Vision-language models for decoding provider attention during neonatal resuscitation

Neonatal resuscitations demand an exceptional level of attentiveness from providers, who must process multiple streams of information simultaneously. Gaze strongly influences decision making; thus, understanding where a provider is looking during neonatal resuscitations could inform provider training, enhance real-time decision support, and improve the design of delivery rooms and neonatal intensive care units (NICUs). Current approaches to quantifying neonatal providers' gaze rely on manual coding or simulations, which limit scalability and utility. Here, we introduce an automated, real-time, deep learning approach capable of decoding provider gaze into semantic classes directly from first-person point-of-view videos recorded during live resuscitations. Combining state-of-the-art, real-time segmentation with vision-language models (CLIP), our low-shot pipeline attains 91\% classification accuracy in identifying gaze targets without training. Upon fine-tuning, the performance of our gaze-guided vision transformer exceeds 98\% accuracy in gaze classification, approaching human-level precision. This system, capable of real-time inference, enables objective quantification of provider attention dynamics during live neonatal resuscitation. Our approach offers a scalable solution that seamlessly integrates with existing infrastructure for data-scarce gaze analysis, thereby offering new opportunities for understanding and refining clinical decision making.

Prospective Learning: Back to the Future

Research on both natural intelligence (NI) and artificial intelligence (AI) generally assumes that the future resembles the past: intelligent agents or systems (what we call 'intelligence') observe and act on the world, then use this experience to act on future experiences of the same kind. We call this 'retrospective learning'. For example, an intelligence may see a set of pictures of objects, along with their names, and learn to name them. A retrospective learning intelligence would merely be able to name more pictures of the same objects. We argue that this is not what true intelligence is about. In many real world problems, both NIs and AIs will have to learn for an uncertain future. Both must update their internal models to be useful for future tasks, such as naming fundamentally new objects and using these objects effectively in a new context or to achieve previously unencountered goals. This ability to learn for the future we call 'prospective learning'. We articulate four relevant factors that jointly define prospective learning. Continual learning enables intelligences to remember those aspects of the past which it believes will be most useful in the future. Prospective constraints (including biases and priors) facilitate the intelligence finding general solutions that will be applicable to future problems. Curiosity motivates taking actions that inform future decision making, including in previously unmet situations. Causal estimation enables learning the structure of relations that guide choosing actions for specific outcomes, even when the specific action-outcome contingencies have never been observed before. We argue that a paradigm shift from retrospective to prospective learning will enable the communities that study intelligence to unite and overcome existing bottlenecks to more effectively explain, augment, and engineer intelligences.