Justin F. Rousseau

Liyan Tang, Tanya Goyal, Alexander R. Fabbri et al. · microsoft-research, salesforce

The propensity of abstractive summarization models to make factual errors has been studied extensively, including design of metrics to detect factual errors and annotation of errors in current systems' outputs. However, the ever-evolving nature of summarization systems, metrics, and annotated benchmarks makes factuality evaluation a moving target, and drawing clear comparisons among metrics has become increasingly difficult. In this work, we aggregate factuality error annotations from nine existing datasets and stratify them according to the underlying summarization model. We compare performance of state-of-the-art factuality metrics, including recent ChatGPT-based metrics, on this stratified benchmark and show that their performance varies significantly across different types of summarization models. Critically, our analysis shows that much of the recent improvement in the factuality detection space has been on summaries from older (pre-Transformer) models instead of more relevant recent summarization models. We further perform a finer-grained analysis per error-type and find similar performance variance across error types for different factuality metrics. Our results show that no one metric is superior in all settings or for all error types, and we provide recommendations for best practices given these insights.

Ajay Jaiswal, Peihao Wang, Tianlong Chen et al.

Despite the enormous success of Graph Convolutional Networks (GCNs) in modeling graph-structured data, most of the current GCNs are shallow due to the notoriously challenging problems of over-smoothening and information squashing along with conventional difficulty caused by vanishing gradients and over-fitting. Previous works have been primarily focused on the study of over-smoothening and over-squashing phenomena in training deep GCNs. Surprisingly, in comparison with CNNs/RNNs, very limited attention has been given to understanding how healthy gradient flow can benefit the trainability of deep GCNs. In this paper, firstly, we provide a new perspective of gradient flow to understand the substandard performance of deep GCNs and hypothesize that by facilitating healthy gradient flow, we can significantly improve their trainability, as well as achieve state-of-the-art (SOTA) level performance from vanilla-GCNs. Next, we argue that blindly adopting the Glorot initialization for GCNs is not optimal, and derive a topology-aware isometric initialization scheme for vanilla-GCNs based on the principles of isometry. Additionally, contrary to ad-hoc addition of skip-connections, we propose to use gradient-guided dynamic rewiring of vanilla-GCNs} with skip connections. Our dynamic rewiring method uses the gradient flow within each layer during training to introduce on-demand skip-connections adaptively. We provide extensive empirical evidence across multiple datasets that our methods improve gradient flow in deep vanilla-GCNs and significantly boost their performance to comfortably compete and outperform many fancy state-of-the-art methods. Codes are available at: https://github.com/VITA-Group/GradientGCN.

Ajay Jaiswal, Tianlong Chen, Justin F. Rousseau et al.

Deep neural networks (DNNs) have rapidly become a \textit{de facto} choice for medical image understanding tasks. However, DNNs are notoriously fragile to the class imbalance in image classification. We further point out that such imbalance fragility can be amplified when it comes to more sophisticated tasks such as pathology localization, as imbalances in such problems can have highly complex and often implicit forms of presence. For example, different pathology can have different sizes or colors (w.r.t.the background), different underlying demographic distributions, and in general different difficulty levels to recognize, even in a meticulously curated balanced distribution of training data. In this paper, we propose to use pruning to automatically and adaptively identify \textit{hard-to-learn} (HTL) training samples, and improve pathology localization by attending them explicitly, during training in \textit{supervised, semi-supervised, and weakly-supervised} settings. Our main inspiration is drawn from the recent finding that deep classification models have difficult-to-memorize samples and those may be effectively exposed through network pruning \cite{hooker2019compressed} - and we extend such observation beyond classification for the first time. We also present an interesting demographic analysis which illustrates HTLs ability to capture complex demographic imbalances. Our extensive experiments on the Skin Lesion Localization task in multiple training settings by paying additional attention to HTLs show significant improvement of localization performance by $\sim$2-3\%.

Ajay Jaiswal, Kumar Ashutosh, Justin F Rousseau et al.

AI-powered Medical Imaging has recently achieved enormous attention due to its ability to provide fast-paced healthcare diagnoses. However, it usually suffers from a lack of high-quality datasets due to high annotation cost, inter-observer variability, human annotator error, and errors in computer-generated labels. Deep learning models trained on noisy labelled datasets are sensitive to the noise type and lead to less generalization on the unseen samples. To address this challenge, we propose a Robust Stochastic Knowledge Distillation (RoS-KD) framework which mimics the notion of learning a topic from multiple sources to ensure deterrence in learning noisy information. More specifically, RoS-KD learns a smooth, well-informed, and robust student manifold by distilling knowledge from multiple teachers trained on overlapping subsets of training data. Our extensive experiments on popular medical imaging classification tasks (cardiopulmonary disease and lesion classification) using real-world datasets, show the performance benefit of RoS-KD, its ability to distill knowledge from many popular large networks (ResNet-50, DenseNet-121, MobileNet-V2) in a comparatively small network, and its robustness to adversarial attacks (PGD, FSGM). More specifically, RoS-KD achieves >2% and >4% improvement on F1-score for lesion classification and cardiopulmonary disease classification tasks, respectively, when the underlying student is ResNet-18 against recent competitive knowledge distillation baseline. Additionally, on cardiopulmonary disease classification task, RoS-KD outperforms most of the SOTA baselines by ~1% gain in AUC score.

