Roland Eils

Sijia Li, Xiaoyu Tan, Qixing Wang et al.

Ventilator decision support requires sequential decisions that track evolving physiology and disease trajectories while respecting safety boundaries and clinician specific tuning styles. Rule based approaches rarely generalize personalization, and end to end reinforcement learning or single large language model systems remain difficult to control and audit. We propose the Ventilator Decision Support System (VDSS), a human in the loop multi agent framework that coordinates modular decision components through contract driven structured interfaces and produces traceable evidence for review. VDSS performs online preference adaptation with a contextual bandit, updating clinician specific preferences from the final accepted decision at each adjustment cycle and using them to guide subsequent recommendations. Structured rejection feedback triggers targeted replanning to reduce unproductive iterations and improve interaction stability. Retrospective ICU trajectory replay with expert review indicates higher recommendation acceptability and fewer interaction rounds to reach an acceptable plan, supporting clinically deployable human AI collaboration.

Andre Vauvelle, Benjamin Wild, Aylin Cakiroglu et al.

Survival analysis is a crucial semi-supervised task in machine learning with numerous real-world applications, particularly in healthcare. Currently, the most common approach to survival analysis is based on Cox's partial likelihood, which can be interpreted as a ranking model optimized on a lower bound of the concordance index. This relation between ranking models and Cox's partial likelihood considers only pairwise comparisons. Recent work has developed differentiable sorting methods which relax this pairwise independence assumption, enabling the ranking of sets of samples. However, current differentiable sorting methods cannot account for censoring, a key factor in many real-world datasets. To address this limitation, we propose a novel method called Diffsurv. We extend differentiable sorting methods to handle censored tasks by predicting matrices of possible permutations that take into account the label uncertainty introduced by censored samples. We contrast this approach with methods derived from partial likelihood and ranking losses. Our experiments show that Diffsurv outperforms established baselines in various simulated and real-world risk prediction scenarios. Additionally, we demonstrate the benefits of the algorithmic supervision enabled by Diffsurv by presenting a novel method for top-k risk prediction that outperforms current methods.

Stefan Hegselmann, Georg von Arnim, Tillmann Rheude et al.

Electronic Health Records (EHRs) offer considerable potential for clinical prediction, but their complexity and heterogeneity present significant challenges for traditional machine learning methods. Recently, domain-specific EHR foundation models trained on large volumes of unlabeled EHR data have shown improved predictive accuracy and generalization. However, their development is constrained by limited access to diverse, high-quality datasets, and inconsistencies in coding standards and clinical practices. In this study, we explore the use of general-purpose Large Language Models (LLMs) to encode EHR into high-dimensional representations for downstream clinical prediction tasks. We convert structured EHR data into Markdown-formatted plain-text documents by replacing medical codes with natural language descriptions. This enables the use of LLMs and their extensive semantic understanding and generalization capabilities as effective encoders of EHRs without requiring access to private medical training data. We show that LLM-based embeddings can often match or even surpass the performance of a specialized EHR foundation model, CLMBR-T-Base, across 15 diverse clinical tasks from the EHRSHOT benchmark. Critically, our approach requires no institution-specific training and can incorporate any medical code with a text description, whereas existing EHR foundation models operate on fixed vocabularies and can only process codes seen during pretraining. To demonstrate generalizability, we further evaluate the approach on the UK Biobank (UKB) cohort, out-of-domain for CLMBR-T-Base, whose fixed vocabulary covers only 16% of UKB codes. Notably, an LLM-based model achieves superior performance for prediction of disease onset, hospitalization, and mortality, indicating robustness to population and coding shifts.

Tillmann Rheude, Roland Eils, Benjamin Wild

Real-world machine learning applications often involve data from multiple modalities that must be integrated effectively to make robust predictions. However, in many practical settings, not all modalities are available for every sample, and acquiring additional modalities can be costly. This raises the question: which samples should be prioritized for additional modality acquisition when resources are limited? While prior work has explored individual-level acquisition strategies and training-time active learning paradigms, test-time and cohort-based acquisition remain underexplored. We introduce Cohort-based Active Modality Acquisition (CAMA), a novel test-time setting to formalize the challenge of selecting which samples should receive additional modalities. We derive acquisition strategies that leverage a combination of generative imputation and discriminative modeling to estimate the expected benefit of acquiring missing modalities based on common evaluation metrics. We also introduce upper-bound heuristics that provide performance ceilings to benchmark acquisition strategies. Experiments on multimodal datasets with up to 15 modalities demonstrate that our proposed imputation-based strategies can more effectively guide the acquisition of additional modalities for selected samples compared with methods relying solely on unimodal information, entropy-based guidance, or random selection. We showcase the real-world relevance and scalability of our method by demonstrating its ability to effectively guide the costly acquisition of proteomics data for disease prediction in a large prospective cohort, the UK Biobank (UKBB). Our work provides an effective approach for optimizing modality acquisition at the cohort level, enabling more effective use of resources in constrained settings.