Doudou Zhou

Doudou Zhou, Yufeng Zhang, Aaron Sonabend-W et al.

Evidence-based or data-driven dynamic treatment regimes are essential for personalized medicine, which can benefit from offline reinforcement learning (RL). Although massive healthcare data are available across medical institutions, they are prohibited from sharing due to privacy constraints. Besides, heterogeneity exists in different sites. As a result, federated offline RL algorithms are necessary and promising to deal with the problems. In this paper, we propose a multi-site Markov decision process model that allows for both homogeneous and heterogeneous effects across sites. The proposed model makes the analysis of the site-level features possible. We design the first federated policy optimization algorithm for offline RL with sample complexity. The proposed algorithm is communication-efficient, which requires only a single round of communication interaction by exchanging summary statistics. We give a theoretical guarantee for the proposed algorithm, where the suboptimality for the learned policies is comparable to the rate as if data is not distributed. Extensive simulations demonstrate the effectiveness of the proposed algorithm. The method is applied to a sepsis dataset in multiple sites to illustrate its use in clinical settings.

Bryan Cai, Sihang Zeng, Yucong Lin et al. · tsinghua

Electronic health records (EHR) contain narrative notes that provide extensive details on the medical condition and management of patients. Natural language processing (NLP) of clinical notes can use observed frequencies of clinical terms as predictive features for downstream applications such as clinical decision making and patient trajectory prediction. However, due to the vast number of highly similar and related clinical concepts, a more effective modeling strategy is to represent clinical terms as semantic embeddings via representation learning and use the low dimensional embeddings as feature vectors for predictive modeling. To achieve efficient representation, fine-tuning pretrained language models with biomedical knowledge graphs may generate better embeddings for biomedical terms than those from standard language models alone. These embeddings can effectively discriminate synonymous pairs of from those that are unrelated. However, they often fail to capture different degrees of similarity or relatedness for concepts that are hierarchical in nature. To overcome this limitation, we propose HiPrBERT, a novel biomedical term representation model trained on additionally complied data that contains hierarchical structures for various biomedical terms. We modify an existing contrastive loss function to extract information from these hierarchies. Our numerical experiments demonstrate that HiPrBERT effectively learns the pair-wise distance from hierarchical information, resulting in a substantially more informative embeddings for further biomedical applications

Tianxi Cai, Dong Xia, Luwan Zhang et al.

Network analysis has been a powerful tool to unveil relationships and interactions among a large number of objects. Yet its effectiveness in accurately identifying important node-node interactions is challenged by the rapidly growing network size, with data being collected at an unprecedented granularity and scale. Common wisdom to overcome such high dimensionality is collapsing nodes into smaller groups and conducting connectivity analysis on the group level. Dividing efforts into two phases inevitably opens a gap in consistency and drives down efficiency. Consensus learning emerges as a new normal for common knowledge discovery with multiple data sources available. In this paper, we propose a unified multi-view sparse low-rank block model (msLBM) framework, which enables simultaneous grouping and connectivity analysis by combining multiple data sources. The msLBM framework efficiently represents overlapping information across large scale concepts and accommodates different types of heterogeneity across sources. Both features are desirable when analyzing high dimensional electronic health record (EHR) datasets from multiple health systems. An estimating procedure based on the alternating minimization algorithm is proposed. Our theoretical results demonstrate that a consensus knowledge graph can be more accurately learned by leveraging multi-source datasets, and statistically optimal rates can be achieved under mild conditions. Applications to the real world EHR data suggest that our proposed msLBM algorithm can more reliably reveal network structure among clinical concepts by effectively combining summary level EHR data from multiple health systems.

Yang Yang, Kathryn Pollak, Bibhas Chakraborty et al.

Objective: Electronic health record (EHR) phenotyping often relies on noisy proxy labels, which undermine the reliability of downstream risk prediction. Active learning can reduce annotation costs, but most rely on fixed heuristics and do not ensure that phenotype refinement improves prediction performance. Our goal was to develop a framework that directly uses downstream prediction performance as feedback to guide phenotype correction and sample selection under constrained labeling budgets. Materials and Methods: We propose Reinforcement-Enhanced Label-Efficient Active Phenotyping (RELEAP), a reinforcement learning-based active learning framework. RELEAP adaptively integrates multiple querying strategies and, unlike prior methods, updates its policy based on feedback from downstream models. We evaluated RELEAP on a de-identified Duke University Health System (DUHS) cohort (2014-2024) for incident lung cancer risk prediction, using logistic regression and penalized Cox survival models. Performance was benchmarked against noisy-label baselines and single-strategy active learning. Results: RELEAP consistently outperformed all baselines. Logistic AUC increased from 0.774 to 0.805 and survival C-index from 0.718 to 0.752. Using downstream performance as feedback, RELEAP produced smoother and more stable gains than heuristic methods under the same labeling budget. Discussion: By linking phenotype refinement to prediction outcomes, RELEAP learns which samples most improve downstream discrimination and calibration, offering a more principled alternative to fixed active learning rules. Conclusion: RELEAP optimizes phenotype correction through downstream feedback, offering a scalable, label-efficient paradigm that reduces manual chart review and enhances the reliability of EHR-based risk prediction.

