Prescribing Large Language Models for Perioperative Care: What's The Right Dose for Pre-trained Models?

Postoperative risk predictions can inform effective perioperative care management and planning. We aimed to assess whether clinical large language models (LLMs) can predict postoperative risks using clinical texts with various training strategies. The main cohort involved 84,875 records from Barnes Jewish Hospital (BJH) system between 2018 and 2021. Methods were replicated on Beth Israel Deaconess's MIMIC dataset. Both studies had mean duration of follow-up based on the length of postoperative ICU stay less than 7 days. For the BJH dataset, outcomes included 30-day mortality, pulmonary embolism (PE) and pneumonia. Three domain adaptation and finetuning strategies were implemented for BioGPT, ClinicalBERT and BioClinicalBERT: self-supervised objectives; incorporating labels with semi-supervised fine-tuning; and foundational modelling through multi-task learning. Model performance was compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC) for classification tasks, and mean squared error (MSE) and R2 for regression tasks. Pre-trained LLMs outperformed traditional word embeddings, with absolute maximal gains of 38.3% for AUROC and 14% for AUPRC. Adapting models further improved performance: (1) self-supervised finetuning by 3.2% for AUROC and 1.5% for AUPRC; (2) semi-supervised finetuning by 1.8% for AUROC and 2% for AUPRC, compared to self-supervised finetuning; (3) foundational modelling by 3.6% for AUROC and 2.6% for AUPRC, compared to self-supervised finetuning. Pre-trained clinical LLMs offer opportunities for postoperative risk predictions in unforeseen data, with peaks in foundational models indicating the potential of task-agnostic learning towards the generalizability of LLMs in perioperative care.

Progressive Neural Compression for Adaptive Image Offloading under Timing Constraints

IoT devices are increasingly the source of data for machine learning (ML) applications running on edge servers. Data transmissions from devices to servers are often over local wireless networks whose bandwidth is not just limited but, more importantly, variable. Furthermore, in cyber-physical systems interacting with the physical environment, image offloading is also commonly subject to timing constraints. It is, therefore, important to develop an adaptive approach that maximizes the inference performance of ML applications under timing constraints and the resource constraints of IoT devices. In this paper, we use image classification as our target application and propose progressive neural compression (PNC) as an efficient solution to this problem. Although neural compression has been used to compress images for different ML applications, existing solutions often produce fixed-size outputs that are unsuitable for timing-constrained offloading over variable bandwidth. To address this limitation, we train a multi-objective rateless autoencoder that optimizes for multiple compression rates via stochastic taildrop to create a compression solution that produces features ordered according to their importance to inference performance. Features are then transmitted in that order based on available bandwidth, with classification ultimately performed using the (sub)set of features received by the deadline. We demonstrate the benefits of PNC over state-of-the-art neural compression approaches and traditional compression methods on a testbed comprising an IoT device and an edge server connected over a wireless network with varying bandwidth.

Utilizing Semantic Textual Similarity for Clinical Survey Data Feature Selection

Survey data can contain a high number of features while having a comparatively low quantity of examples. Machine learning models that attempt to predict outcomes from survey data under these conditions can overfit and result in poor generalizability. One remedy to this issue is feature selection, which attempts to select an optimal subset of features to learn upon. A relatively unexplored source of information in the feature selection process is the usage of textual names of features, which may be semantically indicative of which features are relevant to a target outcome. The relationships between feature names and target names can be evaluated using language models (LMs) to produce semantic textual similarity (STS) scores, which can then be used to select features. We examine the performance using STS to select features directly and in the minimal-redundancy-maximal-relevance (mRMR) algorithm. The performance of STS as a feature selection metric is evaluated against preliminary survey data collected as a part of a clinical study on persistent post-surgical pain (PPSP). The results suggest that features selected with STS can result in higher performance models compared to traditional feature selection algorithms.

Assisting Clinical Decisions for Scarcely Available Treatment via Disentangled Latent Representation

Extracorporeal membrane oxygenation (ECMO) is an essential life-supporting modality for COVID-19 patients who are refractory to conventional therapies. However, the proper treatment decision has been the subject of significant debate and it remains controversial about who benefits from this scarcely available and technically complex treatment option. To support clinical decisions, it is a critical need to predict the treatment need and the potential treatment and no-treatment responses. Targeting this clinical challenge, we propose Treatment Variational AutoEncoder (TVAE), a novel approach for individualized treatment analysis. TVAE is specifically designed to address the modeling challenges like ECMO with strong treatment selection bias and scarce treatment cases. TVAE conceptualizes the treatment decision as a multi-scale problem. We model a patient's potential treatment assignment and the factual and counterfactual outcomes as part of their intrinsic characteristics that can be represented by a deep latent variable model. The factual and counterfactual prediction errors are alleviated via a reconstruction regularization scheme together with semi-supervision, and the selection bias and the scarcity of treatment cases are mitigated by the disentangled and distribution-matched latent space and the label-balancing generative strategy. We evaluate TVAE on two real-world COVID-19 datasets: an international dataset collected from 1651 hospitals across 63 countries, and a institutional dataset collected from 15 hospitals. The results show that TVAE outperforms state-of-the-art treatment effect models in predicting both the propensity scores and factual outcomes on heterogeneous COVID-19 datasets. Additional experiments also show TVAE outperforms the best existing models in individual treatment effect estimation on the synthesized IHDP benchmark dataset.

