OBJECTIVE: To develop an electronic medical record (EMR) data processing tool that confers clinical context to machine learning (ML) algorithms for error handling, bias mitigation, and interpretability. MATERIALS AND METHODS: We present Trust-MAPS, an algorithm that translates clinical domain knowledge into high-dimensional, mixed-integer programming models that capture physiological and biological constraints on clinical measurements. EMR data are projected onto this constrained space, effectively bringing outliers to fall within a physiologically feasible range. We then compute the distance of each data point from the constrained space modeling healthy physiology to quantify deviation from the norm. These distances, termed "trust-scores," are integrated into the feature space for downstream ML applications. We demonstrate the utility of Trust-MAPS by training a binary classifier for early sepsis prediction on data from the 2019 PhysioNet Computing in Cardiology Challenge, using the XGBoost algorithm and applying SMOTE for overcoming class-imbalance. RESULTS: The Trust-MAPS framework shows desirable behavior in handling potential errors and boosting predictive performance. We achieve an area under the receiver operating characteristic curve of 0.91 (95% CI, 0.89-0.92) for predicting sepsis 6 hours before onset-a marked 15% improvement over a baseline model trained without Trust-MAPS. DISCUSSIONS: Downstream classification performance improves after Trust-MAPS preprocessing, highlighting the bias reducing capabilities of the error-handling projections. Trust-scores emerge as clinically meaningful features that not only boost predictive performance for clinical decision support tasks but also lend interpretability to ML models. CONCLUSION: This work is the first to translate clinical domain knowledge into mathematical constraints, model cross-vital dependencies, and identify aberrations in high-dimensional medical data. Our method allows for error handling in EMR and confers interpretability and superior predictive power to models trained for clinical decision support.

Optimization algorithms such as projected Newton's method, FISTA, mirror descent and its variants enjoy near-optimal regret bounds and convergence rates, but suffer from a computational bottleneck of computing ``projections" in potentially each iteration (e.g., $O(T^{1/2})$ regret of online mirror descent). On the other hand, conditional gradient variants solve a linear optimization in each iteration, but result in suboptimal rates (e.g., $O(T^{3/4})$ regret of online Frank-Wolfe). Motivated by this trade-off in runtime v/s convergence rates, we consider iterative projections of close-by points over widely-prevalent submodular base polytopes $B(f)$. We develop a toolkit to speed up the computation of projections using both discrete and continuous perspectives. We subsequently adapt the away-step Frank-Wolfe algorithm to use this information and enable early termination. For the special case of cardinality based submodular polytopes, we improve the runtime of computing certain Bregman projections by a factor of $\Omega(n/\log(n))$. Our theoretical results show orders of magnitude reduction in runtime in preliminary computational experiments.

Descent directions such as movement towards Frank-Wolfe vertices, away steps, in-face away steps and pairwise directions have been an important design consideration in conditional gradient descent (CGD) variants. In this work, we attempt to demystify the impact of movement in these directions towards attaining constrained minimizers. The best local direction of descent is the directional derivative of the projection of the gradient, which we refer to as the "shadow" of the gradient. We show that the continuous-time dynamics of moving in the shadow are equivalent to those of PGD however non-trivial to discretize. By projecting gradients in PGD, one not only ensures feasibility but also is able to "wrap" around the convex region. We show that Frank-Wolfe (FW) vertices in fact recover the maximal wrap one can obtain by projecting gradients, thus providing a new perspective to these steps. We also claim that the shadow steps give the best direction of descent emanating from the convex hull of all possible away-vertices. Opening up the PGD movements in terms of shadow steps gives linear convergence, dependent on the number of faces. We combine these insights into a novel Shadow-CG method that uses FW steps (i.e., wrap around the polytope) and shadow steps (i.e., optimal local descent direction), while enjoying linear convergence. Our analysis develops properties of directional derivatives of projections (which may be of independent interest), while providing a unifying view of various descent directions in the CGD literature.