Doudou Zhou, Yiran Zhang, Dian Jin et al.

Clinical decision-making often involves selecting tests that are costly, invasive, or time-consuming, motivating individualized, sequential strategies for what to measure and when to stop ascertaining. We study the problem of learning cost-optimal sequential decision policies from retrospective data, where test availability depends on prior results, inducing informative missingness. Under a sequential missing-at-random mechanism, we develop a doubly robust Q-learning framework for estimating optimal policies. The method introduces path-specific inverse probability weights that account for heterogeneous test trajectories and satisfy a normalization property conditional on the observed history. By combining these weights with auxiliary contrast models, we construct orthogonal pseudo-outcomes that enable unbiased policy learning when either the acquisition model or the contrast model is correctly specified. We establish oracle inequalities for the stage-wise contrast estimators, along with convergence rates, regret bounds, and misclassification rates for the learned policy. Simulations demonstrate improved cost-adjusted performance over weighted and complete-case baselines, and an application to a prostate cancer cohort study illustrates how the method reduces testing cost without compromising predictive accuracy.

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.

Jessica Gronsbell, Vidul Ayakulangara Panickan, Chris Lin et al.

Integrative analysis of multi-institutional Electronic Health Record (EHR) data enhances the reliability and generalizability of translational research by leveraging larger, more diverse patient cohorts and incorporating multiple data modalities. However, harmonizing EHR data across institutions poses major challenges due to data heterogeneity, semantic differences, and privacy concerns. To address these challenges, we introduce $\textit{PEHRT}$, a standardized pipeline for efficient EHR data harmonization consisting of two core modules: (1) data pre-processing and (2) representation learning. PEHRT maps EHR data to standard coding systems and uses advanced machine learning to generate research-ready datasets without requiring individual-level data sharing. Our pipeline is also data model agnostic and designed for streamlined execution across institutions based on our extensive real-world experience. We provide a complete suite of open source software, accompanied by a user-friendly tutorial, and demonstrate the utility of PEHRT in a variety of tasks using data from diverse healthcare systems.

Kaicheng Zhang, Sinian Zhang, Doudou Zhou et al.

Transfer learning is a powerful paradigm for leveraging knowledge from source domains to enhance learning in a target domain. However, traditional transfer learning approaches often focus on scalar or multivariate data within Euclidean spaces, limiting their applicability to complex data structures such as probability distributions. To address this limitation, we introduce a novel transfer learning framework for regression models whose outputs are probability distributions residing in the Wasserstein space. When the informative subset of transferable source domains is known, we propose an estimator with provable asymptotic convergence rates, quantifying the impact of domain similarity on transfer efficiency. For cases where the informative subset is unknown, we develop a data-driven transfer learning procedure designed to mitigate negative transfer. The proposed methods are supported by rigorous theoretical analysis and are validated through extensive simulations and real-world applications. The code is available at https://github.com/h7nian/WaTL

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.

Mingyuan Xu, Zongqi Xia, Tianxi Cai et al.

We often collect data from multiple sites (e.g., hospitals) that share common structure but also exhibit heterogeneity. This paper aims to learn robust sequential decision-making policies from such offline, multi-site datasets. To model cross-site uncertainty, we study distributionally robust MDPs with a group-linear structure: all sites share a common feature map, and both the transition kernels and expected reward functions are linear in these shared features. We introduce feature-wise (d-rectangular) uncertainty sets, which preserve tractable robust Bellman recursions while maintaining key cross-site structure. Building on this, we then develop an offline algorithm based on pessimistic value iteration that includes: (i) per-site ridge regression for Bellman targets, (ii) feature-wise worst-case (row-wise minimization) aggregation, and (iii) a data-dependent pessimism penalty computed from the diagonals of the inverse design matrices. We further propose a cluster-level extension that pools similar sites to improve sample efficiency, guided by prior knowledge of site similarity. Under a robust partial coverage assumption, we prove a suboptimality bound for the resulting policy. Overall, our framework addresses multi-site learning with heterogeneous data sources and provides a principled approach to robust planning without relying on strong state-action rectangularity assumptions.

