Major depressive disorder (MDD) presents challenges in diagnosis and treatment due to its complex and heterogeneous nature. Emerging evidence indicates that reward processing abnormalities may serve as a behavioral marker for MDD. To measure reward processing, patients perform computer-based behavioral tasks that involve making choices or responding to stimulants that are associated with different outcomes. Reinforcement learning (RL) models are fitted to extract parameters that measure various aspects of reward processing to characterize how patients make decisions in behavioral tasks. Recent findings suggest the inadequacy of characterizing reward learning solely based on a single RL model; instead, there may be a switching of decision-making processes between multiple strategies. An important scientific question is how the dynamics of learning strategies in decision-making affect the reward learning ability of individuals with MDD. Motivated by the probabilistic reward task (PRT) within the EMBARC study, we propose a novel RL-HMM framework for analyzing reward-based decision-making. Our model accommodates learning strategy switching between two distinct approaches under a hidden Markov model (HMM): subjects making decisions based on the RL model or opting for random choices. We account for continuous RL state space and allow time-varying transition probabilities in the HMM. We introduce a computationally efficient EM algorithm for parameter estimation and employ a nonparametric bootstrap for inference. We apply our approach to the EMBARC study to show that MDD patients are less engaged in RL compared to the healthy controls, and engagement is associated with brain activities in the negative affect circuitry during an emotional conflict task.
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Individualized treatment rules (ITRs) have been widely applied in many fields such as precision medicine and personalized marketing. Beyond the extensive studies on ITR for binary or multiple treatments, there is considerable interest in applying combination treatments. This paper introduces a novel ITR estimation method for combination treatments incorporating interaction effects among treatments. Specifically, we propose the generalized $\psi$-loss as a non-convex surrogate in the residual weighted learning framework, offering desirable statistical and computational properties. Statistically, the minimizer of the proposed surrogate loss is Fisher-consistent with the optimal decision rules, incorporating interaction effects at any intensity level - a significant improvement over existing methods. Computationally, the proposed method applies the difference-of-convex algorithm for efficient computation. Through simulation studies and real-world data applications, we demonstrate the superior performance of the proposed method in recommending combination treatments.
Recently, diffusion-based methods for monocular 3D human pose estimation have achieved state-of-the-art (SOTA) performance by directly regressing the 3D joint coordinates from the 2D pose sequence. Although some methods decompose the task into bone length and bone direction prediction based on the human anatomical skeleton to explicitly incorporate more human body prior constraints, the performance of these methods is significantly lower than that of the SOTA diffusion-based methods. This can be attributed to the tree structure of the human skeleton. Direct application of the disentangled method could amplify the accumulation of hierarchical errors, propagating through each hierarchy. Meanwhile, the hierarchical information has not been fully explored by the previous methods. To address these problems, a Disentangled Diffusion-based 3D Human Pose Estimation method with Hierarchical Spatial and Temporal Denoiser is proposed, termed DDHPose. In our approach: (1) We disentangle the 3D pose and diffuse the bone length and bone direction during the forward process of the diffusion model to effectively model the human pose prior. A disentanglement loss is proposed to supervise diffusion model learning. (2) For the reverse process, we propose Hierarchical Spatial and Temporal Denoiser (HSTDenoiser) to improve the hierarchical modeling of each joint. Our HSTDenoiser comprises two components: the Hierarchical-Related Spatial Transformer (HRST) and the Hierarchical-Related Temporal Transformer (HRTT). HRST exploits joint spatial information and the influence of the parent joint on each joint for spatial modeling, while HRTT utilizes information from both the joint and its hierarchical adjacent joints to explore the hierarchical temporal correlations among joints.
Recently, with increasing interest in pet healthcare, the demand for computer-aided diagnosis (CAD) systems in veterinary medicine has increased. The development of veterinary CAD has stagnated due to a lack of sufficient radiology data. To overcome the challenge, we propose a generative active learning framework based on a variational autoencoder. This approach aims to alleviate the scarcity of reliable data for CAD systems in veterinary medicine. This study utilizes datasets comprising cardiomegaly radiograph data. After removing annotations and standardizing images, we employed a framework for data augmentation, which consists of a data generation phase and a query phase for filtering the generated data. The experimental results revealed that as the data generated through this framework was added to the training data of the generative model, the frechet inception distance consistently decreased from 84.14 to 50.75 on the radiograph. Subsequently, when the generated data were incorporated into the training of the classification model, the false positive of the confusion matrix also improved from 0.16 to 0.66 on the radiograph. The proposed framework has the potential to address the challenges of data scarcity in medical CAD, contributing to its advancement.
This study designs an adaptive experiment for efficiently estimating average treatment effect (ATEs). We consider an adaptive experiment where an experimenter sequentially samples an experimental unit from a covariate density decided by the experimenter and assigns a treatment. After assigning a treatment, the experimenter observes the corresponding outcome immediately. At the end of the experiment, the experimenter estimates an ATE using gathered samples. The objective of the experimenter is to estimate the ATE with a smaller asymptotic variance. Existing studies have designed experiments that adaptively optimize the propensity score (treatment-assignment probability). As a generalization of such an approach, we propose a framework under which an experimenter optimizes the covariate density, as well as the propensity score, and find that optimizing both covariate density and propensity score reduces the asymptotic variance more than optimizing only the propensity score. Based on this idea, in each round of our experiment, the experimenter optimizes the covariate density and propensity score based on past observations. To design an adaptive experiment, we first derive the efficient covariate density and propensity score that minimizes the semiparametric efficiency bound, a lower bound for the asymptotic variance given a fixed covariate density and a fixed propensity score. Next, we design an adaptive experiment using the efficient covariate density and propensity score sequentially estimated during the experiment. Lastly, we propose an ATE estimator whose asymptotic variance aligns with the minimized semiparametric efficiency bound.
