Marzyeh Ghassemi

Yuzhe Yang, Haoran Zhang, Dina Katabi et al.

Machine learning models often perform poorly on subgroups that are underrepresented in the training data. Yet, little is understood on the variation in mechanisms that cause subpopulation shifts, and how algorithms generalize across such diverse shifts at scale. In this work, we provide a fine-grained analysis of subpopulation shift. We first propose a unified framework that dissects and explains common shifts in subgroups. We then establish a comprehensive benchmark of 20 state-of-the-art algorithms evaluated on 12 real-world datasets in vision, language, and healthcare domains. With results obtained from training over 10,000 models, we reveal intriguing observations for future progress in this space. First, existing algorithms only improve subgroup robustness over certain types of shifts but not others. Moreover, while current algorithms rely on group-annotated validation data for model selection, we find that a simple selection criterion based on worst-class accuracy is surprisingly effective even without any group information. Finally, unlike existing works that solely aim to improve worst-group accuracy (WGA), we demonstrate the fundamental tradeoff between WGA and other important metrics, highlighting the need to carefully choose testing metrics. Code and data are available at: https://github.com/YyzHarry/SubpopBench.

Thomas Hartvigsen, Swami Sankaranarayanan, Hamid Palangi et al.

Deployed language models decay over time due to shifting inputs, changing user needs, or emergent world-knowledge gaps. When such problems are identified, we want to make targeted edits while avoiding expensive retraining. However, current model editors, which modify such behaviors of pre-trained models, degrade model performance quickly across multiple, sequential edits. We propose GRACE, a lifelong model editing method, which implements spot-fixes on streaming errors of a deployed model, ensuring minimal impact on unrelated inputs. GRACE writes new mappings into a pre-trained model's latent space, creating a discrete, local codebook of edits without altering model weights. This is the first method enabling thousands of sequential edits using only streaming errors. Our experiments on T5, BERT, and GPT models show GRACE's state-of-the-art performance in making and retaining edits, while generalizing to unseen inputs. Our code is available at https://www.github.com/thartvigsen/grace}.

Karim Lekadir, Aasa Feragen, Abdul Joseph Fofanah et al. · eth-zurich

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

Mehdi Fatemi, Mary Wu, Jeremy Petch et al. · microsoft-research

Reinforcement learning (RL) tasks are typically framed as Markov Decision Processes (MDPs), assuming that decisions are made at fixed time intervals. However, many applications of great importance, including healthcare, do not satisfy this assumption, yet they are commonly modelled as MDPs after an artificial reshaping of the data. In addition, most healthcare (and similar) problems are offline by nature, allowing for only retrospective studies. To address both challenges, we begin by discussing the Semi-MDP (SMDP) framework, which formally handles actions of variable timings. We next present a formal way to apply SMDP modifications to nearly any given value-based offline RL method. We use this theory to introduce three SMDP-based offline RL algorithms, namely, SDQN, SDDQN, and SBCQ. We then experimentally demonstrate that only these SMDP-based algorithms learn the optimal policy in variable-time environments, whereas their MDP counterparts do not. Finally, we apply our new algorithms to a real-world offline dataset pertaining to warfarin dosing for stroke prevention and demonstrate similar results.

Jiyoung Lee, Seungho Kim, Seunghyun Won et al. · nvidia, utoronto

AI alignment refers to models acting towards human-intended goals, preferences, or ethical principles. Given that most large-scale deep learning models act as black boxes and cannot be manually controlled, analyzing the similarity between models and humans can be a proxy measure for ensuring AI safety. In this paper, we focus on the models' visual perception alignment with humans, further referred to as AI-human visual alignment. Specifically, we propose a new dataset for measuring AI-human visual alignment in terms of image classification, a fundamental task in machine perception. In order to evaluate AI-human visual alignment, a dataset should encompass samples with various scenarios that may arise in the real world and have gold human perception labels. Our dataset consists of three groups of samples, namely Must-Act (i.e., Must-Classify), Must-Abstain, and Uncertain, based on the quantity and clarity of visual information in an image and further divided into eight categories. All samples have a gold human perception label; even Uncertain (severely blurry) sample labels were obtained via crowd-sourcing. The validity of our dataset is verified by sampling theory, statistical theories related to survey design, and experts in the related fields. Using our dataset, we analyze the visual alignment and reliability of five popular visual perception models and seven abstention methods. Our code and data is available at https://github.com/jiyounglee-0523/VisAlign.

Juhan Bae, Nathan Ng, Alston Lo et al. · utoronto

Influence functions efficiently estimate the effect of removing a single training data point on a model's learned parameters. While influence estimates align well with leave-one-out retraining for linear models, recent works have shown this alignment is often poor in neural networks. In this work, we investigate the specific factors that cause this discrepancy by decomposing it into five separate terms. We study the contributions of each term on a variety of architectures and datasets and how they vary with factors such as network width and training time. While practical influence function estimates may be a poor match to leave-one-out retraining for nonlinear networks, we show they are often a good approximation to a different object we term the proximal Bregman response function (PBRF). Since the PBRF can still be used to answer many of the questions motivating influence functions, such as identifying influential or mislabeled examples, our results suggest that current algorithms for influence function estimation give more informative results than previous error analyses would suggest.

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

Xuhai Xu, Bingsheng Yao, Yuanzhe Dong et al.

