arXiv subjects

Yilin Ning

Publications and source records attributed to Yilin Ning.

At least 19 recordsLinked to original sources

arXiv2026

Toward Global Large Language Models in Medicine

Despite continuous advances in medical technology, the global distribution of health care resources remains uneven. The development of large language models (LLMs) has transformed the landscape of medicine and holds promise for improving health care quality and expanding access to medical information globally. However, existing LLMs are primarily trained on high-resource languages, limiting their applicability in global medical scenarios. To address this gap, we constructed GlobMed, a large multilingual medical dataset, containing over 500,000 entries spanning 12 languages, including four low-resource languages. Building on this, we established GlobMed-Bench, which systematically assesses 56 state-of-the-art proprietary and open-weight LLMs across multiple multilingual medical tasks, revealing significant performance disparities across languages, particularly for low-resource languages. Additionally, we introduced GlobMed-LLMs, a suite of multilingual medical LLMs trained on GlobMed, with parameters ranging from 1.7B to 8B. GlobMed-LLMs achieved an average performance improvement of over 40% relative to baseline models, with a more than threefold increase in performance on low-resource languages. Together, these resources provide an important foundation for advancing the equitable development and application of LLMs globally, enabling broader language communities to benefit from technological advances.

cs.CL↗

arXiv2025

Attention-Guided Fair AI Modeling for Skin Cancer Diagnosis

Artificial intelligence (AI) has shown remarkable promise in dermatology, offering accurate and non-invasive diagnosis of skin cancer. While extensive research has addressed skin tone-related bias, gender bias in dermatologic AI remains underexplored, leading to unequal care and reinforcing existing gender disparities. In this study, we developed LesionAttn, a fairness-aware algorithm that integrates clinical knowledge into model design by directing attention toward lesion regions, mirroring the diagnostic focus of clinicians. Combined with Pareto-frontier optimization for dual-objective model selection, LesionAttn balances fairness and predictive accuracy. Validated on two large-scale dermatological datasets, LesionAttn significantly mitigates gender bias while maintaining high diagnostic performance, outperforming existing bias mitigation algorithms. Our study highlights the potential of embedding clinical knowledge into AI development to advance both model performance and fairness, and further to foster interdisciplinary collaboration between clinicians and AI developers.

eess.IV↗

arXiv2025

Equitable Survival Prediction: A Fairness-Aware Survival Modeling (FASM) Approach

As machine learning models become increasingly integrated into healthcare, structural inequities and social biases embedded in clinical data can be perpetuated or even amplified by data-driven models. In survival analysis, censoring and time dynamics can further add complexity to fair model development. Additionally, algorithmic fairness approaches often overlook disparities in cross-group rankings, e.g., high-risk Black patients may be ranked below lower-risk White patients who do not experience the event of mortality. Such misranking can reinforce biological essentialism and undermine equitable care. We propose a Fairness-Aware Survival Modeling (FASM), designed to mitigate algorithmic bias regarding both intra-group and cross-group risk rankings over time. Using breast cancer prognosis as a representative case and applying FASM to SEER breast cancer data, we show that FASM substantially improves fairness while preserving discrimination performance comparable to fairness-unaware survival models. Time-stratified evaluations show that FASM maintains stable fairness over a 10-year horizon, with the greatest improvements observed during the mid-term of follow-up. Our approach enables the development of survival models that prioritize both accuracy and equity in clinical decision-making, advancing fairness as a core principle in clinical care.

cs.LG↗

arXiv2025

Gender Bias in Large Language Models for Healthcare: Assignment Consistency and Clinical Implications