Li Shi, Redoan Rahman, Esther Melamed et al.

This paper applies eXplainable Artificial Intelligence (XAI) methods to investigate the socioeconomic disparities in COVID patient mortality. An Extreme Gradient Boosting (XGBoost) prediction model is built based on a de-identified Austin area hospital dataset to predict the mortality of COVID-19 patients. We apply two XAI methods, Shapley Additive exPlanations (SHAP) and Locally Interpretable Model Agnostic Explanations (LIME), to compare the global and local interpretation of feature importance. This paper demonstrates the advantages of using XAI which shows the feature importance and decisive capability. Furthermore, we use the XAI methods to cross-validate their interpretations for individual patients. The XAI models reveal that Medicare financial class, older age, and gender have high impact on the mortality prediction. We find that LIME local interpretation does not show significant differences in feature importance comparing to SHAP, which suggests pattern confirmation. This paper demonstrates the importance of XAI methods in cross-validation of feature attributions.

Xizhi Wu, Nelly Estefanie Garduno-Rapp, Justin F Rousseau et al.

Unlike most primary headaches, secondary headaches need specialized care and can have devastating consequences if not treated promptly. Clinical guidelines highlight several 'red flag' features, such as thunderclap onset, meningismus, papilledema, focal neurologic deficits, signs of temporal arteritis, systemic illness, and the 'worst headache of their life' presentation. Despite these guidelines, determining which patients require urgent evaluation remains challenging in primary care settings. Clinicians often work with limited time, incomplete information, and diverse symptom presentations, which can lead to under-recognition and inappropriate care. We present a large language model (LLM)-based multi-agent clinical decision support system built on an orchestrator-specialist architecture, designed to perform explicit and interpretable secondary headache diagnosis from free-text clinical vignettes. The multi-agent system decomposes diagnosis into seven domain-specialized agents, each producing a structured and evidence-grounded rationale, while a central orchestrator performs task decomposition and coordinates agent routing. We evaluated the multi-agent system using 90 expert-validated secondary headache cases and compared its performance with a single-LLM baseline across two prompting strategies: question-based prompting (QPrompt) and clinical practice guideline-based prompting (GPrompt). We tested five open-source LLMs (Qwen-30B, GPT-OSS-20B, Qwen-14B, Qwen-8B, and Llama-3.1-8B), and found that the orchestrated multi-agent system with GPrompt consistently achieved the highest F1 scores, with larger gains in smaller models. These findings demonstrate that structured multi-agent reasoning improves accuracy beyond prompt engineering alone and offers a transparent, clinically aligned approach for explainable decision support in secondary headache diagnosis.

Redoan Rahman, Jooyeong Kang, Justin F Rousseau et al.

This paper applies multiple machine learning (ML) algorithms to a dataset of de-identified COVID-19 patients provided by the COVID-19 Research Database. The dataset consists of 20,878 COVID-positive patients, among which 9,177 patients died in the year 2020. This paper aims to understand and interpret the association of socio-economic characteristics of patients with their mortality instead of maximizing prediction accuracy. According to our analysis, a patients households annual and disposable income, age, education, and employment status significantly impacts a machine learning models prediction. We also observe several individual patient data, which gives us insight into how the feature values impact the prediction for that data point. This paper analyzes the global and local interpretation of machine learning models on socio-economic data of COVID patients.

Gongbo Zhang, Zihan Xu, Qiao Jin et al.

While holding great promise for improving and facilitating healthcare, large language models (LLMs) struggle to produce up-to-date responses on evolving topics due to outdated knowledge or hallucination. Retrieval-augmented generation (RAG) is a pivotal innovation that improves the accuracy and relevance of LLM responses by integrating LLMs with a search engine and external sources of knowledge. However, the quality of RAG responses can be largely impacted by the rank and density of key information in the retrieval results, such as the "lost-in-the-middle" problem. In this work, we aim to improve the robustness and reliability of the RAG workflow in the medical domain. Specifically, we propose a map-reduce strategy, BriefContext, to combat the "lost-in-the-middle" issue without modifying the model weights. We demonstrated the advantage of the workflow with various LLM backbones and on multiple QA datasets. This method promises to improve the safety and reliability of LLMs deployed in healthcare domains.

Yufei Shen, Ji Hwan Park, Minchao Huang et al.

