Nan Liu

Nan Liu, Shuang Li, Yilun Du et al. · mit

Large text-guided diffusion models, such as DALLE-2, are able to generate stunning photorealistic images given natural language descriptions. While such models are highly flexible, they struggle to understand the composition of certain concepts, such as confusing the attributes of different objects or relations between objects. In this paper, we propose an alternative structured approach for compositional generation using diffusion models. An image is generated by composing a set of diffusion models, with each of them modeling a certain component of the image. To do this, we interpret diffusion models as energy-based models in which the data distributions defined by the energy functions may be explicitly combined. The proposed method can generate scenes at test time that are substantially more complex than those seen in training, composing sentence descriptions, object relations, human facial attributes, and even generalizing to new combinations that are rarely seen in the real world. We further illustrate how our approach may be used to compose pre-trained text-guided diffusion models and generate photorealistic images containing all the details described in the input descriptions, including the binding of certain object attributes that have been shown difficult for DALLE-2. These results point to the effectiveness of the proposed method in promoting structured generalization for visual generation. Project page: https://energy-based-model.github.io/Compositional-Visual-Generation-with-Composable-Diffusion-Models/

Qi Chen, Shuhan Ding, Yu Gu et al.

Variational autoencoders (VAEs) compress high resolution CT volumes into compact latents while preserving clinically relevant structure. However, training CT-specific VAEs from scratch or heavily fine-tuning them incurs substantial computational and engineering cost, and often degrades under heterogeneous scanners, protocols, and diseases. This paper makes a progressive stride toward training-free medical VAEs by leveraging a critical observation: a single Foundation VAE, pretrained at scale on natural images and videos, can serve as a unified interface for CT Reconstruction, Augmentation, and Generation. With both encoder and decoder frozen, the Foundation VAE reconstructs CT volumes with preserved anatomy while suppressing acquisition noise; training segmentation models on these reconstructions improves surface accuracy by 3.9% NSD on average for pancreatic tumor and lung tumor. Within the same Foundation VAE latent space, a conditional latent diffusion model achieves 3.9% lower average FVD with 36.2% higher CT CLIP score, and improves multi-disease generation faithfulness across 18 types by 2.76% AUC. These results demonstrate Foundation VAEs as a practical interface for scalable CT representation reuse and faithful CT generation. Our code and demo are available at https://github.com/qic999/Foundation-VAE.

Nan Liu, Yilun Du, Shuang Li et al. · mit

Text-to-image generative models have enabled high-resolution image synthesis across different domains, but require users to specify the content they wish to generate. In this paper, we consider the inverse problem -- given a collection of different images, can we discover the generative concepts that represent each image? We present an unsupervised approach to discover generative concepts from a collection of images, disentangling different art styles in paintings, objects, and lighting from kitchen scenes, and discovering image classes given ImageNet images. We show how such generative concepts can accurately represent the content of images, be recombined and composed to generate new artistic and hybrid images, and be further used as a representation for downstream classification tasks.

Kabilan Elangovan, Jasmine Chiat Ling Ong, Liyuan Jin et al.

Large Language Models (LLMs) have emerged as a potential solution to assist digital health development with patient education, commonly medication-related enquires. We trained and validated Med-Pal, a medication domain-specific LLM-chatbot fine-tuned with a fine-grained and expert curated dataset from a selection of five light-weighted open-source LLMs of smaller parameter size (7 billion or less) regarding computational constraints and prioritizing operational efficiency. A multi-disciplinary team performed a clinical evaluation of LLMs responses using the SCORE criteria, focusing on safety, accuracy, bias, reproducibility, and ease of understanding. Best performing light-weighted LLM was chosen as Med-Pal for further engineering with guard-railing using adversarial prompting. Med-Pal and existing light-weighted LLMs, including pretrained Biomistral and finetuned Meerkat, were validated on an independent dataset on a broad range of medication-related questions (231 in total), 12 different question types across 14 different medication classes. Mistral-7b emerged as the top performer among selected lightweight LLMs, achieving the highest median score of 14 and 71.9% high-quality responses in accuracy and safety domains, hence chosen as the backbone LLM for Med-Pal. When compared against Biomistral, Med-pal outperformed in generating responses appropriate for patient communication, with significant reductions bias and errors typical of general LLMs. Comparable performance was observed when comparing Med-Pal with Meerkat. Med-Pal showcases the feasibility of developing and employing fine-tuned light-weighted LLMs to enhance digital health communications.

Mingxuan Liu, Siqi Li, Han Yuan et al.

Objective: The proper handling of missing values is critical to delivering reliable estimates and decisions, especially in high-stakes fields such as clinical research. The increasing diversity and complexity of data have led many researchers to develop deep learning (DL)-based imputation techniques. We conducted a systematic review to evaluate the use of these techniques, with a particular focus on data types, aiming to assist healthcare researchers from various disciplines in dealing with missing values. Methods: We searched five databases (MEDLINE, Web of Science, Embase, CINAHL, and Scopus) for articles published prior to August 2021 that applied DL-based models to imputation. We assessed selected publications from four perspectives: health data types, model backbone (i.e., main architecture), imputation strategies, and comparison with non-DL-based methods. Based on data types, we created an evidence map to illustrate the adoption of DL models. Results: We included 64 articles, of which tabular static (26.6%, 17/64) and temporal data (37.5%, 24/64) were the most frequently investigated. We found that model backbone(s) differed among data types as well as the imputation strategy. The "integrated" strategy, that is, the imputation task being solved concurrently with downstream tasks, was popular for tabular temporal (50%, 12/24) and multi-modal data (71.4%, 5/7), but limited for other data types. Moreover, DL-based imputation methods yielded better imputation accuracy in most studies, compared with non-DL-based methods. Conclusion: DL-based imputation models can be customized based on data type, addressing the corresponding missing patterns, and its associated "integrated" strategy can enhance the efficacy of imputation, especially in scenarios where data is complex. Future research may focus on the portability and fairness of DL-based models for healthcare data imputation.

Xuanhao Mu, Kundan Thota, Nan Liu et al.

Open-source energy system models disaggregate zonal electricity demand to substations through Voronoi-based preprocessing pipelines that combine socioeconomic weighting with auxiliary spatial corrections. Whether the same auxiliary data helps or harms when the weighting component shifts from rule-based to learned has not been investigated. We fix Voronoi partitioning and cross two design axes on metered demand from 1,891 British primary substations: the demand-weighting method and the mechanism through which Nighttime Light (NTL) intensity and substation-proximity signals enter the allocation, giving 15 configurations. Mechanism-isolation experiments further test additive post-correction and random-noise controls to pinpoint the structural cause of any performance reversal. The same auxiliary data reduces RMSE by 41 % on the static base but increases it by 21 % on the GNN base under multiplicative post-correction (p < 0.001 for both); the best static pipeline outperforms the best GNN variant by 19 %. Post-correction on the GNN improves rank-order correlation (p < 0.001) yet worsens absolute error, so correlation-only evaluation masks the calibration penalty. The isolation experiments trace this reversal to the multiplicative correction form under demand conservation constraints, not to signal redundancy; switching to additive post-correction eliminates the antagonism entirely. A transfer check on 13 German primary substations confirms directional replication and shows amplified antagonism where the GNN baseline already explains over 95 % of demand variance. The NTL and proximity signals behind the 41 % static improvement are publicly available at no cost and should be adopted as default corrections in static pipelines; method evaluation should report RMSE and correlation jointly, as the two metrics diverge under post-correction on learned representations.

