Federated Learning (FL) enables collaborative clinical modelling across distributed electronic health records (EHRs) without sharing sensitive patient data. However, variations in medical practice, documentation standards, and data collection across institutions create data-view heterogeneity, where clients possess different or only partially overlapping clinical feature sets. This misalignment hinders the use of standard FL methods. Existing approaches rely on complex preprocessing and manual harmonisation, which can cause information loss, reduce data utility, limit scalability, and restrict client-specific personalisation. To address these limitations, we propose Personalised Attention-based Federated Graph Network (PAFNet), a scalable FL framework that enables meaningful parameter exchange across heterogeneous clients by mapping their distinct data-views into a shared latent space through client-specific projection layers. It then applies a personalised adaptation mechanism using trainable parameter masks, allowing each client to selectively incorporate global model parameters relevant to its own feature set. This design preserves local specificity, improves generalisation, and removes the need for heavy manual preprocessing common in existing approaches. Across CURIAL, eICU, and MIMIC-III datasets, PAFNet consistently outperformed state-of-the-art data-view heterogeneity FL baselines, demonstrating strong generalisation under substantial differences in client feature sets. By enabling effective personalisation and cross-institutional knowledge sharing without extensive harmonisation, PAFNet offers a robust and scalable solution for the federated training of clinical models in data-view heterogeneous environments.

While machine learning algorithms hold promise for personalised medicine, their clinical adoption remains limited, partly due to biases that can compromise the reliability of predictions. In this article, we focus on sample selection bias (SSB), a specific type of bias where the study population is less representative of the target population, leading to biased and potentially harmful decisions. Despite being well-known in the literature, SSB remains scarcely studied in machine learning for healthcare. Moreover, the existing machine learning techniques try to correct the bias mostly by balancing distributions between the study and the target populations, which may result in a loss of predictive performance. To address these problems, our study illustrates the potential risks associated with SSB by examining SSB’s impact on the performance of machine learning algorithms. Most importantly, we propose a new research direction for addressing SSB, based on the target population identification rather than the bias correction. Specifically, we propose two independent networks (T-Net) and a multitasking network (MT-Net) for addressing SSB, where one network/task identifies the target subpopulation which is representative of the study population and the second makes predictions for the identified subpopulation. Our empirical results with synthetic and semi-synthetic datasets highlight that SSB can lead to a large drop in the performance of an algorithm for the target population as compared with the study population, as well as a substantial difference in the performance for the target subpopulations that are representative of the selected and the non-selected patients from the study population. Furthermore, our proposed techniques demonstrate robustness across various settings, including different dataset sizes, event rates and selection rates, outperforming the existing bias correction techniques.

Given radiology images, automatic radiology report generation aims to produce informative text that reports diseases. It can benefit current clinical practice in diagnostic radiology. Existing methods typically rely on large-scale medical datasets annotated by clinicians to train desirable models. However, for novel diseases, sufficient training data are typically not available. We propose a prompt-based deep learning framework, i.e., PromptLLM, to align, autoencode, and prompt the (large) language model to generate reports for novel diseases accurately and efficiently. Our method includes three major steps: 1) aligning visual images and textual reports to learn general knowledge across modalities from diseases where labeled data are sufficient, 2) autoencoding the LLM using unlabeled data of novel diseases to learn the specific knowledge and writing styles of the novel disease, and 3) prompting the LLM with learned knowledge and writing styles to report the novel diseases contained in the radiology images. Through the above three steps, with limited labels on novel diseases, we show that PromptLLM can rapidly learn the corresponding knowledge for accurate novel disease reporting. The experiments on COVID-19 and diverse thorax diseases show that our approach, utilizing 1% of the training data, achieves desirable performance compared to previous methods. It shows that our approach allows us to relax the reliance on labeled data that is common to existing methods. It could have a real-world impact on data analysis during the early stages of novel diseases.

