EMERGE: Integrating RAG for Improved Multimodal EHR Predictive Modeling

The integration of multimodal Electronic Health Records (EHR) data has notably advanced clinical predictive capabilities. However, current models that utilize clinical notes and multivariate time-series EHR data often lack the necessary medical context for precise clinical tasks. Previous methods using knowledge graphs (KGs) primarily focus on structured knowledge extraction. To address this, we propose EMERGE, a Retrieval-Augmented Generation (RAG) driven framework aimed at enhancing multimodal EHR predictive modeling. Our approach extracts entities from both time-series data and clinical notes by prompting Large Language Models (LLMs) and aligns them with professional PrimeKG to ensure consistency. Beyond triplet relationships, we include entities' definitions and descriptions to provide richer semantics. The extracted knowledge is then used to generate task-relevant summaries of patients' health statuses. These summaries are fused with other modalities utilizing an adaptive multimodal fusion network with cross-attention. Extensive experiments on the MIMIC-III and MIMIC-IV datasets for in-hospital mortality and 30-day readmission tasks demonstrate the superior performance of the EMERGE framework compared to baseline models. Comprehensive ablation studies and analyses underscore the efficacy of each designed module and the framework's robustness to data sparsity. EMERGE significantly enhances the use of multimodal EHR data in healthcare, bridging the gap with nuanced medical contexts crucial for informed clinical predictions.

Cross-Modality Jailbreak and Mismatched Attacks on Medical Multimodal Large Language Models

Security concerns related to Large Language Models (LLMs) have been extensively explored, yet the safety implications for Multimodal Large Language Models (MLLMs), particularly in medical contexts (MedMLLMs), remain insufficiently studied. This paper delves into the underexplored security vulnerabilities of MedMLLMs, especially when deployed in clinical environments where the accuracy and relevance of question-and-answer interactions are critically tested against complex medical challenges. By combining existing clinical medical data with atypical natural phenomena, we redefine two types of attacks: mismatched malicious attack (2M-attack) and optimized mismatched malicious attack (O2M-attack). Using our own constructed voluminous 3MAD dataset, which covers a wide range of medical image modalities and harmful medical scenarios, we conduct a comprehensive analysis and propose the MCM optimization method, which significantly enhances the attack success rate on MedMLLMs. Evaluations with this dataset and novel attack methods, including white-box attacks on LLaVA-Med and transfer attacks on four other state-of-the-art models, indicate that even MedMLLMs designed with enhanced security features are vulnerable to security breaches. Our work underscores the urgent need for a concerted effort to implement robust security measures and enhance the safety and efficacy of open-source MedMLLMs, particularly given the potential severity of jailbreak attacks and other malicious or clinically significant exploits in medical settings. For further research and replication, anonymous access to our code is available at https://github.com/dirtycomputer/O2M_attack. Warning: Medical large model jailbreaking may generate content that includes unverified diagnoses and treatment recommendations. Always consult professional medical advice.

AGFSync: Leveraging AI-Generated Feedback for Preference Optimization in Text-to-Image Generation

Text-to-Image (T2I) diffusion models have achieved remarkable success in image generation. Despite their progress, challenges remain in both prompt-following ability, image quality and lack of high-quality datasets, which are essential for refining these models. As acquiring labeled data is costly, we introduce AGFSync, a framework that enhances T2I diffusion models through Direct Preference Optimization (DPO) in a fully AI-driven approach. AGFSync utilizes Vision-Language Models (VLM) to assess image quality across style, coherence, and aesthetics, generating feedback data within an AI-driven loop. By applying AGFSync to leading T2I models such as SD v1.4, v1.5, and SDXL, our extensive experiments on the TIFA dataset demonstrate notable improvements in VQA scores, aesthetic evaluations, and performance on the HPSv2 benchmark, consistently outperforming the base models. AGFSync's method of refining T2I diffusion models paves the way for scalable alignment techniques.