Yuzhe Li, Yong Liu, Bo Li et al.

In this paper, we focus our attention on private Empirical Risk Minimization (ERM), which is one of the most commonly used data analysis method. We take the first step towards solving the above problem by theoretically exploring the effect of epsilon (the parameter of differential privacy that determines the strength of privacy guarantee) on utility of the learning model. We trace the change of utility with modification of epsilon and reveal an established relationship between epsilon and utility. We then formalize this relationship and propose a practical approach for estimating the utility under an arbitrary value of epsilon. Both theoretical analysis and experimental results demonstrate high estimation accuracy and broad applicability of our approach in practical applications. As providing algorithms with strong utility guarantees that also give privacy when possible becomes more and more accepted, our approach would have high practical value and may be likely to be adopted by companies and organizations that would like to preserve privacy but are unwilling to compromise on utility.

Siqi Li, Pinyan Liu, Gustavo G. Nascimento et al.

Federated learning (FL) has gained popularity in clinical research in recent years to facilitate privacy-preserving collaboration. Structured data, one of the most prevalent forms of clinical data, has experienced significant growth in volume concurrently, notably with the widespread adoption of electronic health records in clinical practice. This review examines FL applications on structured medical data, identifies contemporary limitations and discusses potential innovations. We searched five databases, SCOPUS, MEDLINE, Web of Science, Embase, and CINAHL, to identify articles that applied FL to structured medical data and reported results following the PRISMA guidelines. Each selected publication was evaluated from three primary perspectives, including data quality, modeling strategies, and FL frameworks. Out of the 1160 papers screened, 34 met the inclusion criteria, with each article consisting of one or more studies that used FL to handle structured clinical/medical data. Of these, 24 utilized data acquired from electronic health records, with clinical predictions and association studies being the most common clinical research tasks that FL was applied to. Only one article exclusively explored the vertical FL setting, while the remaining 33 explored the horizontal FL setting, with only 14 discussing comparisons between single-site (local) and FL (global) analysis. The existing FL applications on structured medical data lack sufficient evaluations of clinically meaningful benefits, particularly when compared to single-site analyses. Therefore, it is crucial for future FL applications to prioritize clinical motivations and develop designs and methodologies that can effectively support and aid clinical practice and research.

Siqi Li, Yilin Ning, Marcus Eng Hock Ong et al.

We propose FedScore, a privacy-preserving federated learning framework for scoring system generation across multiple sites to facilitate cross-institutional collaborations. The FedScore framework includes five modules: federated variable ranking, federated variable transformation, federated score derivation, federated model selection and federated model evaluation. To illustrate usage and assess FedScore's performance, we built a hypothetical global scoring system for mortality prediction within 30 days after a visit to an emergency department using 10 simulated sites divided from a tertiary hospital in Singapore. We employed a pre-existing score generator to construct 10 local scoring systems independently at each site and we also developed a scoring system using centralized data for comparison. We compared the acquired FedScore model's performance with that of other scoring models using the receiver operating characteristic (ROC) analysis. The FedScore model achieved an average area under the curve (AUC) value of 0.763 across all sites, with a standard deviation (SD) of 0.020. We also calculated the average AUC values and SDs for each local model, and the FedScore model showed promising accuracy and stability with a high average AUC value which was closest to the one of the pooled model and SD which was lower than that of most local models. This study demonstrates that FedScore is a privacy-preserving scoring system generator with potentially good generalizability.

Madhurima Panja, Tanujit Chakraborty, Sk Shahid Nadim et al.

Dengue fever is a virulent disease spreading over 100 tropical and subtropical countries in Africa, the Americas, and Asia. This arboviral disease affects around 400 million people globally, severely distressing the healthcare systems. The unavailability of a specific drug and ready-to-use vaccine makes the situation worse. Hence, policymakers must rely on early warning systems to control intervention-related decisions. Forecasts routinely provide critical information for dangerous epidemic events. However, the available forecasting models (e.g., weather-driven mechanistic, statistical time series, and machine learning models) lack a clear understanding of different components to improve prediction accuracy and often provide unstable and unreliable forecasts. This study proposes an ensemble wavelet neural network with exogenous factor(s) (XEWNet) model that can produce reliable estimates for dengue outbreak prediction for three geographical regions, namely San Juan, Iquitos, and Ahmedabad. The proposed XEWNet model is flexible and can easily incorporate exogenous climate variable(s) confirmed by statistical causality tests in its scalable framework. The proposed model is an integrated approach that uses wavelet transformation into an ensemble neural network framework that helps in generating more reliable long-term forecasts. The proposed XEWNet allows complex non-linear relationships between the dengue incidence cases and rainfall; however, mathematically interpretable, fast in execution, and easily comprehensible. The proposal's competitiveness is measured using computational experiments based on various statistical metrics and several statistical comparison tests. In comparison with statistical, machine learning, and deep learning methods, our proposed XEWNet performs better in 75% of the cases for short-term and long-term forecasting of dengue incidence.

Madhurima Panja, Tanujit Chakraborty, Uttam Kumar et al.

Infectious diseases remain among the top contributors to human illness and death worldwide, among which many diseases produce epidemic waves of infection. The unavailability of specific drugs and ready-to-use vaccines to prevent most of these epidemics makes the situation worse. These force public health officials and policymakers to rely on early warning systems generated by reliable and accurate forecasts of epidemics. Accurate forecasts of epidemics can assist stakeholders in tailoring countermeasures, such as vaccination campaigns, staff scheduling, and resource allocation, to the situation at hand, which could translate to reductions in the impact of a disease. Unfortunately, most of these past epidemics exhibit nonlinear and non-stationary characteristics due to their spreading fluctuations based on seasonal-dependent variability and the nature of these epidemics. We analyse a wide variety of epidemic time series datasets using a maximal overlap discrete wavelet transform (MODWT) based autoregressive neural network and call it EWNet model. MODWT techniques effectively characterize non-stationary behavior and seasonal dependencies in the epidemic time series and improve the nonlinear forecasting scheme of the autoregressive neural network in the proposed ensemble wavelet network framework. From a nonlinear time series viewpoint, we explore the asymptotic stationarity of the proposed EWNet model to show the asymptotic behavior of the associated Markov Chain. We also theoretically investigate the effect of learning stability and the choice of hidden neurons in the proposal. From a practical perspective, we compare our proposed EWNet framework with several statistical, machine learning, and deep learning models. Experimental results show that the proposed EWNet is highly competitive compared to the state-of-the-art epidemic forecasting methods.