Wearable cuffless blood pressure (BP) technology is emerging as a critical tool for monitoring hypertension, the leading risk factor of most cardiovascular diseases. However, current cuffless BP methods are not accurate enough for clinical use, because they mainly use single or dual modalities/features as inputs for estimation. To address this challenge, we propose multimodal McBP-Net, built with hybrid CNN-LSTM architecture combing two-layer convolution operations with four-layer LSTMs to capture both local signal features and temporal dependencies for continuous dynamic beat-to-beat BP estimation. The McBP-Net includes photoplethysmographic, electrocardiographic, impedanceplethysmographic (IPG), and skin temperature (ST) signals as inputs. Validated on 23 subjects undergoing cold pressor test to induce large BP variability, the McBP-Net achieves the mean absolute errors of 4.19 and 2.98 mmHg for systolic BP (SBP) and diastolic BP (DBP), respectively, which fall within the accuracy range required by the Grade A of IEEE standard. The integration of four multimodal signals improves performance by 16.20%, 37.37%, and 49.52% over three-, dual-, and single-modality approaches, respectively, with significant contributions from IPG and ST signals. Notably, ST shows a strong nonlinear relationship with BP with high mutual information of 0.9056 for SBP. Furthermore, McBP-Net achieves a reasonable balance between accuracy and computational efficiency, offering inference speed of 36.7% faster and reducing computational demands by 78% compared to transformer-based models tested. Importantly, it maintains robust performance, with only a 0.21 mmHg degradation in dynamic SBP estimation when trained on rest-stage data. McBP-Net demonstrates promising potential in medical-grade wearable cuffless dynamic BP measurements.

Fenglin Liu, Zheng Li, Hongjian Zhou, Qingyu Yin, Jingfeng Yang, Xianfeng Tang, Chen Luo, Ming Zeng, Haoming Jiang, Yifan Gao, Priyanka Nigam, Sreyashi Nag, Bing Yin, Yining Hua, Xuan Zhou, Omid Rohanian, Anshul Thakur, Lei Clifton, David A. Clifton. Proceedings of the 2024 Conference on Empirical Methods in Natural Language Processing. 2024.

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Abstract Specialised pre-trained language models are becoming more frequent in Natural language Processing (NLP) since they can potentially outperform models trained on generic texts. BioBERT (Sanh et al., Distilbert, a distilled version of bert: smaller, faster, cheaper and lighter. arXiv preprint arXiv: 1910.01108, 2019) and BioClinicalBERT (Alsentzer et al., Publicly available clinical bert embeddings. In Proceedings of the 2nd Clinical Natural Language Processing Workshop, pp. 72–78, 2019) are two examples of such models that have shown promise in medical NLP tasks. Many of these models are overparametrised and resource-intensive, but thanks to techniques like knowledge distillation, it is possible to create smaller versions that perform almost as well as their larger counterparts. In this work, we specifically focus on development of compact language models for processing clinical texts (i.e. progress notes, discharge summaries, etc). We developed a number of efficient lightweight clinical transformers using knowledge distillation and continual learning, with the number of parameters ranging from $15$ million to $65$ million. These models performed comparably to larger models such as BioBERT and ClinicalBioBERT and significantly outperformed other compact models trained on general or biomedical data. Our extensive evaluation was done across several standard datasets and covered a wide range of clinical text-mining tasks, including natural language inference, relation extraction, named entity recognition and sequence classification. To our knowledge, this is the first comprehensive study specifically focused on creating efficient and compact transformers for clinical NLP tasks. The models and code used in this study can be found on our Huggingface profile at https://huggingface.co/nlpie and Github page at https://github.com/nlpie-research/Lightweight-Clinical-Transformers , respectively, promoting reproducibility of our results.

The design of neural networks typically involves trial-and-error, a time-consuming process for obtaining an optimal architecture, even for experienced researchers. Additionally, it is widely accepted that loss functions of deep neural networks are generally non-convex with respect to the parameters to be optimised. We propose the Layer-wise Convex Theorem to ensure that the loss is convex with respect to the parameters of a given layer, achieved by constraining each layer to be an overdetermined system of non-linear equations. Based on this theorem, we developed an end-to-end algorithm (the AutoNet) to automatically generate layer-wise convex networks (LCNs) for any given training set. We then demonstrate the performance of the AutoNet-generated LCNs (AutoNet-LCNs) compared to state-of-the-art models on three electrocardiogram (ECG) classification benchmark datasets, with further validation on two non-ECG benchmark datasets for more general tasks. The AutoNet-LCN was able to find networks customised for each dataset without manual fine-tuning under 2 GPU-hours, and the resulting networks outperformed the state-of-the-art models with fewer than 5% parameters on all the above five benchmark datasets. The efficiency and robustness of the AutoNet-LCN markedly reduce model discovery costs and enable efficient training of deep learning models in resource-constrained settings.

