C Mathematical and Quantitative Methods
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While patients are known to respond differently to drug therapies, current clinical practice often still follows a standardized dosage regimen for all patients. For drugs with a narrow range of both effective and safe concentrations, this approach may lead to a high incidence of adverse events or subtherapeutic dosing in the presence of high patient variability. Model-informedprecision dosing (MIPD) is a quantitative approach towards dose individualization based on mathematical modeling of dose-response relationships integrating therapeutic drug/biomarker monitoring (TDM) data. MIPD may considerably improve the efficacy and safety of many drug therapies. Current MIPD approaches, however, rely either on pre-calculated dosing tables or on simple point predictions of the therapy outcome. These
approaches lack a quantification of uncertainties and the ability to account for effects that are delayed. In addition, the underlying models are not improved while applied to patient data. Therefore, current approaches are not well suited for informed clinical decision-making based on a differentiated understanding of the individually predicted therapy outcome.
The objective of this thesis is to develop mathematical approaches for MIPD, which (i) provide efficient fully Bayesian forecasting of the individual therapy outcome including associated uncertainties, (ii) integrate Markov decision processes via reinforcement learning (RL) for a comprehensive decision framework for dose individualization, (iii) allow for continuous learning across patients and hospitals. Cytotoxic anticancer chemotherapy with its major dose-limiting toxicity, neutropenia, serves as a therapeutically relevant application example.
For more comprehensive therapy forecasting, we apply Bayesian data assimilation (DA) approaches, integrating patient-specific TDM data into mathematical models of chemotherapy-induced neutropenia that build on prior population analyses. The value of uncertainty quantification is demonstrated as it allows reliable computation of the patient-specific probabilities of relevant clinical quantities, e.g., the neutropenia grade. In view of novel home monitoring devices that increase the amount of TDM data available, the data processing of
sequential DA methods proves to be more efficient and facilitates handling of the variability between dosing events.
By transferring concepts from DA and RL we develop novel approaches for MIPD. While DA-guided dosing integrates individualized uncertainties into dose selection, RL-guided dosing provides a framework to consider delayed effects of dose selections. The combined
DA-RL approach takes into account both aspects simultaneously and thus represents a holistic approach towards MIPD. Additionally, we show that RL can be used to gain insights into important patient characteristics for dose selection. The novel dosing strategies substantially reduce the occurrence of both subtherapeutic and life-threatening neutropenia grades in a simulation study based on a recent clinical study (CEPAC-TDM trial) compared to currently used MIPD approaches.
If MIPD is to be implemented in routine clinical practice, a certain model bias with respect to the underlying model is inevitable, as the models are typically based on data from comparably small clinical trials that reflect only to a limited extent the diversity in real-world patient populations. We propose a sequential hierarchical Bayesian inference framework that enables continuous cross-patient learning to learn the underlying model parameters of the target patient population. It is important to note that the approach only requires summary information of the individual patient data to update the model. This separation of the individual inference from population inference enables implementation across different centers of care.
The proposed approaches substantially improve current MIPD approaches, taking into account new trends in health care and aspects of practical applicability. They enable progress towards more informed clinical decision-making, ultimately increasing patient benefits beyond the current practice.
The plasmasphere is a dynamic region of cold, dense plasma surrounding the Earth. Its shape and size are highly susceptible to variations in solar and geomagnetic conditions. Having an accurate model of plasma density in the plasmasphere is important for GNSS navigation and for predicting hazardous effects of radiation in space on spacecraft. The distribution of cold plasma and its dynamic dependence on solar wind and geomagnetic conditions remain, however, poorly quantified. Existing empirical models of plasma density tend to be oversimplified as they are based on statistical averages over static parameters. Understanding the global dynamics of the plasmasphere using observations from space remains a challenge, as existing density measurements are sparse and limited to locations where satellites can provide in-situ observations. In this dissertation, we demonstrate how such sparse electron density measurements can be used to reconstruct the global electron density distribution in the plasmasphere and capture its dynamic dependence on solar wind and geomagnetic conditions.
First, we develop an automated algorithm to determine the electron density from in-situ measurements of the electric field on the Van Allen Probes spacecraft. In particular, we design a neural network to infer the upper hybrid resonance frequency from the dynamic spectrograms obtained with the Electric and Magnetic Field Instrument Suite and Integrated Science (EMFISIS) instrumentation suite, which is then used to calculate the electron number density. The developed Neural-network-based Upper hybrid Resonance Determination (NURD) algorithm is applied to more than four years of EMFISIS measurements to produce the publicly available electron density data set.
We utilize the obtained electron density data set to develop a new global model of plasma density by employing a neural network-based modeling approach. In addition to the location, the model takes the time history of geomagnetic indices and location as inputs, and produces electron density in the equatorial plane as an output. It is extensively validated using in-situ density measurements from the Van Allen Probes mission, and also by comparing the predicted global evolution of the plasmasphere with the global IMAGE EUV images of He+ distribution. The model successfully reproduces erosion of the plasmasphere on the night side as well as plume formation and evolution, and agrees well with data.
The performance of neural networks strongly depends on the availability of training data, which is limited during intervals of high geomagnetic activity. In order to provide reliable density predictions during such intervals, we can employ physics-based modeling. We develop a new approach for optimally combining the neural network- and physics-based models of the plasmasphere by means of data assimilation. The developed approach utilizes advantages of both neural network- and physics-based modeling and produces reliable global plasma density reconstructions for quiet, disturbed, and extreme geomagnetic conditions.
Finally, we extend the developed machine learning-based tools and apply them to another important problem in the field of space weather, the prediction of the geomagnetic index Kp. The Kp index is one of the most widely used indicators for space weather alerts and serves as input to various models, such as for the thermosphere, the radiation belts and the plasmasphere. It is therefore crucial to predict the Kp index accurately. Previous work in this area has mostly employed artificial neural networks to nowcast and make short-term predictions of Kp, basing their inferences on the recent history of Kp and solar wind measurements at L1. We analyze how the performance of neural networks compares to other machine learning algorithms for nowcasting and forecasting Kp for up to 12 hours ahead. Additionally, we investigate several machine learning and information theory methods for selecting the optimal inputs to a predictive model of Kp. The developed tools for feature selection can also be applied to other problems in space physics in order to reduce the input dimensionality and identify the most important drivers.
Research outlined in this dissertation clearly demonstrates that machine learning tools can be used to develop empirical models from sparse data and also can be used to understand the underlying physical processes. Combining machine learning, physics-based modeling and data assimilation allows us to develop novel methods benefiting from these different approaches.