ECG-FM: An Open Electrocardiogram Foundation Model

The electrocardiogram (ECG) is a ubiquitous diagnostic test. Conventional task-specific ECG analysis models require large numbers of expensive ECG annotations or associated labels to train. Transfer learning techniques have been shown to improve generalization and reduce reliance on labeled data. We present ECG-FM, an open foundation model for ECG analysis, and conduct a comprehensive study performed on a dataset of 1.66 million ECGs sourced from both publicly available and private institutional sources. ECG-FM adopts a transformer-based architecture and is pretrained on 2.5 million samples using ECG-specific augmentations and contrastive learning, as well as a continuous signal masking objective. Our transparent evaluation includes a diverse range of downstream tasks, where we predict ECG interpretation labels, reduced left ventricular ejection fraction, and abnormal cardiac troponin. Affirming ECG-FM's effectiveness as a foundation model, we demonstrate how its command of contextual information results in strong performance, rich pretrained embeddings, and reliable interpretability. Due to a lack of open-weight practices, we highlight how ECG analysis is lagging behind other medical machine learning subfields in terms of foundation model adoption. Our code is available at https://github.com/bowang-lab/ECG-FM/.

GLEAMS: Bridging the Gap Between Local and Global Explanations

The explainability of machine learning algorithms is crucial, and numerous methods have emerged recently. Local, post-hoc methods assign an attribution score to each feature, indicating its importance for the prediction. However, these methods require recalculating explanations for each example. On the other side, while there exist global approaches they often produce explanations that are either overly simplistic and unreliable or excessively complex. To bridge this gap, we propose GLEAMS, a novel method that partitions the input space and learns an interpretable model within each sub-region, thereby providing both faithful local and global surrogates. We demonstrate GLEAMS' effectiveness on both synthetic and real-world data, highlighting its desirable properties and human-understandable insights.

Hard to Explain: On the Computational Hardness of In-Distribution Model Interpretation

The ability to interpret Machine Learning (ML) models is becoming increasingly essential. However, despite significant progress in the field, there remains a lack of rigorous characterization regarding the innate interpretability of different models. In an attempt to bridge this gap, recent work has demonstrated that it is possible to formally assess interpretability by studying the computational complexity of explaining the decisions of various models. In this setting, if explanations for a particular model can be obtained efficiently, the model is considered interpretable (since it can be explained ``easily''). However, if generating explanations over an ML model is computationally intractable, it is considered uninterpretable. Prior research identified two key factors that influence the complexity of interpreting an ML model: (i) the type of the model (e.g., neural networks, decision trees, etc.); and (ii) the form of explanation (e.g., contrastive explanations, Shapley values, etc.). In this work, we claim that a third, important factor must also be considered for this analysis -- the underlying distribution over which the explanation is obtained. Considering the underlying distribution is key in avoiding explanations that are socially misaligned, i.e., convey information that is biased and unhelpful to users. We demonstrate the significant influence of the underlying distribution on the resulting overall interpretation complexity, in two settings: (i) prediction models paired with an external out-of-distribution (OOD) detector; and (ii) prediction models designed to inherently generate socially aligned explanations. Our findings prove that the expressiveness of the distribution can significantly influence the overall complexity of interpretation, and identify essential prerequisites that a model must possess to generate socially aligned explanations.

Counterfactual Explanations with Probabilistic Guarantees on their Robustness to Model Change

Counterfactual explanations (CFEs) guide users on how to adjust inputs to machine learning models to achieve desired outputs. While existing research primarily addresses static scenarios, real-world applications often involve data or model changes, potentially invalidating previously generated CFEs and rendering user-induced input changes ineffective. Current methods addressing this issue often support only specific models or change types, require extensive hyperparameter tuning, or fail to provide probabilistic guarantees on CFE robustness to model changes. This paper proposes a novel approach for generating CFEs that provides probabilistic guarantees for any model and change type, while offering interpretable and easy-to-select hyperparameters. We establish a theoretical framework for probabilistically defining robustness to model change and demonstrate how our BetaRCE method directly stems from it. BetaRCE is a post-hoc method applied alongside a chosen base CFE generation method to enhance the quality of the explanation beyond robustness. It facilitates a transition from the base explanation to a more robust one with user-adjusted probability bounds. Through experimental comparisons with baselines, we show that BetaRCE yields robust, most plausible, and closest to baseline counterfactual explanations.