Mingxuan Liu, Yilin Ning, Salinelat Teixayavong et al.

Artificial intelligence (AI) has demonstrated the ability to extract insights from data, but the issue of fairness remains a concern in high-stakes fields such as healthcare. Despite extensive discussion and efforts in algorithm development, AI fairness and clinical concerns have not been adequately addressed. In this paper, we discuss the misalignment between technical and clinical perspectives of AI fairness, highlight the barriers to AI fairness' translation to healthcare, advocate multidisciplinary collaboration to bridge the knowledge gap, and provide possible solutions to address the clinical concerns pertaining to AI fairness.

Siqi Li, Di Miao, Qiming Wu et al.

Federated learning (FL) has shown promising potential in safeguarding data privacy in healthcare collaborations. While the term "FL" was originally coined by the engineering community, the statistical field has also explored similar privacy-preserving algorithms. Statistical FL algorithms, however, remain considerably less recognized than their engineering counterparts. Our goal was to bridge the gap by presenting the first comprehensive comparison of FL frameworks from both engineering and statistical domains. We evaluated five FL frameworks using both simulated and real-world data. The results indicate that statistical FL algorithms yield less biased point estimates for model coefficients and offer convenient confidence interval estimations. In contrast, engineering-based methods tend to generate more accurate predictions, sometimes surpassing central pooled and statistical FL models. This study underscores the relative strengths and weaknesses of both types of methods, emphasizing the need for increased awareness and their integration in future FL applications.

Mingxuan Liu, Yilin Ning, Han Yuan et al.

Objective: Shapley additive explanations (SHAP) is a popular post-hoc technique for explaining black box models. While the impact of data imbalance on predictive models has been extensively studied, it remains largely unknown with respect to SHAP-based model explanations. This study sought to investigate the effects of data imbalance on SHAP explanations for deep learning models, and to propose a strategy to mitigate these effects. Materials and Methods: We propose to adjust class distributions in the background and explanation data in SHAP when explaining black box models. Our data balancing strategy is to compose background data and explanation data with an equal distribution of classes. To evaluate the effects of data adjustment on model explanation, we propose to use the beeswarm plot as a qualitative tool to identify "abnormal" explanation artifacts, and quantitatively test the consistency between variable importance and prediction power. We demonstrated our proposed approach in an empirical study that predicted inpatient mortality using the Medical Information Mart for Intensive Care (MIMIC-III) data and a multilayer perceptron. Results: Using the data balancing strategy would allow us to reduce the number of the artifacts in the beeswarm plot, thus mitigating the negative effects of data imbalance. Additionally, with the balancing strategy, the top-ranked variables from the corresponding importance ranking demonstrated improved discrimination power. Discussion and Conclusion: Our findings suggest that balanced background and explanation data could help reduce the noise in explanation results induced by skewed data distribution and improve the reliability of variable importance ranking. Furthermore, these balancing procedures improve the potential of SHAP in identifying patients with abnormal characteristics in clinical applications.

Madhurima Panja, Danny D'Agostino, Huitao Li et al.

The increasing adoption of data-driven decision-making in public health has established epidemic forecasting as a critical area of research. Recent advances in multivariate forecasting models better capture complex temporal dependencies than conventional univariate approaches, which model individual series independently. Despite this potential, the development of robust epidemic forecasting methods is constrained by the lack of high-quality benchmarks comprising diverse multivariate datasets across infectious diseases and geographical regions. To address this gap, we present EpiCastBench, a large-scale benchmarking framework featuring 40 curated (correlated) multivariate epidemic datasets. These publicly available datasets span a wide range of infectious diseases and exhibit diverse characteristics in terms of temporal granularity, series length, and sparsity. We analyze these datasets to identify their global features and structural patterns. To ensure reproducibility and fair comparison, we establish standardized evaluation settings, including a unified forecasting horizon, consistent preprocessing pipelines, diverse performance metrics, and statistical significance testing. By leveraging this framework, we conduct a comprehensive evaluation of 15 multivariate forecasting models spanning statistical baselines to state-of-the-art deep learning and foundation models. All datasets and code are publicly available on Kaggle (https://www.kaggle.com/datasets/aimltsf/epicastbench) and GitHub (https://github.com/aimltsf/EpiCastBench).

Ting Fang Tan, Kabilan Elangovan, Jasmine Ong et al.

A comprehensive qualitative evaluation framework for large language models (LLM) in healthcare that expands beyond traditional accuracy and quantitative metrics needed. We propose 5 key aspects for evaluation of LLMs: Safety, Consensus, Objectivity, Reproducibility and Explainability (S.C.O.R.E.). We suggest that S.C.O.R.E. may form the basis for an evaluation framework for future LLM-based models that are safe, reliable, trustworthy, and ethical for healthcare and clinical applications.

Yilin Ning, Salinelat Teixayavong, Yuqing Shang et al.

The widespread use of ChatGPT and other emerging technology powered by generative artificial intelligence (GenAI) has drawn much attention to potential ethical issues, especially in high-stakes applications such as healthcare, but ethical discussions are yet to translate into operationalisable solutions. Furthermore, ongoing ethical discussions often neglect other types of GenAI that have been used to synthesise data (e.g., images) for research and practical purposes, which resolved some ethical issues and exposed others. We conduct a scoping review of ethical discussions on GenAI in healthcare to comprehensively analyse gaps in the current research, and further propose to reduce the gaps by developing a checklist for comprehensive assessment and transparent documentation of ethical discussions in GenAI research. The checklist can be readily integrated into the current peer review and publication system to enhance GenAI research, and may be used for ethics-related disclosures for GenAI-powered products, healthcare applications of such products and beyond.

Yilin Ning, Victor Volovici, Marcus Eng Hock Ong et al.

A prediction model is most useful if it generalizes beyond the development data with external validations, but to what extent should it generalize remains unclear. In practice, prediction models are externally validated using data from very different settings, including populations from other health systems or countries, with predictably poor results. This may not be a fair reflection of the performance of the model which was designed for a specific target population or setting, and may be stretching the expected model generalizability. To address this, we suggest to externally validate a model using new data from the target population to ensure clear implications of validation performance on model reliability, whereas model generalizability to broader settings should be carefully investigated during model development instead of explored post-hoc. Based on this perspective, we propose a roadmap that facilitates the development and application of reliable, fair, and trustworthy artificial intelligence prediction models.

Siqi Li, Xin Li, Kunyu Yu et al.