Advances in large language models (LLMs) have empowered a variety of applications. However, there is still a significant gap in research when it comes to understanding and enhancing the capabilities of LLMs in the field of mental health. In this work, we present a comprehensive evaluation of multiple LLMs on various mental health prediction tasks via online text data, including Alpaca, Alpaca-LoRA, FLAN-T5, GPT-3.5, and GPT-4. We conduct a broad range of experiments, covering zero-shot prompting, few-shot prompting, and instruction fine-tuning. The results indicate a promising yet limited performance of LLMs with zero-shot and few-shot prompt designs for mental health tasks. More importantly, our experiments show that instruction finetuning can significantly boost the performance of LLMs for all tasks simultaneously. Our best-finetuned models, Mental-Alpaca and Mental-FLAN-T5, outperform the best prompt design of GPT-3.5 (25 and 15 times bigger) by 10.9% on balanced accuracy and the best of GPT-4 (250 and 150 times bigger) by 4.8%. They further perform on par with the state-of-the-art task-specific language model. We also conduct an exploratory case study on LLMs' capability on mental health reasoning tasks, illustrating the promising capability of certain models such as GPT-4. We summarize our findings into a set of action guidelines for potential methods to enhance LLMs' capability for mental health tasks. Meanwhile, we also emphasize the important limitations before achieving deployability in real-world mental health settings, such as known racial and gender bias. We highlight the important ethical risks accompanying this line of research.

Rob Brekelmans, Sicong Huang, Marzyeh Ghassemi et al. · utoronto

Mutual information (MI) is a fundamental quantity in information theory and machine learning. However, direct estimation of MI is intractable, even if the true joint probability density for the variables of interest is known, as it involves estimating a potentially high-dimensional log partition function. In this work, we present a unifying view of existing MI bounds from the perspective of importance sampling, and propose three novel bounds based on this approach. Since accurate estimation of MI without density information requires a sample size exponential in the true MI, we assume either a single marginal or the full joint density information is known. In settings where the full joint density is available, we propose Multi-Sample Annealed Importance Sampling (AIS) bounds on MI, which we demonstrate can tightly estimate large values of MI in our experiments. In settings where only a single marginal distribution is known, we propose Generalized IWAE (GIWAE) and MINE-AIS bounds. Our GIWAE bound unifies variational and contrastive bounds in a single framework that generalizes InfoNCE, IWAE, and Barber-Agakov bounds. Our MINE-AIS method improves upon existing energy-based methods such as MINE-DV and MINE-F by directly optimizing a tighter lower bound on MI. MINE-AIS uses MCMC sampling to estimate gradients for training and Multi-Sample AIS for evaluating the bound. Our methods are particularly suitable for evaluating MI in deep generative models, since explicit forms of the marginal or joint densities are often available. We evaluate our bounds on estimating the MI of VAEs and GANs trained on the MNIST and CIFAR datasets, and showcase significant gains over existing bounds in these challenging settings with high ground truth MI.

Taylor W. Killian, Sonali Parbhoo, Marzyeh Ghassemi · utoronto

In safety-critical decision-making scenarios being able to identify worst-case outcomes, or dead-ends is crucial in order to develop safe and reliable policies in practice. These situations are typically rife with uncertainty due to unknown or stochastic characteristics of the environment as well as limited offline training data. As a result, the value of a decision at any time point should be based on the distribution of its anticipated effects. We propose a framework to identify worst-case decision points, by explicitly estimating distributions of the expected return of a decision. These estimates enable earlier indication of dead-ends in a manner that is tunable based on the risk tolerance of the designed task. We demonstrate the utility of Distributional Dead-end Discovery (DistDeD) in a toy domain as well as when assessing the risk of severely ill patients in the intensive care unit reaching a point where death is unavoidable. We find that DistDeD significantly improves over prior discovery approaches, providing indications of the risk 10 hours earlier on average as well as increasing detection by 20%.

Rafi Al Attrach, Rajna Fani, Sebastian Lobentanzer et al.

Croissant has emerged as the metadata standard for machine learning datasets, providing a structured, JSON-LD-based format that makes dataset discovery, automated ingestion, and reproducible analysis machine-checkable across ML platforms. Adoption has accelerated, and NeurIPS now requires Croissant metadata in every submission to its dataset tracks. Yet in practice Croissant generation usually starts with uploading data to a public platform, a path infeasible for governed and large local repositories that hold much of the high-value data ML increasingly relies on. We release Croissant Baker, a local-first, open-source command-line tool that generates validated Croissant metadata directly from a dataset directory through a modular handler registry. We evaluate Croissant Baker on over 140 datasets, scaling to MIMIC-IV at 886 million rows and 374 Parquet files. On held-out comparisons against producer-authored or standards-derived ground truth, Croissant Baker reaches 97-100% agreement across multiple domains.

Haoran Zhang, Natalie Dullerud, Karsten Roth et al.

Deep learning models have reached or surpassed human-level performance in the field of medical imaging, especially in disease diagnosis using chest x-rays. However, prior work has found that such classifiers can exhibit biases in the form of gaps in predictive performance across protected groups. In this paper, we question whether striving to achieve zero disparities in predictive performance (i.e. group fairness) is the appropriate fairness definition in the clinical setting, over minimax fairness, which focuses on maximizing the performance of the worst-case group. We benchmark the performance of nine methods in improving classifier fairness across these two definitions. We find, consistent with prior work on non-clinical data, that methods which strive to achieve better worst-group performance do not outperform simple data balancing. We also find that methods which achieve group fairness do so by worsening performance for all groups. In light of these results, we discuss the utility of fairness definitions in the clinical setting, advocating for an investigation of the bias-inducing mechanisms in the underlying data generating process whenever possible.

Aparna Balagopalan, Haoran Zhang, Kimia Hamidieh et al.

Machine learning models in safety-critical settings like healthcare are often blackboxes: they contain a large number of parameters which are not transparent to users. Post-hoc explainability methods where a simple, human-interpretable model imitates the behavior of these blackbox models are often proposed to help users trust model predictions. In this work, we audit the quality of such explanations for different protected subgroups using real data from four settings in finance, healthcare, college admissions, and the US justice system. Across two different blackbox model architectures and four popular explainability methods, we find that the approximation quality of explanation models, also known as the fidelity, differs significantly between subgroups. We also demonstrate that pairing explainability methods with recent advances in robust machine learning can improve explanation fairness in some settings. However, we highlight the importance of communicating details of non-zero fidelity gaps to users, since a single solution might not exist across all settings. Finally, we discuss the implications of unfair explanation models as a challenging and understudied problem facing the machine learning community.

