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Federated learning holds great potential for enabling large-scale healthcare research and collaboration across multiple centres while ensuring data privacy and security are not compromised. Although numerous recent studies suggest or utilize federated learning based methods in healthcare, it remains unclear which ones have potential clinical utility. This review paper considers and analyzes the most recent studies up to May 2024 that describe federated learning based methods in healthcare. After a thorough review, we find that the vast majority are not appropriate for clinical use due to their methodological flaws and/or underlying biases which include but are not limited to privacy concerns, generalization issues, and communication costs. As a result, the effectiveness of federated learning in healthcare is significantly compromised. To overcome these challenges, we provide recommendations and promising opportunities that might be implemented to resolve these problems and improve the quality of model development in federated learning with healthcare.

We argue that the selective inclusion of data points based on latent objectives is common in practical situations, such as music sequences. Since this selection process often distorts statistical analysis, previous work primarily views it as a bias to be corrected and proposes various methods to mitigate its effect. However, while controlling this bias is crucial, selection also offers an opportunity to provide a deeper insight into the hidden generation process, as it is a fundamental mechanism underlying what we observe. In particular, overlooking selection in sequential data can lead to an incomplete or overcomplicated inductive bias in modeling, such as assuming a universal autoregressive structure for all dependencies. Therefore, rather than merely viewing it as a bias, we explore the causal structure of selection in sequential data to delve deeper into the complete causal process. Specifically, we show that selection structure is identifiable without any parametric assumptions or interventional experiments. Moreover, even in cases where selection variables coexist with latent confounders, we still establish the nonparametric identifiability under appropriate structural conditions. Meanwhile, we also propose a provably correct algorithm to detect and identify selection structures as well as other types of dependencies. The framework has been validated empirically on both synthetic data and real-world music., Comment: ICML 2024

The widespread integration of Machine Learning systems in daily life, particularly in high-stakes domains, has raised concerns about the fairness implications. While prior works have investigated static fairness measures, recent studies reveal that automated decision-making has long-term implications and that off-the-shelf fairness approaches may not serve the purpose of achieving long-term fairness. Additionally, the existence of feedback loops and the interaction between models and the environment introduces additional complexities that may deviate from the initial fairness goals. In this survey, we review existing literature on long-term fairness from different perspectives and present a taxonomy for long-term fairness studies. We highlight key challenges and consider future research directions, analyzing both current issues and potential further explorations.

Large language models (LLMs) can easily generate biased and discriminative responses. As LLMs tap into consequential decision-making (e.g., hiring and healthcare), it is of crucial importance to develop strategies to mitigate these biases. This paper focuses on social bias, tackling the association between demographic information and LLM outputs. We propose a causality-guided debiasing framework that utilizes causal understandings of (1) the data-generating process of the training corpus fed to LLMs, and (2) the internal reasoning process of LLM inference, to guide the design of prompts for debiasing LLM outputs through selection mechanisms. Our framework unifies existing de-biasing prompting approaches such as inhibitive instructions and in-context contrastive examples, and sheds light on new ways of debiasing by encouraging bias-free reasoning. Our strong empirical performance on real-world datasets demonstrates that our framework provides principled guidelines on debiasing LLM outputs even with only the black-box access., Comment: 18 pages, 11 figures

Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway trees remains prohibitively time-consuming. While significant efforts have been made towards enhancing airway modelling, current public-available datasets concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023' (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for prognosis, a strong airway-derived biomarker (Hazard ratio>1.5, p<0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers., Comment: 19 pages

We reveal and address the frequently overlooked yet important issue of disguised procedural unfairness, namely, the potentially inadvertent alterations on the behavior of neutral (i.e., not problematic) aspects of data generating process, and/or the lack of procedural assurance of the greatest benefit of the least advantaged individuals. Inspired by John Rawls's advocacy for pure procedural justice, we view automated decision-making as a microcosm of social institutions, and consider how the data generating process itself can satisfy the requirements of procedural fairness. We propose a framework that decouples the objectionable data generating components from the neutral ones by utilizing reference points and the associated value instantiation rule. Our findings highlight the necessity of preventing disguised procedural unfairness, drawing attention not only to the objectionable data generating components that we aim to mitigate, but also more importantly, to the neutral components that we intend to keep unaffected.