Clinical and biomedical research in low-resource settings often faces significant challenges due to the need for high-quality data with sufficient sample sizes to construct effective models. These constraints hinder robust model training and prompt researchers to seek methods for leveraging existing knowledge from related studies to support new research efforts. Transfer learning (TL), a machine learning technique, emerges as a powerful solution by utilizing knowledge from pre-trained models to enhance the performance of new models, offering promise across various healthcare domains. Despite its conceptual origins in the 1990s, the application of TL in medical research has remained limited, especially beyond image analysis. In our review of TL applications in structured clinical and biomedical data, we screened 3,515 papers, with 55 meeting the inclusion criteria. Among these, only 2% (one out of 55) utilized external studies, and 7% (four out of 55) addressed scenarios involving multi-site collaborations with privacy constraints. To achieve actionable TL with structured medical data while addressing regional disparities, inequality, and privacy constraints in healthcare research, we advocate for the careful identification of appropriate source data and models, the selection of suitable TL frameworks, and the validation of TL models with proper baselines.

Rui Yang, Huitao Li, Weihao Xuan et al.

Despite continuous advances in medical technology, the global distribution of health care resources remains uneven. The development of large language models (LLMs) has transformed the landscape of medicine and holds promise for improving health care quality and expanding access to medical information globally. However, existing LLMs are primarily trained on high-resource languages, limiting their applicability in global medical scenarios. To address this gap, we constructed GlobMed, a large multilingual medical dataset, containing over 500,000 entries spanning 12 languages, including four low-resource languages. Building on this, we established GlobMed-Bench, which systematically assesses 56 state-of-the-art proprietary and open-weight LLMs across multiple multilingual medical tasks, revealing significant performance disparities across languages, particularly for low-resource languages. Additionally, we introduced GlobMed-LLMs, a suite of multilingual medical LLMs trained on GlobMed, with parameters ranging from 1.7B to 8B. GlobMed-LLMs achieved an average performance improvement of over 40% relative to baseline models, with a more than threefold increase in performance on low-resource languages. Together, these resources provide an important foundation for advancing the equitable development and application of LLMs globally, enabling broader language communities to benefit from technological advances.

Siqi Li, Chuan Hong, Ziye Tian et al.

Deploying clinical prediction models across healthcare systems often fails when key training covariates are unavailable at deployment and labeled outcomes are limited in the target domain. For example, high-performing models for out-of-hospital cardiac arrest (OHCA) rely on detailed prehospital measurements routinely collected in high-resource settings but unavailable in many international registries. Existing methods either discard missing covariates, sacrificing predictive information, or rely on untestable assumptions about their target distribution. We propose DRUM (\underline{D}istributionally \underline{R}obust \underline{U}nsupervised transfer learning with structurally \underline{M}issing covariates), a framework that transfers prediction models to target populations where certain covariates are structurally absent and outcome labels are unavailable. DRUM partitions covariates into shared components ($X$), observed across all settings, and missing components ($A$), observed only in the source. Rather than imputing missing covariates, DRUM optimizes worst-case predictive performance over the unknown target distribution of $A \mid X$ using a neural network generator, with a robustness parameter controlling allowable deviation from the source conditional. We further develop a bias correction procedure that reduces sensitivity to nuisance estimation error. Simulations show substantial improvements in both mean and worst-case prediction error under distribution shift. Applied to cross-national OHCA prediction, transferring models from a US registry to multiple Asian registries where prehospital variables are unrecorded, DRUM yields better-calibrated predictions and improved clinical classification performance across sites.

Tianyu Liu, Weihao Xuan, Hao Wu et al.

Advances in AI have introduced several strong models in computational pathology to usher it into the era of multi-modal diagnosis, analysis, and interpretation. However, the current pathology-specific visual language models still lack capacities in making the diagnosis with rigorous reasoning paths as well as handling divergent tasks, and thus, challenges of building AI Copilots for real scenarios still exist. Here we introduce TeamPath, an AI system powered by reinforcement learning and router-enhanced solutions based on large-scale histopathology multimodal datasets, to work as a virtual assistant for expert-level disease diagnosis, patch-level information summarization, and cross-modality generation to integrate transcriptomic information for clinical usage. We also collaborate with pathologists from Yale School of Medicine to demonstrate that TeamPath can assist them in working more efficiently by identifying and correcting expert conclusions and reasoning paths. We also discuss the human evaluation results to support the reasoning quality from TeamPath. Overall, TeamPath can flexibly choose the best settings according to the needs, and serve as an innovative and reliable system for information communication across different modalities and experts.

Yilin Ning, Mingxuan Liu, Nan Liu

Current practice in interpretable machine learning often focuses on explaining the final model trained from data, e.g., by using the Shapley additive explanations (SHAP) method. The recently developed Shapley variable importance cloud (ShapleyVIC) extends the current practice to a group of "nearly optimal models" to provide comprehensive and robust variable importance assessments, with estimated uncertainty intervals for a more complete understanding of variable contributions to predictions. ShapleyVIC was initially developed for applications with traditional regression models, and the benefits of ShapleyVIC inference have been demonstrated in real-life prediction tasks using the logistic regression model. However, as a model-agnostic approach, ShapleyVIC application is not limited to such scenarios. In this work, we extend ShapleyVIC implementation for machine learning models to enable wider applications, and propose it as a useful complement to the current SHAP analysis to enable more trustworthy applications of these black-box models.

Qinyi Lu, Nan Liu, Wei Kang

We consider a coded caching problem with multiple demands under a privacy constraint. In this problem, a server with access to \(N\) files serves \(K\) users over a shared link, and each user requests \(L\) distinct files. The privacy constraint requires that each user obtain no information about the demands of the other users. We propose a new achievable scheme for arbitrary numbers of files and users. The scheme is obtained via a transformation from a non-private coded caching scheme under uncoded placement for \(N\) files and \(K \cdot \min\{N,KL\}\) users, where each user requests one file and the demands are restricted to a subset of all possible demands. We then derive a converse bound, and the proposed scheme is shown to be order optimal within a factor of 6 of this bound.

Rui Yang, Matthew Yu Heng Wong, Huitao Li et al.

The rapid growth of medical knowledge and increasing complexity of clinical practice pose challenges. In this context, large language models (LLMs) have demonstrated value; however, inherent limitations remain. Retrieval-augmented generation (RAG) technologies show potential to enhance their clinical applicability. This study reviewed RAG applications in medicine. We found that research primarily relied on publicly available data, with limited application in private data. For retrieval, approaches commonly relied on English-centric embedding models, while LLMs were mostly generic, with limited use of medical-specific LLMs. For evaluation, automated metrics evaluated generation quality and task performance, whereas human evaluation focused on accuracy, completeness, relevance, and fluency, with insufficient attention to bias and safety. RAG applications were concentrated on question answering, report generation, text summarization, and information extraction. Overall, medical RAG remains at an early stage, requiring advances in clinical validation, cross-linguistic adaptation, and support for low-resource settings to enable trustworthy and responsible global use.

Ziwen Wang, Siqi Li, Marcus Eng Hock Ong et al.

