Hepatology
Variational Consensus Monte Carlo for Bayesian Mixture
Fendler, Julie, Crowe, Francesca L., Marshall, Tom, Richardson, Sylvia, Kirk, Paul D. W.
Motivated by the privacy, sensitivity and sharing limitations of health data, we present a comprehensive pipeline for inference of Bayesian mixture models within a federated learning setting, i.e. when data cannot be fully shared or pooled across compute nodes. We adopt a Consensus Monte Carlo (CMC) approach, in which an MCMC algorithm is run independently within each data silo to estimate local posterior distributions, which are then aggregated to approximate the posterior over the full data. The variational CMC approach of Rabinovich, Angelino and Jordan (2015) [1] frames the aggregation step as a variational inference problem, but their application to mixtures assumes the number of clusters and key mixture parameters to be known. Our main methodological contributions are: (i) an extension of variational CMC to over-fitted Bayesian mixture models that infer the number of clusters and all model parameters, without requiring conjugacy; (ii) novel cluster-matching algorithms suitable for cross-silo settings in which not every cluster appears in each local dataset; (iii) a number of inference strategies for the aggregation step, matched to different federated learning constraints; and (iv) guidelines for choosing among these in practice. A comprehensive simulation study validates the framework and allows us to compare to state-of-the-art federated learning alternatives. Notably, we show that when the composition of local datasets reflects the underlying clustering structure in the data, our approach can recover small clusters with greater accuracy than standard MCMC applied to the pooled data. We illustrate the framework on large-scale electronic health record data, identifying multi-morbidity patterns in a British geriatric population.
Conformal Risk Prediction for Non-Alcoholic Fatty Liver Disease Using Gradient Boosting with Distribution-Free Coverages
Non-alcoholic fatty liver disease (NAFLD) affects roughly 25% of global adults, posing substantial hepatic and cardiovascular risks. Yet, population-level screening tools remain inadequate. We present Method, a machine-learning framework for NAFLD risk prediction coupling gradient-boosted decision trees with conformal prediction to yield calibrated, distribution-free coverage guarantees on individual risk estimates. It integrates a mutual-information-based stability selection procedure to identify a compact, clinically interpretable feature subset via bootstrap resampling, constructing prediction sets whose marginal coverage provably exceeds a user-specified confidence level. We evaluated Method on a multicenter cohort from Guangzhou, China (primary n=2,187; external validation n=412) using 78 candidate features across demographics, metabolic biomarkers, and lifestyle factors. Method achieves an AUROC of 0.912 internally and 0.891 externally, outperforming deep neural networks, TabNet, support vector machines, and logistic regression. Conformal prediction sets achieve 91.3% empirical coverage at the 90% nominal level. A three-tier risk stratification derived from these scores separates the population into distinct groups, with the high-risk subgroup showing a 12-month progression rate 4.7 times that of the low-risk tier. The selected features -- notably waist circumference, ALT, GGT, triglycerides, fasting glucose, and BMI -- align with established metabolic risk factors, providing biological plausibility.
Sparse Functional Singular Value Decomposition for Biclustering and Triclustering Longitudinal Data
Zhao, Yue, Chekouo, Thierry, Safo, Sandra
Identifying subtypes of complex conditions, such as Inflammatory Bowel Disease (IBD), often requires capturing latent patterns in longitudinal omics data. However, these data are typically high-dimensional, sparsely sampled, and irregularly observed over time, posing substantial challenges for conventional (bi)clustering and functional data analysis methods. We propose Tri-SfSVD, a unified sparse functional Singular Value Decomposition framework for discovering biclusters and triclusters in longitudinal data. Unlike existing functional biclustering methods that rely on ad hoc imputation or enforce restrictive shape-homogeneity assumptions, Tri-SfSVD integrates continuous trajectory estimation with simultaneous subject, feature, and temporal selection within a single optimization framework. By imposing sparse penalties across subjects, variables, and temporal subregions, the proposed method works directly on observed data to uncover localized structures at the subject, subject-feature, and subject-feature-time levels. Extensive simulations demonstrate that Tri-SfSVD outperforms existing approaches in high-dimensional settings. Applied to IBD multi-omics data, the method identified three biclusters linking sample clusters with distinct IBD-related clinical characteristics to microbial pathway groups associated with specific bacterial taxa, providing interpretable subject-pathway associations for characterizing disease heterogeneity. Applied to multi-channel EEG data, the method identified three triclusters linking sample clusters with distinct alcohol-related phenotypes to localized brain activity patterns, including subgroup differences separated by temporal subregions within the same spatial region.
