Generation of automated clinical notes have been posited as a strategy to mitigate physician burnout. In particular, an automated narrative summary of a patient's hospital stay could supplement the hospital course section of the discharge summary that inpatient physicians document in electronic health record (EHR) systems. In the current study, we developed and evaluated an automated method for summarizing the hospital course section using encoder-decoder sequence-to-sequence transformer models. We fine tuned BERT and BART models and optimized for factuality through constraining beam search, which we trained and tested using EHR data from patients admitted to the neurology unit of an academic medical center. The approach demonstrated good ROUGE scores with an R-2 of 13.76. In a blind evaluation, two board-certified physicians rated 62% of the automated summaries as meeting the standard of care, which suggests the method may be useful clinically. To our knowledge, this study is among the first to demonstrate an automated method for generating a discharge summary hospital course that approaches a quality level of what a physician would write.
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Twin revolutions in wearable technologies and smartphone-delivered digital health interventions have significantly expanded the accessibility and uptake of mobile health (mHealth) interventions across various health science domains. Sequentially randomized experiments called micro-randomized trials (MRTs) have grown in popularity to empirically evaluate the effectiveness of these mHealth intervention components. MRTs have given rise to a new class of causal estimands known as "causal excursion effects", which enable health scientists to assess how intervention effectiveness changes over time or is moderated by individual characteristics, context, or responses in the past. However, current data analysis methods for estimating causal excursion effects require pre-specified features of the observed high-dimensional history to construct a working model of an important nuisance parameter. While machine learning algorithms are ideal for automatic feature construction, their naive application to causal excursion estimation can lead to bias under model misspecification, potentially yielding incorrect conclusions about intervention effectiveness. To address this issue, this paper revisits the estimation of causal excursion effects from a meta-learner perspective, where the analyst remains agnostic to the choices of supervised learning algorithms used to estimate nuisance parameters. The paper presents asymptotic properties of the novel estimators and compares them theoretically and through extensive simulation experiments, demonstrating relative efficiency gains and supporting the recommendation for a doubly robust alternative to existing methods. Finally, the practical utility of the proposed methods is demonstrated by analyzing data from a multi-institution cohort of first-year medical residents in the United States (NeCamp et al., 2020).
The problem of estimating return levels of river discharge, relevant in flood frequency analysis, is tackled by relying on the extreme value theory. The Generalized Extreme Value (GEV) distribution is assumed to model annual maxima values of river discharge registered at multiple gauging stations belonging to the same river basin. The specific features of the data from the Upper Danube basin drive the definition of the proposed statistical model. Firstly, Bayesian P-splines are considered to account for the non-linear effects of station-specific covariates on the GEV parameters. Secondly, the problem of functional and variable selection is addressed by imposing a grouped horseshoe prior on the coefficients, to encourage the shrinkage of non-relevant components to zero. A cross-validation study is organized to compare the proposed modeling solution to other models, showing its potential in reducing the uncertainty of the ungauged predictions without affecting their calibration.
Various methods for Multi-Agent Reinforcement Learning (MARL) have been developed with the assumption that agents' policies are based on accurate state information. However, policies learned through Deep Reinforcement Learning (DRL) are susceptible to adversarial state perturbation attacks. In this work, we propose a State-Adversarial Markov Game (SAMG) and make the first attempt to investigate the fundamental properties of MARL under state uncertainties. Our analysis shows that the commonly used solution concepts of optimal agent policy and robust Nash equilibrium do not always exist in SAMGs. To circumvent this difficulty, we consider a new solution concept called robust agent policy, where agents aim to maximize the worst-case expected state value. We prove the existence of robust agent policy for finite state and finite action SAMGs. Additionally, we propose a Robust Multi-Agent Adversarial Actor-Critic (RMA3C) algorithm to learn robust policies for MARL agents under state uncertainties. Our experiments demonstrate that our algorithm outperforms existing methods when faced with state perturbations and greatly improves the robustness of MARL policies. Our code is public on //songyanghan.github.io/what_is_solution/.
In credit scoring, machine learning models are known to outperform standard parametric models. As they condition access to credit, banking supervisors and internal model validation teams need to monitor their predictive performance and to identify the features with the highest impact on performance. To facilitate this, we introduce the XPER methodology to decompose a performance metric (e.g., AUC, $R^2$) into specific contributions associated with the various features of a classification or regression model. XPER is theoretically grounded on Shapley values and is both model-agnostic and performance metric-agnostic. Furthermore, it can be implemented either at the model level or at the individual level. Using a novel dataset of car loans, we decompose the AUC of a machine-learning model trained to forecast the default probability of loan applicants. We show that a small number of features can explain a surprisingly large part of the model performance. Furthermore, we find that the features that contribute the most to the predictive performance of the model may not be the ones that contribute the most to individual forecasts (SHAP). We also show how XPER can be used to deal with heterogeneity issues and significantly boost out-of-sample performance.
Separating signals from an additive mixture may be an unnecessarily hard problem when one is only interested in specific properties of a given signal. In this work, we tackle simpler "statistical component separation" problems that focus on recovering a predefined set of statistical descriptors of a target signal from a noisy mixture. Assuming access to samples of the noise process, we investigate a method devised to match the statistics of the solution candidate corrupted by noise samples with those of the observed mixture. We first analyze the behavior of this method using simple examples with analytically tractable calculations. Then, we apply it in an image denoising context employing 1) wavelet-based descriptors, 2) ConvNet-based descriptors on astrophysics and ImageNet data. In the case of 1), we show that our method better recovers the descriptors of the target data than a standard denoising method in most situations. Additionally, despite not constructed for this purpose, it performs surprisingly well in terms of peak signal-to-noise ratio on full signal reconstruction. In comparison, representation 2) appears less suitable for image denoising. Finally, we extend this method by introducing a diffusive stepwise algorithm which gives a new perspective to the initial method and leads to promising results for image denoising under specific circumstances.