Hammaad Adam, Ming Ying Yang, Kenrick Cato et al.

Clinical notes are becoming an increasingly important data source for machine learning (ML) applications in healthcare. Prior research has shown that deploying ML models can perpetuate existing biases against racial minorities, as bias can be implicitly embedded in data. In this study, we investigate the level of implicit race information available to ML models and human experts and the implications of model-detectable differences in clinical notes. Our work makes three key contributions. First, we find that models can identify patient self-reported race from clinical notes even when the notes are stripped of explicit indicators of race. Second, we determine that human experts are not able to accurately predict patient race from the same redacted clinical notes. Finally, we demonstrate the potential harm of this implicit information in a simulation study, and show that models trained on these race-redacted clinical notes can still perpetuate existing biases in clinical treatment decisions.

Haoran Zhang, Harvineet Singh, Marzyeh Ghassemi et al.

Machine learning models frequently experience performance drops under distribution shifts. The underlying cause of such shifts may be multiple simultaneous factors such as changes in data quality, differences in specific covariate distributions, or changes in the relationship between label and features. When a model does fail during deployment, attributing performance change to these factors is critical for the model developer to identify the root cause and take mitigating actions. In this work, we introduce the problem of attributing performance differences between environments to distribution shifts in the underlying data generating mechanisms. We formulate the problem as a cooperative game where the players are distributions. We define the value of a set of distributions to be the change in model performance when only this set of distributions has changed between environments, and derive an importance weighting method for computing the value of an arbitrary set of distributions. The contribution of each distribution to the total performance change is then quantified as its Shapley value. We demonstrate the correctness and utility of our method on synthetic, semi-synthetic, and real-world case studies, showing its effectiveness in attributing performance changes to a wide range of distribution shifts.

Nathan Ng, Neha Hulkund, Kyunghyun Cho et al.

Developing and deploying machine learning models safely depends on the ability to characterize and compare their abilities to generalize to new environments. Although recent work has proposed a variety of methods that can directly predict or theoretically bound the generalization capacity of a model, they rely on strong assumptions such as matching train/test distributions and access to model gradients. In order to characterize generalization when these assumptions are not satisfied, we propose neighborhood invariance, a measure of a classifier's output invariance in a local transformation neighborhood. Specifically, we sample a set of transformations and given an input test point, calculate the invariance as the largest fraction of transformed points classified into the same class. Crucially, our measure is simple to calculate, does not depend on the test point's true label, makes no assumptions about the data distribution or model, and can be applied even in out-of-domain (OOD) settings where existing methods cannot, requiring only selecting a set of appropriate data transformations. In experiments on robustness benchmarks in image classification, sentiment analysis, and natural language inference, we demonstrate a strong and robust correlation between our neighborhood invariance measure and actual OOD generalization on over 4,600 models evaluated on over 100 unique train/test domain pairs.

Natalie Dullerud, Karsten Roth, Kimia Hamidieh et al.

Deep metric learning (DML) enables learning with less supervision through its emphasis on the similarity structure of representations. There has been much work on improving generalization of DML in settings like zero-shot retrieval, but little is known about its implications for fairness. In this paper, we are the first to evaluate state-of-the-art DML methods trained on imbalanced data, and to show the negative impact these representations have on minority subgroup performance when used for downstream tasks. In this work, we first define fairness in DML through an analysis of three properties of the representation space -- inter-class alignment, intra-class alignment, and uniformity -- and propose finDML, the fairness in non-balanced DML benchmark to characterize representation fairness. Utilizing finDML, we find bias in DML representations to propagate to common downstream classification tasks. Surprisingly, this bias is propagated even when training data in the downstream task is re-balanced. To address this problem, we present Partial Attribute De-correlation (PARADE) to de-correlate feature representations from sensitive attributes and reduce performance gaps between subgroups in both embedding space and downstream metrics.

Vinith M. Suriyakumar, Marzyeh Ghassemi, Berk Ustun

Machine learning models are often personalized with categorical attributes that are protected, sensitive, self-reported, or costly to acquire. In this work, we show models that are personalized with group attributes can reduce performance at a group level. We propose formal conditions to ensure the "fair use" of group attributes in prediction tasks by training one additional model -- i.e., collective preference guarantees to ensure that each group who provides personal data will receive a tailored gain in performance in return. We present sufficient conditions to ensure fair use in empirical risk minimization and characterize failure modes that lead to fair use violations due to standard practices in model development and deployment. We present a comprehensive empirical study of fair use in clinical prediction tasks. Our results demonstrate the prevalence of fair use violations in practice and illustrate simple interventions to mitigate their harm.

Edward H. Lee, Brendan Kelly, Emre Altinmakas et al.

While it is well known that population differences from genetics, sex, race, and environmental factors contribute to disease, AI studies in medicine have largely focused on locoregional patient cohorts with less diverse data sources. Such limitation stems from barriers to large-scale data share and ethical concerns over data privacy. Federated learning (FL) is one potential pathway for AI development that enables learning across hospitals without data share. In this study, we show the results of various FL strategies on one of the largest and most diverse COVID-19 chest CT datasets: 21 participating hospitals across five continents that comprise >10,000 patients with >1 million images. We also propose an FL strategy that leverages synthetically generated data to overcome class and size imbalances. We also describe the sources of data heterogeneity in the context of FL, and show how even among the correctly labeled populations, disparities can arise due to these biases.

Kumail Alhamoud, Yasir Ghunaim, Motasem Alfarra et al.