Deep learning-based Generative Models have the potential to convert low-resolution CT images into high-resolution counterparts without long acquisition times and increased radiation exposure in thin-slice CT imaging. However, procuring appropriate training data for these Super-Resolution (SR) models is challenging. Previous SR research has simulated thick-slice CT images from thin-slice CT images to create training pairs. However, these methods either rely on simplistic interpolation techniques that lack realism or sinogram reconstruction, which require the release of raw data and complex reconstruction algorithms. Thus, we introduce a simple yet realistic method to generate thick CT images from thin-slice CT images, facilitating the creation of training pairs for SR algorithms. The training pairs produced by our method closely resemble real data distributions (PSNR=49.74 vs. 40.66, p$<$0.05). A multivariate Cox regression analysis involving thick slice CT images with lung fibrosis revealed that only the radiomics features extracted using our method demonstrated a significant correlation with mortality (HR=1.19 and HR=1.14, p$<$0.005). This paper represents the first to identify and address the challenge of generating appropriate paired training data for Deep Learning-based CT SR models, which enhances the efficacy and applicability of SR models in real-world scenarios., Comment: 11 pages, 4 figures

The pursuit of long-term fairness involves the interplay between decision-making and the underlying data generating process. In this paper, through causal modeling with a directed acyclic graph (DAG) on the decision-distribution interplay, we investigate the possibility of achieving long-term fairness from a dynamic perspective. We propose Tier Balancing, a technically more challenging but more natural notion to achieve in the context of long-term, dynamic fairness analysis. Different from previous fairness notions that are defined purely on observed variables, our notion goes one step further, capturing behind-the-scenes situation changes on the unobserved latent causal factors that directly carry out the influence from the current decision to the future data distribution. Under the specified dynamics, we prove that in general one cannot achieve the long-term fairness goal only through one-step interventions. Furthermore, in the effort of approaching long-term fairness, we consider the mission of "getting closer to" the long-term fairness goal and present possibility and impossibility results accordingly.

Discontinuity in the delineation of peripheral bronchioles hinders the potential clinical application of automated airway segmentation models. Moreover, the deployment of such models is limited by the data heterogeneity across different centres, and pathological abnormalities also make achieving accurate robust segmentation in distal small airways difficult. Meanwhile, the diagnosis and prognosis of lung diseases often rely on evaluating structural changes in those anatomical regions. To address this gap, this paper presents a patch-scale adversarial-based refinement network that takes in preliminary segmentation along with original CT images and outputs a refined mask of the airway structure. The method is validated on three different datasets encompassing healthy cases, cases with cystic fibrosis and cases with COVID-19. The results are quantitatively evaluated by seven metrics and achieved more than a 15% rise in detected length ratio and detected branch ratio, showing promising performance compared to previously proposed models. The visual illustration also proves our refinement guided by a patch-scale discriminator and centreline objective functions is effective in detecting discontinuities and missing bronchioles. Furthermore, the generalizability of our refinement pipeline is tested on three previous models and improves their segmentation completeness significantly., Comment: 8 Pages, 7 figures

Airway segmentation is crucial for the examination, diagnosis, and prognosis of lung diseases, while its manual delineation is unduly burdensome. To alleviate this time-consuming and potentially subjective manual procedure, researchers have proposed methods to automatically segment airways from computerized tomography (CT) images. However, some small-sized airway branches (e.g., bronchus and terminal bronchioles) significantly aggravate the difficulty of automatic segmentation by machine learning models. In particular, the variance of voxel values and the severe data imbalance in airway branches make the computational module prone to discontinuous and false-negative predictions. especially for cohorts with different lung diseases. Attention mechanism has shown the capacity to segment complex structures, while fuzzy logic can reduce the uncertainty in feature representations. Therefore, the integration of deep attention networks and fuzzy theory, given by the fuzzy attention layer, should be an escalated solution for better generalization and robustness. This paper presents an efficient method for airway segmentation, comprising a novel fuzzy attention neural network and a comprehensive loss function to enhance the spatial continuity of airway segmentation. The deep fuzzy set is formulated by a set of voxels in the feature map and a learnable Gaussian membership function. Different from the existing attention mechanism, the proposed channel-specific fuzzy attention addresses the issue of heterogeneous features in different channels. Furthermore, a novel evaluation metric is proposed to assess both the continuity and completeness of airway structures. The efficiency, generalization and robustness of the proposed method have been proved by training on normal lung disease while testing on datasets of lung cancer, COVID-19 and pulmonary fibrosis., Comment: 12 pages, 5 figures, Submitted to IEEE TNNLS

Various structures in human physiology follow a treelike morphology, which often expresses complexity at very fine scales. Examples of such structures are intrathoracic airways, retinal blood vessels, and hepatic blood vessels. Large collections of 2D and 3D images have been made available by medical imaging modalities such as magnetic resonance imaging (MRI), computed tomography (CT), Optical coherence tomography (OCT) and ultrasound in which the spatial arrangement can be observed. Segmentation of these structures in medical imaging is of great importance since the analysis of the structure provides insights into disease diagnosis, treatment planning, and prognosis. Manually labelling extensive data by radiologists is often time-consuming and error-prone. As a result, automated or semi-automated computational models have become a popular research field of medical imaging in the past two decades, and many have been developed to date. In this survey, we aim to provide a comprehensive review of currently publicly available datasets, segmentation algorithms, and evaluation metrics. In addition, current challenges and future research directions are discussed., Comment: 30 pages, 19 figures, submitted to CBM journal

