IMPORTANCE Women are underdiagnosed and undertreated for cardiovascular disease. Automatic quantification of breast arterial calcification on screening mammography can identify women at risk for cardiovascular disease and enable earlier treatment and management of disease. OBJECTIVE To determine whether artificial-intelligence based automatic quantification of BAC from screening mammograms predicts cardiovascular disease and mortality in a large, racially diverse, multi-institutional population, both independently and beyond traditional risk factors and ASCVD scores. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 116,135 women from two healthcare systems (Emory Healthcare and Mayo Clinic Enterprise) who had screening mammograms and either experienced a major adverse cardiovascular event, death, or had at least 5 years of clinical follow-up. BAC was quantified using a novel transformer-based neural network architecture for semantic segmentation. BAC severity was categorized into four groups (no BAC, mild, moderate, and severe), with outcomes assessed using Kaplan-Meier analysis and Cox proportional-hazards models. MAIN OUTCOMES AND MEASURES Major Adverse Cardiovascular Events (MACE), including acute myocardial infarction, stroke, heart failure, and all-cause mortality, adjusted for traditional risk factors and Atherosclerotic CVD (ASCVD) risk scores. RESULTS BAC severity was independently associated with MACE after adjusting for cardiovascular risk factors, with increasing hazard ratios from mild (HR 1.18-1.22),

Peer review is crucial for advancing and improving science through constructive criticism. However, toxic feedback can discourage authors and hinder scientific progress. This work explores an important but underexplored area: detecting toxicity in peer reviews. We first define toxicity in peer reviews across four distinct categories and curate a dataset of peer reviews from the OpenReview platform, annotated by human experts according to these definitions. Leveraging this dataset, we benchmark a variety of models, including a dedicated toxicity detection model, a sentiment analysis model, several open-source large language models (LLMs), and two closed-source LLMs. Our experiments explore the impact of different prompt granularities, from coarse to fine-grained instructions, on model performance. Notably, state-of-the-art LLMs like GPT-4 exhibit low alignment with human judgments under simple prompts but achieve improved alignment with detailed instructions. Moreover, the model's confidence score is a good indicator of better alignment with human judgments. For example, GPT-4 achieves a Cohen's Kappa score of 0.56 with human judgments, which increases to 0.63 when using only predictions with a confidence score higher than 95%. Overall, our dataset and benchmarks underscore the need for continued research to enhance toxicity detection capabilities of LLMs. By addressing this issue, our work aims to contribute to a healthy and responsible environment for constructive academic discourse and scientific collaboration.

The integration of Large Language Models (LLMs) into the healthcare domain has the potential to significantly enhance patient care and support through the development of empathetic, patient-facing chatbots. This study investigates an intriguing question Can ChatGPT respond with a greater degree of empathy than those typically offered by physicians? To answer this question, we collect a de-identified dataset of patient messages and physician responses from Mayo Clinic and generate alternative replies using ChatGPT. Our analyses incorporate novel empathy ranking evaluation (EMRank) involving both automated metrics and human assessments to gauge the empathy level of responses. Our findings indicate that LLM-powered chatbots have the potential to surpass human physicians in delivering empathetic communication, suggesting a promising avenue for enhancing patient care and reducing professional burnout. The study not only highlights the importance of empathy in patient interactions but also proposes a set of effective automatic empathy ranking metrics, paving the way for the broader adoption of LLMs in healthcare.

Automated classification of cancer pathology reports can extract information from unstructured reports and categorize each report into structured diagnosis and severity categories. Thus, such system can reduce the burden for populating tumor registries, help registration for clinical trial as well as developing large dataset for deep learning model development using true pathologic ground truth. However, the content of breast pathology reports can be difficult for categorize due to the high linguistic variability in content and wide variety of potential diagnoses >50. Existing NLP models are primarily focused on developing classifier for primary breast cancer types (e.g. IDC, DCIS, ILC) and tumor characteristics, and ignore the rare diagnosis of cancer subtypes. We then developed a hierarchical hybrid transformer-based pipeline (59 labels) - Hierarchical Classification System for Breast Cancer Specimen Report (HCSBC), which utilizes the potential of the transformer context-preserving NLP technique and compared our model to several state of the art ML and DL models. We trained the model on the EUH data and evaluated our model's performance on two external datasets - MGH and Mayo Clinic. We publicly release the code and a live application under Huggingface spaces repository

Although deep learning models for abnormality classification can perform well in screening mammography, the demographic, imaging, and clinical characteristics associated with increased risk of model failure remain unclear. This retrospective study uses the Emory BrEast Imaging Dataset(EMBED) containing mammograms from 115931 patients imaged at Emory Healthcare between 2013-2020, with BI-RADS assessment, region of interest coordinates for abnormalities, imaging features, pathologic outcomes, and patient demographics. Multiple deep learning models were trained to distinguish between abnormal tissue patches and randomly selected normal tissue patches from screening mammograms. We assessed model performance by subgroups defined by age, race, pathologic outcome, tissue density, and imaging characteristics and investigated their associations with false negatives (FN) and false positives (FP). We also performed multivariate logistic regression to control for confounding between subgroups. The top-performing model, ResNet152V2, achieved accuracy of 92.6%(95%CI=92.0-93.2%), and AUC 0.975(95%CI=0.972-0.978). Before controlling for confounding, nearly all subgroups showed statistically significant differences in model performance. However, after controlling for confounding, we found lower FN risk associates with Other race(RR=0.828;p=.050), biopsy-proven benign lesions(RR=0.927;p=.011), and mass(RR=0.921;p=.010) or asymmetry(RR=0.854;p=.040); higher FN risk associates with architectural distortion (RR=1.037;p<.001). Higher FP risk associates to BI-RADS density C(RR=1.891;p<.001) and D(RR=2.486;p<.001). Our results demonstrate subgroup analysis is important in mammogram classifier performance evaluation, and controlling for confounding between subgroups elucidates the true associations between variables and model failure. These results can help guide developing future breast cancer detection models.