For medical imaging AI models to be clinically impactful, they must generalize. However, this goal is hindered by (i) diverse types of distribution shifts, such as temporal, demographic, and label shifts, and (ii) limited diversity in datasets that are siloed within single medical institutions. While these limitations have spurred interest in federated learning, current evaluation benchmarks fail to evaluate different shifts simultaneously. However, in real healthcare settings, multiple types of shifts co-exist, yet their impact on medical imaging performance remains unstudied. In response, we introduce FedMedICL, a unified framework and benchmark to holistically evaluate federated medical imaging challenges, simultaneously capturing label, demographic, and temporal distribution shifts. We comprehensively evaluate several popular methods on six diverse medical imaging datasets (totaling 550 GPU hours). Furthermore, we use FedMedICL to simulate COVID-19 propagation across hospitals and evaluate whether methods can adapt to pandemic changes in disease prevalence. We find that a simple batch balancing technique surpasses advanced methods in average performance across FedMedICL experiments. This finding questions the applicability of results from previous, narrow benchmarks in real-world medical settings.

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.

Yik Siu Chan, Narutatsu Ri, Yuxin Xiao et al.

Despite extensive safety alignment efforts, large language models (LLMs) remain vulnerable to jailbreak attacks that elicit harmful behavior. While existing studies predominantly focus on attack methods that require technical expertise, two critical questions remain underexplored: (1) Are jailbroken responses truly useful in enabling average users to carry out harmful actions? (2) Do safety vulnerabilities exist in more common, simple human-LLM interactions? In this paper, we demonstrate that LLM responses most effectively facilitate harmful actions when they are both actionable and informative--two attributes easily elicited in multi-step, multilingual interactions. Using this insight, we propose HarmScore, a jailbreak metric that measures how effectively an LLM response enables harmful actions, and Speak Easy, a simple multi-step, multilingual attack framework. Notably, by incorporating Speak Easy into direct request and jailbreak baselines, we see an average absolute increase of 0.319 in Attack Success Rate and 0.426 in HarmScore in both open-source and proprietary LLMs across four safety benchmarks. Our work reveals a critical yet often overlooked vulnerability: Malicious users can easily exploit common interaction patterns for harmful intentions.

Hasan Abed Al Kader Hammoud, Kumail Alhamoud, Abed Hammoud et al.

Recent work on enhancing the reasoning abilities of large language models (LLMs) has introduced explicit length control as a means of constraining computational cost while preserving accuracy. However, existing approaches rely on fixed-length training budgets, which do not take advantage of the natural progression from exploration to compression during learning. In this work, we propose a curriculum learning strategy for length-controlled reasoning using Group Relative Policy Optimization (GRPO). Our method starts with generous token budgets and gradually tightens them over training, encouraging models to first discover effective solution strategies and then distill them into more concise reasoning traces. We augment GRPO with a reward function that balances three signals: task correctness (via verifier feedback), length efficiency, and formatting adherence (via structural tags). Experiments on GSM8K, MATH500, SVAMP, College Math, and GSM+ demonstrate that curriculum-based training consistently outperforms fixed-budget baselines at the same final budget, achieving higher accuracy and significantly improved token efficiency. We further ablate the impact of reward weighting and decay schedule design, showing that progressive constraint serves as a powerful inductive bias for training efficient reasoning models. Our code and checkpoints are released at: https://github.com/hammoudhasan/curriculum_grpo.

Sepehr Kazemi Ranjbar, Kumail Alhamoud, Marzyeh Ghassemi

Vision-Language Models (VLMs) struggle with negation. Given a prompt like "retrieve (or generate) a street scene without pedestrians," they often fail to respect the "not." Existing methods address this limitation by fine-tuning on large negation datasets, but such retraining often compromises the model's zero-shot performance on affirmative prompts. We show that the embedding space of VLMs, such as CLIP, can be divided into semantically consistent subspaces. Based on this property, we propose a training-free framework that models negation as a subspace in the joint embedding space rather than a single point (Figure 1). To find the matching image for a caption such as "A but not N," we construct two spherical caps around the embeddings of A and N, and we score images by the central direction of the region that is close to A and far from N. Across retrieval, MCQ, and text-to-image tasks, our method improves negation understanding by about 30% on average over prior methods. It closes the gap between affirmative and negated prompts while preserving the zero-shot performance that fine-tuned models fail to maintain. Code will be released upon publication.

Sana Tonekaboni, Lena Stempfle, Adibvafa Fallahpour et al.

Foundation models trained on large-scale de-identified electronic health records (EHRs) hold promise for clinical applications. However, their capacity to memorize patient information raises important privacy concerns. In this work, we introduce a suite of black-box evaluation tests to assess privacy-related memorization risks in foundation models trained on structured EHR data. Our framework includes methods for probing memorization at both the embedding and generative levels, and aims to distinguish between model generalization and harmful memorization in clinically relevant settings. We contextualize memorization in terms of its potential to compromise patient privacy, particularly for vulnerable subgroups. We validate our approach on a publicly available EHR foundation model and release an open-source toolkit to facilitate reproducible and collaborative privacy assessments in healthcare AI.

Yuxin Xiao, Shulammite Lim, Tom Joseph Pollard et al.

Data sharing is crucial for open science and reproducible research, but the legal sharing of clinical data requires the removal of protected health information from electronic health records. This process, known as de-identification, is often achieved through the use of machine learning algorithms by many commercial and open-source systems. While these systems have shown compelling results on average, the variation in their performance across different demographic groups has not been thoroughly examined. In this work, we investigate the bias of de-identification systems on names in clinical notes via a large-scale empirical analysis. To achieve this, we create 16 name sets that vary along four demographic dimensions: gender, race, name popularity, and the decade of popularity. We insert these names into 100 manually curated clinical templates and evaluate the performance of nine public and private de-identification methods. Our findings reveal that there are statistically significant performance gaps along a majority of the demographic dimensions in most methods. We further illustrate that de-identification quality is affected by polysemy in names, gender context, and clinical note characteristics. To mitigate the identified gaps, we propose a simple and method-agnostic solution by fine-tuning de-identification methods with clinical context and diverse names. Overall, it is imperative to address the bias in existing methods immediately so that downstream stakeholders can build high-quality systems to serve all demographic parties fairly.