Huichao Li, Junhan Yu, Doudou Zhou

Multimodal representation learning is commonly built on a shared-private decomposition, treating latent information as either common to all modalities or specific to one. This binary view is often inadequate: many factors are shared by only subsets of modalities, and ignoring such partial sharing can over-align unrelated signals and obscure complementary information. We propose Hierarchical Contrastive Learning (HCL), a framework that learns globally shared, partially shared, and modality-specific representations within a unified model. HCL combines a hierarchical latent-variable formulation with structural sparsity and a structure-aware contrastive objective that aligns only modalities that genuinely share a latent factor. Under uncorrelated latent variables, we prove identifiability of the hierarchical decomposition, establish recovery guarantees for the loading matrices, and derive parameter estimation and excess-risk bounds for downstream prediction. Simulations show accurate recovery of hierarchical structure and effective selection of task-relevant components. On multimodal electronic health records, HCL yields more informative representations and consistently improves predictive performance.

Jiawei Wu, DouDou Zhou

Machine unlearning has emerged as a critical capability for addressing privacy, safety, and regulatory concerns in large language models (LLMs). Existing methods operate at the sequence level, applying uniform updates across all tokens despite only a subset encoding the knowledge targeted for removal. This introduces gradient noise, degrades utility, and leads to suboptimal forgetting. We propose TokenUnlearn, a token-level attribution framework that identifies and selectively targets critical tokens. Our approach combines knowledge-aware signals via masking, and entropy-aware signals to yield importance scores for precise token selection. We develop two complementary strategies: hard selection, applying unlearning only to high-importance tokens, and soft weighting, modulating gradient contributions based on importance scores. Both extend existing methods to token-level variants. Theoretical analysis shows token-level selection improves gradient signal-to-noise ratio. Experiments on TOFU and WMDP benchmarks across three model architectures demonstrate consistent improvements over sequence-level baselines in both forgetting effectiveness and utility preservation.

Xinzi Tan, Kejian Zhang, Junhan Yu et al.

Marked Temporal Point Processes (MTPPs) arise naturally in medical, social, commercial, and financial domains. However, existing Transformer-based methods mostly inject temporal information only via positional encodings, relying on shared or parametric decay structures, which limits their ability to capture heterogeneous and type-specific temporal effects. Inspired by this observation, we derive a novel attention operator called Hawkes Attention from the multivariate Hawkes process theory for MTPP, using learnable per-type neural kernels to modulate query, key and value projections, thereby replacing the corresponding parts in the traditional attention. Benefited from the design, Hawkes Attention unifies event timing and content interaction, learning both the time-relevant behavior and type-specific excitation patterns from the data. The experimental results show that our method achieves better performance compared to the baselines. In addition to the general MTPP, our attention mechanism can also be easily applied to specific temporal structures, such as time series forecasting.

Doudou Zhou, Han Tong, Linshanshan Wang et al.

The adoption of EHRs has expanded opportunities to leverage data-driven algorithms in clinical care and research. A major bottleneck in effectively conducting multi-institutional EHR studies is the data heterogeneity across systems with numerous codes that either do not exist or represent different clinical concepts across institutions. The need for data privacy further limits the feasibility of including multi-institutional patient-level data required to study similarities and differences across patient subgroups. To address these challenges, we developed the GAME algorithm. Tested and validated across 7 institutions and 2 languages, GAME integrates data in several levels: (1) at the institutional level with knowledge graphs to establish relationships between codes and existing knowledge sources, providing the medical context for standard codes and their relationship to each other; (2) between institutions, leveraging language models to determine the relationships between institution-specific codes with established standard codes; and (3) quantifying the strength of the relationships between codes using a graph attention network. Jointly trained embeddings are created using transfer and federated learning to preserve data privacy. In this study, we demonstrate the applicability of GAME in selecting relevant features as inputs for AI-driven algorithms in a range of conditions, e.g., heart failure, rheumatoid arthritis. We then highlight the application of GAME harmonized multi-institutional EHR data in a study of Alzheimer's disease outcomes and suicide risk among patients with mental health disorders, without sharing patient-level data outside individual institutions.