Privacy-preserving model co-training in medical research is often hindered by server-dependent architectures incompatible with protected hospital data systems and by the predominant focus on relative effect measures (hazard ratios) which lack clinical interpretability for absolute survival risk assessment. We propose FedRD, a communication-efficient framework for federated risk difference estimation in distributed survival data. Unlike typical federated learning frameworks (e.g., FedAvg) that require persistent server connections and extensive iterative communication, FedRD is server-independent with minimal communication: one round of summary statistics exchange for the stratified model and three rounds for the unstratified model. Crucially, FedRD provides valid confidence intervals and hypothesis testing--capabilities absent in FedAvg-based frameworks. We provide theoretical guarantees by establishing the asymptotic properties of FedRD and prove that FedRD (unstratified) is asymptotically equivalent to pooled individual-level analysis. Simulation studies and real-world clinical applications across different countries demonstrate that FedRD outperforms local and federated baselines in both estimation accuracy and prediction performance, providing an architecturally feasible solution for absolute risk assessment in privacy-restricted, multi-site clinical studies.

Boya Zhang, Alban Bornet, Rui Yang et al.

How do language models use contextual information to answer health questions? How are their responses impacted by conflicting contexts? We assess the ability of language models to reason over long, conflicting biomedical contexts using HealthContradict, an expert-verified dataset comprising 920 unique instances, each consisting of a health-related question, a factual answer supported by scientific evidence, and two documents presenting contradictory stances. We consider several prompt settings, including correct, incorrect or contradictory context, and measure their impact on model outputs. Compared to existing medical question-answering evaluation benchmarks, HealthContradict provides greater distinctions of language models' contextual reasoning capabilities. Our experiments show that the strength of fine-tuned biomedical language models lies not only in their parametric knowledge from pretraining, but also in their ability to exploit correct context while resisting incorrect context.

Han Yuan, Chuan Hong, Nguyen Tuan Anh Tran et al.

Pneumothorax is a medical emergency caused by abnormal accumulation of air in the pleural space - the potential space between the lungs and chest wall. On 2D chest radiographs, pneumothorax occurs within the thoracic cavity and outside of the mediastinum and we refer to this area as "lung+ space". While deep learning (DL) has increasingly been utilized to segment pneumothorax lesions in chest radiographs, many existing DL models employ an end-to-end approach. These models directly map chest radiographs to clinician-annotated lesion areas, often neglecting the vital domain knowledge that pneumothorax is inherently location-sensitive. We propose a novel approach that incorporates the lung+ space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs. To circumvent the need for additional annotations and to prevent potential label leakage on the target task, our method utilizes external datasets and an auxiliary task of lung segmentation. This approach generates a specific constraint of lung+ space for each chest radiograph. Furthermore, we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets. Our results demonstrated significant improvements, with average performance gains of 4.6%, 3.6%, and 3.3% regarding Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Hausdorff Distance (HD). Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation.

Peisong Zhang, Manqiang Peng, Yuxuan Wu et al.

Estimating individualized treatment effects from longitudinal observational data is central to data-driven medicine, yet existing methods face a fundamental limitation: reducing confounding bias often suppresses clinically informative heterogeneity, degrading patient-specific predictions. Here, we identify this tension as a bias-precision paradox in causal representation learning and introduce sampling-based maximum mean discrepancy (sMMD), a stochastic alignment strategy that replaces global adversarial balancing with subset-level matching. We instantiate this approach in a framework for counterfactual outcome prediction with attribution-grounded interpretability. Across two large-scale ICU cohorts (n = 27,783), our framework improves accuracy under distribution shift, reducing error by up to 11.5% and substantially increasing recall in high-risk tasks. Mechanistic analyses show that sMMD selectively preserves clinically decisive variables. In human-AI evaluation, our method outperforms clinicians-in-training and large language models, and improves clinician accuracy by 14.7% while reducing decision time, enabling interpretable, real-time clinical decision support.

Wangxuan Fan, Siqi Li, Doudou Zhou et al.

Explainable artificial intelligence (XAI) is essential for trustworthy machine learning (ML), particularly in high-stakes domains such as healthcare and finance. Shapley value (SV) methods provide a principled framework for feature attribution in complex models but incur high computational costs, limiting their scalability in high-dimensional settings. We propose Stochastic Iterative Momentum for Shapley Value Approximation (SIM-Shapley), a stable and efficient SV approximation method inspired by stochastic optimization. We analyze variance theoretically, prove linear $Q$-convergence, and demonstrate improved empirical stability and low bias in practice on real-world datasets. In our numerical experiments, SIM-Shapley reduces computation time by up to 85% relative to state-of-the-art baselines while maintaining comparable feature attribution quality. Beyond feature attribution, our stochastic mini-batch iterative framework extends naturally to a broader class of sample average approximation problems, offering a new avenue for improving computational efficiency with stability guarantees. Code is publicly available at https://github.com/nliulab/SIM-Shapley.

Mingxuan Liu, Yuhe Ke, Wentao Zhu et al.

The integration of large language models (LLMs) into healthcare holds promise to enhance clinical decision-making, yet their susceptibility to biases remains a critical concern. Gender has long influenced physician behaviors and patient outcomes, raising concerns that LLMs assuming human-like roles, such as clinicians or medical educators, may replicate or amplify gender-related biases. Using case studies from the New England Journal of Medicine Challenge (NEJM), we assigned genders (female, male, or unspecified) to multiple open-source and proprietary LLMs. We evaluated their response consistency across LLM-gender assignments regarding both LLM-based diagnosis and models' judgments on the clinical relevance or necessity of patient gender. In our findings, diagnoses were relatively consistent across LLM genders for most models. However, for patient gender's relevance and necessity in LLM-based diagnosis, all models demonstrated substantial inconsistency across LLM genders, particularly for relevance judgements. Some models even displayed a systematic female-male disparity in their interpretation of patient gender. These findings present an underexplored bias that could undermine the reliability of LLMs in clinical practice, underscoring the need for routine checks of identity-assignment consistency when interacting with LLMs to ensure reliable and equitable AI-supported clinical care.

Kunyu Yu, Rui Yang, Jingchi Liao et al.

Foundation models have emerged as a powerful approach for processing electronic health records (EHRs), offering flexibility to handle diverse medical data modalities. In this study, we present a comprehensive benchmark that evaluates the performance, fairness, and interpretability of foundation models, both as unimodal encoders and as multimodal learners, using the publicly available MIMIC-IV database. To support consistent and reproducible evaluation, we developed a standardized data processing pipeline that harmonizes heterogeneous clinical records into an analysis-ready format. We systematically compared eight foundation models, encompassing both unimodal and multimodal models, as well as domain-specific and general-purpose variants. Our findings demonstrate that incorporating multiple data modalities leads to consistent improvements in predictive performance without introducing additional bias. Through this benchmark, we aim to support the development of effective and trustworthy multimodal artificial intelligence (AI) systems for real-world clinical applications. Our code is available at https://github.com/nliulab/MIMIC-Multimodal.

Qiming Wu, Siqi Li, Doudou Zhou et al.