Timo Milbich, Karsten Roth, Samarth Sinha et al.

Deep Metric Learning (DML) aims to find representations suitable for zero-shot transfer to a priori unknown test distributions. However, common evaluation protocols only test a single, fixed data split in which train and test classes are assigned randomly. More realistic evaluations should consider a broad spectrum of distribution shifts with potentially varying degree and difficulty. In this work, we systematically construct train-test splits of increasing difficulty and present the ooDML benchmark to characterize generalization under out-of-distribution shifts in DML. ooDML is designed to probe the generalization performance on much more challenging, diverse train-to-test distribution shifts. Based on our new benchmark, we conduct a thorough empirical analysis of state-of-the-art DML methods. We find that while generalization tends to consistently degrade with difficulty, some methods are better at retaining performance as the distribution shift increases. Finally, we propose few-shot DML as an efficient way to consistently improve generalization in response to unknown test shifts presented in ooDML. Code available here: https://github.com/CompVis/Characterizing_Generalization_in_DML.

Karsten Roth, Timo Milbich, Björn Ommer et al.

Deep Metric Learning (DML) provides a crucial tool for visual similarity and zero-shot applications by learning generalizing embedding spaces, although recent work in DML has shown strong performance saturation across training objectives. However, generalization capacity is known to scale with the embedding space dimensionality. Unfortunately, high dimensional embeddings also create higher retrieval cost for downstream applications. To remedy this, we propose \emph{Simultaneous Similarity-based Self-distillation (S2SD). S2SD extends DML with knowledge distillation from auxiliary, high-dimensional embedding and feature spaces to leverage complementary context during training while retaining test-time cost and with negligible changes to the training time. Experiments and ablations across different objectives and standard benchmarks show S2SD offers notable improvements of up to 7% in Recall@1, while also setting a new state-of-the-art. Code available at https://github.com/MLforHealth/S2SD.

Joseph Paul Cohen, Paul Morrison, Lan Dao et al.

Across the world's coronavirus disease 2019 (COVID-19) hot spots, the need to streamline patient diagnosis and management has become more pressing than ever. As one of the main imaging tools, chest X-rays (CXRs) are common, fast, non-invasive, relatively cheap, and potentially bedside to monitor the progression of the disease. This paper describes the first public COVID-19 image data collection as well as a preliminary exploration of possible use cases for the data. This dataset currently contains hundreds of frontal view X-rays and is the largest public resource for COVID-19 image and prognostic data, making it a necessary resource to develop and evaluate tools to aid in the treatment of COVID-19. It was manually aggregated from publication figures as well as various web based repositories into a machine learning (ML) friendly format with accompanying dataloader code. We collected frontal and lateral view imagery and metadata such as the time since first symptoms, intensive care unit (ICU) status, survival status, intubation status, or hospital location. We present multiple possible use cases for the data such as predicting the need for the ICU, predicting patient survival, and understanding a patient's trajectory during treatment. Data can be accessed here: https://github.com/ieee8023/covid-chestxray-dataset

Joseph Paul Cohen, Lan Dao, Paul Morrison et al.

Purpose: The need to streamline patient management for COVID-19 has become more pressing than ever. Chest X-rays provide a non-invasive (potentially bedside) tool to monitor the progression of the disease. In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. Such a tool can gauge severity of COVID-19 lung infections (and pneumonia in general) that can be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the ICU. Methods: Images from a public COVID-19 database were scored retrospectively by three blinded experts in terms of the extent of lung involvement as well as the degree of opacity. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results: This study finds that training a regression model on a subset of the outputs from an this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. Conclusions: These results indicate that our model's ability to gauge severity of COVID-19 lung infections could be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the intensive care unit (ICU). A proper clinical trial is needed to evaluate efficacy. To enable this we make our code, labels, and data available online at https://github.com/mlmed/torchxrayvision/tree/master/scripts/covid-severity and https://github.com/ieee8023/covid-chestxray-dataset

Laleh Seyyed-Kalantari, Guanxiong Liu, Matthew McDermott et al.

Machine learning systems have received much attention recently for their ability to achieve expert-level performance on clinical tasks, particularly in medical imaging. Here, we examine the extent to which state-of-the-art deep learning classifiers trained to yield diagnostic labels from X-ray images are biased with respect to protected attributes. We train convolution neural networks to predict 14 diagnostic labels in 3 prominent public chest X-ray datasets: MIMIC-CXR, Chest-Xray8, CheXpert, as well as a multi-site aggregation of all those datasets. We evaluate the TPR disparity -- the difference in true positive rates (TPR) -- among different protected attributes such as patient sex, age, race, and insurance type as a proxy for socioeconomic status. We demonstrate that TPR disparities exist in the state-of-the-art classifiers in all datasets, for all clinical tasks, and all subgroups. A multi-source dataset corresponds to the smallest disparities, suggesting one way to reduce bias. We find that TPR disparities are not significantly correlated with a subgroup's proportional disease burden. As clinical models move from papers to products, we encourage clinical decision makers to carefully audit for algorithmic disparities prior to deployment. Our code can be found at, https://github.com/LalehSeyyed/CheXclusion

Shirly Wang, Matthew B. A. McDermott, Geeticka Chauhan et al.

