Benjamin S. Glicksberg

Akhil Vaid, Joy Jiang, Ashwin Sawant et al.

The electrocardiogram (ECG) is a ubiquitous diagnostic modality. Convolutional neural networks (CNNs) applied towards ECG analysis require large sample sizes, and transfer learning approaches result in suboptimal performance when pre-training is done on natural images. We leveraged masked image modeling to create the first vision-based transformer model, HeartBEiT, for electrocardiogram waveform analysis. We pre-trained this model on 8.5 million ECGs and then compared performance vs. standard CNN architectures for diagnosis of hypertrophic cardiomyopathy, low left ventricular ejection fraction and ST elevation myocardial infarction using differing training sample sizes and independent validation datasets. We show that HeartBEiT has significantly higher performance at lower sample sizes compared to other models. Finally, we also show that HeartBEiT improves explainability of diagnosis by highlighting biologically relevant regions of the EKG vs. standard CNNs. Thus, we present the first vision-based waveform transformer that can be used to develop specialized models for ECG analysis especially at low sample sizes.

Sonish Sivarajkumar, Pratyush Tandale, Ankit Bhardwaj et al.

Transcription factors (TFs) play a vital role in the regulation of gene expression thereby making them critical to many cellular processes. In this study, we used graph machine learning methods to create a compendium of TF cascades using data extracted from the STRING database. A TF cascade is a sequence of TFs that regulate each other, forming a directed path in the TF network. We constructed a knowledge graph of 81,488 unique TF cascades, with the longest cascade consisting of 62 TFs. Our results highlight the complex and intricate nature of TF interactions, where multiple TFs work together to regulate gene expression. We also identified 10 TFs with the highest regulatory influence based on centrality measurements, providing valuable information for researchers interested in studying specific TFs. Furthermore, our pathway enrichment analysis revealed significant enrichment of various pathways and functional categories, including those involved in cancer and other diseases, as well as those involved in development, differentiation, and cell signaling. The enriched pathways identified in this study may have potential as targets for therapeutic intervention in diseases associated with dysregulation of transcription factors. We have released the dataset, knowledge graph, and graphML methods for the TF cascades, and created a website to display the results, which can be accessed by researchers interested in using this dataset. Our study provides a valuable resource for understanding the complex network of interactions between TFs and their regulatory roles in cellular processes.

Akhil Vaid, Joshua Lampert, Juhee Lee et al.

Generative Large Language Models (LLMs) hold significant promise in healthcare, demonstrating capabilities such as passing medical licensing exams and providing clinical knowledge. However, their current use as information retrieval tools is limited by challenges like data staleness, resource demands, and occasional generation of incorrect information. This study assessed the potential of LLMs to function as autonomous agents in a simulated tertiary care medical center, using real-world clinical cases across multiple specialties. Both proprietary and open-source LLMs were evaluated, with Retrieval Augmented Generation (RAG) enhancing contextual relevance. Proprietary models, particularly GPT-4, generally outperformed open-source models, showing improved guideline adherence and more accurate responses with RAG. The manual evaluation by expert clinicians was crucial in validating models' outputs, underscoring the importance of human oversight in LLM operation. Further, the study emphasizes Natural Language Programming (NLP) as the appropriate paradigm for modifying model behavior, allowing for precise adjustments through tailored prompts and real-world interactions. This approach highlights the potential of LLMs to significantly enhance and supplement clinical decision-making, while also emphasizing the value of continuous expert involvement and the flexibility of NLP to ensure their reliability and effectiveness in healthcare settings.

Dhavalkumar Patel, Ganesh Raut, Satya Narayan Cheetirala et al.

