Stress is a pervasive global health issue that can lead to severe mental health problems. Early detection offers timely intervention and prevention of stress-related disorders. The current early detection models perform "black box" inference suffering from limited explainability and trust which blocks the real-world clinical application. Thanks to the generative properties introduced by the Large Language Models (LLMs), the decision and the prediction from such models are semi-interpretable through the corresponding description. However, the existing LLMs are mostly trained for general purposes without the guidance of psychological cognitive theory. To this end, we first highlight the importance of prior theory with the observation of performance boosted by the chain-of-thoughts tailored for stress detection. This method termed Cognition Chain explicates the generation of stress through a step-by-step cognitive perspective based on cognitive appraisal theory with a progress pipeline: Stimulus $\rightarrow$ Evaluation $\rightarrow$ Reaction $\rightarrow$ Stress State, guiding LLMs to provide comprehensive reasoning explanations. We further study the benefits brought by the proposed Cognition Chain format by utilising it as a synthetic dataset generation template for LLMs instruction-tuning and introduce CogInstruct, an instruction-tuning dataset for stress detection. This dataset is developed using a three-stage self-reflective annotation pipeline that enables LLMs to autonomously generate and refine instructional data. By instruction-tuning Llama3 with CogInstruct, we develop CogLLM, an explainable stress detection model. Evaluations demonstrate that CogLLM achieves outstanding performance while enhancing explainability. Our work contributes a novel approach by integrating cognitive theories into LLM reasoning processes, offering a promising direction for future explainable AI research.

Effective training of large Vision-Language Models (VLMs) on resource-constrained client devices in Federated Learning (FL) requires the usage of parameter-efficient fine-tuning (PEFT) strategies. To this end, we demonstrate the impact of two factors \textit{viz.}, client-specific layer importance score that selects the most important VLM layers for fine-tuning and inter-client layer diversity score that encourages diverse layer selection across clients for optimal VLM layer selection. We first theoretically motivate and leverage the principal eigenvalue magnitude of layerwise Neural Tangent Kernels and show its effectiveness as client-specific layer importance score. Next, we propose a novel layer updating strategy dubbed F$^3$OCUS that jointly optimizes the layer importance and diversity factors by employing a data-free, multi-objective, meta-heuristic optimization on the server. We explore 5 different meta-heuristic algorithms and compare their effectiveness for selecting model layers and adapter layers towards PEFT-FL. Furthermore, we release a new MedVQA-FL dataset involving overall 707,962 VQA triplets and 9 modality-specific clients and utilize it to train and evaluate our method. Overall, we conduct more than 10,000 client-level experiments on 6 Vision-Language FL task settings involving 58 medical image datasets and 4 different VLM architectures of varying sizes to demonstrate the effectiveness of the proposed method.

Large AI models trained on audio data may have the potential to rapidly classify patients, enhancing medical decision-making and potentially improving outcomes through early detection. Existing technologies depend on limited datasets using expensive recording equipment in high-income, English-speaking countries. This challenges deployment in resource-constrained, high-volume settings where audio data may have a profound impact. This report introduces a novel data type and a corresponding collection system that captures health data through guided questions using only a mobile/web application. This application ultimately results in an audio electronic health record (voice EHR) which may contain complex biomarkers of health from conventional voice/respiratory features, speech patterns, and language with semantic meaning - compensating for the typical limitations of unimodal clinical datasets. This report introduces a consortium of partners for global work, presents the application used for data collection, and showcases the potential of informative voice EHR to advance the scalability and diversity of audio AI.

The entry of large language models (LLMs) into research and commercial spaces has led to a trend of ever-larger models, with initial promises of generalisability, followed by a widespread desire to downsize and create specialised models without the need for complete fine-tuning, using Parameter Efficient Fine-tuning (PEFT) methods. We present an investigation into the suitability of different PEFT methods to clinical decision-making tasks, across a range of model sizes, including extremely small models with as few as $25$ million parameters. Our analysis shows that the performance of most PEFT approaches varies significantly from one task to another, with the exception of LoRA, which maintains relatively high performance across all model sizes and tasks, typically approaching or matching full fine-tuned performance. The effectiveness of PEFT methods in the clinical domain is evident, particularly for specialised models which can operate on low-cost, in-house computing infrastructure. The advantages of these models, in terms of speed and reduced training costs, dramatically outweighs any performance gain from large foundation LLMs. Furthermore, we highlight how domain-specific pre-training interacts with PEFT methods and model size, and discuss how these factors interplay to provide the best efficiency-performance trade-off. Full code available at: tbd.