Robust machine learning relies on access to data that can be used with standardized frameworks in important tasks and the ability to develop models whose performance can be reasonably reproduced. In machine learning for healthcare, the community faces reproducibility challenges due to a lack of publicly accessible data and a lack of standardized data processing frameworks. We present MIMIC-Extract, an open-source pipeline for transforming raw electronic health record (EHR) data for critical care patients contained in the publicly-available MIMIC-III database into dataframes that are directly usable in common machine learning pipelines. MIMIC-Extract addresses three primary challenges in making complex health records data accessible to the broader machine learning community. First, it provides standardized data processing functions, including unit conversion, outlier detection, and aggregating semantically equivalent features, thus accounting for duplication and reducing missingness. Second, it preserves the time series nature of clinical data and can be easily integrated into clinically actionable prediction tasks in machine learning for health. Finally, it is highly extensible so that other researchers with related questions can easily use the same pipeline. We demonstrate the utility of this pipeline by showcasing several benchmark tasks and baseline results.

Marzyeh Ghassemi, Mahima Pushkarna, James Wexler et al.

Making decisions about what clinical tasks to prepare for is multi-factored, and especially challenging in intensive care environments where resources must be balanced with patient needs. Electronic health records (EHRs) are a rich data source, but are task-agnostic and can be difficult to use as summarizations of patient needs for a specific task, such as "could this patient need a ventilator tomorrow?" In this paper, we introduce ClinicalVis, an open-source EHR visualization-based prototype system for task-focused design evaluation of interactions between healthcare providers (HCPs) and EHRs. We situate ClinicalVis in a task-focused proof-of-concept design study targeting these interactions with real patient data. We conduct an empirical study of 14 HCPs, and discuss our findings on usability, accuracy, preference, and confidence in treatment decisions. We also present design implications that our findings suggest for future EHR interfaces, the presentation of clinical data for task-based planning, and evaluating task-focused HCP/EHR interactions in practice.

Jiacheng Zhu, Kristjan Greenewald, Kimia Nadjahi et al.

Parameter-efficient fine-tuning optimizes large, pre-trained foundation models by updating a subset of parameters; in this class, Low-Rank Adaptation (LoRA) is particularly effective. Inspired by an effort to investigate the different roles of LoRA matrices during fine-tuning, this paper characterizes and leverages unexpected asymmetry in the importance of low-rank adapter matrices. Specifically, when updating the parameter matrices of a neural network by adding a product $BA$, we observe that the $B$ and $A$ matrices have distinct functions: $A$ extracts features from the input, while $B$ uses these features to create the desired output. Based on this observation, we demonstrate that fine-tuning $B$ is inherently more effective than fine-tuning $A$, and that a random untrained $A$ should perform nearly as well as a fine-tuned one. Using an information-theoretic lens, we also bound the generalization of low-rank adapters, showing that the parameter savings of exclusively training $B$ improves the bound. We support our conclusions with experiments on RoBERTa, BART-Large, LLaMA-2, and ViTs.

Kimia Hamidieh, Haoran Zhang, Walter Gerych et al.

Vision-language models, like CLIP (Contrastive Language Image Pretraining), are becoming increasingly popular for a wide range of multimodal retrieval tasks. However, prior work has shown that large language and deep vision models can learn historical biases contained in their training sets, leading to perpetuation of stereotypes and potential downstream harm. In this work, we conduct a systematic analysis of the social biases that are present in CLIP, with a focus on the interaction between image and text modalities. We first propose a taxonomy of social biases called So-B-IT, which contains 374 words categorized across ten types of bias. Each type can lead to societal harm if associated with a particular demographic group. Using this taxonomy, we examine images retrieved by CLIP from a facial image dataset using each word as part of a prompt. We find that CLIP frequently displays undesirable associations between harmful words and specific demographic groups, such as retrieving mostly pictures of Middle Eastern men when asked to retrieve images of a "terrorist". Finally, we conduct an analysis of the source of such biases, by showing that the same harmful stereotypes are also present in a large image-text dataset used to train CLIP models for examples of biases that we find. Our findings highlight the importance of evaluating and addressing bias in vision-language models, and suggest the need for transparency and fairness-aware curation of large pre-training datasets.

Adiba Orzikulova, Han Xiao, Zhipeng Li et al.

Despite a rich history of investigating smartphone overuse intervention techniques, AI-based just-in-time adaptive intervention (JITAI) methods for overuse reduction are lacking. We develop Time2Stop, an intelligent, adaptive, and explainable JITAI system that leverages machine learning to identify optimal intervention timings, introduces interventions with transparent AI explanations, and collects user feedback to establish a human-AI loop and adapt the intervention model over time. We conducted an 8-week field experiment (N=71) to evaluate the effectiveness of both the adaptation and explanation aspects of Time2Stop. Our results indicate that our adaptive models significantly outperform the baseline methods on intervention accuracy (>32.8\% relatively) and receptivity (>8.0\%). In addition, incorporating explanations further enhances the effectiveness by 53.8\% and 11.4\% on accuracy and receptivity, respectively. Moreover, Time2Stop significantly reduces overuse, decreasing app visit frequency by 7.0$\sim$8.9\%. Our subjective data also echoed these quantitative measures. Participants preferred the adaptive interventions and rated the system highly on intervention time accuracy, effectiveness, and level of trust. We envision our work can inspire future research on JITAI systems with a human-AI loop to evolve with users.

Kumail Alhamoud, Shaden Alshammari, Yonglong Tian et al.