Tianxi Cai, Feiqing Huang, Ryumei Nakada et al.

Electronic health record (EHR) systems contain a wealth of multimodal clinical data including structured data like clinical codes and unstructured data such as clinical notes. However, many existing EHR-focused studies has traditionally either concentrated on an individual modality or merged different modalities in a rather rudimentary fashion. This approach often results in the perception of structured and unstructured data as separate entities, neglecting the inherent synergy between them. Specifically, the two important modalities contain clinically relevant, inextricably linked and complementary health information. A more complete picture of a patient's medical history is captured by the joint analysis of the two modalities of data. Despite the great success of multimodal contrastive learning on vision-language, its potential remains under-explored in the realm of multimodal EHR, particularly in terms of its theoretical understanding. To accommodate the statistical analysis of multimodal EHR data, in this paper, we propose a novel multimodal feature embedding generative model and design a multimodal contrastive loss to obtain the multimodal EHR feature representation. Our theoretical analysis demonstrates the effectiveness of multimodal learning compared to single-modality learning and connects the solution of the loss function to the singular value decomposition of a pointwise mutual information matrix. This connection paves the way for a privacy-preserving algorithm tailored for multimodal EHR feature representation learning. Simulation studies show that the proposed algorithm performs well under a variety of configurations. We further validate the clinical utility of the proposed algorithm in real-world EHR data.

Junhan Yu, Zhunyi Feng, Junwei Lu et al.

Electronic Health Records (EHR) contain valuable clinical information for predicting patient outcomes and guiding healthcare decisions. However, effectively modeling Electronic Health Records (EHRs) requires addressing data heterogeneity and complex temporal patterns. Standard approaches often struggle with irregular time intervals between clinical events. We propose TALE-EHR, a Transformer-based framework featuring a novel time-aware attention mechanism that explicitly models continuous temporal gaps to capture fine-grained sequence dynamics. To complement this temporal modeling with robust semantics, TALE-EHR leverages embeddings derived from standardized code descriptions using a pre-trained Large Language Model (LLM), providing a strong foundation for understanding clinical concepts. Experiments on the MIMIC-IV and PIC dataset demonstrate that our approach outperforms state-of-the-art baselines on tasks such as disease progression forecasting. TALE-EHR underscores the benefit of integrating explicit, continuous temporal modeling with strong semantic representations provides a powerful solution for advancing EHR analysis.

Mingyuan Xu, Xinzi Tan, Jiawei Wu et al.

Evaluating large language models (LLMs) on open-ended tasks without ground-truth labels is increasingly done via the LLM-as-a-judge paradigm. A critical but under-modeled issue is that judge LLMs differ substantially in reliability; treating all judges equally can yield biased leaderboards and misleading uncertainty estimates. More data can make evaluation more confidently wrong under misspecified aggregation. We propose a judge-aware ranking framework that extends the Bradley-Terry-Luce model by introducing judge-specific discrimination parameters, jointly estimating latent model quality and judge reliability from pairwise comparisons without reference labels. We establish identifiability up to natural normalizations and prove consistency and asymptotic normality of the maximum likelihood estimator, enabling confidence intervals for score differences and rank comparisons. Across multiple public benchmarks and a newly collected dataset, our method improves agreement with human preferences, achieves higher data efficiency than unweighted baselines, and produces calibrated uncertainty quantification for LLM rankings.

Minh Duc Vu, Mingshuo Liu, Doudou Zhou

Measuring how central or typical a data point is underpins robust estimation, ranking, and outlier detection, but classical depth notions become expensive and unstable in high dimensions and are hard to extend beyond Euclidean data. We introduce Fused Unified centrality Score Estimation (FUSE), a neural centrality framework that operates on top of arbitrary representations. FUSE combines a global head, trained from pairwise distance-based comparisons to learn an anchor-free centrality score, with a local head, trained by denoising score matching to approximate a smoothed log-density potential. A single parameter between 0 and 1 interpolates between these calibrated signals, yielding depth-like centrality from different views via one forward pass. Across synthetic distributions, real images, time series, and text data, and standard outlier detection benchmarks, FUSE recovers meaningful classical ordering, reveals multi-scale geometric structures, and attains competitive performance with strong classical baselines while remaining simple and efficient.

Yinjie Wang, Doudou Zhou, Yue Liu et al.