LightM-UNet: Mamba Assists in Lightweight UNet for Medical Image Segmentation

UNet and its variants have been widely used in medical image segmentation. However, these models, especially those based on Transformer architectures, pose challenges due to their large number of parameters and computational loads, making them unsuitable for mobile health applications. Recently, State Space Models (SSMs), exemplified by Mamba, have emerged as competitive alternatives to CNN and Transformer architectures. Building upon this, we employ Mamba as a lightweight substitute for CNN and Transformer within UNet, aiming at tackling challenges stemming from computational resource limitations in real medical settings. To this end, we introduce the Lightweight Mamba UNet (LightM-UNet) that integrates Mamba and UNet in a lightweight framework. Specifically, LightM-UNet leverages the Residual Vision Mamba Layer in a pure Mamba fashion to extract deep semantic features and model long-range spatial dependencies, with linear computational complexity. Extensive experiments conducted on two real-world 2D/3D datasets demonstrate that LightM-UNet surpasses existing state-of-the-art literature. Notably, when compared to the renowned nnU-Net, LightM-UNet achieves superior segmentation performance while drastically reducing parameter and computation costs by 116x and 21x, respectively. This highlights the potential of Mamba in facilitating model lightweighting. Our code implementation is publicly available at https://github.com/MrBlankness/LightM-UNet.

REALM: RAG-Driven Enhancement of Multimodal Electronic Health Records Analysis via Large Language Models

The integration of multimodal Electronic Health Records (EHR) data has significantly improved clinical predictive capabilities. Leveraging clinical notes and multivariate time-series EHR, existing models often lack the medical context relevent to clinical tasks, prompting the incorporation of external knowledge, particularly from the knowledge graph (KG). Previous approaches with KG knowledge have primarily focused on structured knowledge extraction, neglecting unstructured data modalities and semantic high dimensional medical knowledge. In response, we propose REALM, a Retrieval-Augmented Generation (RAG) driven framework to enhance multimodal EHR representations that address these limitations. Firstly, we apply Large Language Model (LLM) to encode long context clinical notes and GRU model to encode time-series EHR data. Secondly, we prompt LLM to extract task-relevant medical entities and match entities in professionally labeled external knowledge graph (PrimeKG) with corresponding medical knowledge. By matching and aligning with clinical standards, our framework eliminates hallucinations and ensures consistency. Lastly, we propose an adaptive multimodal fusion network to integrate extracted knowledge with multimodal EHR data. Our extensive experiments on MIMIC-III mortality and readmission tasks showcase the superior performance of our REALM framework over baselines, emphasizing the effectiveness of each module. REALM framework contributes to refining the use of multimodal EHR data in healthcare and bridging the gap with nuanced medical context essential for informed clinical predictions.

Progressive Conservative Adaptation for Evolving Target Domains

Conventional domain adaptation typically transfers knowledge from a source domain to a stationary target domain. However, in many real-world cases, target data usually emerge sequentially and have continuously evolving distributions. Restoring and adapting to such target data results in escalating computational and resource consumption over time. Hence, it is vital to devise algorithms to address the evolving domain adaptation (EDA) problem, \emph{i.e.,} adapting models to evolving target domains without access to historic target domains. To achieve this goal, we propose a simple yet effective approach, termed progressive conservative adaptation (PCAda). To manage new target data that diverges from previous distributions, we fine-tune the classifier head based on the progressively updated class prototypes. Moreover, as adjusting to the most recent target domain can interfere with the features learned from previous target domains, we develop a conservative sparse attention mechanism. This mechanism restricts feature adaptation within essential dimensions, thus easing the inference related to historical knowledge. The proposed PCAda is implemented with a meta-learning framework, which achieves the fast adaptation of the classifier with the help of the progressively updated class prototypes in the inner loop and learns a generalized feature without severely interfering with the historic knowledge via the conservative sparse attention in the outer loop. Experiments on Rotated MNIST, Caltran, and Portraits datasets demonstrate the effectiveness of our method.

Prompting Large Language Models for Zero-Shot Clinical Prediction with Structured Longitudinal Electronic Health Record Data

The inherent complexity of structured longitudinal Electronic Health Records (EHR) data poses a significant challenge when integrated with Large Language Models (LLMs), which are traditionally tailored for natural language processing. Motivated by the urgent need for swift decision-making during new disease outbreaks, where traditional predictive models often fail due to a lack of historical data, this research investigates the adaptability of LLMs, like GPT-4, to EHR data. We particularly focus on their zero-shot capabilities, which enable them to make predictions in scenarios in which they haven't been explicitly trained. In response to the longitudinal, sparse, and knowledge-infused nature of EHR data, our prompting approach involves taking into account specific EHR characteristics such as units and reference ranges, and employing an in-context learning strategy that aligns with clinical contexts. Our comprehensive experiments on the MIMIC-IV and TJH datasets demonstrate that with our elaborately designed prompting framework, LLMs can improve prediction performance in key tasks such as mortality, length-of-stay, and 30-day readmission by about 35\%, surpassing ML models in few-shot settings. Our research underscores the potential of LLMs in enhancing clinical decision-making, especially in urgent healthcare situations like the outbreak of emerging diseases with no labeled data. The code is publicly available at https://github.com/yhzhu99/llm4healthcare for reproducibility.

