Changchang Yin

Changchang Yin, Pin-Yu Chen, Bingsheng Yao et al.

Sepsis is the leading cause of in-hospital mortality in the USA. Early sepsis onset prediction and diagnosis could significantly improve the survival of sepsis patients. Existing predictive models are usually trained on high-quality data with few missing information, while missing values widely exist in real-world clinical scenarios (especially in the first hours of admissions to the hospital), which causes a significant decrease in accuracy and an increase in uncertainty for the predictive models. The common method to handle missing values is imputation, which replaces the unavailable variables with estimates from the observed data. The uncertainty of imputation results can be propagated to the sepsis prediction outputs, which have not been studied in existing works on either sepsis prediction or uncertainty quantification. In this study, we first define such propagated uncertainty as the variance of prediction output and then introduce uncertainty propagation methods to quantify the propagated uncertainty. Moreover, for the potential high-risk patients with low confidence due to limited observations, we propose a robust active sensing algorithm to increase confidence by actively recommending clinicians to observe the most informative variables. We validate the proposed models in both publicly available data (i.e., MIMIC-III and AmsterdamUMCdb) and proprietary data in The Ohio State University Wexner Medical Center (OSUWMC). The experimental results show that the propagated uncertainty is dominant at the beginning of admissions to hospitals and the proposed algorithm outperforms state-of-the-art active sensing methods. Finally, we implement a SepsisLab system for early sepsis prediction and active sensing based on our pre-trained models. Clinicians and potential sepsis patients can benefit from the system in early prediction and diagnosis of sepsis.

Shao Zhang, Jianing Yu, Xuhai Xu et al.

Today's AI systems for medical decision support often succeed on benchmark datasets in research papers but fail in real-world deployment. This work focuses on the decision making of sepsis, an acute life-threatening systematic infection that requires an early diagnosis with high uncertainty from the clinician. Our aim is to explore the design requirements for AI systems that can support clinical experts in making better decisions for the early diagnosis of sepsis. The study begins with a formative study investigating why clinical experts abandon an existing AI-powered Sepsis predictive module in their electrical health record (EHR) system. We argue that a human-centered AI system needs to support human experts in the intermediate stages of a medical decision-making process (e.g., generating hypotheses or gathering data), instead of focusing only on the final decision. Therefore, we build SepsisLab based on a state-of-the-art AI algorithm and extend it to predict the future projection of sepsis development, visualize the prediction uncertainty, and propose actionable suggestions (i.e., which additional laboratory tests can be collected) to reduce such uncertainty. Through heuristic evaluation with six clinicians using our prototype system, we demonstrate that SepsisLab enables a promising human-AI collaboration paradigm for the future of AI-assisted sepsis diagnosis and other high-stakes medical decision making.

Changchang Yin, Ruoqi Liu, Jeffrey Caterino et al.

Despite intense efforts in basic and clinical research, an individualized ventilation strategy for critically ill patients remains a major challenge. Recently, dynamic treatment regime (DTR) with reinforcement learning (RL) on electronic health records (EHR) has attracted interest from both the healthcare industry and machine learning research community. However, most learned DTR policies might be biased due to the existence of confounders. Although some treatment actions non-survivors received may be helpful, if confounders cause the mortality, the training of RL models guided by long-term outcomes (e.g., 90-day mortality) would punish those treatment actions causing the learned DTR policies to be suboptimal. In this study, we develop a new deconfounding actor-critic network (DAC) to learn optimal DTR policies for patients. To alleviate confounding issues, we incorporate a patient resampling module and a confounding balance module into our actor-critic framework. To avoid punishing the effective treatment actions non-survivors received, we design a short-term reward to capture patients' immediate health state changes. Combining short-term with long-term rewards could further improve the model performance. Moreover, we introduce a policy adaptation method to successfully transfer the learned model to new-source small-scale datasets. The experimental results on one semi-synthetic and two different real-world datasets show the proposed model outperforms the state-of-the-art models. The proposed model provides individualized treatment decisions for mechanical ventilation that could improve patient outcomes.

Zishan Gu, Changchang Yin, Fenglin Liu et al.