The integration of large language models (LLMs) into healthcare holds promise to enhance clinical decision-making, yet their susceptibility to biases remains a critical concern. Gender has long influenced physician behaviors and patient outcomes, raising concerns that LLMs assuming human-like roles, such as clinicians or medical educators, may replicate or amplify gender-related biases. Using case studies from the New England Journal of Medicine Challenge (NEJM), we assigned genders (female, male, or unspecified) to multiple open-source and proprietary LLMs. We evaluated their response consistency across LLM-gender assignments regarding both LLM-based diagnosis and models' judgments on the clinical relevance or necessity of patient gender. In our findings, diagnoses were relatively consistent across LLM genders for most models. However, for patient gender's relevance and necessity in LLM-based diagnosis, all models demonstrated substantial inconsistency across LLM genders, particularly for relevance judgements. Some models even displayed a systematic female-male disparity in their interpretation of patient gender. These findings present an underexplored bias that could undermine the reliability of LLMs in clinical practice, underscoring the need for routine checks of identity-assignment consistency when interacting with LLMs to ensure reliable and equitable AI-supported clinical care.

cs.CL↗

arXiv2025

seeBias: A Comprehensive Tool for Assessing and Visualizing AI Fairness

Fairness in artificial intelligence (AI) prediction models is increasingly emphasized to support responsible adoption in high-stakes domains such as health care and criminal justice. Guidelines and implementation frameworks highlight the importance of both predictive accuracy and equitable outcomes. However, current fairness toolkits often evaluate classification performance disparities in isolation, with limited attention to other critical aspects such as calibration. To address these gaps, we present seeBias, an R package for comprehensive evaluation of model fairness and predictive performance. seeBias offers an integrated evaluation across classification, calibration, and other performance domains, providing a more complete view of model behavior. It includes customizable visualizations to support transparent reporting and responsible AI implementation. Using public datasets from criminal justice and healthcare, we demonstrate how seeBias supports fairness evaluations, and uncovers disparities that conventional fairness metrics may overlook. The R package is available on GitHub, and a Python version is under development.

cs.LG↗

arXiv2025

Regulatory Science Innovation for Generative AI and Large Language Models in Health and Medicine: A Global Call for Action

The integration of generative AI (GenAI) and large language models (LLMs) in healthcare presents both unprecedented opportunities and challenges, necessitating innovative regulatory approaches. GenAI and LLMs offer broad applications, from automating clinical workflows to personalizing diagnostics. However, the non-deterministic outputs, broad functionalities and complex integration of GenAI and LLMs challenge existing medical device regulatory frameworks, including the total product life cycle (TPLC) approach. Here we discuss the constraints of the TPLC approach to GenAI and LLM-based medical device regulation, and advocate for global collaboration in regulatory science research. This serves as the foundation for developing innovative approaches including adaptive policies and regulatory sandboxes, to test and refine governance in real-world settings. International harmonization, as seen with the International Medical Device Regulators Forum, is essential to manage implications of LLM on global health, including risks of widening health inequities driven by inherent model biases. By engaging multidisciplinary expertise, prioritizing iterative, data-driven approaches, and focusing on the needs of diverse populations, global regulatory science research enables the responsible and equitable advancement of LLM innovations in healthcare.

cs.CY↗

arXiv2024

FairFML: Fair Federated Machine Learning with a Case Study on Reducing Gender Disparities in Cardiac Arrest Outcome Prediction

Objective: Mitigating algorithmic disparities is a critical challenge in healthcare research, where ensuring equity and fairness is paramount. While large-scale healthcare data exist across multiple institutions, cross-institutional collaborations often face privacy constraints, highlighting the need for privacy-preserving solutions that also promote fairness. Materials and Methods: In this study, we present Fair Federated Machine Learning (FairFML), a model-agnostic solution designed to reduce algorithmic bias in cross-institutional healthcare collaborations while preserving patient privacy. As a proof of concept, we validated FairFML using a real-world clinical case study focused on reducing gender disparities in cardiac arrest outcome prediction. Results: We demonstrate that the proposed FairFML framework enhances fairness in federated learning (FL) models without compromising predictive performance. Our findings show that FairFML improves model fairness by up to 65% compared to the centralized model, while maintaining performance comparable to both local and centralized models, as measured by receiver operating characteristic analysis. Discussion and Conclusion: FairFML offers a promising and flexible solution for FL collaborations, with its adaptability allowing seamless integration with various FL frameworks and models, from traditional statistical methods to deep learning techniques. This makes FairFML a robust approach for developing fairer FL models across diverse clinical and biomedical applications.

