MORE-CLEAR: Multimodal Offline Reinforcement learning for Clinical notes Leveraged Enhanced State Representation

Sepsis, a life-threatening inflammatory response to infection, causes organ dysfunction, making early detection and optimal management critical. Previous reinforcement learning (RL) approaches to sepsis management rely primarily on structured data, such as lab results or vital signs, and on a dearth of a comprehensive understanding of the patient's condition. In this work, we propose a Multimodal Offline REinforcement learning for Clinical notes Leveraged Enhanced stAte Representation (MORE-CLEAR) framework for sepsis control in intensive care units. MORE-CLEAR employs pre-trained large-scale language models (LLMs) to facilitate the extraction of rich semantic representations from clinical notes, preserving clinical context and improving patient state representation. Gated fusion and cross-modal attention allow dynamic weight adjustment in the context of time and the effective integration of multimodal data. Extensive cross-validation using two public (MIMIC-III and MIMIC-IV) and one private dataset demonstrates that MORE-CLEAR significantly improves estimated survival rate and policy performance compared to single-modal RL approaches. To our knowledge, this is the first to leverage LLM capabilities within a multimodal offline RL for better state representation in medical applications. This approach can potentially expedite the treatment and management of sepsis by enabling reinforcement learning models to propose enhanced actions based on a more comprehensive understanding of patient conditions.

Spatio-Temporal Split Learning for Privacy-Preserving Medical Platforms: Case Studies with COVID-19 CT, X-Ray, and Cholesterol Data

Machine learning requires a large volume of sample data, especially when it is used in high-accuracy medical applications. However, patient records are one of the most sensitive private information that is not usually shared among institutes. This paper presents spatio-temporal split learning, a distributed deep neural network framework, which is a turning point in allowing collaboration among privacy-sensitive organizations. Our spatio-temporal split learning presents how distributed machine learning can be efficiently conducted with minimal privacy concerns. The proposed split learning consists of a number of clients and a centralized server. Each client has only has one hidden layer, which acts as the privacy-preserving layer, and the centralized server comprises the other hidden layers and the output layer. Since the centralized server does not need to access the training data and trains the deep neural network with parameters received from the privacy-preserving layer, privacy of original data is guaranteed. We have coined the term, spatio-temporal split learning, as multiple clients are spatially distributed to cover diverse datasets from different participants, and we can temporally split the learning process, detaching the privacy preserving layer from the rest of the learning process to minimize privacy breaches. This paper shows how we can analyze the medical data whilst ensuring privacy using our proposed multi-site spatio-temporal split learning algorithm on Coronavirus Disease-19 (COVID-19) chest Computed Tomography (CT) scans, MUsculoskeletal RAdiographs (MURA) X-ray images, and cholesterol levels.