Leveraging Frequency Domain Learning in 3D Vessel Segmentation

Coronary microvascular disease constitutes a substantial risk to human health. Employing computer-aided analysis and diagnostic systems, medical professionals can intervene early in disease progression, with 3D vessel segmentation serving as a crucial component. Nevertheless, conventional U-Net architectures tend to yield incoherent and imprecise segmentation outcomes, particularly for small vessel structures. While models with attention mechanisms, such as Transformers and large convolutional kernels, demonstrate superior performance, their extensive computational demands during training and inference lead to increased time complexity. In this study, we leverage Fourier domain learning as a substitute for multi-scale convolutional kernels in 3D hierarchical segmentation models, which can reduce computational expenses while preserving global receptive fields within the network. Furthermore, a zero-parameter frequency domain fusion method is designed to improve the skip connections in U-Net architecture. Experimental results on a public dataset and an in-house dataset indicate that our novel Fourier transformation-based network achieves remarkable dice performance (84.37\% on ASACA500 and 80.32\% on ImageCAS) in tubular vessel segmentation tasks and substantially reduces computational requirements without compromising global receptive fields.

Leveraging Prototype Patient Representations with Feature-Missing-Aware Calibration to Mitigate EHR Data Sparsity

Electronic Health Record (EHR) data frequently exhibits sparse characteristics, posing challenges for predictive modeling. Current direct imputation such as matrix imputation approaches hinge on referencing analogous rows or columns to complete raw missing data and do not differentiate between imputed and actual values. As a result, models may inadvertently incorporate irrelevant or deceptive information with respect to the prediction objective, thereby compromising the efficacy of downstream performance. While some methods strive to recalibrate or augment EHR embeddings after direct imputation, they often mistakenly prioritize imputed features. This misprioritization can introduce biases or inaccuracies into the model. To tackle these issues, our work resorts to indirect imputation, where we leverage prototype representations from similar patients to obtain a denser embedding. Recognizing the limitation that missing features are typically treated the same as present ones when measuring similar patients, our approach designs a feature confidence learner module. This module is sensitive to the missing feature status, enabling the model to better judge the reliability of each feature. Moreover, we propose a novel patient similarity metric that takes feature confidence into account, ensuring that evaluations are not based merely on potentially inaccurate imputed values. Consequently, our work captures dense prototype patient representations with feature-missing-aware calibration process. Comprehensive experiments demonstrate that designed model surpasses established EHR-focused models with a statistically significant improvement on MIMIC-III and MIMIC-IV datasets in-hospital mortality outcome prediction task. The code is publicly available at \url{https://github.com/yhzhu99/SparseEHR} to assure the reproducibility.

M$^3$Fair: Mitigating Bias in Healthcare Data through Multi-Level and Multi-Sensitive-Attribute Reweighting Method

In the data-driven artificial intelligence paradigm, models heavily rely on large amounts of training data. However, factors like sampling distribution imbalance can lead to issues of bias and unfairness in healthcare data. Sensitive attributes, such as race, gender, age, and medical condition, are characteristics of individuals that are commonly associated with discrimination or bias. In healthcare AI, these attributes can play a significant role in determining the quality of care that individuals receive. For example, minority groups often receive fewer procedures and poorer-quality medical care than white individuals in US. Therefore, detecting and mitigating bias in data is crucial to enhancing health equity. Bias mitigation methods include pre-processing, in-processing, and post-processing. Among them, Reweighting (RW) is a widely used pre-processing method that performs well in balancing machine learning performance and fairness performance. RW adjusts the weights for samples within each (group, label) combination, where these weights are utilized in loss functions. However, RW is limited to considering only a single sensitive attribute when mitigating bias and assumes that each sensitive attribute is equally important. This may result in potential inaccuracies when addressing intersectional bias. To address these limitations, we propose M3Fair, a multi-level and multi-sensitive-attribute reweighting method by extending the RW method to multiple sensitive attributes at multiple levels. Our experiments on real-world datasets show that the approach is effective, straightforward, and generalizable in addressing the healthcare fairness issues.