Electronic Health Records (EHRs), comprising diverse clinical data such as diagnoses, medications, and laboratory results, hold great promise for translational research. EHR-derived data have advanced disease prevention, improved clinical trial recruitment, and generated real-world evidence. Synthesizing EHRs across institutions enables large-scale, generalizable studies that capture rare diseases and population diversity, but remains hindered by the heterogeneity of medical codes, institution-specific terminologies, and the absence of standardized data structures. These barriers limit the interpretability, comparability, and scalability of EHR-based analyses, underscoring the need for robust methods to harmonize and extract meaningful insights from distributed, heterogeneous data. To address this, we propose MASH (Multi-source Automated Structured Hierarchy), a fully automated framework that aligns medical codes across institutions using neural optimal transport and constructs hierarchical graphs with learned hyperbolic embeddings. During training, MASH integrates information from pre-trained language models, co-occurrence patterns, textual descriptions, and supervised labels to capture semantic and hierarchical relationships among medical concepts more effectively. Applied to real-world EHR data, including diagnosis, medication, and laboratory codes, MASH produces interpretable hierarchical graphs that facilitate the navigation and understanding of heterogeneous clinical data. Notably, it generates the first automated hierarchies for unstructured local laboratory codes, establishing foundational references for downstream applications.

Yue Kang, Mingshuo Liu, Bongsoo Yi et al.

Generalized linear bandits have been extensively studied due to their broad applicability in real-world online decision-making problems. However, these methods typically assume that the expected reward function is known to the users, an assumption that is often unrealistic in practice. Misspecification of this link function can lead to the failure of all existing algorithms. In this work, we address this critical limitation by introducing a new problem of generalized linear bandits with unknown reward functions, also known as single index bandits. We first consider the case where the unknown reward function is monotonically increasing, and propose two novel and efficient algorithms, STOR and ESTOR, that achieve decent regrets under standard assumptions. Notably, our ESTOR can obtain the nearly optimal regret bound $\tilde{O}_T(\sqrt{T})$ in terms of the time horizon $T$. We then extend our methods to the high-dimensional sparse setting and show that the same regret rate can be attained with the sparsity index. Next, we introduce GSTOR, an algorithm that is agnostic to general reward functions, and establish regret bounds under a Gaussian design assumption. Finally, we validate the efficiency and effectiveness of our algorithms through experiments on both synthetic and real-world datasets.

Sinian Zhang, Kaicheng Zhang, Ziping Xu et al.

The linear Markov Decision Process (MDP) framework offers a principled foundation for reinforcement learning (RL) with strong theoretical guarantees and sample efficiency. However, its restrictive assumption-that both transition dynamics and reward functions are linear in the same feature space-limits its applicability in real-world domains, where rewards often exhibit nonlinear or discrete structures. Motivated by applications such as healthcare and e-commerce, where data is scarce and reward signals can be binary or count-valued, we propose the Generalized Linear MDP (GLMDP) framework-an extension of the linear MDP framework-that models rewards using generalized linear models (GLMs) while maintaining linear transition dynamics. We establish the Bellman completeness of GLMDPs with respect to a new function class that accommodates nonlinear rewards and develop two offline RL algorithms: Generalized Pessimistic Value Iteration (GPEVI) and a semi-supervised variant (SS-GPEVI) that utilizes both labeled and unlabeled trajectories. Our algorithms achieve theoretical guarantees on policy suboptimality and demonstrate improved sample efficiency in settings where reward labels are expensive or limited.

Doudou Zhou, Tianxi Cai, Junwei Lu

Matrix completion has attracted attention in many fields, including statistics, applied mathematics, and electrical engineering. Most of the works focus on the independent sampling models under which the observed entries are sampled independently. Motivated by applications in the integration of knowledge graphs derived from multi-source biomedical data such as those from Electronic Health Records (EHR) and biomedical text, we propose the {\bf B}lock-wise {\bf O}verlapping {\bf N}oisy {\bf M}atrix {\bf I}ntegration (BONMI) to treat blockwise missingness of symmetric matrices representing relatedness between entity pairs. Our idea is to exploit the orthogonal Procrustes problem to align the eigenspace of the two sub-matrices, then complete the missing blocks by the inner product of the two low-rank components. Besides, we prove the statistical rate for the eigenspace of the underlying matrix, which is comparable to the rate under the independently missing assumption. Simulation studies show that the method performs well under a variety of configurations. In the real data analysis, the method is applied to two tasks: (i) the integrating of several point-wise mutual information matrices built by English EHR and Chinese medical text data, and (ii) the machine translation between English and Chinese medical concepts. Our method shows an advantage over existing methods.