Large Vision Language Models (LVLMs) have recently achieved superior performance in various tasks on natural image and text data, which inspires a large amount of studies for LVLMs fine-tuning and training. Despite their advancements, there has been scant research on the robustness of these models against hallucination when fine-tuned on smaller datasets. In this study, we introduce a new benchmark dataset, the Medical Visual Hallucination Test (MedVH), to evaluate the hallucination of domain-specific LVLMs. MedVH comprises five tasks to evaluate hallucinations in LVLMs within the medical context, which includes tasks for comprehensive understanding of textual and visual input, as well as long textual response generation. Our extensive experiments with both general and medical LVLMs reveal that, although medical LVLMs demonstrate promising performance on standard medical tasks, they are particularly susceptible to hallucinations, often more so than the general models, raising significant concerns about the reliability of these domain-specific models. For medical LVLMs to be truly valuable in real-world applications, they must not only accurately integrate medical knowledge but also maintain robust reasoning abilities to prevent hallucination. Our work paves the way for future evaluations of these studies.

Jiahao Xu, Changchang Yin, Odysseas Chatzipanagiotou et al.

Surgical site infection (SSI) is one of the most common and costly healthcare-associated infections and and surgical wound care remains a significant clinical challenge in preventing SSIs and improving patient outcomes. While recent studies have explored the use of deep learning for preliminary surgical wound screening, progress has been hindered by concerns over data privacy and the high costs associated with expert annotation. Currently, no publicly available dataset or benchmark encompasses various types of surgical wounds, resulting in the absence of an open-source Surgical-Wound screening tool. To address this gap: (1) we present SurgWound, the first open-source dataset featuring a diverse array of surgical wound types. It contains 697 surgical wound images annotated by 3 professional surgeons with eight fine-grained clinical attributes. (2) Based on SurgWound, we introduce the first benchmark for surgical wound diagnosis, which includes visual question answering (VQA) and report generation tasks to comprehensively evaluate model performance. (3) Furthermore, we propose a three-stage learning framework, WoundQwen, for surgical wound diagnosis. In the first stage, we employ five independent MLLMs to accurately predict specific surgical wound characteristics. In the second stage, these predictions serve as additional knowledge inputs to two MLLMs responsible for diagnosing outcomes, which assess infection risk and guide subsequent interventions. In the third stage, we train a MLLM that integrates the diagnostic results from the previous two stages to produce a comprehensive report. This three-stage framework can analyze detailed surgical wound characteristics and provide subsequent instructions to patients based on surgical images, paving the way for personalized wound care, timely intervention, and improved patient outcomes.

Thai-Hoang Pham, Yuanlong Wang, Changchang Yin et al.

Domain adaptation (DA) tackles the issue of distribution shift by learning a model from a source domain that generalizes to a target domain. However, most existing DA methods are designed for scenarios where the source and target domain data lie within the same feature space, which limits their applicability in real-world situations. Recently, heterogeneous DA (HeDA) methods have been introduced to address the challenges posed by heterogeneous feature space between source and target domains. Despite their successes, current HeDA techniques fall short when there is a mismatch in both feature and label spaces. To address this, this paper explores a new DA scenario called open-set HeDA (OSHeDA). In OSHeDA, the model must not only handle heterogeneity in feature space but also identify samples belonging to novel classes. To tackle this challenge, we first develop a novel theoretical framework that constructs learning bounds for prediction error on target domain. Guided by this framework, we propose a new DA method called Representation Learning for OSHeDA (RL-OSHeDA). This method is designed to simultaneously transfer knowledge between heterogeneous data sources and identify novel classes. Experiments across text, image, and clinical data demonstrate the effectiveness of our algorithm. Model implementation is available at \url{https://github.com/pth1993/OSHeDA}.

Zicong Zhang, Kimerly Powell, Changchang Yin et al.

White Matter Hyperintensities (WMH) are the most common manifestation of cerebral small vessel disease (cSVD) on the brain MRI. Accurate WMH segmentation algorithms are important to determine cSVD burden and its clinical consequences. Most of existing WMH segmentation algorithms require both fluid attenuated inversion recovery (FLAIR) images and T1-weighted images as inputs. However, T1-weighted images are typically not part of standard clinicalscans which are acquired for patients with acute stroke. In this paper, we propose a novel brain atlas guided attention U-Net (BAGAU-Net) that leverages only FLAIR images with a spatially-registered white matter (WM) brain atlas to yield competitive WMH segmentation performance. Specifically, we designed a dual-path segmentation model with two novel connecting mechanisms, namely multi-input attention module (MAM) and attention fusion module (AFM) to fuse the information from two paths for accurate results. Experiments on two publicly available datasets show the effectiveness of the proposed BAGAU-Net. With only FLAIR images and WM brain atlas, BAGAU-Net outperforms the state-of-the-art method with T1-weighted images, paving the way for effective development of WMH segmentation. Availability:https://github.com/Ericzhang1/BAGAU-Net

Jiayuan Chen, Changchang Yin, Yuanlong Wang et al.

