Difference-in-differences (DiD) is the most popular observational causal inference method in health policy, employed to evaluate the real-world impact of policies and programs. To estimate treatment effects, DiD relies on the "parallel trends assumption", that on average treatment and comparison groups would have had parallel trajectories in the absence of an intervention. Historically, DiD has been considered broadly applicable and straightforward to implement, but recent years have seen rapid advancements in DiD methods. This paper reviews and synthesizes these innovations for medical and health policy researchers. We focus on four topics: (1) assessing the parallel trends assumption in health policy contexts; (2) relaxing the parallel trends assumption when appropriate; (3) employing estimators to account for staggered treatment timing; and (4) conducting robust inference for analyses in which normal-based clustered standard errors are inappropriate. For each, we explain challenges and common pitfalls in traditional DiD and modern methods available to address these issues.
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Patient trajectories from electronic health records are widely used to predict potential outcomes of treatments over time, which then allows to personalize care. Yet, existing neural methods for this purpose have a key limitation: while some adjust for time-varying confounding, these methods assume that the time series are recorded in discrete time. In other words, they are constrained to settings where measurements and treatments are conducted at fixed time steps, even though this is unrealistic in medical practice. In this work, we aim to predict potential outcomes in continuous time. The latter is of direct practical relevance because it allows for modeling patient trajectories where measurements and treatments take place at arbitrary, irregular timestamps. We thus propose a new method called stabilized continuous time inverse propensity network (SCIP-Net). For this, we further derive stabilized inverse propensity weights for robust prediction of the potential outcomes. To the best of our knowledge, our SCIP-Net is the first neural method that performs proper adjustments for time-varying confounding in continuous time.
Smart medical devices are an integral component of the healthcare Internet of Things (IoT), providing patients with various healthcare services through an IoT-based application. Ensuring the dependability of such applications through system and integration-level testing mandates the physical integration of numerous medical devices, which is costly and impractical. In this context, digital twins of medical devices play an essential role in facilitating testing automation. Testing with digital twins without accounting for uncertain environmental factors of medical devices leaves many functionalities of IoT-based healthcare applications untested. In addition, digital twins operating without environmental factors remain out of sync and uncalibrated with their corresponding devices functioning in the real environment. To deal with these challenges, in this paper, we propose a model-based approach (EnvDT) for modeling and simulating the environment of medical devices' digital twins under uncertainties. We empirically evaluate the EnvDT using three medicine dispensers, Karie, Medido, and Pilly connected to a real-world IoT-based healthcare application. Our evaluation targets analyzing the coverage of environment models and the diversity of uncertain scenarios generated for digital twins. Results show that EnvDT achieves approximately 61% coverage of environment models and generates diverse uncertain scenarios (with a near-maximum diversity value of 0.62) during multiple environmental simulations.
Semi-supervised medical image segmentation (SSMIS) has been demonstrated the potential to mitigate the issue of limited medical labeled data. However, confirmation and cognitive biases may affect the prevalent teacher-student based SSMIS methods due to erroneous pseudo-labels. To tackle this challenge, we improve the mean teacher approach and propose the Students Discrepancy-Informed Correction Learning (SDCL) framework that includes two students and one non-trainable teacher, which utilizes the segmentation difference between the two students to guide the self-correcting learning. The essence of SDCL is to identify the areas of segmentation discrepancy as the potential bias areas, and then encourage the model to review the correct cognition and rectify their own biases in these areas. To facilitate the bias correction learning with continuous review and rectification, two correction loss functions are employed to minimize the correct segmentation voxel distance and maximize the erroneous segmentation voxel entropy. We conducted experiments on three public medical image datasets: two 3D datasets (CT and MRI) and one 2D dataset (MRI). The results show that our SDCL surpasses the current State-of-the-Art (SOTA) methods by 2.57\%, 3.04\%, and 2.34\% in the Dice score on the Pancreas, LA, and ACDC datasets, respectively. In addition, the accuracy of our method is very close to the fully supervised method on the ACDC dataset, and even exceeds the fully supervised method on the Pancreas and LA dataset. (Code available at \url{//github.com/pascalcpp/SDCL}).