Many practical vision-language applications require models that understand negation, e.g., when using natural language to retrieve images which contain certain objects but not others. Despite advancements in vision-language models (VLMs) through large-scale training, their ability to comprehend negation remains underexplored. This study addresses the question: how well do current VLMs understand negation? We introduce NegBench, a new benchmark designed to evaluate negation understanding across 18 task variations and $79$k examples spanning image, video, and medical datasets. The benchmark consists of two core tasks designed to evaluate negation understanding in diverse multimodal settings: Retrieval with Negation and Multiple Choice Questions with Negated Captions. Our evaluation reveals that modern VLMs struggle significantly with negation, often performing at chance level. To address these shortcomings, we explore a data-centric approach wherein we finetune CLIP models on large-scale synthetic datasets containing millions of negated captions. We show that this approach can result in a 10% increase in recall on negated queries and a 28% boost in accuracy on multiple-choice questions with negated captions.

Saadia Gabriel, Isha Puri, Xuhai Xu et al.

Large language models (LLMs) are already being piloted for clinical use in hospital systems like NYU Langone, Dana-Farber and the NHS. A proposed deployment use case is psychotherapy, where a LLM-powered chatbot can treat a patient undergoing a mental health crisis. Deployment of LLMs for mental health response could hypothetically broaden access to psychotherapy and provide new possibilities for personalizing care. However, recent high-profile failures, like damaging dieting advice offered by the Tessa chatbot to patients with eating disorders, have led to doubt about their reliability in high-stakes and safety-critical settings. In this work, we develop an evaluation framework for determining whether LLM response is a viable and ethical path forward for the automation of mental health treatment. Our framework measures equity in empathy and adherence of LLM responses to motivational interviewing theory. Using human evaluation with trained clinicians and automatic quality-of-care metrics grounded in psychology research, we compare the responses provided by peer-to-peer responders to those provided by a state-of-the-art LLM. We show that LLMs like GPT-4 use implicit and explicit cues to infer patient demographics like race. We then show that there are statistically significant discrepancies between patient subgroups: Responses to Black posters consistently have lower empathy than for any other demographic group (2%-13% lower than the control group). Promisingly, we do find that the manner in which responses are generated significantly impacts the quality of the response. We conclude by proposing safety guidelines for the potential deployment of LLMs for mental health response.

David Rolnick, Alan Aspuru-Guzik, Sara Beery et al. · mit

As applications of machine learning proliferate, innovative algorithms inspired by specific real-world challenges have become increasingly important. Such work offers the potential for significant impact not merely in domains of application but also in machine learning itself. In this paper, we describe the paradigm of application-driven research in machine learning, contrasting it with the more standard paradigm of methods-driven research. We illustrate the benefits of application-driven machine learning and how this approach can productively synergize with methods-driven work. Despite these benefits, we find that reviewing, hiring, and teaching practices in machine learning often hold back application-driven innovation. We outline how these processes may be improved.

Walter Gerych, Haoran Zhang, Kimia Hamidieh et al.

Vision-language model (VLM) embeddings have been shown to encode biases present in their training data, such as societal biases that prescribe negative characteristics to members of various racial and gender identities. VLMs are being quickly adopted for a variety of tasks ranging from few-shot classification to text-guided image generation, making debiasing VLM embeddings crucial. Debiasing approaches that fine-tune the VLM often suffer from catastrophic forgetting. On the other hand, fine-tuning-free methods typically utilize a "one-size-fits-all" approach that assumes that correlation with the spurious attribute can be explained using a single linear direction across all possible inputs. In this work, we propose Bend-VLM, a nonlinear, fine-tuning-free approach for VLM embedding debiasing that tailors the debiasing operation to each unique input. This allows for a more flexible debiasing approach. Additionally, we do not require knowledge of the set of inputs a priori to inference time, making our method more appropriate for online, open-set tasks such as retrieval and text guided image generation.

Niklas Mannhardt, Elizabeth Bondi-Kelly, Barbara Lam et al. · microsoft-research

Large language models (LLMs) have immense potential to make information more accessible, particularly in medicine, where complex medical jargon can hinder patient comprehension of clinical notes. We developed a patient-facing tool using LLMs to make clinical notes more readable by simplifying, extracting information from, and adding context to the notes. We piloted the tool with clinical notes donated by patients with a history of breast cancer and synthetic notes from a clinician. Participants (N=200, healthy, female-identifying patients) were randomly assigned three clinical notes in our tool with varying levels of augmentations and answered quantitative and qualitative questions evaluating their understanding of follow-up actions. Augmentations significantly increased their quantitative understanding scores. In-depth interviews were conducted with participants (N=7, patients with a history of breast cancer), revealing both positive sentiments about the augmentations and concerns about AI. We also performed a qualitative clinician-driven analysis of the model's error modes.

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.

Saadia Gabriel, Liang Lyu, James Siderius et al.

The spread of misinformation on social media platforms threatens democratic processes, contributes to massive economic losses, and endangers public health. Many efforts to address misinformation focus on a knowledge deficit model and propose interventions for improving users' critical thinking through access to facts. Such efforts are often hampered by challenges with scalability, and by platform users' personal biases. The emergence of generative AI presents promising opportunities for countering misinformation at scale across ideological barriers. In this paper, we introduce a framework (MisinfoEval) for generating and comprehensively evaluating large language model (LLM) based misinformation interventions. We present (1) an experiment with a simulated social media environment to measure effectiveness of misinformation interventions, and (2) a second experiment with personalized explanations tailored to the demographics and beliefs of users with the goal of countering misinformation by appealing to their pre-existing values. Our findings confirm that LLM-based interventions are highly effective at correcting user behavior (improving overall user accuracy at reliability labeling by up to 41.72%). Furthermore, we find that users favor more personalized interventions when making decisions about news reliability and users shown personalized interventions have significantly higher accuracy at identifying misinformation.