In this work, we study a natural nonparametric estimator of the transition probability matrices of a finite controlled Markov chain. We consider an offline setting with a fixed dataset, collected using a so-called logging policy. We develop sample complexity bounds for the estimator and establish conditions for minimaxity. Our statistical bounds depend on the logging policy through its mixing properties. We show that achieving a particular statistical risk bound involves a subtle and interesting trade-off between the strength of the mixing properties and the number of samples. We demonstrate the validity of our results under various examples, such as ergodic Markov chains, weakly ergodic inhomogeneous Markov chains, and controlled Markov chains with non-stationary Markov, episodic, and greedy controls. Lastly, we use these sample complexity bounds to establish concomitant ones for offline evaluation of stationary Markov control policies.

Migraine is a high-prevalence and disabling neurological disorder. However, information migraine management in real-world settings could be limited to traditional health information sources. In this paper, we (i) verify that there is substantial migraine-related chatter available on social media (Twitter and Reddit), self-reported by migraine sufferers; (ii) develop a platform-independent text classification system for automatically detecting self-reported migraine-related posts, and (iii) conduct analyses of the self-reported posts to assess the utility of social media for studying this problem. We manually annotated 5750 Twitter posts and 302 Reddit posts. Our system achieved an F1 score of 0.90 on Twitter and 0.93 on Reddit. Analysis of information posted by our 'migraine cohort' revealed the presence of a plethora of relevant information about migraine therapies and patient sentiments associated with them. Our study forms the foundation for conducting an in-depth analysis of migraine-related information using social media data.

Measures to predict 30-day readmission are considered an important quality factor for hospitals as accurate predictions can reduce the overall cost of care by identifying high risk patients before they are discharged. While recent deep learning-based studies have shown promising empirical results on readmission prediction, several limitations exist that may hinder widespread clinical utility, such as (a) only patients with certain conditions are considered, (b) existing approaches do not leverage data temporality, (c) individual admissions are assumed independent of each other, which is unrealistic, (d) prior studies are usually limited to single source of data and single center data. To address these limitations, we propose a multimodal, modality-agnostic spatiotemporal graph neural network (MM-STGNN) for prediction of 30-day all-cause hospital readmission that fuses multimodal in-patient longitudinal data. By training and evaluating our methods using longitudinal chest radiographs and electronic health records from two independent centers, we demonstrate that MM-STGNN achieves AUROC of 0.79 on both primary and external datasets. Furthermore, MM-STGNN significantly outperforms the current clinical reference standard, LACE+ score (AUROC=0.61), on the primary dataset. For subset populations of patients with heart and vascular disease, our model also outperforms baselines on predicting 30-day readmission (e.g., 3.7 point improvement in AUROC in patients with heart disease). Lastly, qualitative model interpretability analysis indicates that while patients' primary diagnoses were not explicitly used to train the model, node features crucial for model prediction directly reflect patients' primary diagnoses. Importantly, our MM-STGNN is agnostic to node feature modalities and could be utilized to integrate multimodal data for triaging patients in various downstream resource allocation tasks.

Obtaining enough labeled data to robustly train complex discriminative models is a major bottleneck in the machine learning pipeline. A popular solution is combining multiple sources of weak supervision using generative models. The structure of these models affects the quality of the training labels, but is difficult to learn without any ground truth labels. We instead rely on weak supervision sources having some structure by virtue of being encoded programmatically. We present Coral, a paradigm that infers generative model structure by statically analyzing the code for these heuristics, thus significantly reducing the amount of data required to learn structure.

We propose a deep learning model - Probabilistic Prognostic Estimates of Survival in Metastatic Cancer Patients (PPES-Met) for estimating short-term life expectancy (3 months) of the patients by analyzing free-text clinical notes in the electronic medical record, while maintaining the temporal visit sequence. In a single framework, we integrated semantic data mapping and neural embedding technique to produce a text processing method that extracts relevant information from heterogeneous types of clinical notes in an unsupervised manner, and we designed a recurrent neural network to model the temporal dependency of the patient visits. The model was trained on a large dataset (10,293 patients) and validated on a separated dataset (1818 patients). Our method achieved an area under the ROC curve (AUC) of 0.89. To provide explain-ability, we developed an interactive graphical tool that may improve physician understanding of the basis for the model's predictions. The high accuracy and explain-ability of the PPES-Met model may enable our model to be used as a decision support tool to personalize metastatic cancer treatment and provide valuable assistance to the physicians.