. To deal with missing features for many patients, we use a learning core that is robust to missing features. Further, we build ensembles that parsimoniously exploit the small patient numbers we have for learning. To deal with the 'missing verification evidence' challenge, we introduce counterfactual treatment verification, a verification scheme that juxtaposes the effectiveness of the recommendations of our approach to the effectiveness of the RCT assignments in the cases of agreement/disagreement between the two. RESULTS AND LIMITATIONS: We demonstrate that our approach leverages the RCT data for learning and verification, by showing that the DSS suggests treatments that improve the outcome. The results are limited through the small number of patients per treatment; while our ensemble is designed to mitigate this effect, the predictive performance of the methods is affected by the smallness of the data. OUTLOOK: We provide a basis for the establishment of decision supporting routines on treatments that have been tested in RCTs but have not yet been deployed clinically. Practitioners can use our approach to train and validate a DSS on new treatments by simply using the RCT data available to them. More work is needed to strengthen the robustness of the predictors. Since there are no further data available to this purpose, but those already used, the potential of synthetic data generation seems an appropriate alternative.

Health apps have the potential to collect data in real life, which makes them a useful tool. Users can monitor themselves, and researchers can gain comprehensive insights. However, user behavior is subject to fluctuations. On the one hand, this makes it complicated to use machine learning techniques, and on the other hand, there is a need to predict activity to stimulate it when necessary.This paper investigates user participation, focusing on their usage behavior, possible patterns of engagement, and resulting neighborhoods. The goal is to use these insights to predict a user’s engagement. Three ways of modeling patterns of engagement are presented. Neighborhood methods are used to infer conclusions about future behavior from the information of other users. Three methods are proposed to predict the length of a phase of inactivity, the length of the next phase of activity, and its values and structure.Applied to two real-world datasets, the results show that the approaches are suitable for making these predictions.These findings can be used to understand better and predict the behavior of mHealth users and plan possible interventions. This research expands the boundaries of research using self-monitoring mHealth apps, as user behavior can now be more easily formalized and applied. Furthermore, the approach can help to influence user engagement in a targeted way. Thus, this contribution exceeds our previous state-of-the-art work in its possibilities.

Applications in mobile health (mHealth) empower self-monitoring of chronic conditions of the user and also offer insights to medical experts. The data generated by these apps constitute one time series per user. These time series vary substantially in length and contain ‘gaps’, as users pause or stop interacting with the app. In order to design measures that promote patient engagement with the app, it is necessary to predict and understand decline in engagement. We measured the performance of the algorithms on two real-world datasets from an mHealth app. We show that all approaches outperform the baseline and that shapelet, dictionary and matrix distance approach perform similarly for long-term prediction. This is particularly important because it allows early intervention towards increase of engagement. In this paper, we present an approach that uses the missingness information to process time series with large gaps.

Adherence and phases of non-adherence in the usage of mHealth apps for self-monitoring generate time series characterized by gaps of varying duration. These reduce the knowledge that can be gained from the data because important observations are not captured. In this paper, an approach is presented that allows experts to estimate the possible duration of a user’s absence in order to build on it and take appropriate action.For this purpose, the users’ time series (with gaps and of different lengths) are decomposed into sequences that have no gaps anymore. Each sequence is associated with the duration of the subsequent gap. Using unsupervised binning, these gap values are sorted into a predefined number of categories. Sequences with similar gap durations are thus assigned the same category labels, grouped using unsupervised time series clustering and are assigned with cluster labels. Thus triplets are derived consisting of user ID, cluster label and gap category label. These triplets can then be used for collaborative filtering with matrix factorization. It is now possible to estimate the gap duration even if the same sequence has not yet been observed for the app user.The results show that the quality of binning depends on the appropriate choice of the number of categories, on the technique used, and on the maximum length of the gaps. In this example, a 5-star rating, the Fischer-Jenks algorithm and a maximum gap length of 30 days. We demonstrate how clustering can be used to gradually adapt the time series to the conditions of collaborative filtering and how complex matrix factorization models respond better to the complex structures of the data and lead to better results. In this work, K-Medoids and Agglomerative Clustering obtained applicable results and for matrix factorization SVD++.We believe that our approach provides a valuable back-end tool for experts to better assess the adherence of users to a selfmonitoring app.