Kyle O'Brien, Nathan Ng, Isha Puri et al. · harvard

Machine learning models for text classification often excel on in-distribution (ID) data but struggle with unseen out-of-distribution (OOD) inputs. Most techniques for improving OOD robustness are not applicable to settings where the model is effectively a black box, such as when the weights are frozen, retraining is costly, or the model is leveraged via an API. Test-time augmentation (TTA) is a simple post-hoc technique for improving robustness that sidesteps black-box constraints by aggregating predictions across multiple augmentations of the test input. TTA has seen limited use in NLP due to the challenge of generating effective natural language augmentations. In this work, we propose LLM-TTA, which uses LLM-generated augmentations as TTA's augmentation function. LLM-TTA outperforms conventional augmentation functions across sentiment, toxicity, and news classification tasks for BERT and T5 models, with BERT's OOD robustness improving by an average of 4.48 percentage points without regressing average ID performance. We explore selectively augmenting inputs based on prediction entropy to reduce the rate of expensive LLM augmentations, allowing us to maintain performance gains while reducing the average number of generated augmentations by 57.74\%. LLM-TTA is agnostic to the task model architecture, does not require OOD labels, and is effective across low and high-resource settings. We share our data, models, and code for reproducibility.

Yuzhe Yang, Haoran Zhang, Judy W Gichoya et al.

As artificial intelligence (AI) rapidly approaches human-level performance in medical imaging, it is crucial that it does not exacerbate or propagate healthcare disparities. Prior research has established AI's capacity to infer demographic data from chest X-rays, leading to a key concern: do models using demographic shortcuts have unfair predictions across subpopulations? In this study, we conduct a thorough investigation into the extent to which medical AI utilizes demographic encodings, focusing on potential fairness discrepancies within both in-distribution training sets and external test sets. Our analysis covers three key medical imaging disciplines: radiology, dermatology, and ophthalmology, and incorporates data from six global chest X-ray datasets. We confirm that medical imaging AI leverages demographic shortcuts in disease classification. While correcting shortcuts algorithmically effectively addresses fairness gaps to create "locally optimal" models within the original data distribution, this optimality is not true in new test settings. Surprisingly, we find that models with less encoding of demographic attributes are often most "globally optimal", exhibiting better fairness during model evaluation in new test environments. Our work establishes best practices for medical imaging models which maintain their performance and fairness in deployments beyond their initial training contexts, underscoring critical considerations for AI clinical deployments across populations and sites.

Divya Shanmugam, Monica Agrawal, Rajiv Movva et al.

The increased capabilities of generative AI have dramatically expanded its possible use cases in medicine. We provide a comprehensive overview of generative AI use cases for clinicians, patients, clinical trial organizers, researchers, and trainees. We then discuss the many challenges -- including maintaining privacy and security, improving transparency and interpretability, upholding equity, and rigorously evaluating models -- which must be overcome to realize this potential, and the open research directions they give rise to.

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.

Qixuan Jin, Walter Gerych, Marzyeh Ghassemi

Spurious features associated with class labels can lead image classifiers to rely on shortcuts that don't generalize well to new domains. This is especially problematic in medical settings, where biased models fail when applied to different hospitals or systems. In such cases, data-driven methods to reduce spurious correlations are preferred, as clinicians can directly validate the modified images. While Denoising Diffusion Probabilistic Models (Diffusion Models) show promise for natural images, they are impractical for medical use due to the difficulty of describing spurious medical features. To address this, we propose Masked Medical Image Inpainting (MaskMedPaint), which uses text-to-image diffusion models to augment training images by inpainting areas outside key classification regions to match the target domain. We demonstrate that MaskMedPaint enhances generalization to target domains across both natural (Waterbirds, iWildCam) and medical (ISIC 2018, Chest X-ray) datasets, given limited unlabeled target images.

Aparna Balagopalan, Kai Wang, Olawale Salaudeen et al.

Machine learning-driven rankings, where individuals (or items) are ranked in response to a query, mediate search exposure or attention in a variety of safety-critical settings. Thus, it is important to ensure that such rankings are fair. Under the goal of equal opportunity, attention allocated to an individual on a ranking interface should be proportional to their relevance across search queries. In this work, we examine amortized fair ranking -- where relevance and attention are cumulated over a sequence of user queries to make fair ranking more feasible in practice. Unlike prior methods that operate on expected amortized attention for each individual, we define new divergence-based measures for attention distribution-based fairness in ranking (DistFaiR), characterizing unfairness as the divergence between the distribution of attention and relevance corresponding to an individual over time. This allows us to propose new definitions of unfairness, which are more reliable at test time. Second, we prove that group fairness is upper-bounded by individual fairness under this definition for a useful class of divergence measures, and experimentally show that maximizing individual fairness through an integer linear programming-based optimization is often beneficial to group fairness. Lastly, we find that prior research in amortized fair ranking ignores critical information about queries, potentially leading to a fairwashing risk in practice by making rankings appear more fair than they actually are.

Xuhai Xu, Haoyu Hu, Haoran Zhang et al.

Artificial intelligence (AI) is increasingly permeating healthcare, from physician assistants to consumer applications. Since AI algorithm's opacity challenges human interaction, explainable AI (XAI) addresses this by providing AI decision-making insight, but evidence suggests XAI can paradoxically induce over-reliance or bias. We present results from two large-scale experiments (623 lay people; 153 primary care physicians, PCPs) combining a fairness-based diagnosis AI model and different XAI explanations to examine how XAI assistance, particularly multimodal large language models (LLMs), influences diagnostic performance. AI assistance balanced across skin tones improved accuracy and reduced diagnostic disparities. However, LLM explanations yielded divergent effects: lay users showed higher automation bias - accuracy boosted when AI was correct, reduced when AI erred - while experienced PCPs remained resilient, benefiting irrespective of AI accuracy. Presenting AI suggestions first also led to worse outcomes when the AI was incorrect for both groups. These findings highlight XAI's varying impact based on expertise and timing, underscoring LLMs as a "double-edged sword" in medical AI and informing future human-AI collaborative system design.