Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. This study explores the role of large language models (LLMs) in mitigating these biases through the utilization of a multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent system, we leveraged GPT-4 Turbo to facilitate interactions among four simulated agents to replicate clinical team dynamics. Each agent has a distinct role: 1) To make the initial and final diagnosis after considering the discussions, 2) The devil's advocate and correct confirmation and anchoring bias, 3) The tutor and facilitator of the discussion to reduce premature closure bias, and 4) To record and summarize the findings. A total of 80 simulations were evaluated for the accuracy of initial diagnosis, top differential diagnosis and final two differential diagnoses. Findings: In a total of 80 responses evaluating both initial and final diagnoses, the initial diagnosis had an accuracy of 0% (0/80), but following multi-agent discussions, the accuracy for the top differential diagnosis increased to 71.3% (57/80), and for the final two differential diagnoses, to 80.0% (64/80). The system demonstrated an ability to reevaluate and correct misconceptions, even in scenarios with misleading initial investigations. Interpretation: The LLM-driven multi-agent conversation system shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios.
The effective management of brain tumors relies on precise typing, subtyping, and grading. This study advances patient care with findings from rigorous multiple instance learning experimentations across various feature extractors and aggregators in brain tumor histopathology. It establishes new performance benchmarks in glioma subtype classification across multiple datasets, including a novel dataset focused on the Indian demographic (IPD- Brain), providing a valuable resource for existing research. Using a ResNet-50, pretrained on histopathology datasets for feature extraction, combined with the Double-Tier Feature Distillation (DTFD) feature aggregator, our approach achieves state-of-the-art AUCs of 88.08 on IPD-Brain and 95.81 on the TCGA-Brain dataset, respectively, for three-way glioma subtype classification. Moreover, it establishes new benchmarks in grading and detecting IHC molecular biomarkers (IDH1R132H, TP53, ATRX, Ki-67) through H&E stained whole slide images for the IPD-Brain dataset. The work also highlights a significant correlation between the model decision-making processes and the diagnostic reasoning of pathologists, underscoring its capability to mimic professional diagnostic procedures.
The hybridisation of robot-assisted gait training and functional electrical stimulation (FES) can provide numerous physiological benefits to neurological patients. However, the design of an effective hybrid controller poses significant challenges. In this over-actuated system, it is extremely difficult to find the right balance between robotic assistance and FES that will provide personalised assistance, prevent muscle fatigue and encourage the patient's active participation in order to accelerate recovery. In this paper, we present an adaptive hybrid robot-FES controller to do this and enable the triadic collaboration between the patient, the robot and FES. A patient-driven controller is designed where the voluntary movement of the patient is prioritised and assistance is provided using FES and the robot in a hierarchical order depending on the patient's performance and their muscles' fitness. The performance of this hybrid adaptive controller is tested in simulation and on one healthy subject. Our results indicate an increase in tracking performance with lower overall assistance, and less muscle fatigue when the hybrid adaptive controller is used, compared to its non adaptive equivalent. This suggests that our hybrid adaptive controller may be able to adapt to the behaviour of the user to provide assistance as needed and prevent the early termination of physical therapy due to muscle fatigue.
Electronic health records (EHR) is an inherently multimodal register of the patient's health status characterized by static data and multivariate time series (MTS). While MTS are a valuable tool for clinical prediction, their fusion with other data modalities can possibly result in more thorough insights and more accurate results. Deep neural networks (DNNs) have emerged as fundamental tools for identifying and defining underlying patterns in the healthcare domain. However, fundamental improvements in interpretability are needed for DNN models to be widely used in the clinical setting. In this study, we present an approach built on a collection of interpretable multimodal data-driven models that may anticipate and understand the emergence of antimicrobial multidrug resistance (AMR) germs in the intensive care unit (ICU) of the University Hospital of Fuenlabrada (Madrid, Spain). The profile and initial health status of the patient are modeled using static variables, while the evolution of the patient's health status during the ICU stay is modeled using several MTS, including mechanical ventilation and antibiotics intake. The multimodal DNNs models proposed in this paper include interpretable principles in addition to being effective at predicting AMR and providing an explainable prediction support system for AMR in the ICU. Furthermore, our proposed methodology based on multimodal models and interpretability schemes can be leveraged in additional clinical problems dealing with EHR data, broadening the impact and applicability of our results.
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.
Imitation learning methods need significant human supervision to learn policies robust to changes in object poses, physical disturbances, and visual distractors. Reinforcement learning, on the other hand, can explore the environment autonomously to learn robust behaviors but may require impractical amounts of unsafe real-world data collection. To learn performant, robust policies without the burden of unsafe real-world data collection or extensive human supervision, we propose RialTo, a system for robustifying real-world imitation learning policies via reinforcement learning in "digital twin" simulation environments constructed on the fly from small amounts of real-world data. To enable this real-to-sim-to-real pipeline, RialTo proposes an easy-to-use interface for quickly scanning and constructing digital twins of real-world environments. We also introduce a novel "inverse distillation" procedure for bringing real-world demonstrations into simulated environments for efficient fine-tuning, with minimal human intervention and engineering required. We evaluate RialTo across a variety of robotic manipulation problems in the real world, such as robustly stacking dishes on a rack, placing books on a shelf, and six other tasks. RialTo increases (over 67%) in policy robustness without requiring extensive human data collection. Project website and videos at //real-to-sim-to-real.github.io/RialTo/
In Bayesian persuasion, an informed sender strategically discloses information to a receiver so as to persuade them to undertake desirable actions. Recently, a growing attention has been devoted to settings in which sender and receivers interact sequentially. Recently, Markov persuasion processes (MPPs) have been introduced to capture sequential scenarios where a sender faces a stream of myopic receivers in a Markovian environment. The MPPs studied so far in the literature suffer from issues that prevent them from being fully operational in practice, e.g., they assume that the sender knows receivers' rewards. We fix such issues by addressing MPPs where the sender has no knowledge about the environment. We design a learning algorithm for the sender, working with partial feedback. We prove that its regret with respect to an optimal information-disclosure policy grows sublinearly in the number of episodes, as it is the case for the loss in persuasiveness cumulated while learning. Moreover, we provide a lower bound for our setting matching the guarantees of our algorithm.