cs.CY↗

arXiv2024

Bridging Data Gaps in Healthcare: A Scoping Review of Transfer Learning in Biomedical Data Analysis

Clinical and biomedical research in low-resource settings often faces significant challenges due to the need for high-quality data with sufficient sample sizes to construct effective models. These constraints hinder robust model training and prompt researchers to seek methods for leveraging existing knowledge from related studies to support new research efforts. Transfer learning (TL), a machine learning technique, emerges as a powerful solution by utilizing knowledge from pre-trained models to enhance the performance of new models, offering promise across various healthcare domains. Despite its conceptual origins in the 1990s, the application of TL in medical research has remained limited, especially beyond image analysis. In our review of TL applications in structured clinical and biomedical data, we screened 3,515 papers, with 55 meeting the inclusion criteria. Among these, only 2% (one out of 55) utilized external studies, and 7% (four out of 55) addressed scenarios involving multi-site collaborations with privacy constraints. To achieve actionable TL with structured medical data while addressing regional disparities, inequality, and privacy constraints in healthcare research, we advocate for the careful identification of appropriate source data and models, the selection of suitable TL frameworks, and the validation of TL models with proper baselines.

cs.LG↗

arXiv2024

Retrieval-Augmented Generation for Generative Artificial Intelligence in Medicine

Generative artificial intelligence (AI) has brought revolutionary innovations in various fields, including medicine. However, it also exhibits limitations. In response, retrieval-augmented generation (RAG) provides a potential solution, enabling models to generate more accurate contents by leveraging the retrieval of external knowledge. With the rapid advancement of generative AI, RAG can pave the way for connecting this transformative technology with medical applications and is expected to bring innovations in equity, reliability, and personalization to health care.

cs.AI↗

arXiv2024

Towards Clinical AI Fairness: Filling Gaps in the Puzzle

The ethical integration of Artificial Intelligence (AI) in healthcare necessitates addressing fairness-a concept that is highly context-specific across medical fields. Extensive studies have been conducted to expand the technical components of AI fairness, while tremendous calls for AI fairness have been raised from healthcare. Despite this, a significant disconnect persists between technical advancements and their practical clinical applications, resulting in a lack of contextualized discussion of AI fairness in clinical settings. Through a detailed evidence gap analysis, our review systematically pinpoints several deficiencies concerning both healthcare data and the provided AI fairness solutions. We highlight the scarcity of research on AI fairness in many medical domains where AI technology is increasingly utilized. Additionally, our analysis highlights a substantial reliance on group fairness, aiming to ensure equality among demographic groups from a macro healthcare system perspective; in contrast, individual fairness, focusing on equity at a more granular level, is frequently overlooked. To bridge these gaps, our review advances actionable strategies for both the healthcare and AI research communities. Beyond applying existing AI fairness methods in healthcare, we further emphasize the importance of involving healthcare professionals to refine AI fairness concepts and methods to ensure contextually relevant and ethically sound AI applications in healthcare.

cs.AI↗

arXiv2024

Fairness-Aware Interpretable Modeling (FAIM) for Trustworthy Machine Learning in Healthcare

The escalating integration of machine learning in high-stakes fields such as healthcare raises substantial concerns about model fairness. We propose an interpretable framework - Fairness-Aware Interpretable Modeling (FAIM), to improve model fairness without compromising performance, featuring an interactive interface to identify a "fairer" model from a set of high-performing models and promoting the integration of data-driven evidence and clinical expertise to enhance contextualized fairness. We demonstrated FAIM's value in reducing sex and race biases by predicting hospital admission with two real-world databases, MIMIC-IV-ED and SGH-ED. We show that for both datasets, FAIM models not only exhibited satisfactory discriminatory performance but also significantly mitigated biases as measured by well-established fairness metrics, outperforming commonly used bias-mitigation methods. Our approach demonstrates the feasibility of improving fairness without sacrificing performance and provides an a modeling mode that invites domain experts to engage, fostering a multidisciplinary effort toward tailored AI fairness.

