drug discovery. Most existing drug repurposing studies using real-world patient data often treat the entire population as homogeneous, ignoring the heterogeneity of treatment responses across patient subgroups. This approach may overlook promising drugs that benefit specific subgroups but lack notable treatment effects across the entire population, potentially limiting the number of repurposable candidates identified. To address this, we introduce STEDR, a novel drug repurposing framework that integrates subgroup analysis with treatment effect estimation. Our approach first identifies repurposing candidates by emulating multiple clinical trials on real-world patient data and then characterizes patient subgroups by learning subgroup-specific treatment effects. We deploy STEDR to Alzheimer's Disease (AD), a condition with few approved drugs and known heterogeneity in treatment responses. We emulate trials for over one thousand medications on a large-scale real-world database covering over 8 million patients, identifying 14 drug candidates with beneficial effects to AD in characterized subgroups. Experiments demonstrate STEDR's superior capability in identifying repurposing candidates compared to existing approaches. Additionally, our method can characterize clinically relevant patient subgroups associated with important AD-related risk factors, paving the way for precision drug repurposing.

Precise estimation of treatment effects is crucial for accurately evaluating the intervention. While deep learning models have exhibited promising performance in learning counterfactual representations for treatment effect estimation (TEE), a major limitation in most of these models is that they often overlook the diversity of treatment effects across potential subgroups that have varying treatment effects and characteristics, treating the entire population as a homogeneous group. This limitation restricts the ability to precisely estimate treatment effects and provide targeted treatment recommendations. In this paper, we propose a novel treatment effect estimation model, named SubgroupTE, which incorporates subgroup identification in TEE. SubgroupTE identifies heterogeneous subgroups with different responses and more precisely estimates treatment effects by considering subgroup-specific treatment effects in the estimation process. In addition, we introduce an expectation-maximization (EM)-based training process that iteratively optimizes estimation and subgrouping networks to improve both estimation and subgroup identification. Comprehensive experiments on the synthetic and semi-synthetic datasets demonstrate the outstanding performance of SubgroupTE compared to the existing works for treatment effect estimation and subgrouping models. Additionally, a real-world study demonstrates the capabilities of SubgroupTE in enhancing targeted treatment recommendations for patients with opioid use disorder (OUD) by incorporating subgroup identification with treatment effect estimation.

Treatment effect estimation (TEE) is the task of determining the impact of various treatments on patient outcomes. Current TEE methods fall short due to reliance on limited labeled data and challenges posed by sparse and high-dimensional observational patient data. To address the challenges, we introduce a novel pre-training and fine-tuning framework, KG-TREAT, which synergizes large-scale observational patient data with biomedical knowledge graphs (KGs) to enhance TEE. Unlike previous approaches, KG-TREAT constructs dual-focus KGs and integrates a deep bi-level attention synergy method for in-depth information fusion, enabling distinct encoding of treatment-covariate and outcome-covariate relationships. KG-TREAT also incorporates two pre-training tasks to ensure a thorough grounding and contextualization of patient data and KGs. Evaluation on four downstream TEE tasks shows KG-TREAT’s superiority over existing methods, with an average improvement of 7% in Area under the ROC Curve (AUC) and 9% in Influence Function-based Precision of Estimating Heterogeneous Effects (IF-PEHE). The effectiveness of our estimated treatment effects is further affirmed by alignment with established randomized clinical trial findings.

We introduce MMMU: a new benchmark designed to evaluate multimodal models on massive multi-discipline tasks demanding college-level subject knowledge and deliberate reasoning. MMMU includes 11.5K meticulously collected multimodal questions from college exams, quizzes, and text-books, covering six core disciplines: Art & Design, Busi-ness, Science, Health & Medicine, Humanities & Social Science, and Tech & Engineering. These questions span 30 subjects and 183 subfields, comprising 30 highly het-erogeneous image types, such as charts, diagrams, maps, tables, music sheets, and chemical structures. Unlike existing benchmarks, MMMU focuses on advanced perception and reasoning with domain-specific knowledge, challenging models to perform tasks akin to those faced by experts. The evaluation of 28 open-source LMMs as well as the propri-etary GPT-4V(ision) and Gemini highlights the substantial challenges posed by MMMU. Even the advanced GPT-4V and Gemini Ultra only achieve accuracies of 56% and 59% respectively, indicating significant room for improvement. We believe MMMU will stimulate the community to build next-generation multimodal foundation models towards expert artificial general intelligence.

Deep learning models have demonstrated promising results in estimating treatment effects (TEE). However, most of them overlook the variations in treatment outcomes among subgroups with distinct characteristics. This limitation hinders their ability to provide accurate estimations and treatment recommendations for specific subgroups. In this study, we introduce a novel neural network-based framework, named SubgroupTE, which incorporates subgroup identification and treatment effect estimation. SubgroupTE identifies diverse subgroups and simultaneously estimates treatment effects for each subgroup, improving the treatment effect estimation by considering the heterogeneity of treatment responses. Comparative experiments on synthetic data show that SubgroupTE outperforms existing models in treatment effect estimation. Furthermore, experiments on a real-world dataset related to opioid use disorder (OUD) demonstrate the potential of our approach to enhance personalized treatment recommendations for OUD patients.