Mobile Health (mhealth) applications are increasing in popularity, and the collection of disease-specific time series data using Ecological Momentary Assessment (EMA) questionnaires has been shown to help in the creation of personalised predictors for next-step forecasting, which can be crucial in giving preemptive interventions. In this work, we propose a framework that aims to mitigate a common issue in EMA data - that some users contribute a bulk of the data while most users contribute too little. Our proposed framework aims to discover a `useful' neighbourhood of `long' users for `short' ones, by optimising for the error of the user-level predictors for users with little data available for learning. For each user-level predictor, this is done by iteratively adding the next-most-similar long user from a similarity-ordered list as long as the error of the learned model does not increase. This method is compared against a baseline that exploits all available data for the long users, as well as an exhaustive search model that retains only only those users that yield the lowest error predictor. We also explore multiple ways to define similarity, and study the impact of each on the two search strategies on two EMA datasets from an mHealth app `TrackYourDiabetes' - with users from Bulgaria and Spain. Our experiments over the two datasets show a 2.5% and 36.6% improvement respectively for RMSE while using on average 42.8% and 69.9% less data than the baseline method.

Electronic health records (EHR) often include multiple perspectives on a patient's current state of well-being (e.g. vital signs and subjective indicators measured by questionnaires). In this study, we use these perspectives to build phenotypes of chronic tinnitus patients and investigate how these phenotypes are associated with response to treatment. Therefore, we model patients as nodes in a network, where those perspectives are interpreted as layers of a multi-layer network. To identify phenotypes of patients in the network, we implement a community detection algorithm. Some of these communities can be considered as phenotypes if they represent subgroups of patients that are similar according to the investigated perspectives. Furthermore, we analyze the influence of the layers on the final community structure of patients. We then propose a method to add layers given their community structure similarity. Finally, we fit a model, per community, to predict the treatment outcome. In some communities, this prediction outperformed the baseline scenario where the predictor was fitted to all patients.

Abstract Some mHealth apps record user activity continuously and unobtrusively, while other apps rely by nature on user engagement and self-discipline: users are asked to enter data that cannot be assessed otherwise, e.g., on how they feel and what non-measurable symptoms they have. Over time, this leads to substantial differences in the length of the time series of recordings for the different users. In this study, we propose two algorithms for wellbeing-prediction from such time series, and we compare their performance on the users of a pilot study on diabetic patients - with time series length varying between 8 and 87 recordings. Our first approach learns a model from the few users, on which many recordings are available, and applies this model to predict the 2nd, 3rd, and so forth recording of users newly joining the mHealth platform. Our second approach rather exploits the similarity among the first few recordings of newly arriving users. Our results for the first approach indicate that the target variable for users who use the app for long are not predictive for users who use the app only for a short time. Our results for the second approach indicate that few initial recordings suffice to inform the predictive model and improve performance considerably.

Personalized medicine benefits from the identification of subpopulations that exhibit higher prevalence of a disease than the general population: such subpopulations can become the target of more intensive investigations to identify risk factors and to develop dedicated therapies. Classification rule discovery algorithms are an appropriate tool for discovering such subpopulations: they scale well, even for multi-dimensional data and deliver comprehensible patterns. However, they may generate hundreds of rules and thus call for exploration methods. In this study, we extend the tool Interactive Medical Miner for the discovery of classification rules, into the Interactive Classification rule Explorer ICE, which offers functionalities for rule exploration, grouping, rule visualization and statistics. We report on our first results for the classification of cohort data on goiter, a disorder of the thyroid gland.