Early detection of cognitive impairment is critical for timely diagnosis and intervention, yet infrequent clinical assessments often lack the sensitivity and temporal resolution to capture subtle cognitive declines in older adults. Passive smartphone sensing has emerged as a promising approach for naturalistic and continuous cognitive monitoring. Building on this potential, we implemented a Long Short-Term Memory (LSTM) model to detect cognitive impairment from sequences of daily behavioral features, derived from multimodal sensing data collected in an ongoing one-year study of older adults. Our key contributions are two techniques to enhance model generalizability across participants: (1) routine-aware augmentation, which generates synthetic sequences by replacing each day with behaviorally similar alternatives, and (2) demographic personalization, which reweights training samples to emphasize those from individuals demographically similar to the test participant. Evaluated on 6-month data from 36 older adults, these techniques jointly improved the Area Under the Precision-Recall Curve (AUPRC) of the model trained on sensing and demographic features from 0.637 to 0.766, highlighting the potential of scalable monitoring of cognitive impairment in aging populations with passive sensing.

Qiao Jin, Fangyuan Chen, Yiliang Zhou et al.

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4V's rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges - an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals. Evaluation results confirmed that GPT-4V performs comparatively to human physicians regarding multi-choice accuracy (81.6% vs. 77.8%). GPT-4V also performs well in cases where physicians incorrectly answer, with over 78% accuracy. However, we discovered that GPT-4V frequently presents flawed rationales in cases where it makes the correct final choices (35.5%), most prominent in image comprehension (27.2%). Regardless of GPT-4V's high accuracy in multi-choice questions, our findings emphasize the necessity for further in-depth evaluations of its rationales before integrating such multimodal AI models into clinical workflows.

Liyan Tang, Yifan Peng, Yanshan Wang et al.

A human decision-maker benefits the most from an AI assistant that corrects for their biases. For problems such as generating interpretation of a radiology report given findings, a system predicting only highly likely outcomes may be less useful, where such outcomes are already obvious to the user. To alleviate biases in human decision-making, it is worth considering a broad differential diagnosis, going beyond the most likely options. We introduce a new task, "less likely brainstorming," that asks a model to generate outputs that humans think are relevant but less likely to happen. We explore the task in two settings: a brain MRI interpretation generation setting and an everyday commonsense reasoning setting. We found that a baseline approach of training with less likely hypotheses as targets generates outputs that humans evaluate as either likely or irrelevant nearly half of the time; standard MLE training is not effective. To tackle this problem, we propose a controlled text generation method that uses a novel contrastive learning strategy to encourage models to differentiate between generating likely and less likely outputs according to humans. We compare our method with several state-of-the-art controlled text generation models via automatic and human evaluations and show that our models' capability of generating less likely outputs is improved.

Ajay Jaiswal, Liyan Tang, Meheli Ghosh et al.

Radiology reports are unstructured and contain the imaging findings and corresponding diagnoses transcribed by radiologists which include clinical facts and negated and/or uncertain statements. Extracting pathologic findings and diagnoses from radiology reports is important for quality control, population health, and monitoring of disease progress. Existing works, primarily rely either on rule-based systems or transformer-based pre-trained model fine-tuning, but could not take the factual and uncertain information into consideration, and therefore generate false-positive outputs. In this work, we introduce three sedulous augmentation techniques which retain factual and critical information while generating augmentations for contrastive learning. We introduce RadBERT-CL, which fuses these information into BlueBert via a self-supervised contrastive loss. Our experiments on MIMIC-CXR show superior performance of RadBERT-CL on fine-tuning for multi-class, multi-label report classification. We illustrate that when few labeled data are available, RadBERT-CL outperforms conventional SOTA transformers (BERT/BlueBert) by significantly larger margins (6-11%). We also show that the representations learned by RadBERT-CL can capture critical medical information in the latent space.

Ajay Jaiswal, Tianhao Li, Cyprian Zander et al.

Computer-aided diagnosis plays a salient role in more accessible and accurate cardiopulmonary diseases classification and localization on chest radiography. Millions of people get affected and die due to these diseases without an accurate and timely diagnosis. Recently proposed contrastive learning heavily relies on data augmentation, especially positive data augmentation. However, generating clinically-accurate data augmentations for medical images is extremely difficult because the common data augmentation methods in computer vision, such as sharp, blur, and crop operations, can severely alter the clinical settings of medical images. In this paper, we proposed a novel and simple data augmentation method based on patient metadata and supervised knowledge to create clinically accurate positive and negative augmentations for chest X-rays. We introduce an end-to-end framework, SCALP, which extends the self-supervised contrastive approach to a supervised setting. Specifically, SCALP pulls together chest X-rays from the same patient (positive keys) and pushes apart chest X-rays from different patients (negative keys). In addition, it uses ResNet-50 along with the triplet-attention mechanism to identify cardiopulmonary diseases, and Grad-CAM++ to highlight the abnormal regions. Our extensive experiments demonstrate that SCALP outperforms existing baselines with significant margins in both classification and localization tasks. Specifically, the average classification AUCs improve from 82.8% (SOTA using DenseNet-121) to 83.9% (SCALP using ResNet-50), while the localization results improve on average by 3.7% over different IoU thresholds.