Hyewon Jeong

Hyewon Jeong, Collin M. Stultz, Marzyeh Ghassemi

Heart failure is a debilitating condition that affects millions of people worldwide and has a significant impact on their quality of life and mortality rates. An objective assessment of cardiac pressures remains an important method for the diagnosis and treatment prognostication for patients with heart failure. Although cardiac catheterization is the gold standard for estimating central hemodynamic pressures, it is an invasive procedure that carries inherent risks, making it a potentially dangerous procedure for some patients. Approaches that leverage non-invasive signals - such as electrocardiogram (ECG) - have the promise to make the routine estimation of cardiac pressures feasible in both inpatient and outpatient settings. Prior models trained to estimate intracardiac pressures (e.g., mean pulmonary capillary wedge pressure (mPCWP)) in a supervised fashion have shown good discriminatory ability but have been limited to the labeled dataset from the heart failure cohort. To address this issue and build a robust representation, we apply deep metric learning (DML) and propose a novel self-supervised DML with distance-based mining that improves the performance of a model with limited labels. We use a dataset that contains over 5.4 million ECGs without concomitant central pressure labels to pre-train a self-supervised DML model which showed improved classification of elevated mPCWP compared to self-supervised contrastive baselines. Additionally, the supervised DML model that uses ECGs with access to 8,172 mPCWP labels demonstrated significantly better performance on the mPCWP regression task compared to the supervised baseline. Moreover, our data suggest that DML yields models that are performant across patient subgroups, even when some patient subgroups are under-represented in the dataset. Our code is available at https://github.com/mandiehyewon/ssldml

Haoran Zhang, Aparna Balagopalan, Nassim Oufattole et al.

Large repositories of image-caption pairs are essential for the development of vision-language models. However, these datasets are often extracted from noisy data scraped from the web, and contain many mislabeled instances. In order to improve the reliability of downstream models, it is important to identify and filter images with incorrect captions. However, beyond filtering based on image-caption embedding similarity, no prior works have proposed other methods to filter noisy multimodal data, or concretely assessed the impact of noisy captioning data on downstream training. In this work, we propose, theoretically justify, and empirically validate LEMoN, a method to identify label errors in image-caption datasets. Our method leverages the multimodal neighborhood of image-caption pairs in the latent space of contrastively pretrained multimodal models to automatically identify label errors. Through empirical evaluations across eight datasets and twelve baselines, we find that LEMoN outperforms the baselines by over 3% in label error detection, and that training on datasets filtered using our method improves downstream captioning performance by more than 2 BLEU points over noisy training.

Maxwell A. Xu, Jaya Narain, Gregory Darnell et al.

We present RelCon, a novel self-supervised Relative Contrastive learning approach for training a motion foundation model from wearable accelerometry sensors. First, a learnable distance measure is trained to capture motif similarity and domain-specific semantic information such as rotation invariance. Then, the learned distance provides a measurement of semantic similarity between a pair of accelerometry time-series, which we use to train our foundation model to model relative relationships across time and across subjects. The foundation model is trained on 1 billion segments from 87,376 participants, and achieves state-of-the-art performance across multiple downstream tasks, including human activity recognition and gait metric regression. To our knowledge, we are the first to show the generalizability of a foundation model with motion data from wearables across distinct evaluation tasks.

Hyewon Jeong, Nassim Oufattole, Matthew Mcdermott et al.

In clinical practice, one often needs to identify whether a patient is at high risk of adverse outcomes after some key medical event. For example, quantifying the risk of adverse outcomes after an acute cardiovascular event helps healthcare providers identify those patients at the highest risk of poor outcomes; i.e., patients who benefit from invasive therapies that can lower their risk. Assessing the risk of adverse outcomes, however, is challenging due to the complexity, variability, and heterogeneity of longitudinal medical data, especially for individuals suffering from chronic diseases like heart failure. In this paper, we introduce Event-Based Contrastive Learning (EBCL) - a method for learning embeddings of heterogeneous patient data that preserves temporal information before and after key index events. We demonstrate that EBCL can be used to construct models that yield improved performance on important downstream tasks relative to other pretraining methods. We develop and test the method using a cohort of heart failure patients obtained from a large hospital network and the publicly available MIMIC-IV dataset consisting of patients in an intensive care unit at a large tertiary care center. On both cohorts, EBCL pretraining yields models that are performant with respect to a number of downstream tasks, including mortality, hospital readmission, and length of stay. In addition, unsupervised EBCL embeddings effectively cluster heart failure patients into subgroups with distinct outcomes, thereby providing information that helps identify new heart failure phenotypes. The contrastive framework around the index event can be adapted to a wide array of time-series datasets and provides information that can be used to guide personalized care.