Medical data poses a daunting challenge for AI algorithms: it exists in many different modalities, experiences frequent distribution shifts, and suffers from a scarcity of examples and labels. Recent advances, including transformers and self-supervised learning, promise a more universal approach that can be applied flexibly across these diverse conditions. To measure and drive progress in this direction, we present BenchMD: a benchmark that tests how well unified, modality-agnostic methods, including architectures and training techniques (e.g. self-supervised learning, ImageNet pretraining),perform on a diverse array of clinically-relevant medical tasks. BenchMD combines 19 publicly available datasets for 7 medical modalities, including 1D sensor data, 2D images, and 3D volumetric scans. Our benchmark reflects real-world data constraints by evaluating methods across a range of dataset sizes, including challenging few-shot settings that incentivize the use of pretraining. Finally, we evaluate performance on out-of-distribution data collected at different hospitals than the training data, representing naturally-occurring distribution shifts that frequently degrade the performance of medical AI models. Our baseline results demonstrate that no unified learning technique achieves strong performance across all modalities, leaving ample room for improvement on the benchmark. Code is released at //github.com/rajpurkarlab/BenchMD.
This paper presents a novel approach to Bayesian nonparametric spectral analysis of stationary multivariate time series. Starting with a parametric vector-autoregressive model, the parametric likelihood is nonparametrically adjusted in the frequency domain to account for potential deviations from parametric assumptions. We show mutual contiguity of the nonparametrically corrected likelihood, the multivariate Whittle likelihood approximation and the exact likelihood for Gaussian time series. A multivariate extension of the nonparametric Bernstein-Dirichlet process prior for univariate spectral densities to the space of Hermitian positive definite spectral density matrices is specified directly on the correction matrices. An infinite series representation of this prior is then used to develop a Markov chain Monte Carlo algorithm to sample from the posterior distribution. The code is made publicly available for ease of use and reproducibility. With this novel approach we provide a generalization of the multivariate Whittle-likelihood-based method of Meier et al. (2020) as well as an extension of the nonparametrically corrected likelihood for univariate stationary time series of Kirch et al. (2019) to the multivariate case. We demonstrate that the nonparametrically corrected likelihood combines the efficiencies of a parametric with the robustness of a nonparametric model. Its numerical accuracy is illustrated in a comprehensive simulation study. We illustrate its practical advantages by a spectral analysis of two environmental time series data sets: a bivariate time series of the Southern Oscillation Index and fish recruitment and time series of windspeed data at six locations in California.
Game theory has by now found numerous applications in various fields, including economics, industry, jurisprudence, and artificial intelligence, where each player only cares about its own interest in a noncooperative or cooperative manner, but without obvious malice to other players. However, in many practical applications, such as poker, chess, evader pursuing, drug interdiction, coast guard, cyber-security, and national defense, players often have apparently adversarial stances, that is, selfish actions of each player inevitably or intentionally inflict loss or wreak havoc on other players. Along this line, this paper provides a systematic survey on three main game models widely employed in adversarial games, i.e., zero-sum normal-form and extensive-form games, Stackelberg (security) games, zero-sum differential games, from an array of perspectives, including basic knowledge of game models, (approximate) equilibrium concepts, problem classifications, research frontiers, (approximate) optimal strategy seeking techniques, prevailing algorithms, and practical applications. Finally, promising future research directions are also discussed for relevant adversarial games.
Deep Learning (DL) is the most widely used tool in the contemporary field of computer vision. Its ability to accurately solve complex problems is employed in vision research to learn deep neural models for a variety of tasks, including security critical applications. However, it is now known that DL is vulnerable to adversarial attacks that can manipulate its predictions by introducing visually imperceptible perturbations in images and videos. Since the discovery of this phenomenon in 2013~[1], it has attracted significant attention of researchers from multiple sub-fields of machine intelligence. In [2], we reviewed the contributions made by the computer vision community in adversarial attacks on deep learning (and their defenses) until the advent of year 2018. Many of those contributions have inspired new directions in this area, which has matured significantly since witnessing the first generation methods. Hence, as a legacy sequel of [2], this literature review focuses on the advances in this area since 2018. To ensure authenticity, we mainly consider peer-reviewed contributions published in the prestigious sources of computer vision and machine learning research. Besides a comprehensive literature review, the article also provides concise definitions of technical terminologies for non-experts in this domain. Finally, this article discusses challenges and future outlook of this direction based on the literature reviewed herein and [2].
With the advances of data-driven machine learning research, a wide variety of prediction problems have been tackled. It has become critical to explore how machine learning and specifically deep learning methods can be exploited to analyse healthcare data. A major limitation of existing methods has been the focus on grid-like data; however, the structure of physiological recordings are often irregular and unordered which makes it difficult to conceptualise them as a matrix. As such, graph neural networks have attracted significant attention by exploiting implicit information that resides in a biological system, with interactive nodes connected by edges whose weights can be either temporal associations or anatomical junctions. In this survey, we thoroughly review the different types of graph architectures and their applications in healthcare. We provide an overview of these methods in a systematic manner, organized by their domain of application including functional connectivity, anatomical structure and electrical-based analysis. We also outline the limitations of existing techniques and discuss potential directions for future research.
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