Ensuring fairness is critical when applying artificial intelligence to high-stakes domains such as healthcare, where predictive models trained on imbalanced and demographically skewed data risk exacerbating existing disparities. Federated learning (FL) enables privacy-preserving collaboration across institutions, but remains vulnerable to both algorithmic bias and subgroup imbalance - particularly when multiple sensitive attributes intersect. We propose FedIDA (Fed erated Learning for Imbalance and D isparity A wareness), a framework-agnostic method that combines fairness-aware regularization with group-conditional oversampling. FedIDA supports multiple sensitive attributes and heterogeneous data distributions without altering the convergence behavior of the underlying FL algorithm. We provide theoretical analysis establishing fairness improvement bounds using Lipschitz continuity and concentration inequalities, and show that FedIDA reduces the variance of fairness metrics across test sets. Empirical results on both benchmark and real-world clinical datasets confirm that FedIDA consistently improves fairness while maintaining competitive predictive performance, demonstrating its effectiveness for equitable and privacy-preserving modeling in healthcare. The source code is available on GitHub.

Feng Xie, Jun Zhou, Jin Wee Lee et al.

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

Won Park, Nan Liu, Qi Alfred Chen et al.

A critical aspect of autonomous vehicles (AVs) is the object detection stage, which is increasingly being performed with sensor fusion models: multimodal 3D object detection models which utilize both 2D RGB image data and 3D data from a LIDAR sensor as inputs. In this work, we perform the first study to analyze the robustness of a high-performance, open source sensor fusion model architecture towards adversarial attacks and challenge the popular belief that the use of additional sensors automatically mitigate the risk of adversarial attacks. We find that despite the use of a LIDAR sensor, the model is vulnerable to our purposefully crafted image-based adversarial attacks including disappearance, universal patch, and spoofing. After identifying the underlying reason, we explore some potential defenses and provide some recommendations for improved sensor fusion models.

Tianyu Liu, Wangjie Zheng, Rui Yang et al.

Accurate and timely diagnosis is essential for effective treatment, particularly in the context of rare diseases. However, current diagnostic workflows often lead to prolonged assessment times and low accuracy. To address these limitations, we introduce Hygieia, a multi-modal AI agent system designed to support precision disease diagnosis by integrating diverse data sources, including phenotypic features, genetic profiles, and clinical records. Hygieia features a router-based and knowledge-enhanced framework that mitigates hallucination and tailors diagnostic strategies to different disease categories. Notably, it prioritizes risk-related genomic factors for rare diseases and provides confidence scores to assist clinical decision-making. We conducted a comprehensive evaluation demonstrating that Hygieia achieves state-of-the-art performance across multiple diagnostic benchmarks. In collaboration with clinical experts from Yale School of Medicine and Duke-NUS Medical School, we further validated its practical utility by showing (1) Hygieia's superior diagnostic performance compared to physicians with an improvement from 12%-60% and (2) its effectiveness in assisting clinicians with medical records for handling real-world cases. Our findings indicate that Hygieia not only enhances diagnostic accuracy and interpretability but also significantly reduces clinician workload, highlighting its potential as a valuable tool in clinical decision support systems.

YuHe Ke, Liyuan Jin, Kabilan Elangovan et al.

Purpose: Large Language Models (LLMs) hold significant promise for medical applications. Retrieval Augmented Generation (RAG) emerges as a promising approach for customizing domain knowledge in LLMs. This case study presents the development and evaluation of an LLM-RAG pipeline tailored for healthcare, focusing specifically on preoperative medicine. Methods: We developed an LLM-RAG model using 35 preoperative guidelines and tested it against human-generated responses, with a total of 1260 responses evaluated. The RAG process involved converting clinical documents into text using Python-based frameworks like LangChain and Llamaindex, and processing these texts into chunks for embedding and retrieval. Vector storage techniques and selected embedding models to optimize data retrieval, using Pinecone for vector storage with a dimensionality of 1536 and cosine similarity for loss metrics. Human-generated answers, provided by junior doctors, were used as a comparison. Results: The LLM-RAG model generated answers within an average of 15-20 seconds, significantly faster than the 10 minutes typically required by humans. Among the basic LLMs, GPT4.0 exhibited the best accuracy of 80.1%. This accuracy was further increased to 91.4% when the model was enhanced with RAG. Compared to the human-generated instructions, which had an accuracy of 86.3%, the performance of the GPT4.0 RAG model demonstrated non-inferiority (p=0.610). Conclusions: In this case study, we demonstrated a LLM-RAG model for healthcare implementation. The pipeline shows the advantages of grounded knowledge, upgradability, and scalability as important aspects of healthcare LLM deployment.

Weihao Xuan, Rui Yang, Heli Qi et al.

Existing large language model (LLM) evaluation benchmarks primarily focus on English, while current multilingual tasks lack parallel questions that specifically assess cross-linguistic reasoning abilities. This dual limitation makes it challenging to comprehensively assess LLMs' performance in the multilingual setting. To fill this gap, we introduce MMLU-ProX, a comprehensive benchmark covering 29 languages, built on an English benchmark. Each language version consists of 11,829 identical questions, enabling direct cross-linguistic comparisons. Additionally, to meet efficient evaluation needs, we provide a lite version containing 658 questions per language. To ensure the high quality of MMLU-ProX, we employ a rigorous development process that involves multiple powerful LLMs for translation, followed by expert review to ensure accurate expression, consistent terminology, and cultural relevance. Building on this, we systematically evaluate 36 state-of-the-art LLMs, including reasoning-enhanced and multilingual-optimized LLMs. The results reveal significant disparities in the multilingual capabilities of LLMs: While they perform well in high-resource languages, their performance declines markedly in low-resource languages, with gaps of up to 24.3%. Through MMLU-ProX, we aim to advance the development of more inclusive AI systems and promote equitable access to technology across global contexts.

Johanna Karras, Yingwei Li, Nan Liu et al.

We present Fashion-VDM, a video diffusion model (VDM) for generating virtual try-on videos. Given an input garment image and person video, our method aims to generate a high-quality try-on video of the person wearing the given garment, while preserving the person's identity and motion. Image-based virtual try-on has shown impressive results; however, existing video virtual try-on (VVT) methods are still lacking garment details and temporal consistency. To address these issues, we propose a diffusion-based architecture for video virtual try-on, split classifier-free guidance for increased control over the conditioning inputs, and a progressive temporal training strategy for single-pass 64-frame, 512px video generation. We also demonstrate the effectiveness of joint image-video training for video try-on, especially when video data is limited. Our qualitative and quantitative experiments show that our approach sets the new state-of-the-art for video virtual try-on. For additional results, visit our project page: https://johannakarras.github.io/Fashion-VDM.

Han Yuan, Chuan Hong, Pengtao Jiang et al.