Deep learning-based predictive models, leveraging Electronic Health Records (EHR), are receiving increasing attention in healthcare. An effective representation of a patient's EHR should hierarchically encompass both the temporal relationships between historical visits and medical events, and the inherent structural information within these elements. Existing patient representation methods can be roughly categorized into sequential representation and graphical representation. The sequential representation methods focus only on the temporal relationships among longitudinal visits. On the other hand, the graphical representation approaches, while adept at extracting the graph-structured relationships between various medical events, fall short in effectively integrate temporal information. To capture both types of information, we model a patient's EHR as a novel temporal heterogeneous graph. This graph includes historical visits nodes and medical events nodes. It propagates structured information from medical event nodes to visit nodes and utilizes time-aware visit nodes to capture changes in the patient's health status. Furthermore, we introduce a novel temporal graph transformer (TRANS) that integrates temporal edge features, global positional encoding, and local structural encoding into heterogeneous graph convolution, capturing both temporal and structural information. We validate the effectiveness of TRANS through extensive experiments on three real-world datasets. The results show that our proposed approach achieves state-of-the-art performance.

Xiangrui Liu, Yuanyuan Zhang, Qianyu Shang et al.

Foundation models, first introduced in 2021, refer to large-scale pretrained models (e.g., large language models (LLMs) and vision-language models (VLMs)) that learn from extensive unlabeled datasets through unsupervised methods, enabling them to excel in diverse downstream tasks. These models, like GPT, can be adapted to various applications such as question answering and visual understanding, outperforming task-specific AI models and earning their name due to broad applicability across fields. The development of biomedical foundation models marks a significant milestone in the use of artificial intelligence (AI) to understand complex biological phenomena and advance medical research and practice. This survey explores the potential of foundation models in diverse domains within biomedical fields, including computational biology, drug discovery and development, clinical informatics, medical imaging, and public health. The purpose of this survey is to inspire ongoing research in the application of foundation models to health science.

Changchang Yin, Shihan Fu, Bingsheng Yao et al.

Sepsis is an organ dysfunction caused by a deregulated immune response to an infection. Early sepsis prediction and identification allow for timely intervention, leading to improved clinical outcomes. Clinical calculators (e.g., the six-organ dysfunction assessment of SOFA) play a vital role in sepsis identification within clinicians' workflow, providing evidence-based risk assessments essential for sepsis diagnosis. However, artificial intelligence (AI) sepsis prediction models typically generate a single sepsis risk score without incorporating clinical calculators for assessing organ dysfunctions, making the models less convincing and transparent to clinicians. To bridge the gap, we propose to mimic clinicians' workflow with a novel framework SepsisCalc to integrate clinical calculators into the predictive model, yielding a clinically transparent and precise model for utilization in clinical settings. Practically, clinical calculators usually combine information from multiple component variables in Electronic Health Records (EHR), and might not be applicable when the variables are (partially) missing. We mitigate this issue by representing EHRs as temporal graphs and integrating a learning module to dynamically add the accurately estimated calculator to the graphs. Experimental results on real-world datasets show that the proposed model outperforms state-of-the-art methods on sepsis prediction tasks. Moreover, we developed a system to identify organ dysfunctions and potential sepsis risks, providing a human-AI interaction tool for deployment, which can help clinicians understand the prediction outputs and prepare timely interventions for the corresponding dysfunctions, paving the way for actionable clinical decision-making support for early intervention.

Zishan Gu, Fenglin Liu, Changchang Yin et al.

