Using Whole Slide Image Representations from Self-Supervised Contrastive Learning for Melanoma Concordance Regression

Although melanoma occurs more rarely than several other skin cancers, patients' long term survival rate is extremely low if the diagnosis is missed. Diagnosis is complicated by a high discordance rate among pathologists when distinguishing between melanoma and benign melanocytic lesions. A tool that provides potential concordance information to healthcare providers could help inform diagnostic, prognostic, and therapeutic decision-making for challenging melanoma cases. We present a melanoma concordance regression deep learning model capable of predicting the concordance rate of invasive melanoma or melanoma in-situ from digitized Whole Slide Images (WSIs). The salient features corresponding to melanoma concordance were learned in a self-supervised manner with the contrastive learning method, SimCLR. We trained a SimCLR feature extractor with 83,356 WSI tiles randomly sampled from 10,895 specimens originating from four distinct pathology labs. We trained a separate melanoma concordance regression model on 990 specimens with available concordance ground truth annotations from three pathology labs and tested the model on 211 specimens. We achieved a Root Mean Squared Error (RMSE) of 0.28 +/- 0.01 on the test set. We also investigated the performance of using the predicted concordance rate as a malignancy classifier, and achieved a precision and recall of 0.85 +/- 0.05 and 0.61 +/- 0.06, respectively, on the test set. These results are an important first step for building an artificial intelligence (AI) system capable of predicting the results of consulting a panel of experts and delivering a score based on the degree to which the experts would agree on a particular diagnosis. Such a system could be used to suggest additional testing or other action such as ordering additional stains or genetic tests.

Patient-Specific Effects of Medication Using Latent Force Models with Gaussian Processes

Multi-output Gaussian processes (GPs) are a flexible Bayesian nonparametric framework that has proven useful in jointly modeling the physiological states of patients in medical time series data. However, capturing the short-term effects of drugs and therapeutic interventions on patient physiological state remains challenging. We propose a novel approach that models the effect of interventions as a hybrid Gaussian process composed of a GP capturing patient physiology convolved with a latent force model capturing effects of treatments on specific physiological features. This convolution of a multi-output GP with a GP including a causal time-marked kernel leads to a well-characterized model of the patients' physiological state responding to interventions. We show that our model leads to analytically tractable cross-covariance functions, allowing scalable inference. Our hierarchical model includes estimates of patient-specific effects but allows sharing of support across patients. Our approach achieves competitive predictive performance on challenging hospital data, where we recover patient-specific response to the administration of three common drugs: one antihypertensive drug and two anticoagulants.

Machine Learning for Health (ML4H) Workshop at NeurIPS 2018

This volume represents the accepted submissions from the Machine Learning for Health (ML4H) workshop at the conference on Neural Information Processing Systems (NeurIPS) 2018, held on December 8, 2018 in Montreal, Canada.

Sparse Multi-Output Gaussian Processes for Medical Time Series Prediction

In the scenario of real-time monitoring of hospital patients, high-quality inference of patients' health status using all information available from clinical covariates and lab tests is essential to enable successful medical interventions and improve patient outcomes. Developing a computational framework that can learn from observational large-scale electronic health records (EHRs) and make accurate real-time predictions is a critical step. In this work, we develop and explore a Bayesian nonparametric model based on Gaussian process (GP) regression for hospital patient monitoring. We propose MedGP, a statistical framework that incorporates 24 clinical and lab covariates and supports a rich reference data set from which relationships between observed covariates may be inferred and exploited for high-quality inference of patient state over time. To do this, we develop a highly structured sparse GP kernel to enable tractable computation over tens of thousands of time points while estimating correlations among clinical covariates, patients, and periodicity in patient observations. MedGP has a number of benefits over current methods, including (i) not requiring an alignment of the time series data, (ii) quantifying confidence regions in the predictions, (iii) exploiting a vast and rich database of patients, and (iv) inferring interpretable relationships among clinical covariates. We evaluate and compare results from MedGP on the task of online prediction for three patient subgroups from two medical data sets across 8,043 patients. We found MedGP improves online prediction over baseline methods for nearly all covariates across different disease subgroups and studies. The publicly available code is at https://github.com/bee-hive/MedGP.

A Reinforcement Learning Approach to Weaning of Mechanical Ventilation in Intensive Care Units

The management of invasive mechanical ventilation, and the regulation of sedation and analgesia during ventilation, constitutes a major part of the care of patients admitted to intensive care units. Both prolonged dependence on mechanical ventilation and premature extubation are associated with increased risk of complications and higher hospital costs, but clinical opinion on the best protocol for weaning patients off of a ventilator varies. This work aims to develop a decision support tool that uses available patient information to predict time-to-extubation readiness and to recommend a personalized regime of sedation dosage and ventilator support. To this end, we use off-policy reinforcement learning algorithms to determine the best action at a given patient state from sub-optimal historical ICU data. We compare treatment policies from fitted Q-iteration with extremely randomized trees and with feedforward neural networks, and demonstrate that the policies learnt show promise in recommending weaning protocols with improved outcomes, in terms of minimizing rates of reintubation and regulating physiological stability.