Background: Pneumothorax is an acute thoracic disease caused by abnormal air collection between the lungs and chest wall. To address the opaqueness often associated with deep learning (DL) models, explainable artificial intelligence (XAI) methods have been introduced to outline regions related to pneumothorax diagnoses made by DL models. However, these explanations sometimes diverge from actual lesion areas, highlighting the need for further improvement. Method: We propose a template-guided approach to incorporate the clinical knowledge of pneumothorax into model explanations generated by XAI methods, thereby enhancing the quality of these explanations. Utilizing one lesion delineation created by radiologists, our approach first generates a template that represents potential areas of pneumothorax occurrence. This template is then superimposed on model explanations to filter out extraneous explanations that fall outside the template's boundaries. To validate its efficacy, we carried out a comparative analysis of three XAI methods with and without our template guidance when explaining two DL models in two real-world datasets. Results: The proposed approach consistently improved baseline XAI methods across twelve benchmark scenarios built on three XAI methods, two DL models, and two datasets. The average incremental percentages, calculated by the performance improvements over the baseline performance, were 97.8% in Intersection over Union (IoU) and 94.1% in Dice Similarity Coefficient (DSC) when comparing model explanations and ground-truth lesion areas. Conclusions: In the context of pneumothorax diagnoses, we proposed a template-guided approach for improving AI explanations. We anticipate that our template guidance will forge a fresh approach to elucidating AI models by integrating clinical domain expertise.

Ting Fang Tan, Kabilan Elangovan, Liyuan Jin et al.

Purpose: To assess the alignment of GPT-4-based evaluation to human clinician experts, for the evaluation of responses to ophthalmology-related patient queries generated by fine-tuned LLM chatbots. Methods: 400 ophthalmology questions and paired answers were created by ophthalmologists to represent commonly asked patient questions, divided into fine-tuning (368; 92%), and testing (40; 8%). We find-tuned 5 different LLMs, including LLAMA2-7b, LLAMA2-7b-Chat, LLAMA2-13b, and LLAMA2-13b-Chat. For the testing dataset, additional 8 glaucoma QnA pairs were included. 200 responses to the testing dataset were generated by 5 fine-tuned LLMs for evaluation. A customized clinical evaluation rubric was used to guide GPT-4 evaluation, grounded on clinical accuracy, relevance, patient safety, and ease of understanding. GPT-4 evaluation was then compared against ranking by 5 clinicians for clinical alignment. Results: Among all fine-tuned LLMs, GPT-3.5 scored the highest (87.1%), followed by LLAMA2-13b (80.9%), LLAMA2-13b-chat (75.5%), LLAMA2-7b-Chat (70%) and LLAMA2-7b (68.8%) based on the GPT-4 evaluation. GPT-4 evaluation demonstrated significant agreement with human clinician rankings, with Spearman and Kendall Tau correlation coefficients of 0.90 and 0.80 respectively; while correlation based on Cohen Kappa was more modest at 0.50. Notably, qualitative analysis and the glaucoma sub-analysis revealed clinical inaccuracies in the LLM-generated responses, which were appropriately identified by the GPT-4 evaluation. Conclusion: The notable clinical alignment of GPT-4 evaluation highlighted its potential to streamline the clinical evaluation of LLM chatbot responses to healthcare-related queries. By complementing the existing clinician-dependent manual grading, this efficient and automated evaluation could assist the validation of future developments in LLM applications for healthcare.

Ziwen Wang, Jin Wee Lee, Tanujit Chakraborty et al.

Survival analysis is essential for studying time-to-event outcomes and providing a dynamic understanding of the probability of an event occurring over time. Various survival analysis techniques, from traditional statistical models to state-of-the-art machine learning algorithms, support healthcare intervention and policy decisions. However, there remains ongoing discussion about their comparative performance. We conducted a comparative study of several survival analysis methods, including Cox proportional hazards (CoxPH), stepwise CoxPH, elastic net penalized Cox model, Random Survival Forests (RSF), Gradient Boosting machine (GBM) learning, AutoScore-Survival, DeepSurv, time-dependent Cox model based on neural network (CoxTime), and DeepHit survival neural network. We applied the concordance index (C-index) for model goodness-of-fit, and integral Brier scores (IBS) for calibration, and considered the model interpretability. As a case study, we performed a retrospective analysis of patients admitted through the emergency department of a tertiary hospital from 2017 to 2019, predicting 90-day all-cause mortality based on patient demographics, clinicopathological features, and historical data. The results of the C-index indicate that deep learning achieved comparable performance, with DeepSurv producing the best discrimination (DeepSurv: 0.893; CoxTime: 0.892; DeepHit: 0.891). The calibration of DeepSurv (IBS: 0.041) performed the best, followed by RSF (IBS: 0.042) and GBM (IBS: 0.0421), all using the full variables. Moreover, AutoScore-Survival, using a minimal variable subset, is easy to interpret, and can achieve good discrimination and calibration (C-index: 0.867; IBS: 0.044). While all models were satisfactory, DeepSurv exhibited the best discrimination and calibration. In addition, AutoScore-Survival offers a more parsimonious model and excellent interpretability.

Jasmine Chiat Ling Ong, Yilin Ning, Mingxuan Liu et al.

The integration of generative AI (GenAI) and large language models (LLMs) in healthcare presents both unprecedented opportunities and challenges, necessitating innovative regulatory approaches. GenAI and LLMs offer broad applications, from automating clinical workflows to personalizing diagnostics. However, the non-deterministic outputs, broad functionalities and complex integration of GenAI and LLMs challenge existing medical device regulatory frameworks, including the total product life cycle (TPLC) approach. Here we discuss the constraints of the TPLC approach to GenAI and LLM-based medical device regulation, and advocate for global collaboration in regulatory science research. This serves as the foundation for developing innovative approaches including adaptive policies and regulatory sandboxes, to test and refine governance in real-world settings. International harmonization, as seen with the International Medical Device Regulators Forum, is essential to manage implications of LLM on global health, including risks of widening health inequities driven by inherent model biases. By engaging multidisciplinary expertise, prioritizing iterative, data-driven approaches, and focusing on the needs of diverse populations, global regulatory science research enables the responsible and equitable advancement of LLM innovations in healthcare.

Aaron Tu, Weihao Xuan, Heli Qi et al. · gatech

Reinforcement learning with verifiable rewards (RLVR) is a practical and scalable approach to enhancing large language models in areas such as math, code, and other structured tasks. Two questions motivate this paper: how much of the reported gains survive under strictly parity-controlled evaluation, and whether RLVR is cost-free or exacts a measurable tax. We argue that progress is real, but gains are often overstated due to three forces - an RLVR tax, evaluation pitfalls, and data contamination. Using a partial-prompt contamination audit and matched-budget reproductions across base and RL models, we show that several headline gaps shrink or vanish under clean, parity-controlled evaluation. We then propose a tax-aware training and evaluation protocol that co-optimizes accuracy, grounding, and calibrated abstention and standardizes budgeting and provenance checks. Applied to recent RLVR setups, this protocol yields more reliable estimates of reasoning gains and, in several cases, revises prior conclusions. Our position is constructive: RLVR is valuable and industry-ready; we advocate keeping its practical benefits while prioritizing reliability, safety, and measurement.