The adoption of large language models (LLMs) in healthcare has attracted significant research interest. However, their performance in healthcare remains under-investigated and potentially limited, due to i) they lack rich domain-specific knowledge and medical reasoning skills; and ii) most state-of-the-art LLMs are unimodal, text-only models that cannot directly process multimodal inputs. To this end, we propose a multimodal medical collaborative reasoning framework \textbf{MultiMedRes}, which incorporates a learner agent to proactively gain essential information from domain-specific expert models, to solve medical multimodal reasoning problems. Our method includes three steps: i) \textbf{Inquire}: The learner agent first decomposes given complex medical reasoning problems into multiple domain-specific sub-problems; ii) \textbf{Interact}: The agent then interacts with domain-specific expert models by repeating the ``ask-answer'' process to progressively obtain different domain-specific knowledge; iii) \textbf{Integrate}: The agent finally integrates all the acquired domain-specific knowledge to accurately address the medical reasoning problem. We validate the effectiveness of our method on the task of difference visual question answering for X-ray images. The experiments demonstrate that our zero-shot prediction achieves state-of-the-art performance, and even outperforms the fully supervised methods. Besides, our approach can be incorporated into various LLMs and multimodal LLMs to significantly boost their performance.

Changchang Yin, Hong-You Chen, Wei-Lun Chao et al.

Individual treatment effect (ITE) estimation is to evaluate the causal effects of treatment strategies on some important outcomes, which is a crucial problem in healthcare. Most existing ITE estimation methods are designed for centralized settings. However, in real-world clinical scenarios, the raw data are usually not shareable among hospitals due to the potential privacy and security risks, which makes the methods not applicable. In this work, we study the ITE estimation task in a federated setting, which allows us to harness the decentralized data from multiple hospitals. Due to the unavoidable confounding bias in the collected data, a model directly learned from it would be inaccurate. One well-known solution is Inverse Probability Treatment Weighting (IPTW), which uses the conditional probability of treatment given the covariates to re-weight each training example. Applying IPTW in a federated setting, however, is non-trivial. We found that even with a well-estimated conditional probability, the local model training step using each hospital's data alone would still suffer from confounding bias. To address this, we propose FED-IPTW, a novel algorithm to extend IPTW into a federated setting that enforces both global (over all the data) and local (within each hospital) decorrelation between covariates and treatments. We validated our approach on the task of comparing the treatment effects of mechanical ventilation on improving survival probability for patients with breadth difficulties in the intensive care unit (ICU). We conducted experiments on both synthetic and real-world eICU datasets and the results show that FED-IPTW outperform state-of-the-art methods on all the metrics on factual prediction and ITE estimation tasks, paving the way for personalized treatment strategy design in mechanical ventilation usage.

Yuanlong Wang, Pengqi Wang, Changchang Yin et al.

Living environments play a vital role in the prevalence and progression of diseases, and understanding their impact on patient's health status becomes increasingly crucial for developing AI models. However, due to the lack of long-term and fine-grained spatial and temporal data in public and population health studies, most existing studies fail to incorporate environmental data, limiting the models' performance and real-world application. To address this shortage, we developed SatHealth, a novel dataset combining multimodal spatiotemporal data, including environmental data, satellite images, all-disease prevalences estimated from medical claims, and social determinants of health (SDoH) indicators. We conducted experiments under two use cases with SatHealth: regional public health modeling and personal disease risk prediction. Experimental results show that living environmental information can significantly improve AI models' performance and temporal-spatial generalizability on various tasks. Finally, we deploy a web-based application to provide an exploration tool for SatHealth and one-click access to both our data and regional environmental embedding to facilitate plug-and-play utilization. SatHealth is now published with data in Ohio, and we will keep updating SatHealth to cover the other parts of the US. With the web application and published code pipeline, our work provides valuable angles and resources to include environmental data in healthcare research and establishes a foundational framework for future research in environmental health informatics.

Ying Lei, Yancheng Cao, Will Wang et al.