Content-aware Token Sharing for Efficient Semantic Segmentation with Vision Transformers

This paper introduces Content-aware Token Sharing (CTS), a token reduction approach that improves the computational efficiency of semantic segmentation networks that use Vision Transformers (ViTs). Existing works have proposed token reduction approaches to improve the efficiency of ViT-based image classification networks, but these methods are not directly applicable to semantic segmentation, which we address in this work. We observe that, for semantic segmentation, multiple image patches can share a token if they contain the same semantic class, as they contain redundant information. Our approach leverages this by employing an efficient, class-agnostic policy network that predicts if image patches contain the same semantic class, and lets them share a token if they do. With experiments, we explore the critical design choices of CTS and show its effectiveness on the ADE20K, Pascal Context and Cityscapes datasets, various ViT backbones, and different segmentation decoders. With Content-aware Token Sharing, we are able to reduce the number of processed tokens by up to 44%, without diminishing the segmentation quality.

Self-explaining Hierarchical Model for Intraoperative Time Series

Major postoperative complications are devastating to surgical patients. Some of these complications are potentially preventable via early predictions based on intraoperative data. However, intraoperative data comprise long and fine-grained multivariate time series, prohibiting the effective learning of accurate models. The large gaps associated with clinical events and protocols are usually ignored. Moreover, deep models generally lack transparency. Nevertheless, the interpretability is crucial to assist clinicians in planning for and delivering postoperative care and timely interventions. Towards this end, we propose a hierarchical model combining the strength of both attention and recurrent models for intraoperative time series. We further develop an explanation module for the hierarchical model to interpret the predictions by providing contributions of intraoperative data in a fine-grained manner. Experiments on a large dataset of 111,888 surgeries with multiple outcomes and an external high-resolution ICU dataset show that our model can achieve strong predictive performance (i.e., high accuracy) and offer robust interpretations (i.e., high transparency) for predicted outcomes based on intraoperative time series.

Adaptive Edge Offloading for Image Classification Under Rate Limit

This paper considers a setting where embedded devices are used to acquire and classify images. Because of limited computing capacity, embedded devices rely on a parsimonious classification model with uneven accuracy. When local classification is deemed inaccurate, devices can decide to offload the image to an edge server with a more accurate but resource-intensive model. Resource constraints, e.g., network bandwidth, however, require regulating such transmissions to avoid congestion and high latency. The paper investigates this offloading problem when transmissions regulation is through a token bucket, a mechanism commonly used for such purposes. The goal is to devise a lightweight, online offloading policy that optimizes an application-specific metric (e.g., classification accuracy) under the constraints of the token bucket. The paper develops a policy based on a Deep Q-Network (DQN), and demonstrates both its efficacy and the feasibility of its deployment on embedded devices. Of note is the fact that the policy can handle complex input patterns, including correlation in image arrivals and classification accuracy. The evaluation is carried out by performing image classification over a local testbed using synthetic traces generated from the ImageNet image classification benchmark. Implementation of this work is available at https://github.com/qiujiaming315/edgeml-dqn.

HiPAL: A Deep Framework for Physician Burnout Prediction Using Activity Logs in Electronic Health Records

Burnout is a significant public health concern affecting nearly half of the healthcare workforce. This paper presents the first end-to-end deep learning framework for predicting physician burnout based on clinician activity logs, digital traces of their work activities, available in any electronic health record (EHR) system. In contrast to prior approaches that exclusively relied on surveys for burnout measurement, our framework directly learns deep workload representations from large-scale clinician activity logs to predict burnout. We propose the Hierarchical burnout Prediction based on Activity Logs (HiPAL), featuring a pre-trained time-dependent activity embedding mechanism tailored for activity logs and a hierarchical predictive model, which mirrors the natural hierarchical structure of clinician activity logs and captures physician's evolving workload patterns at both short-term and long-term levels. To utilize the large amount of unlabeled activity logs, we propose a semi-supervised framework that learns to transfer knowledge extracted from unlabeled clinician activities to the HiPAL-based prediction model. The experiment on over 15 million clinician activity logs collected from the EHR at a large academic medical center demonstrates the advantages of our proposed framework in predictive performance of physician burnout and training efficiency over state of the art approaches.

Self-Supervised Road Layout Parsing with Graph Auto-Encoding

Aiming for higher-level scene understanding, this work presents a neural network approach that takes a road-layout map in bird's eye view as input, and predicts a human-interpretable graph that represents the road's topological layout. Our approach elevates the understanding of road layouts from pixel level to the level of graphs. To achieve this goal, an image-graph-image auto-encoder is utilized. The network is designed to learn to regress the graph representation at its auto-encoder bottleneck. This learning is self-supervised by an image reconstruction loss, without needing any external manual annotations. We create a synthetic dataset containing common road layout patterns and use it for training of the auto-encoder in addition to the real-world Argoverse dataset. By using this additional synthetic dataset, which conceptually captures human knowledge of road layouts and makes this available to the network for training, we are able to stabilize and further improve the performance of topological road layout understanding on the real-world Argoverse dataset. The evaluation shows that our approach exhibits comparable performance to a strong fully-supervised baseline.

Part-aware Panoptic Segmentation

In this work, we introduce the new scene understanding task of Part-aware Panoptic Segmentation (PPS), which aims to understand a scene at multiple levels of abstraction, and unifies the tasks of scene parsing and part parsing. For this novel task, we provide consistent annotations on two commonly used datasets: Cityscapes and Pascal VOC. Moreover, we present a single metric to evaluate PPS, called Part-aware Panoptic Quality (PartPQ). For this new task, using the metric and annotations, we set multiple baselines by merging results of existing state-of-the-art methods for panoptic segmentation and part segmentation. Finally, we conduct several experiments that evaluate the importance of the different levels of abstraction in this single task.