cs.LG↗

arXiv2024

Developing Federated Time-to-Event Scores Using Heterogeneous Real-World Survival Data

Survival analysis serves as a fundamental component in numerous healthcare applications, where the determination of the time to specific events (such as the onset of a certain disease or death) for patients is crucial for clinical decision-making. Scoring systems are widely used for swift and efficient risk prediction. However, existing methods for constructing survival scores presume that data originates from a single source, posing privacy challenges in collaborations with multiple data owners. We propose a novel framework for building federated scoring systems for multi-site survival outcomes, ensuring both privacy and communication efficiency. We applied our approach to sites with heterogeneous survival data originating from emergency departments in Singapore and the United States. Additionally, we independently developed local scores at each site. In testing datasets from each participant site, our proposed federated scoring system consistently outperformed all local models, evidenced by higher integrated area under the receiver operating characteristic curve (iAUC) values, with a maximum improvement of 11.6%. Additionally, the federated score's time-dependent AUC(t) values showed advantages over local scores, exhibiting narrower confidence intervals (CIs) across most time points. The model developed through our proposed method exhibits effective performance on each local site, signifying noteworthy implications for healthcare research. Sites participating in our proposed federated scoring model training gained benefits by acquiring survival models with enhanced prediction accuracy and efficiency. This study demonstrates the effectiveness of our privacy-preserving federated survival score generation framework and its applicability to real-world heterogeneous survival data.

cs.AI↗

arXiv2024

Survival modeling using deep learning, machine learning and statistical methods: A comparative analysis for predicting mortality after hospital admission

Survival analysis is essential for studying time-to-event outcomes and providing a dynamic understanding of the probability of an event occurring over time. Various survival analysis techniques, from traditional statistical models to state-of-the-art machine learning algorithms, support healthcare intervention and policy decisions. However, there remains ongoing discussion about their comparative performance. We conducted a comparative study of several survival analysis methods, including Cox proportional hazards (CoxPH), stepwise CoxPH, elastic net penalized Cox model, Random Survival Forests (RSF), Gradient Boosting machine (GBM) learning, AutoScore-Survival, DeepSurv, time-dependent Cox model based on neural network (CoxTime), and DeepHit survival neural network. We applied the concordance index (C-index) for model goodness-of-fit, and integral Brier scores (IBS) for calibration, and considered the model interpretability. As a case study, we performed a retrospective analysis of patients admitted through the emergency department of a tertiary hospital from 2017 to 2019, predicting 90-day all-cause mortality based on patient demographics, clinicopathological features, and historical data. The results of the C-index indicate that deep learning achieved comparable performance, with DeepSurv producing the best discrimination (DeepSurv: 0.893; CoxTime: 0.892; DeepHit: 0.891). The calibration of DeepSurv (IBS: 0.041) performed the best, followed by RSF (IBS: 0.042) and GBM (IBS: 0.0421), all using the full variables. Moreover, AutoScore-Survival, using a minimal variable subset, is easy to interpret, and can achieve good discrimination and calibration (C-index: 0.867; IBS: 0.044). While all models were satisfactory, DeepSurv exhibited the best discrimination and calibration. In addition, AutoScore-Survival offers a more parsimonious model and excellent interpretability.

cs.LG↗

arXiv2024

Generative Artificial Intelligence in Healthcare: Ethical Considerations and Assessment Checklist

The widespread use of ChatGPT and other emerging technology powered by generative artificial intelligence (GenAI) has drawn much attention to potential ethical issues, especially in high-stakes applications such as healthcare, but ethical discussions are yet to translate into operationalisable solutions. Furthermore, ongoing ethical discussions often neglect other types of GenAI that have been used to synthesise data (e.g., images) for research and practical purposes, which resolved some ethical issues and exposed others. We conduct a scoping review of ethical discussions on GenAI in healthcare to comprehensively analyse gaps in the current research, and further propose to reduce the gaps by developing a checklist for comprehensive assessment and transparent documentation of ethical discussions in GenAI research. The checklist can be readily integrated into the current peer review and publication system to enhance GenAI research, and may be used for ethics-related disclosures for GenAI-powered products, healthcare applications of such products and beyond.