While just-in-time interventions (JITIs) have effectively targeted common health behaviors, individuals often have unique needs to intervene in personal undesirable actions that can negatively affect physical, mental, and social well-being. We present WatchGuardian, a smartwatch-based JITI system that empowers users to define custom interventions for these personal actions with a small number of samples. For the model to detect new actions based on limited new data samples, we developed a few-shot learning pipeline that finetuned a pre-trained inertial measurement unit (IMU) model on public hand-gesture datasets. We then designed a data augmentation and synthesis process to train additional classification layers for customization. Our offline evaluation with 26 participants showed that with three, five, and ten examples, our approach achieved an average accuracy of 76.8%, 84.7%, and 87.7%, and an F1 score of 74.8%, 84.2%, and 87.2% We then conducted a four-hour intervention study to compare WatchGuardian against a rule-based intervention. Our results demonstrated that our system led to a significant reduction by 64.0 +- 22.6% in undesirable actions, substantially outperforming the baseline by 29.0%. Our findings underscore the effectiveness of a customizable, AI-driven JITI system for individuals in need of behavioral intervention in personal undesirable actions. We envision that our work can inspire broader applications of user-defined personalized intervention with advanced AI solutions.

Zicong Zhang, Changchang Yin, Ping Zhang

Disease progression modeling (DPM) involves using mathematical frameworks to quantitatively measure the severity of how certain disease progresses. DPM is useful in many ways such as predicting health state, categorizing disease stages, and assessing patients disease trajectory etc. Recently, with wider availability of electronic health records (EHR) and the broad application of data-driven machine learning method, DPM has attracted much attention yet remains two major challenges: (i) Due to the existence of irregularity, heterogeneity and long-term dependency in EHRs, most existing DPM methods might not be able to provide comprehensive patient representations. (ii) Lots of records in EHRs might be irrelevant to the target disease. Most existing models learn to automatically focus on the relevant information instead of explicitly capture the target-relevant events, which might make the learned model suboptimal. To address these two issues, we propose Temporal Clustering with External Memory Network (TC-EMNet) for DPM that groups patients with similar trajectories to form disease clusters/stages. TC-EMNet uses a variational autoencoder (VAE) to capture internal complexity from the input data and utilizes an external memory work to capture long term distance information, both of which are helpful for producing comprehensive patient states. Last but not least, k-means algorithm is adopted to cluster the extracted comprehensive patient states to capture disease progression. Experiments on two real-world datasets show that our model demonstrates competitive clustering performance against state-of-the-art methods and is able to identify clinically meaningful clusters. The visualization of the extracted patient states shows that the proposed model can generate better patient states than the baselines.

Thai-Hoang Pham, Changchang Yin, Laxmi Mehta et al.

Complication risk profiling is a key challenge in the healthcare domain due to the complex interaction between heterogeneous entities (e.g., visit, disease, medication) in clinical data. With the availability of real-world clinical data such as electronic health records and insurance claims, many deep learning methods are proposed for complication risk profiling. However, these existing methods face two open challenges. First, data heterogeneity relates to those methods leveraging clinical data from a single view only while the data can be considered from multiple views (e.g., sequence of clinical visits, set of clinical features). Second, generalized prediction relates to most of those methods focusing on single-task learning, whereas each complication onset is predicted independently, leading to suboptimal models. We propose a multi-view multi-task network (MuViTaNet) for predicting the onset of multiple complications to tackle these issues. In particular, MuViTaNet complements patient representation by using a multi-view encoder to effectively extract information by considering clinical data as both sequences of clinical visits and sets of clinical features. In addition, it leverages additional information from both related labeled and unlabeled datasets to generate more generalized representations by using a new multi-task learning scheme for making more accurate predictions. The experimental results show that MuViTaNet outperforms existing methods for profiling the development of cardiac complications in breast cancer survivors. Furthermore, thanks to its multi-view multi-task architecture, MuViTaNet also provides an effective mechanism for interpreting its predictions in multiple perspectives, thereby helping clinicians discover the underlying mechanism triggering the onset and for making better clinical treatments in real-world scenarios.

Fenglin Liu, Changchang Yin, Xian Wu et al.

Recently, chest X-ray report generation, which aims to automatically generate descriptions of given chest X-ray images, has received growing research interests. The key challenge of chest X-ray report generation is to accurately capture and describe the abnormal regions. In most cases, the normal regions dominate the entire chest X-ray image, and the corresponding descriptions of these normal regions dominate the final report. Due to such data bias, learning-based models may fail to attend to abnormal regions. In this work, to effectively capture and describe abnormal regions, we propose the Contrastive Attention (CA) model. Instead of solely focusing on the current input image, the CA model compares the current input image with normal images to distill the contrastive information. The acquired contrastive information can better represent the visual features of abnormal regions. According to the experiments on the public IU-X-ray and MIMIC-CXR datasets, incorporating our CA into several existing models can boost their performance across most metrics. In addition, according to the analysis, the CA model can help existing models better attend to the abnormal regions and provide more accurate descriptions which are crucial for an interpretable diagnosis. Specifically, we achieve the state-of-the-art results on the two public datasets.