Intuitionistic Fuzzy Cognitive Maps for Interpretable Image Classification

The interpretability of machine learning models is critical, as users may be reluctant to rely on their inferences. Intuitionistic FCMs (iFCMs) have been proposed as an extension of FCMs offering a natural mechanism to assess the quality of their output through the estimation of hesitancy, a concept resembling to human hesitation in decision making. To address the challenge of interpretable image classification, this paper introduces a novel framework, named Interpretable Intuitionistic FCM (I2FCM) which is domain-independent, simple to implement, and can be applied on Convolutional Neural Network (CNN) models, rendering them interpretable. To the best of our knowledge this is the first time iFCMs are applied for image classification. Further novel contributions include: a feature extraction process focusing on the most informative image regions; a learning algorithm for data-driven determination of the intuitionistic fuzzy interconnections of the iFCM; an inherently interpretable classification approach based on image contents. In the context of image classification, hesitancy is considered as a degree of inconfidence with which an image is categorized to a class. The constructed iFCM model distinguishes the most representative image semantics and analyses them utilizing cause-and-effect relations. The effectiveness of the introduced framework is evaluated on publicly available datasets, and the experimental results confirm that it can provide enhanced classification performance, while providing interpretable inferences.

Early Risk Assessment Model for ICA Timing Strategy in Unstable Angina Patients Using Multi-Modal Machine Learning

Background: Invasive coronary arteriography (ICA) is recognized as the gold standard for diagnosing cardiovascular diseases, including unstable angina (UA). The challenge lies in determining the optimal timing for ICA in UA patients, balancing the need for revascularization in high-risk patients against the potential complications in low-risk ones. Unlike myocardial infarction, UA does not have specific indicators like ST-segment deviation or cardiac enzymes, making risk assessment complex. Objectives: Our study aims to enhance the early risk assessment for UA patients by utilizing machine learning algorithms. These algorithms can potentially identify patients who would benefit most from ICA by analyzing less specific yet related indicators that are challenging for human physicians to interpret. Methods: We collected data from 640 UA patients at Shanghai General Hospital, including medical history and electrocardiograms (ECG). Machine learning algorithms were trained using multi-modal demographic characteristics including clinical risk factors, symptoms, biomarker levels, and ECG features extracted by pre-trained neural networks. The goal was to stratify patients based on their revascularization risk. Additionally, we translated our models into applicable and explainable look-up tables through discretization for practical clinical use. Results: The study achieved an Area Under the Curve (AUC) of $0.719 \pm 0.065$ in risk stratification, significantly surpassing the widely adopted GRACE score's AUC of $0.579 \pm 0.044$. Conclusions: The results suggest that machine learning can provide superior risk stratification for UA patients. This improved stratification could help in balancing the risks, costs, and complications associated with ICA, indicating a potential shift in clinical assessment practices for unstable angina.

RT-Surv: Improving Mortality Prediction After Radiotherapy with Large Language Model Structuring of Large-Scale Unstructured Electronic Health Records

Accurate patient selection is critical in radiotherapy (RT) to prevent ineffective treatments. Traditional survival prediction models, relying on structured data, often lack precision. This study explores the potential of large language models (LLMs) to structure unstructured electronic health record (EHR) data, thereby improving survival prediction accuracy through comprehensive clinical information integration. Data from 34,276 patients treated with RT at Yonsei Cancer Center between 2013 and 2023 were analyzed, encompassing both structured and unstructured data. An open-source LLM was used to structure the unstructured EHR data via single-shot learning, with its performance compared against a domain-specific medical LLM and a smaller variant. Survival prediction models were developed using statistical, machine learning, and deep learning approaches, incorporating both structured and LLM-structured data. Clinical experts evaluated the accuracy of the LLM-structured data. The open-source LLM achieved 87.5% accuracy in structuring unstructured EHR data without additional training, significantly outperforming the domain-specific medical LLM, which reached only 35.8% accuracy. Larger LLMs were more effective, particularly in extracting clinically relevant features like general condition and disease extent, which closely correlated with patient survival. Incorporating LLM-structured clinical features into survival prediction models significantly improved accuracy, with the C-index of deep learning models increasing from 0.737 to 0.820. These models also became more interpretable by emphasizing clinically significant factors. This study shows that general-domain LLMs, even without specific medical training, can effectively structure large-scale unstructured EHR data, substantially enhancing the accuracy and interpretability of clinical predictive models.