Hyewon Jeong, Sarah Jabbour, Yuzhe Yang et al. · uw

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

Nassim Oufattole, Teya Bergamaschi, Aleksia Kolo et al. · mit

Effective, reliable, and scalable development of machine learning (ML) solutions for structured electronic health record (EHR) data requires the ability to reliably generate high-quality baseline models for diverse supervised learning tasks in an efficient and performant manner. Historically, producing such baseline models has been a largely manual effort--individual researchers would need to decide on the particular featurization and tabularization processes to apply to their individual raw, longitudinal data; and then train a supervised model over those data to produce a baseline result to compare novel methods against, all for just one task and one dataset. In this work, powered by complementary advances in core data standardization through the MEDS framework, we dramatically simplify and accelerate this process of tabularizing irregularly sampled time-series data, providing researchers the ability to automatically and scalably featurize and tabularize their longitudinal EHR data across tens of thousands of individual features, hundreds of millions of clinical events, and diverse windowing horizons and aggregation strategies, all before ultimately leveraging these tabular data to automatically produce high-caliber XGBoost baselines in a highly computationally efficient manner. This system scales to dramatically larger datasets than tabularization tools currently available to the community and enables researchers with any MEDS format dataset to immediately begin producing reliable and performant baseline prediction results on various tasks, with minimal human effort required. This system will greatly enhance the reliability, reproducibility, and ease of development of powerful ML solutions for health problems across diverse datasets and clinical settings.

Hyewon Jeong, Siddharth Nayak, Taylor Killian et al.

Sepsis is a life-threatening condition defined by end-organ dysfunction due to a dysregulated host response to infection. Although the Surviving Sepsis Campaign has launched and has been releasing sepsis treatment guidelines to unify and normalize the care for sepsis patients, it has been reported in numerous studies that disparities in care exist across the trajectory of patient stay in the emergency department and intensive care unit. Here, we apply a number of reinforcement learning techniques including behavioral cloning, imitation learning, and inverse reinforcement learning, to learn the optimal policy in the management of septic patient subgroups using expert demonstrations. Then we estimate the counterfactual optimal policies by applying the model to another subset of unseen medical populations and identify the difference in cure by comparing it to the real policy. Our data comes from the sepsis cohort of MIMIC-IV and the clinical data warehouses of the Mass General Brigham healthcare system. The ultimate objective of this work is to use the optimal learned policy function to estimate the counterfactual treatment policy and identify deviations across sub-populations of interest. We hope this approach would help us identify any disparities in care and also changes in cure in response to the publication of national sepsis treatment guidelines.

Jay Heo, Junhyeon Park, Hyewon Jeong et al.

We propose a novel interactive learning framework which we refer to as Interactive Attention Learning (IAL), in which the human supervisors interactively manipulate the allocated attentions, to correct the model's behavior by updating the attention-generating network. However, such a model is prone to overfitting due to scarcity of human annotations, and requires costly retraining. Moreover, it is almost infeasible for the human annotators to examine attentions on tons of instances and features. We tackle these challenges by proposing a sample-efficient attention mechanism and a cost-effective reranking algorithm for instances and features. First, we propose Neural Attention Process (NAP), which is an attention generator that can update its behavior by incorporating new attention-level supervisions without any retraining. Secondly, we propose an algorithm which prioritizes the instances and the features by their negative impacts, such that the model can yield large improvements with minimal human feedback. We validate IAL on various time-series datasets from multiple domains (healthcare, real-estate, and computer vision) on which it significantly outperforms baselines with conventional attention mechanisms, or without cost-effective reranking, with substantially less retraining and human-model interaction cost.