Ruoqi Liu, Changchang Yin, Ping Zhang

Estimating the individual treatment effect (ITE) from observational data is meaningful and practical in healthcare. Existing work mainly relies on the strong ignorability assumption that no hidden confounders exist, which may lead to bias in estimating causal effects. Some studies consider the hidden confounders are designed for static environment and not easily adaptable to a dynamic setting. In fact, most observational data (e.g., electronic medical records) is naturally dynamic and consists of sequential information. In this paper, we propose Deep Sequential Weighting (DSW) for estimating ITE with time-varying confounders. Specifically, DSW infers the hidden confounders by incorporating the current treatment assignments and historical information using a deep recurrent weighting neural network. The learned representations of hidden confounders combined with current observed data are leveraged for potential outcome and treatment predictions. We compute the time-varying inverse probabilities of treatment for re-weighting the population. We conduct comprehensive comparison experiments on fully-synthetic, semi-synthetic and real-world datasets to evaluate the performance of our model and baselines. Results demonstrate that our model can generate unbiased and accurate treatment effect by conditioning both time-varying observed and hidden confounders, paving the way for personalized medicine.

Zihao Zhu, Changchang Yin, Buyue Qian et al.

Evaluating the clinical similarities between pairwise patients is a fundamental problem in healthcare informatics. A proper patient similarity measure enables various downstream applications, such as cohort study and treatment comparative effectiveness research. One major carrier for conducting patient similarity research is Electronic Health Records(EHRs), which are usually heterogeneous, longitudinal, and sparse. Though existing studies on learning patient similarity from EHRs have shown being useful in solving real clinical problems, their applicability is limited due to the lack of medical interpretations. Moreover, most previous methods assume a vector-based representation for patients, which typically requires aggregation of medical events over a certain time period. As a consequence, temporal information will be lost. In this paper, we propose a patient similarity evaluation framework based on the temporal matching of longitudinal patient EHRs. Two efficient methods are presented, unsupervised and supervised, both of which preserve the temporal properties in EHRs. The supervised scheme takes a convolutional neural network architecture and learns an optimal representation of patient clinical records with medical concept embedding. The empirical results on real-world clinical data demonstrate substantial improvement over the baselines. We make our code and sample data available for further study.

Spyridon Bakas, Mauricio Reyes, Andras Jakab et al.

Gliomas are the most common primary brain malignancies, with different degrees of aggressiveness, variable prognosis and various heterogeneous histologic sub-regions, i.e., peritumoral edematous/invaded tissue, necrotic core, active and non-enhancing core. This intrinsic heterogeneity is also portrayed in their radio-phenotype, as their sub-regions are depicted by varying intensity profiles disseminated across multi-parametric magnetic resonance imaging (mpMRI) scans, reflecting varying biological properties. Their heterogeneous shape, extent, and location are some of the factors that make these tumors difficult to resect, and in some cases inoperable. The amount of resected tumor is a factor also considered in longitudinal scans, when evaluating the apparent tumor for potential diagnosis of progression. Furthermore, there is mounting evidence that accurate segmentation of the various tumor sub-regions can offer the basis for quantitative image analysis towards prediction of patient overall survival. This study assesses the state-of-the-art machine learning (ML) methods used for brain tumor image analysis in mpMRI scans, during the last seven instances of the International Brain Tumor Segmentation (BraTS) challenge, i.e., 2012-2018. Specifically, we focus on i) evaluating segmentations of the various glioma sub-regions in pre-operative mpMRI scans, ii) assessing potential tumor progression by virtue of longitudinal growth of tumor sub-regions, beyond use of the RECIST/RANO criteria, and iii) predicting the overall survival from pre-operative mpMRI scans of patients that underwent gross total resection. Finally, we investigate the challenge of identifying the best ML algorithms for each of these tasks, considering that apart from being diverse on each instance of the challenge, the multi-institutional mpMRI BraTS dataset has also been a continuously evolving/growing dataset.