Generative AI is transforming enterprise application development by enabling machines to create content, code, and designs. These models, however, demand substantial computational power and data management. Cloud computing addresses these needs by offering infrastructure to train, deploy, and scale generative AI models. This review examines cloud services for generative AI, focusing on key providers like Amazon Web Services (AWS), Microsoft Azure, Google Cloud, IBM Cloud, Oracle Cloud, and Alibaba Cloud. It compares their strengths, weaknesses, and impact on enterprise growth. We explore the role of high-performance computing (HPC), serverless architectures, edge computing, and storage in supporting generative AI. We also highlight the significance of data management, networking, and AI-specific tools in building and deploying these models. Additionally, the review addresses security concerns, including data privacy, compliance, and AI model protection. It assesses the performance and cost efficiency of various cloud providers and presents case studies from healthcare, finance, and entertainment. We conclude by discussing challenges and future directions, such as technical hurdles, vendor lock-in, sustainability, and regulatory issues. Put together, this work can serve as a guide for practitioners and researchers looking to adopt cloud-based generative AI solutions, serving as a valuable guide to navigating the intricacies of this evolving field.

Ryan T. Scott, Erik L. Antonsen, Lauren M. Sanders et al.

Human space exploration beyond low Earth orbit will involve missions of significant distance and duration. To effectively mitigate myriad space health hazards, paradigm shifts in data and space health systems are necessary to enable Earth-independence, rather than Earth-reliance. Promising developments in the fields of artificial intelligence and machine learning for biology and health can address these needs. We propose an appropriately autonomous and intelligent Precision Space Health system that will monitor, aggregate, and assess biomedical statuses; analyze and predict personalized adverse health outcomes; adapt and respond to newly accumulated data; and provide preventive, actionable, and timely insights to individual deep space crew members and iterative decision support to their crew medical officer. Here we present a summary of recommendations from a workshop organized by the National Aeronautics and Space Administration, on future applications of artificial intelligence in space biology and health. In the next decade, biomonitoring technology, biomarker science, spacecraft hardware, intelligent software, and streamlined data management must mature and be woven together into a Precision Space Health system to enable humanity to thrive in deep space.

Lauren M. Sanders, Jason H. Yang, Ryan T. Scott et al.

Space biology research aims to understand fundamental effects of spaceflight on organisms, develop foundational knowledge to support deep space exploration, and ultimately bioengineer spacecraft and habitats to stabilize the ecosystem of plants, crops, microbes, animals, and humans for sustained multi-planetary life. To advance these aims, the field leverages experiments, platforms, data, and model organisms from both spaceborne and ground-analog studies. As research is extended beyond low Earth orbit, experiments and platforms must be maximally autonomous, light, agile, and intelligent to expedite knowledge discovery. Here we present a summary of recommendations from a workshop organized by the National Aeronautics and Space Administration on artificial intelligence, machine learning, and modeling applications which offer key solutions toward these space biology challenges. In the next decade, the synthesis of artificial intelligence into the field of space biology will deepen the biological understanding of spaceflight effects, facilitate predictive modeling and analytics, support maximally autonomous and reproducible experiments, and efficiently manage spaceborne data and metadata, all with the goal to enable life to thrive in deep space.

Yan Han, Chongyan Chen, Ahmed Tewfik et al.

Building a highly accurate predictive model for classification and localization of abnormalities in chest X-rays usually requires a large number of manually annotated labels and pixel regions (bounding boxes) of abnormalities. However, it is expensive to acquire such annotations, especially the bounding boxes. Recently, contrastive learning has shown strong promise in leveraging unlabeled natural images to produce highly generalizable and discriminative features. However, extending its power to the medical image domain is under-explored and highly non-trivial, since medical images are much less amendable to data augmentations. In contrast, their prior knowledge, as well as radiomic features, is often crucial. To bridge this gap, we propose an end-to-end semi-supervised knowledge-augmented contrastive learning framework, that simultaneously performs disease classification and localization tasks. The key knob of our framework is a unique positive sampling approach tailored for the medical images, by seamlessly integrating radiomic features as a knowledge augmentation. Specifically, we first apply an image encoder to classify the chest X-rays and to generate the image features. We next leverage Grad-CAM to highlight the crucial (abnormal) regions for chest X-rays (even when unannotated), from which we extract radiomic features. The radiomic features are then passed through another dedicated encoder to act as the positive sample for the image features generated from the same chest X-ray. In this way, our framework constitutes a feedback loop for image and radiomic modality features to mutually reinforce each other. Their contrasting yields knowledge-augmented representations that are both robust and interpretable. Extensive experiments on the NIH Chest X-ray dataset demonstrate that our approach outperforms existing baselines in both classification and localization tasks.