Recent work has suggested that certain neural network architectures-particularly recurrent neural networks (RNNs) and implicit neural networks (INNs) are capable of logical extrapolation. That is, one may train such a network on easy instances of a specific task and then apply it successfully to more difficult instances of the same task. In this paper, we revisit this idea and show that (i) The capacity for extrapolation is less robust than previously suggested. Specifically, in the context of a maze-solving task, we show that while INNs (and some RNNs) are capable of generalizing to larger maze instances, they fail to generalize along axes of difficulty other than maze size. (ii) Models that are explicitly trained to converge to a fixed point (e.g. the INN we test) are likely to do so when extrapolating, while models that are not (e.g. the RNN we test) may exhibit more exotic limiting behaviour such as limit cycles, even when they correctly solve the problem. Our results suggest that (i) further study into why such networks extrapolate easily along certain axes of difficulty yet struggle with others is necessary, and (ii) analyzing the dynamics of extrapolation may yield insights into designing more efficient and interpretable logical extrapolators.
We study off-policy evaluation (OPE) in partially observable environments with complex observations, with the goal of developing estimators whose guarantee avoids exponential dependence on the horizon. While such estimators exist for MDPs and POMDPs can be converted to history-based MDPs, their estimation errors depend on the state-density ratio for MDPs which becomes history ratios after conversion, an exponential object. Recently, Uehara et al. [2022a] proposed future-dependent value functions as a promising framework to address this issue, where the guarantee for memoryless policies depends on the density ratio over the latent state space. However, it also depends on the boundedness of the future-dependent value function and other related quantities, which we show could be exponential-in-length and thus erasing the advantage of the method. In this paper, we discover novel coverage assumptions tailored to the structure of POMDPs, such as outcome coverage and belief coverage, which enable polynomial bounds on the aforementioned quantities. As a side product, our analyses also lead to the discovery of new algorithms with complementary properties.
The healthcare landscape is evolving, with patients seeking reliable information about their health conditions and available treatment options. Despite the abundance of information sources, the digital age overwhelms individuals with excess, often inaccurate information. Patients primarily trust medical professionals, highlighting the need for expert-endorsed health information. However, increased patient loads on experts has led to reduced communication time, impacting information sharing. To address this gap, we develop CataractBot, an experts-in-the-loop chatbot powered by LLMs, in collaboration with an eye hospital in India. CataractBot answers cataract surgery related questions instantly by querying a curated knowledge base, and provides expert-verified responses asynchronously. It has multimodal and multilingual capabilities. In an in-the-wild deployment study with 55 participants, CataractBot proved valuable, providing anytime accessibility, saving time, accommodating diverse literacy levels, alleviating power differences, and adding a privacy layer between patients and doctors. Users reported that their trust in the system was established through expert verification. Broadly, our results could inform future work on designing expert-mediated LLM bots.
Endovascular interventions are a life-saving treatment for many diseases, yet suffer from drawbacks such as radiation exposure and potential scarcity of proficient physicians. Robotic assistance during these interventions could be a promising support towards these problems. Research focusing on autonomous endovascular interventions utilizing artificial intelligence-based methodologies is gaining popularity. However, variability in assessment environments hinders the ability to compare and contrast the efficacy of different approaches, primarily due to each study employing a unique evaluation framework. In this study, we present deep reinforcement learning-based autonomous endovascular device navigation on three distinct digital benchmark interventions: BasicWireNav, ArchVariety, and DualDeviceNav. The benchmark interventions were implemented with our modular simulation framework stEVE (simulated EndoVascular Environment). Autonomous controllers were trained solely in simulation and evaluated in simulation and on physical test benches with camera and fluoroscopy feedback. Autonomous control for BasicWireNav and ArchVariety reached high success rates and was successfully transferred from the simulated training environment to the physical test benches, while autonomous control for DualDeviceNav reached a moderate success rate. The experiments demonstrate the feasibility of stEVE and its potential for transferring controllers trained in simulation to real-world scenarios. Nevertheless, they also reveal areas that offer opportunities for future research. This study demonstrates the transferability of autonomous controllers from simulation to the real world in endovascular navigation and lowers the entry barriers and increases the comparability of research on endovascular assistance systems by providing open-source training scripts, benchmarks and the stEVE framework.