Algorithmic fairness has attracted increasing attention in the machine learning community. Various definitions are proposed in the literature, but the differences and connections among them are not clearly addressed. In this paper, we review and reflect on various fairness notions previously proposed in machine learning literature, and make an attempt to draw connections to arguments in moral and political philosophy, especially theories of justice. We also consider fairness inquiries from a dynamic perspective, and further consider the long-term impact that is induced by current prediction and decision. In light of the differences in the characterized fairness, we present a flowchart that encompasses implicit assumptions and expected outcomes of different types of fairness inquiries on the data generating process, on the predicted outcome, and on the induced impact, respectively. This paper demonstrates the importance of matching the mission (which kind of fairness one would like to enforce) and the means (which spectrum of fairness analysis is of interest, what is the appropriate analyzing scheme) to fulfill the intended purpose.

Fairness of machine learning algorithms has been of increasing interest. In order to suppress or eliminate discrimination in prediction, various notions as well as approaches have been proposed to impose fairness. Given a notion of fairness, an essential problem is then whether or not it can always be attained, even if with an unlimited amount of data. This issue is, however, not well addressed yet. In this paper, focusing on the Equalized Odds notion of fairness, we consider the attainability of this criterion and, furthermore, if it is attainable, the optimality of the prediction performance under various settings. In particular, for prediction performed by a deterministic function of input features, we give conditions under which Equalized Odds can hold true; if the stochastic prediction is acceptable, we show that under mild assumptions, fair predictors can always be derived. For classification, we further prove that compared to enforcing fairness by post-processing, one can always benefit from exploiting all available features during training and get potentially better prediction performance while remaining fair. Moreover, while stochastic prediction can attain Equalized Odds with theoretical guarantees, we also discuss its limitation and potential negative social impacts.

The upheaval brought by the arrival of the COVID-19 pandemic has continued to bring fresh challenges over the past two years. During this COVID-19 pandemic, there has been a need for rapid identification of infected patients and specific delineation of infection areas in computed tomography (CT) images. Although deep supervised learning methods have been established quickly, the scarcity of both image-level and pixel-level labels as well as the lack of explainable transparency still hinder the applicability of AI. Can we identify infected patients and delineate the infections with extreme minimal supervision? Semi-supervised learning has demonstrated promising performance under limited labelled data and sufficient unlabelled data. Inspired by semi-supervised learning, we propose a model-agnostic calibrated pseudo-labelling strategy and apply it under a consistency regularization framework to generate explainable identification and delineation results. We demonstrate the effectiveness of our model with the combination of limited labelled data and sufficient unlabelled data or weakly-labelled data. Extensive experiments have shown that our model can efficiently utilize limited labelled data and provide explainable classification and segmentation results for decision-making in clinical routine. The code is available at https://github.com/ayanglab/XAI COVID-19., Comment: 10 pages, 6 figures, IEEE TETCI Accepted

Given an algorithmic predictor that is accurate on some source population consisting of strategic human decision subjects, will it remain accurate if the population respond to it? In our setting, an agent or a user corresponds to a sample $(X,Y)$ drawn from a distribution $\cal{D}$ and will face a model $h$ and its classification result $h(X)$. Agents can modify $X$ to adapt to $h$, which will incur a distribution shift on $(X,Y)$. Our formulation is motivated by applications where the deployed machine learning models are subjected to human agents, and will ultimately face responsive and interactive data distributions. We formalize the discussions of the transferability of a model by studying how the performance of the model trained on the available source distribution (data) would translate to the performance on its induced domain. We provide both upper bounds for the performance gap due to the induced domain shift, as well as lower bounds for the trade-offs that a classifier has to suffer on either the source training distribution or the induced target distribution. We provide further instantiated analysis for two popular domain adaptation settings, including covariate shift and target shift.

Segmentation of cardiac fibrosis and scar are essential for clinical diagnosis and can provide invaluable guidance for the treatment of cardiac diseases. Late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been successful for its efficacy in guiding the clinical diagnosis and treatment reliably. For LGE CMR, many methods have demonstrated success in accurately segmenting scarring regions. Co-registration with other non-contrast-agent (non-CA) modalities, balanced steady-state free precession (bSSFP) and cine magnetic resonance imaging (MRI) for example, can further enhance the efficacy of automated segmentation of cardiac anatomies. Many conventional methods have been proposed to provide automated or semi-automated segmentation of scars. With the development of deep learning in recent years, we can also see more advanced methods that are more efficient in providing more accurate segmentations. This paper conducts a state-of-the-art review of conventional and current state-of-the-art approaches utilising different modalities for accurate cardiac fibrosis and scar segmentation., Comment: 3 figure, 8 tables, 46 pages