SegXAL: Explainable Active Learning for Semantic Segmentation in Driving Scene Scenarios

Most of the sophisticated AI models utilize huge amounts of annotated data and heavy training to achieve high-end performance. However, there are certain challenges that hinder the deployment of AI models "in-the-wild" scenarios, i.e., inefficient use of unlabeled data, lack of incorporation of human expertise, and lack of interpretation of the results. To mitigate these challenges, we propose a novel Explainable Active Learning (XAL) model, XAL-based semantic segmentation model "SegXAL", that can (i) effectively utilize the unlabeled data, (ii) facilitate the "Human-in-the-loop" paradigm, and (iii) augment the model decisions in an interpretable way. In particular, we investigate the application of the SegXAL model for semantic segmentation in driving scene scenarios. The SegXAL model proposes the image regions that require labeling assistance from Oracle by dint of explainable AI (XAI) and uncertainty measures in a weakly-supervised manner. Specifically, we propose a novel Proximity-aware Explainable-AI (PAE) module and Entropy-based Uncertainty (EBU) module to get an Explainable Error Mask, which enables the machine teachers/human experts to provide intuitive reasoning behind the results and to solicit feedback to the AI system via an active learning strategy. Such a mechanism bridges the semantic gap between man and machine through collaborative intelligence, where humans and AI actively enhance each other's complementary strengths. A novel high-confidence sample selection technique based on the DICE similarity coefficient is also presented within the SegXAL framework. Extensive quantitative and qualitative analyses are carried out in the benchmarking Cityscape dataset. Results show the outperformance of our proposed SegXAL against other state-of-the-art models.

2D-OOB: Attributing Data Contribution through Joint Valuation Framework

Data valuation has emerged as a powerful framework to quantify the contribution of each datum to the training of a particular machine learning model. However, it is crucial to recognize that the quality of various cells within a single data point can vary greatly in practice. For example, even in the case of an abnormal data point, not all cells are necessarily noisy. The single scalar valuation assigned by existing methods blurs the distinction between noisy and clean cells of a data point, thereby compromising the interpretability of the valuation. In this paper, we propose 2D-OOB, an out-of-bag estimation framework for jointly determining helpful (or detrimental) samples, as well as the particular cells that drive them. Our comprehensive experiments demonstrate that 2D-OOB achieves state-of-the-art performance across multiple use cases, while being exponentially faster. 2D-OOB excels in detecting and rectifying fine-grained outliers at the cell level, as well as localizing backdoor triggers in data poisoning attacks.

Improving Large Language Model (LLM) fidelity through context-aware grounding: A systematic approach to reliability and veracity

As Large Language Models (LLMs) become increasingly sophisticated and ubiquitous in natural language processing (NLP) applications, ensuring their robustness, trustworthiness, and alignment with human values has become a critical challenge. This paper presents a novel framework for contextual grounding in textual models, with a particular emphasis on the Context Representation stage. Our approach aims to enhance the reliability and ethical alignment of these models through a comprehensive, context-aware methodology. By explicitly capturing and representing relevant situational, cultural, and ethical contexts in a machine-readable format, we lay the foundation for anchoring a model's behavior within these contexts. Our approach leverages techniques from knowledge representation and reasoning, such as ontologies, semantic web technologies, and logic-based formalisms. We evaluate our framework on real-world textual datasets, demonstrating its effectiveness in improving model performance, fairness, and alignment with human expectations, while maintaining high accuracy. Furthermore, we discuss the other key components of the framework, including context-aware encoding, context-aware learning, interpretability and explainability, and continuous monitoring and adaptation. This research contributes to the growing body of work on responsible AI, offering a practical approach to developing more reliable, trustworthy, and ethically-aligned language models. Our findings have significant implications for the deployment of LLMs in sensitive domains such as healthcare, legal systems, and social services, where contextual understanding is paramount.