Rui Yang, Jiayi Tong, Haoyuan Wang et al.

Background. Systematic reviews in comparative effectiveness research require timely evidence synthesis. Preprints accelerate knowledge dissemination but vary in quality, posing challenges for systematic reviews. Methods. We propose AutoConfidence (automated confidence assessment), an advanced framework for predicting preprint publication, which reduces reliance on manual curation and expands the range of predictors, including three key advancements: (1) automated data extraction using natural language processing techniques, (2) semantic embeddings of titles and abstracts, and (3) large language model (LLM)-driven evaluation scores. Additionally, we employed two prediction models: a random forest classifier for binary outcome and a survival cure model that predicts both binary outcome and publication risk over time. Results. The random forest classifier achieved AUROC 0.692 with LLM-driven scores, improving to 0.733 with semantic embeddings and 0.747 with article usage metrics. The survival cure model reached AUROC 0.716 with LLM-driven scores, improving to 0.731 with semantic embeddings. For publication risk prediction, it achieved a concordance index of 0.658, increasing to 0.667 with semantic embeddings. Conclusion. Our study advances the framework for preprint publication prediction through automated data extraction and multiple feature integration. By combining semantic embeddings with LLM-driven evaluations, AutoConfidence enhances predictive performance while reducing manual annotation burden. The framework has the potential to facilitate incorporation of preprint articles during the appraisal phase of systematic reviews, supporting researchers in more effective utilization of preprint resources.

Yu He Ke, Liyuan Jin, Kabilan Elangovan et al.

Large Language Models (LLMs) show potential for medical applications but often lack specialized clinical knowledge. Retrieval Augmented Generation (RAG) allows customization with domain-specific information, making it suitable for healthcare. This study evaluates the accuracy, consistency, and safety of RAG models in determining fitness for surgery and providing preoperative instructions. We developed LLM-RAG models using 35 local and 23 international preoperative guidelines and tested them against human-generated responses. A total of 3,682 responses were evaluated. Clinical documents were processed using Llamaindex, and 10 LLMs, including GPT3.5, GPT4, and Claude-3, were assessed. Fourteen clinical scenarios were analyzed, focusing on seven aspects of preoperative instructions. Established guidelines and expert judgment were used to determine correct responses, with human-generated answers serving as comparisons. The LLM-RAG models generated responses within 20 seconds, significantly faster than clinicians (10 minutes). The GPT4 LLM-RAG model achieved the highest accuracy (96.4% vs. 86.6%, p=0.016), with no hallucinations and producing correct instructions comparable to clinicians. Results were consistent across both local and international guidelines. This study demonstrates the potential of LLM-RAG models for preoperative healthcare tasks, highlighting their efficiency, scalability, and reliability.

Mingxuan Liu, Yilin Ning, Yuhe Ke et al.

The escalating integration of machine learning in high-stakes fields such as healthcare raises substantial concerns about model fairness. We propose an interpretable framework - Fairness-Aware Interpretable Modeling (FAIM), to improve model fairness without compromising performance, featuring an interactive interface to identify a "fairer" model from a set of high-performing models and promoting the integration of data-driven evidence and clinical expertise to enhance contextualized fairness. We demonstrated FAIM's value in reducing sex and race biases by predicting hospital admission with two real-world databases, MIMIC-IV-ED and SGH-ED. We show that for both datasets, FAIM models not only exhibited satisfactory discriminatory performance but also significantly mitigated biases as measured by well-established fairness metrics, outperforming commonly used bias-mitigation methods. Our approach demonstrates the feasibility of improving fairness without sacrificing performance and provides an a modeling mode that invites domain experts to engage, fostering a multidisciplinary effort toward tailored AI fairness.

Siqi Li, Yuqing Shang, Ziwen Wang et al.

Survival analysis serves as a fundamental component in numerous healthcare applications, where the determination of the time to specific events (such as the onset of a certain disease or death) for patients is crucial for clinical decision-making. Scoring systems are widely used for swift and efficient risk prediction. However, existing methods for constructing survival scores presume that data originates from a single source, posing privacy challenges in collaborations with multiple data owners. We propose a novel framework for building federated scoring systems for multi-site survival outcomes, ensuring both privacy and communication efficiency. We applied our approach to sites with heterogeneous survival data originating from emergency departments in Singapore and the United States. Additionally, we independently developed local scores at each site. In testing datasets from each participant site, our proposed federated scoring system consistently outperformed all local models, evidenced by higher integrated area under the receiver operating characteristic curve (iAUC) values, with a maximum improvement of 11.6%. Additionally, the federated score's time-dependent AUC(t) values showed advantages over local scores, exhibiting narrower confidence intervals (CIs) across most time points. The model developed through our proposed method exhibits effective performance on each local site, signifying noteworthy implications for healthcare research. Sites participating in our proposed federated scoring model training gained benefits by acquiring survival models with enhanced prediction accuracy and efficiency. This study demonstrates the effectiveness of our privacy-preserving federated survival score generation framework and its applicability to real-world heterogeneous survival data.

Mengying Yan, Ziye Tian, Siqi Li et al.

Clinical decision support tools built on electronic health records often experience performance drift due to temporal population shifts, particularly when changes in the clinical environment initially affect only a subset of patients, resulting in a transition to mixed populations. Such case-mix changes commonly arise following system-level operational updates or the emergence of new diseases, such as COVID-19. We propose TRACER (Transfer Learning-based Real-time Adaptation for Clinical Evolving Risk), a framework that identifies encounter-level transition membership and adapts predictive models using transfer learning without full retraining. In simulation studies, TRACER outperformed static models trained on historical or contemporary data. In a real-world application predicting hospital admission following emergency department visits across the COVID-19 transition, TRACER improved both discrimination and calibration. TRACER provides a scalable approach for maintaining robust predictive performance under evolving and heterogeneous clinical conditions.

Xuanhao Mu, Jakob Geiges, Nan Liu et al.

In energy system analysis, coupling models with mismatched spatial resolutions is a significant challenge. A common solution is assigning weights to high-resolution geographic units for aggregation, but traditional models are limited by using only a single geospatial attribute. This paper presents an innovative method employing a self-supervised Heterogeneous Graph Neural Network to address this issue. This method models high-resolution geographic units as graph nodes, integrating various geographical features to generate physically meaningful weights for each grid point. These weights enhance the conventional Voronoi-based allocation method, allowing it to go beyond simply geographic proximity by incorporating essential geographic information.In addition, the self-supervised learning paradigm overcomes the lack of accurate ground-truth data. Experimental results demonstrate that applying weights generated by this method to cluster-based Voronoi Diagrams significantly enhances scalability, accuracy, and physical plausibility, while increasing precision compared to traditional methods.