cs.LG↗

arXiv2023

Federated Learning for Clinical Structured Data: A Benchmark Comparison of Engineering and Statistical Approaches

Federated learning (FL) has shown promising potential in safeguarding data privacy in healthcare collaborations. While the term "FL" was originally coined by the engineering community, the statistical field has also explored similar privacy-preserving algorithms. Statistical FL algorithms, however, remain considerably less recognized than their engineering counterparts. Our goal was to bridge the gap by presenting the first comprehensive comparison of FL frameworks from both engineering and statistical domains. We evaluated five FL frameworks using both simulated and real-world data. The results indicate that statistical FL algorithms yield less biased point estimates for model coefficients and offer convenient confidence interval estimations. In contrast, engineering-based methods tend to generate more accurate predictions, sometimes surpassing central pooled and statistical FL models. This study underscores the relative strengths and weaknesses of both types of methods, emphasizing the need for increased awareness and their integration in future FL applications.

cs.LG↗

arXiv2023

Towards clinical AI fairness: A translational perspective

Artificial intelligence (AI) has demonstrated the ability to extract insights from data, but the issue of fairness remains a concern in high-stakes fields such as healthcare. Despite extensive discussion and efforts in algorithm development, AI fairness and clinical concerns have not been adequately addressed. In this paper, we discuss the misalignment between technical and clinical perspectives of AI fairness, highlight the barriers to AI fairness' translation to healthcare, advocate multidisciplinary collaboration to bridge the knowledge gap, and provide possible solutions to address the clinical concerns pertaining to AI fairness.

cs.CY↗

arXiv2023

Federated and distributed learning applications for electronic health records and structured medical data: A scoping review

Federated learning (FL) has gained popularity in clinical research in recent years to facilitate privacy-preserving collaboration. Structured data, one of the most prevalent forms of clinical data, has experienced significant growth in volume concurrently, notably with the widespread adoption of electronic health records in clinical practice. This review examines FL applications on structured medical data, identifies contemporary limitations and discusses potential innovations. We searched five databases, SCOPUS, MEDLINE, Web of Science, Embase, and CINAHL, to identify articles that applied FL to structured medical data and reported results following the PRISMA guidelines. Each selected publication was evaluated from three primary perspectives, including data quality, modeling strategies, and FL frameworks. Out of the 1160 papers screened, 34 met the inclusion criteria, with each article consisting of one or more studies that used FL to handle structured clinical/medical data. Of these, 24 utilized data acquired from electronic health records, with clinical predictions and association studies being the most common clinical research tasks that FL was applied to. Only one article exclusively explored the vertical FL setting, while the remaining 33 explored the horizontal FL setting, with only 14 discussing comparisons between single-site (local) and FL (global) analysis. The existing FL applications on structured medical data lack sufficient evaluations of clinically meaningful benefits, particularly when compared to single-site analyses. Therefore, it is crucial for future FL applications to prioritize clinical motivations and develop designs and methodologies that can effectively support and aid clinical practice and research.

cs.LG↗

arXiv2023

A roadmap to fair and trustworthy prediction model validation in healthcare

A prediction model is most useful if it generalizes beyond the development data with external validations, but to what extent should it generalize remains unclear. In practice, prediction models are externally validated using data from very different settings, including populations from other health systems or countries, with predictably poor results. This may not be a fair reflection of the performance of the model which was designed for a specific target population or setting, and may be stretching the expected model generalizability. To address this, we suggest to externally validate a model using new data from the target population to ensure clear implications of validation performance on model reliability, whereas model generalizability to broader settings should be carefully investigated during model development instead of explored post-hoc. Based on this perspective, we propose a roadmap that facilitates the development and application of reliable, fair, and trustworthy artificial intelligence prediction models.

cs.LG↗