README: Bridging Medical Jargon and Lay Understanding for Patient Education through Data-Centric NLP
The advancement in healthcare has shifted focus toward patient-centric approaches, particularly in self-care and patient education, facilitated by access to Electronic Health Records (EHR). However, medical jargon in EHRs poses significant challenges in patient comprehension. To address this, we introduce a new task of automatically generating lay definitions, aiming to simplify complex medical terms into patient-friendly lay language. We first created the README dataset, an extensive collection of over 50,000 unique (medical term, lay definition) pairs and 300,000 mentions, each offering context-aware lay definitions manually annotated by domain experts. We have also engineered a data-centric Human-AI pipeline that synergizes data filtering, augmentation, and selection to improve data quality. We then used README as the training data for models and leveraged a Retrieval-Augmented Generation method to reduce hallucinations and improve the quality of model outputs. Our extensive automatic and human evaluations demonstrate that open-source mobile-friendly models, when fine-tuned with high-quality data, are capable of matching or even surpassing the performance of state-of-the-art closed-source large language models like ChatGPT. This research represents a significant stride in closing the knowledge gap in patient education and advancing patient-centric healthcare solutions.
There has been a growing interest in the ability of neural networks to solve algorithmic tasks, such as arithmetic, summary statistics, and sorting. While state-of-the-art models like Transformers have demonstrated good generalization performance on in-distribution tasks, their out-of-distribution (OOD) performance is poor when trained end-to-end. In this paper, we focus on value generalization, a common instance of OOD generalization where the test distribution has the same input sequence length as the training distribution, but the value ranges in the training and test distributions do not necessarily overlap. To address this issue, we propose that using fixed positional encodings to determine attention weights-referred to as positional attention-enhances empirical OOD performance while maintaining expressivity. We support our claim about expressivity by proving that Transformers with positional attention can effectively simulate parallel algorithms.
Robots-based smart pharmacies are essential for modern healthcare systems, enabling efficient drug delivery. However, a critical challenge exists in the robotic handling of drugs with varying shapes and overlapping positions, which previous studies have not adequately addressed. To enhance the robotic arm's ability to grasp chaotic, overlapping, and variously shaped drugs, this paper proposed a novel framework combining a multi-stage grasping network with an adaptive robotics mechanism. The framework first preprocessed images using an improved Super-Resolution Convolutional Neural Network (SRCNN) algorithm, and then employed the proposed YOLOv5+E-A-SPPFCSPC+BIFPNC (YOLO-EASB) instance segmentation algorithm for precise drug segmentation. The most suitable drugs for grasping can be determined by assessing the completeness of the segmentation masks. Then, these segmented drugs were processed by our improved Adaptive Feature Fusion and Grasp-Aware Network (IAFFGA-Net) with the optimized loss function, which ensures accurate picking actions even in complex environments. To control the robot grasping, a time-optimal robotic arm trajectory planning algorithm that combines an improved ant colony algorithm with 3-5-3 interpolation was developed, further improving efficiency while ensuring smooth trajectories. Finally, this system was implemented and validated within an adaptive collaborative robot setup, which dynamically adjusts to different production environments and task requirements. Experimental results demonstrate the superiority of our multi-stage grasping network in optimizing smart pharmacy operations, while also showcasing its remarkable adaptability and effectiveness in practical applications.
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