In cross-silo Federated Learning (FL), client selection is critical to ensure high model performance, yet it remains challenging due to data quality decompensation, budget constraints, and incentive compatibility. As training progresses, these factors exacerbate client heterogeneity and degrade global performance. Most existing approaches treat these challenges in isolation, making jointly optimizing multiple factors difficult. To address this, we propose Shapley-Bid Reputation Optimized Federated Learning (SBRO-FL), a unified framework integrating dynamic bidding, reputation modeling, and cost-aware selection. Clients submit bids based on their perceived data quality, and their contributions are evaluated using Shapley values to quantify their marginal impact on the global model. A reputation system, inspired by prospect theory, captures historical performance while penalizing inconsistency. The client selection problem is formulated as a 0-1 integer program that maximizes reputation-weighted utility under budget constraints. Experiments on FashionMNIST, EMNIST, CIFAR-10, and SVHN datasets show that SBRO-FL improves accuracy, convergence speed, and robustness, even in adversarial and low-bid interference scenarios. Our results highlight the importance of balancing data reliability, incentive compatibility, and cost efficiency to enable scalable and trustworthy FL deployments.
We present an end-to-end deep learning framework for automated liver cirrhosis stage estimation from multi-sequence MRI. Cirrhosis is the severe scarring (fibrosis) of the liver and a common endpoint of various chronic liver diseases. Early diagnosis is vital to prevent complications such as decompensation and cancer, which significantly decreases life expectancy. However, diagnosing cirrhosis in its early stages is challenging, and patients often present with life-threatening complications. Our approach integrates multi-scale feature learning with sequence-specific attention mechanisms to capture subtle tissue variations across cirrhosis progression stages. Using CirrMRI600+, a large-scale publicly available dataset of 628 high-resolution MRI scans from 339 patients, we demonstrate state-of-the-art performance in three-stage cirrhosis classification. Our best model achieves 72.8% accuracy on T1W and 63.8% on T2W sequences, significantly outperforming traditional radiomics-based approaches. Through extensive ablation studies, we show that our architecture effectively learns stage-specific imaging biomarkers. We establish new benchmarks for automated cirrhosis staging and provide insights for developing clinically applicable deep learning systems. The source code will be available at https://github.com/JunZengz/CirrhosisStage.
Models that can predict the occurrence of events ahead of time with low false-alarm rates are critical to the acceptance of decision support systems in the medical community. This challenging task is typically treated as a simple binary classification, ignoring temporal dependencies between samples, whereas we propose to exploit this structure. We first introduce a common theoretical framework unifying dynamic survival analysis and early event prediction. Following an analysis of objectives from both fields, we propose Temporal Label Smoothing (TLS), a simpler, yet best-performing method that preserves prediction monotonicity over time. By focusing the objective on areas with a stronger predictive signal, TLS improves performance over all baselines on two large-scale benchmark tasks. Gains are particularly notable along clinically relevant measures, such as event recall at low false-alarm rates. TLS reduces the number of missed events by up to a factor of two over previously used approaches in early event prediction.
Respiratory complications due to coronavirus disease COVID-19 have claimed tens of thousands of lives in 2020. Many cases of COVID-19 escalate from Severe Acute Respiratory Syndrome (SARS-CoV-2) to viral pneumonia to acute respiratory distress syndrome (ARDS) to death. Extracorporeal membranous oxygenation (ECMO) is a life-sustaining oxygenation and ventilation therapy that may be used for patients with severe ARDS when mechanical ventilation is insufficient to sustain life. While early planning and surgical cannulation for ECMO can increase survival, clinicians report the lack of a risk score hinders these efforts. In this work, we leverage machine learning techniques to develop the PEER score, used to highlight critically ill patients with viral or unspecified pneumonia at high risk of mortality or decompensation in a subpopulation eligible for ECMO. The PEER score is validated on two large, publicly available critical care databases and predicts mortality at least as well as other existing risk scores. Stratifying our cohorts into low-risk and high-risk groups, we find that the high-risk group also has a higher proportion of decompensation indicators such as vasopressor and ventilator use. Finally, the PEER score is provided in the form of a nomogram for direct calculation of patient risk, and can be used to highlight at-risk patients among critical care patients eligible for ECMO.
Progress of machine learning in critical care has been difficult to track, in part due to absence of public benchmarks. Other fields of research (such as computer vision and natural language processing) have established various competitions and public benchmarks. Recent availability of large clinical datasets has enabled the possibility of establishing public benchmarks. Taking advantage of this opportunity, we propose a public benchmark suite to address four areas of critical care, namely mortality prediction, estimation of length of stay, patient phenotyping and risk of decompensation. We define each task and compare the performance of both clinical models as well as baseline and deep learning models using eICU critical care dataset of around 73,000 patients. This is the first public benchmark on a multi-centre critical care dataset, comparing the performance of clinical gold standard with our predictive model. We also investigate the impact of numerical variables as well as handling of categorical variables on each of the defined tasks. The source code, detailing our methods and experiments is publicly available such that anyone can replicate our results and build upon our work.
Monitoring patients in ICU is a challenging and high-cost task. Hence, predicting the condition of patients during their ICU stay can help provide better acute care and plan the hospital's resources. There has been continuous progress in machine learning research for ICU management, and most of this work has focused on using time series signals recorded by ICU instruments. In our work, we show that adding clinical notes as another modality improves the performance of the model for three benchmark tasks: in-hospital mortality prediction, modeling decompensation, and length of stay forecasting that play an important role in ICU management. While the time-series data is measured at regular intervals, doctor notes are charted at irregular times, making it challenging to model them together. We propose a method to model them jointly, achieving considerable improvement across benchmark tasks over baseline time-series model. Our implementation can be found at \url{https://github.com/kaggarwal/ClinicalNotesICU}.