Despite intense efforts in basic and clinical research, an individualized ventilation strategy for critically ill patients remains a major challenge. Recently, dynamic treatment regime (DTR) with reinforcement learning (RL) on electronic health records (EHR) has attracted interest from both the healthcare industry and machine learning research community. However, most learned DTR policies might be biased due to the existence of confounders. Although some treatment actions non-survivors received may be helpful, if confounders cause the mortality, the training of RL models guided by long-term outcomes (e.g., 90-day mortality) would punish those treatment actions causing the learned DTR policies to be suboptimal. In this study, we develop a new deconfounding actor-critic network (DAC) to learn optimal DTR policies for patients. To alleviate confounding issues, we incorporate a patient resampling module and a confounding balance module into our actor-critic framework. To avoid punishing the effective treatment actions non-survivors received, we design a short-term reward to capture patients' immediate health state changes. Combining short-term with long-term rewards could further improve the model performance. Moreover, we introduce a policy adaptation method to successfully transfer the learned model to new-source small-scale datasets. The experimental results on one semi-synthetic and two different real-world datasets show the proposed model outperforms the state-of-the-art models. The proposed model provides individualized treatment decisions for mechanical ventilation that could improve patient outcomes.

Estimating the individual treatment effect (ITE) from observational data is meaningful and practical in healthcare. Existing work mainly relies on the strong ignorability assumption that no hidden confounders exist, which may lead to bias in estimating causal effects. Some studies considering the hidden confounders are designed for static environment and not easily adaptable to a dynamic setting. In fact, most observational data (e.g., electronic medical records) is naturally dynamic and consists of sequential information. In this paper, we propose Deep Sequential Weighting (DSW) for estimating ITE with time-varying confounders. Specifically, DSW infers the hidden confounders by incorporating the current treatment assignments and historical information using a deep recurrent weighting neural network. The learned representations of hidden confounders combined with current observed data are leveraged for potential outcome and treatment predictions. We compute the time-varying inverse probabilities of treatment for re-weighting the population. We conduct comprehensive comparison experiments on fully-synthetic, semi-synthetic and real-world datasets to evaluate the performance of our model and baselines. Results demonstrate that our model can generate unbiased and accurate treatment effect by conditioning both time-varying observed and hidden confounders, paving the way for personalized medicine.

Sepsis is a heterogeneous clinical syndrome that is the leading cause of mortality in hospital intensive care units (ICUs). Identification of sepsis subphenotypes may allow for more precise treatments and lead to more targeted clinical interventions. Recently, sepsis subtyping on electronic health records (EHRs) has attracted interest from healthcare researchers. However, most sepsis subtyping studies ignore the temporality of EHR data and suffer from missing values. In this paper, we propose a new sepsis subtyping framework to address the two issues. Our subtyping framework consists of a novel Time-Aware Multi-modal auto-Encoder (TAME) model which introduces time-aware attention mechanism and incorporates multi-modal inputs (e.g., demographics, diagnoses, medications, lab tests and vital signs) to impute missing values, a dynamic time wrapping (DTW) method to measure patients' temporal similarity based on the imputed EHR data, and a weighted k-means algorithm to cluster patients. Comprehensive experiments on real-world datasets show TAME outperforms the baselines on imputation accuracy. After analyzing TAME-imputed EHR data, we identify four novel subphenotypes of sepsis patients, paving the way for improved personalization of sepsis management.

BACKGROUND: Drug-disease associations provide important information for the drug discovery. Wet experiments that identify drug-disease associations are time-consuming and expensive. However, many drug-disease associations are still unobserved or unknown. The development of computational methods for predicting unobserved drug-disease associations is an important and urgent task. RESULTS: In this paper, we proposed a similarity constrained matrix factorization method for the drug-disease association prediction (SCMFDD), which makes use of known drug-disease associations, drug features and disease semantic information. SCMFDD projects the drug-disease association relationship into two low-rank spaces, which uncover latent features for drugs and diseases, and then introduces drug feature-based similarities and disease semantic similarity as constraints for drugs and diseases in low-rank spaces. Different from the classic matrix factorization technique, SCMFDD takes the biological context of the problem into account. In computational experiments, the proposed method can produce high-accuracy performances on benchmark datasets, and outperform existing state-of-the-art prediction methods when evaluated by five-fold cross validation and independent testing. CONCLUSION: We developed a user-friendly web server by using known associations collected from the CTD database, available at http://www.bioinfotech.cn/SCMFDD/ . The case studies show that the server can find out novel associations, which are not included in the CTD database.