Sourced from various sensors and organized chronologically, Multivariate Time-Series (MTS) data involves crucial spatial-temporal dependencies, e.g., correlations among sensors. To capture these dependencies, Graph Neural Networks (GNNs) have emerged as powerful tools, yet their effectiveness is restricted by the quality of graph construction from MTS data. Typically, existing approaches construct graphs solely from MTS signals, which may introduce bias due to a small training dataset and may not accurately represent underlying dependencies. To address this challenge, we propose a novel framework named K-Link, leveraging Large Language Models (LLMs) to encode extensive general knowledge and thereby providing effective solutions to reduce the bias. Leveraging the knowledge embedded in LLMs, such as physical principles, we extract a \textit{Knowledge-Link graph}, capturing vast semantic knowledge of sensors and the linkage of the sensor-level knowledge. To harness the potential of the knowledge-link graph in enhancing the graph derived from MTS data, we propose a graph alignment module, facilitating the transfer of semantic knowledge within the knowledge-link graph into the MTS-derived graph. By doing so, we can improve the graph quality, ensuring effective representation learning with GNNs for MTS data. Extensive experiments demonstrate the efficacy of our approach for superior performance across various MTS-related downstream tasks.
Despite the vast repository of global medical knowledge predominantly being in English, local languages are crucial for delivering tailored healthcare services, particularly in areas with limited medical resources. To extend the reach of medical AI advancements to a broader population, we aim to develop medical LLMs across the six most widely spoken languages, encompassing a global population of 6.1 billion. This effort culminates in the creation of the ApolloCorpora multilingual medical dataset and the XMedBench benchmark. In the multilingual medical benchmark, the released Apollo models, at various relatively-small sizes (i.e., 0.5B, 1.8B, 2B, 6B, and 7B), achieve the best performance among models of equivalent size. Especially, Apollo-7B is the state-of-the-art multilingual medical LLMs up to 70B. Additionally, these lite models could be used to improve the multi-lingual medical capabilities of larger models without fine-tuning in a proxy-tuning fashion. We will open-source training corpora, code, model weights and evaluation benchmark.
Human intelligence thrives on the concept of cognitive synergy, where collaboration and information integration among different cognitive processes yield superior outcomes compared to individual cognitive processes in isolation. Although Large Language Models (LLMs) have demonstrated promising performance as general task-solving agents, they still struggle with tasks that require intensive domain knowledge and complex reasoning. In this work, we propose Solo Performance Prompting (SPP), which transforms a single LLM into a cognitive synergist by engaging in multi-turn self-collaboration with multiple personas. A cognitive synergist refers to an intelligent agent that collaborates with multiple minds, combining their individual strengths and knowledge, to enhance problem-solving and overall performance in complex tasks. By dynamically identifying and simulating different personas based on task inputs, SPP unleashes the potential of cognitive synergy in LLMs. We have discovered that assigning multiple, fine-grained personas in LLMs elicits better problem-solving abilities compared to using a single or fixed number of personas. We evaluate SPP on three challenging tasks: Trivia Creative Writing, Codenames Collaborative, and Logic Grid Puzzle, encompassing both knowledge-intensive and reasoning-intensive types. Unlike previous works, such as Chain-of-Thought, that solely enhance the reasoning abilities in LLMs, SPP effectively elicits internal knowledge acquisition abilities, reduces hallucination, and maintains strong reasoning capabilities. Code, data, and prompts can be found at: //github.com/MikeWangWZHL/Solo-Performance-Prompting.git.
With the advent of deep neural networks, learning-based approaches for 3D reconstruction have gained popularity. However, unlike for images, in 3D there is no canonical representation which is both computationally and memory efficient yet allows for representing high-resolution geometry of arbitrary topology. Many of the state-of-the-art learning-based 3D reconstruction approaches can hence only represent very coarse 3D geometry or are limited to a restricted domain. In this paper, we propose occupancy networks, a new representation for learning-based 3D reconstruction methods. Occupancy networks implicitly represent the 3D surface as the continuous decision boundary of a deep neural network classifier. In contrast to existing approaches, our representation encodes a description of the 3D output at infinite resolution without excessive memory footprint. We validate that our representation can efficiently encode 3D structure and can be inferred from various kinds of input. Our experiments demonstrate competitive results, both qualitatively and quantitatively, for the challenging tasks of 3D reconstruction from single images, noisy point clouds and coarse discrete voxel grids. We believe that occupancy networks will become a useful tool in a wide variety of learning-based 3D tasks.