ContextualSHAP : Enhancing SHAP Explanations Through Contextual Language Generation
Dwiyanti, Latifa, Wibisono, Sergio Ryan, Nambo, Hidetaka
Explainable Artificial Intelligence (XAI) has become an increasingly important area of research, particularly as machine learning models are deployed in high-stakes domains. Among various XAI approaches, SHAP (SHapley Additive exPlanations) has gained prominence due to its ability to provide both global and local explanations across different machine learning models. While SHAP effectively visualizes feature importance, it often lacks contextual explanations that are meaningful for end-users, especially those without technical backgrounds. To address this gap, we propose a Python package that extends SHAP by integrating it with a large language model (LLM), specifically OpenAI's GPT, to generate contextualized textual explanations. This integration is guided by user-defined parameters (such as feature aliases, descriptions, and additional background) to tailor the explanation to both the model context and the user perspective. We hypothesize that this enhancement can improve the perceived understandability of SHAP explanations. To evaluate the effectiveness of the proposed package, we applied it in a healthcare-related case study and conducted user evaluations involving real end-users. The results, based on Likert-scale surveys and follow-up interviews, indicate that the generated explanations were perceived as more understandable and contextually appropriate compared to visual-only outputs. While the findings are preliminary, they suggest that combining visualization with contextualized text may support more user-friendly and trustworthy model explanations.
Upstream Probabilistic Meta-Imputation for Multimodal Pediatric Pancreatitis Classification
Nelson, Max A., Keles, Elif, Tasci, Eminenur Sen, Yazol, Merve, Aktas, Halil Ertugrul, Hong, Ziliang, Bejar, Andrea Mia, Durak, Gorkem, Boyunaga, Oznur Leman, Bagci, Ulas
Pediatric pancreatitis is a progressive and debilitating inflammatory condition, including acute pancreatitis and chronic pancreatitis, that presents significant clinical diagnostic challenges. Machine learning-based methods also face diagnostic challenges due to limited sample availability and multimodal imaging complexity. To address these challenges, this paper introduces Upstream Probabilistic Meta-Imputation (UPMI), a light-weight augmentation strategy that operates upstream of a meta-learner in a low-dimensional meta-feature space rather than in image space. Modality-specific logistic regressions (T1W and T2W MRI radiomics) produce probability outputs that are transformed into a 7-dimensional meta-feature vector. Class-conditional Gaussian mixture models (GMMs) are then fit within each cross-validation fold to sample synthetic meta-features that, combined with real meta-features, train a Random Forest (RF) meta-classifier. On 67 pediatric subjects with paired T1W/T2W MRIs, UPMI achieves a mean AUC of 0.908 $\pm$ 0.072, a $\sim$5% relative gain over a real-only baseline (AUC 0.864 $\pm$ 0.061).
Generative Medical Event Models Improve with Scale
Waxler, Shane, Blazek, Paul, White, Davis, Sneider, Daniel, Chung, Kevin, Nagarathnam, Mani, Williams, Patrick, Voeller, Hank, Wong, Karen, Swanhorst, Matthew, Zhang, Sheng, Usuyama, Naoto, Wong, Cliff, Naumann, Tristan, Poon, Hoifung, Loza, Andrew, Meeker, Daniella, Hain, Seth, Shah, Rahul
Realizing personalized medicine at scale calls for methods that distill insights from longitudinal patient journeys, which can be viewed as a sequence of medical events. Foundation models pretrained on large-scale medical event data represent a promising direction for scaling real-world evidence generation and generalizing to diverse downstream tasks. Using Epic Cosmos, a dataset with medical events from de-identified longitudinal health records for 16.3 billion encounters over 300 million unique patient records from 310 health systems, we introduce the Curiosity models, a family of decoder-only transformer models pretrained on 118 million patients representing 115 billion discrete medical events (151 billion tokens). We present the largest scaling-law study of medical event data, establishing a methodology for pretraining and revealing power-law scaling relationships for compute, tokens, and model size. Consequently, we pretrained a series of compute-optimal models with up to 1 billion parameters. Conditioned on a patient's real-world history, Curiosity autoregressively predicts the next medical event to simulate patient health timelines. We studied 78 real-world tasks, including diagnosis prediction, disease prognosis, and healthcare operations. Remarkably for a foundation model with generic pretraining and simulation-based inference, Curiosity generally outperformed or matched task-specific supervised models on these tasks, without requiring task-specific fine-tuning or few-shot examples. Curiosity's predictive power consistently improves as the model and pretraining scale. Our results show that Curiosity, a generative medical event foundation model, can effectively capture complex clinical dynamics, providing an extensible and generalizable framework to support clinical decision-making, streamline healthcare operations, and improve patient outcomes.