Tingyi Wanyan, Jing Zhang, Ying Ding et al.

Electronic Health Record (EHR) data has been of tremendous utility in Artificial Intelligence (AI) for healthcare such as predicting future clinical events. These tasks, however, often come with many challenges when using classical machine learning models due to a myriad of factors including class imbalance and data heterogeneity (i.e., the complex intra-class variances). To address some of these research gaps, this paper leverages the exciting contrastive learning framework and proposes a novel contrastive regularized clinical classification model. The contrastive loss is found to substantially augment EHR-based prediction: it effectively characterizes the similar/dissimilar patterns (by its "push-and-pull" form), meanwhile mitigating the highly skewed class distribution by learning more balanced feature spaces (as also echoed by recent findings). In particular, when naively exporting the contrastive learning to the EHR data, one hurdle is in generating positive samples, since EHR data is not as amendable to data augmentation as image data. To this end, we have introduced two unique positive sampling strategies specifically tailored for EHR data: a feature-based positive sampling that exploits the feature space neighborhood structure to reinforce the feature learning; and an attribute-based positive sampling that incorporates pre-generated patient similarity metrics to define the sample proximity. Both sampling approaches are designed with an awareness of unique high intra-class variance in EHR data. Our overall framework yields highly competitive experimental results in predicting the mortality risk on real-world COVID-19 EHR data with a total of 5,712 patients admitted to a large, urban health system. Specifically, our method reaches a high AUROC prediction score of 0.959, which outperforms other baselines and alternatives: cross-entropy(0.873) and focal loss(0.931).

Tingyi Wanyan, Hossein Honarvar, Suraj K. Jaladanki et al.

Machine Learning (ML) models typically require large-scale, balanced training data to be robust, generalizable, and effective in the context of healthcare. This has been a major issue for developing ML models for the coronavirus-disease 2019 (COVID-19) pandemic where data is highly imbalanced, particularly within electronic health records (EHR) research. Conventional approaches in ML use cross-entropy loss (CEL) that often suffers from poor margin classification. For the first time, we show that contrastive loss (CL) improves the performance of CEL especially for imbalanced EHR data and the related COVID-19 analyses. This study has been approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai. We use EHR data from five hospitals within the Mount Sinai Health System (MSHS) to predict mortality, intubation, and intensive care unit (ICU) transfer in hospitalized COVID-19 patients over 24 and 48 hour time windows. We train two sequential architectures (RNN and RETAIN) using two loss functions (CEL and CL). Models are tested on full sample data set which contain all available data and restricted data set to emulate higher class imbalance.CL models consistently outperform CEL models with the restricted data set on these tasks with differences ranging from 0.04 to 0.15 for AUPRC and 0.05 to 0.1 for AUROC. For the restricted sample, only the CL model maintains proper clustering and is able to identify important features, such as pulse oximetry. CL outperforms CEL in instances of severe class imbalance, on three EHR outcomes with respect to three performance metrics: predictive power, clustering, and feature importance. We believe that the developed CL framework can be expanded and used for EHR ML work in general.

Tingyi Wanyan, Hossein Honarvar, Ariful Azad et al.