Processing information locked within clinical health records is a challenging task that remains an active area of research in biomedical NLP. In this work, we evaluate a broad set of machine learning techniques ranging from simple RNNs to specialised transformers such as BioBERT on a dataset containing clinical notes along with a set of annotations indicating whether a sample is cancer-related or not. Furthermore, we specifically employ efficient fine-tuning methods from NLP, namely, bottleneck adapters and prompt tuning, to adapt the models to our specialised task. Our evaluations suggest that fine-tuning a frozen BERT model pre-trained on natural language and with bottleneck adapters outperforms all other strategies, including full fine-tuning of the specialised BioBERT model. Based on our findings, we suggest that using bottleneck adapters in low-resource situations with limited access to labelled data or processing capacity could be a viable strategy in biomedical text mining. The code used in the experiments are going to be made available at https://github.com/omidrohanian/bottleneck-adapters.

External validation is often recommended to ensure the generalizability of ML models. However, it neither guarantees generalizability nor equates to a model's clinical usefulness (the ultimate goal of any clinical decision-support tool). External validation is misaligned with current healthcare ML needs. First, patient data changes across time, geography, and facilities. These changes create significant volatility in the performance of a single fixed model (especially for deep learning models, which dominate clinical ML). Second, newer ML techniques, current market forces, and updated regulatory frameworks are enabling frequent updating and monitoring of individual deployed model instances. We submit that external validation is insufficient to establish ML models' safety or utility. Proposals to fix the external validation paradigm do not go far enough. Continued reliance on it as the ultimate test is likely to lead us astray. We propose the MLOps-inspired paradigm of recurring local validation as an alternative that ensures the validity of models while protecting against performance-disruptive data variability. This paradigm relies on site-specific reliability tests before every deployment, followed by regular and recurrent checks throughout the life cycle of the deployed algorithm. Initial and recurrent reliability tests protect against performance-disruptive distribution shifts, and concept drifts that jeopardize patient safety.

Early detection of COVID-19 is an ongoing area of research that can help with triage, monitoring and general health assessment of potential patients and may reduce operational strain on hospitals that cope with the coronavirus pandemic. Different machine learning techniques have been used in the literature to detect coronavirus using routine clinical data (blood tests, and vital signs). Data breaches and information leakage when using these models can bring reputational damage and cause legal issues for hospitals. In spite of this, protecting healthcare models against leakage of potentially sensitive information is an understudied research area. In this work, we examine two machine learning approaches, intended to predict a patient's COVID-19 status using routinely collected and readily available clinical data. We employ adversarial training to explore robust deep learning architectures that protect attributes related to demographic information about the patients. The two models we examine in this work are intended to preserve sensitive information against adversarial attacks and information leakage. In a series of experiments using datasets from the Oxford University Hospitals, Bedfordshire Hospitals NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, and Portsmouth Hospitals University NHS Trust we train and test two neural networks that predict PCR test results using information from basic laboratory blood tests, and vital signs performed on a patients' arrival to hospital. We assess the level of privacy each one of the models can provide and show the efficacy and robustness of our proposed architectures against a comparable baseline. One of our main contributions is that we specifically target the development of effective COVID-19 detection models with built-in mechanisms in order to selectively protect sensitive attributes against adversarial attacks.

Cardiac signals, such as the electrocardiogram, convey a significant amount of information about the health status of a patient which is typically summarized by a clinician in the form of a clinical report, a cumbersome process that is prone to errors. To streamline this routine process, we propose a deep neural network capable of captioning cardiac signals; it receives a cardiac signal as input and generates a clinical report as output. We extend this further to generate multilingual reports. To that end, we create and make publicly available a multilingual clinical report dataset. In the absence of sufficient labelled data, deep neural networks can benefit from a'warmstart', or pre-training, procedure in which parameters are first learned in an arbitrary task. We propose such a task in the form of discriminative multilingual pre-training where tokens from clinical reports are randomly replaced with those from other languages and the network is tasked with predicting the language of all tokens. We show that our method performs on par with state-of-the-art pre-training methods such as MLM, ELECTRA, and MARGE, while simultaneously generating diverse and plausible clinical reports. We also demonstrate that multilingual models can outperform their monolingual counterparts, informally terming this beneficial phenomenon as the'blessing of multilinguality'.

Accurate and reliable prediction of hospital admission location is important due to resource-constraints and space availability in a clinical setting, particularly when dealing with patients who come from the emergency department. In this work we propose a student-teacher network via reinforcement learning to deal with this specific problem. A representation of the weights of the student network is treated as the state and is fed as an input to the teacher network. The teacher network's action is to select the most appropriate batch of data to train the student network on from a training set sorted according to entropy. By validating on three datasets, not only do we show that our approach outperforms state-of-the-art methods on tabular data and performs competitively on image recognition, but also that novel curricula are learned by the teacher network. We demonstrate experimentally that the teacher network can actively learn about the student network and guide it to achieve better performance than if trained alone.