Purpose: The treatment of cardiovascular diseases requires complex and challenging navigation of a guidewire and catheter. This often leads to lengthy interventions during which the patient and clinician are exposed to X-ray radiation. Deep Reinforcement Learning approaches have shown promise in learning this task and may be the key to automating catheter navigation during robotized interventions. Yet, existing training methods show limited capabilities at generalizing to unseen vascular anatomies, requiring to be retrained each time the geometry changes. Methods: In this paper, we propose a zero-shot learning strategy for three-dimensional autonomous endovascular navigation. Using a very small training set of branching patterns, our reinforcement learning algorithm is able to learn a control that can then be applied to unseen vascular anatomies without retraining. Results: We demonstrate our method on 4 different vascular systems, with an average success rate of 95% at reaching random targets on these anatomies. Our strategy is also computationally efficient, allowing the training of our controller to be performed in only 2 hours. Conclusion: Our training method proved its ability to navigate unseen geometries with different characteristics, thanks to a nearly shape-invariant observation space.
Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.
Medical image segmentation is a fundamental and critical step in many image-guided clinical approaches. Recent success of deep learning-based segmentation methods usually relies on a large amount of labeled data, which is particularly difficult and costly to obtain especially in the medical imaging domain where only experts can provide reliable and accurate annotations. Semi-supervised learning has emerged as an appealing strategy and been widely applied to medical image segmentation tasks to train deep models with limited annotations. In this paper, we present a comprehensive review of recently proposed semi-supervised learning methods for medical image segmentation and summarized both the technical novelties and empirical results. Furthermore, we analyze and discuss the limitations and several unsolved problems of existing approaches. We hope this review could inspire the research community to explore solutions for this challenge and further promote the developments in medical image segmentation field.
Clinical Named Entity Recognition (CNER) aims to identify and classify clinical terms such as diseases, symptoms, treatments, exams, and body parts in electronic health records, which is a fundamental and crucial task for clinical and translational research. In recent years, deep neural networks have achieved significant success in named entity recognition and many other Natural Language Processing (NLP) tasks. Most of these algorithms are trained end to end, and can automatically learn features from large scale labeled datasets. However, these data-driven methods typically lack the capability of processing rare or unseen entities. Previous statistical methods and feature engineering practice have demonstrated that human knowledge can provide valuable information for handling rare and unseen cases. In this paper, we address the problem by incorporating dictionaries into deep neural networks for the Chinese CNER task. Two different architectures that extend the Bi-directional Long Short-Term Memory (Bi-LSTM) neural network and five different feature representation schemes are proposed to handle the task. Computational results on the CCKS-2017 Task 2 benchmark dataset show that the proposed method achieves the highly competitive performance compared with the state-of-the-art deep learning methods.
Object tracking is challenging as target objects often undergo drastic appearance changes over time. Recently, adaptive correlation filters have been successfully applied to object tracking. However, tracking algorithms relying on highly adaptive correlation filters are prone to drift due to noisy updates. Moreover, as these algorithms do not maintain long-term memory of target appearance, they cannot recover from tracking failures caused by heavy occlusion or target disappearance in the camera view. In this paper, we propose to learn multiple adaptive correlation filters with both long-term and short-term memory of target appearance for robust object tracking. First, we learn a kernelized correlation filter with an aggressive learning rate for locating target objects precisely. We take into account the appropriate size of surrounding context and the feature representations. Second, we learn a correlation filter over a feature pyramid centered at the estimated target position for predicting scale changes. Third, we learn a complementary correlation filter with a conservative learning rate to maintain long-term memory of target appearance. We use the output responses of this long-term filter to determine if tracking failure occurs. In the case of tracking failures, we apply an incrementally learned detector to recover the target position in a sliding window fashion. Extensive experimental results on large-scale benchmark datasets demonstrate that the proposed algorithm performs favorably against the state-of-the-art methods in terms of efficiency, accuracy, and robustness.
Image segmentation is considered to be one of the critical tasks in hyperspectral remote sensing image processing. Recently, convolutional neural network (CNN) has established itself as a powerful model in segmentation and classification by demonstrating excellent performances. The use of a graphical model such as a conditional random field (CRF) contributes further in capturing contextual information and thus improving the segmentation performance. In this paper, we propose a method to segment hyperspectral images by considering both spectral and spatial information via a combined framework consisting of CNN and CRF. We use multiple spectral cubes to learn deep features using CNN, and then formulate deep CRF with CNN-based unary and pairwise potential functions to effectively extract the semantic correlations between patches consisting of three-dimensional data cubes. Effective piecewise training is applied in order to avoid the computationally expensive iterative CRF inference. Furthermore, we introduce a deep deconvolution network that improves the segmentation masks. We also introduce a new dataset and experimented our proposed method on it along with several widely adopted benchmark datasets to evaluate the effectiveness of our method. By comparing our results with those from several state-of-the-art models, we show the promising potential of our method.
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