Computational prediction of in-hospital mortality in the setting of an intensive care unit can help clinical practitioners to guide care and make early decisions for interventions. As clinical data are complex and varied in their structure and components, continued innovation of modeling strategies is required to identify architectures that can best model outcomes. In this work, we train a Heterogeneous Graph Model (HGM) on Electronic Health Record data and use the resulting embedding vector as additional information added to a Convolutional Neural Network (CNN) model for predicting in-hospital mortality. We show that the additional information provided by including time as a vector in the embedding captures the relationships between medical concepts, lab tests, and diagnoses, which enhances predictive performance. We find that adding HGM to a CNN model increases the mortality prediction accuracy up to 4\%. This framework serves as a foundation for future experiments involving different EHR data types on important healthcare prediction tasks.

Jie Xu, Benjamin S. Glicksberg, Chang Su et al.

With the rapid development of computer software and hardware technologies, more and more healthcare data are becoming readily available from clinical institutions, patients, insurance companies and pharmaceutical industries, among others. This access provides an unprecedented opportunity for data science technologies to derive data-driven insights and improve the quality of care delivery. Healthcare data, however, are usually fragmented and private making it difficult to generate robust results across populations. For example, different hospitals own the electronic health records (EHR) of different patient populations and these records are difficult to share across hospitals because of their sensitive nature. This creates a big barrier for developing effective analytical approaches that are generalizable, which need diverse, "big data". Federated learning, a mechanism of training a shared global model with a central server while keeping all the sensitive data in local institutions where the data belong, provides great promise to connect the fragmented healthcare data sources with privacy-preservation. The goal of this survey is to provide a review for federated learning technologies, particularly within the biomedical space. In particular, we summarize the general solutions to the statistical challenges, system challenges and privacy issues in federated learning, and point out the implications and potentials in healthcare.

Beau Norgeot, Dmytro Lituiev, Benjamin S. Glicksberg et al.

Clinical data for ambulatory care, which accounts for 90% of the nations healthcare spending, is characterized by relatively small sample sizes of longitudinal data, unequal spacing between visits for each patient, with unequal numbers of data points collected across patients. While deep learning has become state-of-the-art for sequence modeling, it is unknown which methods of time aggregation may be best suited for these challenging temporal use cases. Additionally, deep models are often considered uninterpretable by physicians which may prevent the clinical adoption, even of well performing models. We show that time-distributed-dense layers combined with GRUs produce the most generalizable models. Furthermore, we provide a framework for the clinical interpretation of the models.

Marcus A. Badgeley, John R. Zech, Luke Oakden-Rayner et al.

Hip fractures are a leading cause of death and disability among older adults. Hip fractures are also the most commonly missed diagnosis on pelvic radiographs. Computer-Aided Diagnosis (CAD) algorithms have shown promise for helping radiologists detect fractures, but the image features underpinning their predictions are notoriously difficult to understand. In this study, we trained deep learning models on 17,587 radiographs to classify fracture, five patient traits, and 14 hospital process variables. All 20 variables could be predicted from a radiograph (p < 0.05), with the best performances on scanner model (AUC=1.00), scanner brand (AUC=0.98), and whether the order was marked "priority" (AUC=0.79). Fracture was predicted moderately well from the image (AUC=0.78) and better when combining image features with patient data (AUC=0.86, p=2e-9) or patient data plus hospital process features (AUC=0.91, p=1e-21). The model performance on a test set with matched patient variables was significantly lower than a random test set (AUC=0.67, p=0.003); and when the test set was matched on patient and image acquisition variables, the model performed randomly (AUC=0.52, 95% CI 0.46-0.58), indicating that these variables were the main source of the model's predictive ability overall. We also used Naive Bayes to combine evidence from image models with patient and hospital data and found their inclusion improved performance, but that this approach was nevertheless inferior to directly modeling all variables. If CAD algorithms are inexplicably leveraging patient and process variables in their predictions, it is unclear how radiologists should interpret their predictions in the context of other known patient data. Further research is needed to illuminate deep learning decision processes so that computers and clinicians can effectively cooperate.