The majority of patients in the hospital are ambulatory and would benefit significantly from predictive and personalized monitoring systems. Such patients are well suited to having their physiological condition monitored using low-power, minimally intrusive wearable sensors. Despite data-collection systems now being manufactured commercially, allowing physiological data to be acquired from mobile patients, little work has been undertaken on the use of the resultant data in a principled manner for robust patient care, including predictive monitoring. Most current devices generate so many false-positive alerts that devices cannot be used for routine clinical practice. This paper explores principled machine learning approaches to interpreting large quantities of continuously acquired, multivariate physiological data, using wearable patient monitors, where the goal is to provide early warning of serious physiological determination, such that a degree of predictive care may be provided. We adopt a one-class support vector machine formulation, proposing a formulation for determining the free parameters of the model using partial area under the ROC curve, a method arising from the unique requirements of performing online analysis with data from patient-worn sensors. There are few clinical evaluations of machine learning techniques in the literature, so we present results from a study at the Oxford University Hospitals NHS Trust devised to investigate the large-scale clinical use of patient-worn sensors for predictive monitoring in a ward with a high incidence of patient mortality. We show that our system can combine routine manual observations made by clinical staff with the continuous data acquired from wearable sensors. Practical considerations and recommendations based on our experiences of this clinical study are discussed, in the context of a framework for personalized monitoring.

Novelty detection, or one-class classification, is of particular use in the analysis of high-integrity systems, in which examples of failure are rare in comparison with the number of examples of stable behaviour, such that a conventional multi-class classification approach cannot be taken. Support Vector Machines (SVMs) are a popular means of performing novelty detection, and it is conventional practice to use a train-validate-test approach, often involving cross-validation, to train the one-class SVM, and then select appropriate values for its parameters. An alternative method, used with multi-class SVMs, is to calibrate the SVM output into conditional class probabilities. A probabilistic approach offers many advantages over the conventional method, including the facility to select automatically a probabilistic novelty threshold. The contributions of this paper are (i) the development of a probabilistic calibration technique for one-class SVMs, such that on-line novelty detection may be performed in a probabilistic manner; and (ii) the demonstration of the advantages of the proposed method (in comparison to the conventional one-class SVM methodology) using case studies, in which one-class probabilistic SVMs are used to perform condition monitoring of a high-integrity industrial combustion plant, and in detecting deterioration in patient physiological condition during patient vital-sign monitoring.

We consider an integrated patient monitoring system, combining electronic patient records with high-rate acquisition of patient physiological data. There remain many challenges in increasing the robustness of "e-health" applications to a level at which they are clinically useful, particularly in the use of automated algorithms used to detect and cope with artifact in data contained within the electronic patient record, and in analyzing and communicating the resultant data for reporting to clinicians. There is a consequential "plague of pilots," in which engineering prototype systems do not enter into clinical use. This paper describes an approach in which, for the first time, the Emergency Department (ED) of a major research hospital has adopted such systems for use during a large clinical trial. We describe the disadvantages of existing evaluation metrics when applied to such large trials, and propose a solution suitable for large-scale validation. We demonstrate that machine learning technologies embedded within healthcare information systems can provide clinical benefit, with the potential to improve patient outcomes in the busy environment of a major ED and other high-dependence areas of patient care.

Hospital patient outcomes can be improved by the early identification of physiological deterioration. Automatic methods of detecting patient deterioration in vital-sign data typically attempt to identify deviations from assumed normal physiological conditions, which is a one-class approach to classification. This paper investigates the use of a two-class approach, in which abnormal physiology is modelled explicitly. The success of such a method relies on the accuracy of data labels provided by clinical experts, which may be incomplete (due to large dataset size) or imprecise (due to clinical labels covering intervals, rather than each data point within those intervals). We propose a novel method of refining clinical labels such that the two-class classification approach may be adopted for identifying patient deterioration. We demonstrate the effectiveness of the proposed methods using a large dataset acquired in a 24-bed hospital step-down unit.