Current approach to cerebral palsy.

This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90 % of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.

Reviewing the essential roles of remote phenotyping, GWAS and explainable AI in practical marker-assisted selection for drought-tolerant winter wheat breeding.

Marker-assisted selection (MAS) plays a crucial role in crop breeding improving the speed and precision of conventional breeding programmes by quickly and reliably identifying and selecting plants with desired traits. However, the efficacy of MAS depends on several prerequisites, with precise phenotyping being a key aspect of any plant breeding programme. Recent advancements in high-throughput remote phenotyping, facilitated by unmanned aerial vehicles coupled to machine learning, offer a non-destructive and efficient alternative to traditional, time-consuming, and labour-intensive methods. Furthermore, MAS relies on knowledge of marker-trait associations, commonly obtained through genome-wide association studies (GWAS), to understand complex traits such as drought tolerance, including yield components and phenology. However, GWAS has limitations that artificial intelligence (AI) has been shown to partially overcome. Additionally, AI and its explainable variants, which ensure transparency and interpretability, are increasingly being used as recognised problem-solving tools throughout the breeding process. Given these rapid technological advancements, this review provides an overview of state-of-the-art methods and processes underlying each MAS, from phenotyping, genotyping and association analyses to the integration of explainable AI along the entire workflow. In this context, we specifically address the challenges and importance of breeding winter wheat for greater drought tolerance with stable yields, as regional droughts during critical developmental stages pose a threat to winter wheat production. Finally, we explore the transition from scientific progress to practical implementation and discuss ways to bridge the gap between cutting-edge developments and breeders, expediting MAS-based winter wheat breeding for drought tolerance.

CLARUS: An interactive explainable AI platform for manual counterfactuals in graph neural networks.

BACKGROUND: Lack of trust in artificial intelligence (AI) models in medicine is still the key blockage for the use of AI in clinical decision support systems (CDSS). Although AI models are already performing excellently in systems medicine, their black-box nature entails that patient-specific decisions are incomprehensible for the physician. Explainable AI (XAI) algorithms aim to "explain" to a human domain expert, which input features influenced a specific recommendation. However, in the clinical domain, these explanations must lead to some degree of causal understanding by a clinician. RESULTS: We developed the CLARUS platform, aiming to promote human understanding of graph neural network (GNN) predictions. CLARUS enables the visualisation of patient-specific networks, as well as, relevance values for genes and interactions, computed by XAI methods, such as GNNExplainer. This enables domain experts to gain deeper insights into the network and more importantly, the expert can interactively alter the patient-specific network based on the acquired understanding and initiate re-prediction or retraining. This interactivity allows us to ask manual counterfactual questions and analyse the effects on the GNN prediction. CONCLUSION: We present the first interactive XAI platform prototype, CLARUS, that allows not only the evaluation of specific human counterfactual questions based on user-defined alterations of patient networks and a re-prediction of the clinical outcome but also a retraining of the entire GNN after changing the underlying graph structures. The platform is currently hosted by the GWDG on https://rshiny.gwdg.de/apps/clarus/.

Ensemble-GNN: federated ensemble learning with graph neural networks for disease module discovery and classification.

SUMMARY: Federated learning enables collaboration in medicine, where data is scattered across multiple centers without the need to aggregate the data in a central cloud. While, in general, machine learning models can be applied to a wide range of data types, graph neural networks (GNNs) are particularly developed for graphs, which are very common in the biomedical domain. For instance, a patient can be represented by a protein-protein interaction (PPI) network where the nodes contain the patient-specific omics features. Here, we present our Ensemble-GNN software package, which can be used to deploy federated, ensemble-based GNNs in Python. Ensemble-GNN allows to quickly build predictive models utilizing PPI networks consisting of various node features such as gene expression and/or DNA methylation. We exemplary show the results from a public dataset of 981 patients and 8469 genes from the Cancer Genome Atlas (TCGA). AVAILABILITY AND IMPLEMENTATION: The source code is available at https://github.com/pievos101/Ensemble-GNN, and the data at Zenodo (DOI: 10.5281/zenodo.8305122).

Toward human-level concept learning: Pattern benchmarking for AI algorithms.

Artificial intelligence (AI) today is very successful at standard pattern-recognition tasks due to the availability of large amounts of data and advances in statistical data-driven machine learning. However, there is still a large gap between AI pattern recognition and human-level concept learning. Humans can learn amazingly well even under uncertainty from just a few examples and are capable of generalizing these concepts to solve new conceptual problems. The growing interest in explainable machine intelligence requires experimental environments and diagnostic/benchmark datasets to analyze existing approaches and drive progress in pattern analysis and machine intelligence. In this paper, we provide an overview of current AI solutions for benchmarking concept learning, reasoning, and generalization; discuss the state-of-the-art of existing diagnostic/benchmark datasets (such as CLEVR, CLEVRER, CLOSURE, CURI, Bongard-LOGO, V-PROM, RAVEN, Kandinsky Patterns, CLEVR-Humans, CLEVRER-Humans, and their extension containing human language); and provide an outlook of some future research directions in this exciting research domain.

The FeatureCloud Platform for Federated Learning in Biomedicine: Unified Approach.

BACKGROUND: Machine learning and artificial intelligence have shown promising results in many areas and are driven by the increasing amount of available data. However, these data are often distributed across different institutions and cannot be easily shared owing to strict privacy regulations. Federated learning (FL) allows the training of distributed machine learning models without sharing sensitive data. In addition, the implementation is time-consuming and requires advanced programming skills and complex technical infrastructures. OBJECTIVE: Various tools and frameworks have been developed to simplify the development of FL algorithms and provide the necessary technical infrastructure. Although there are many high-quality frameworks, most focus only on a single application case or method. To our knowledge, there are no generic frameworks, meaning that the existing solutions are restricted to a particular type of algorithm or application field. Furthermore, most of these frameworks provide an application programming interface that needs programming knowledge. There is no collection of ready-to-use FL algorithms that are extendable and allow users (eg, researchers) without programming knowledge to apply FL. A central FL platform for both FL algorithm developers and users does not exist. This study aimed to address this gap and make FL available to everyone by developing FeatureCloud, an all-in-one platform for FL in biomedicine and beyond. METHODS: The FeatureCloud platform consists of 3 main components: a global frontend, a global backend, and a local controller. Our platform uses a Docker to separate the local acting components of the platform from the sensitive data systems. We evaluated our platform using 4 different algorithms on 5 data sets for both accuracy and runtime. RESULTS: FeatureCloud removes the complexity of distributed systems for developers and end users by providing a comprehensive platform for executing multi-institutional FL analyses and implementing FL algorithms. Through its integrated artificial intelligence store, federated algorithms can easily be published and reused by the community. To secure sensitive raw data, FeatureCloud supports privacy-enhancing technologies to secure the shared local models and assures high standards in data privacy to comply with the strict General Data Protection Regulation. Our evaluation shows that applications developed in FeatureCloud can produce highly similar results compared with centralized approaches and scale well for an increasing number of participating sites. CONCLUSIONS: FeatureCloud provides a ready-to-use platform that integrates the development and execution of FL algorithms while reducing the complexity to a minimum and removing the hurdles of federated infrastructure. Thus, we believe that it has the potential to greatly increase the accessibility of privacy-preserving and distributed data analyses in biomedicine and beyond.

Multi-omics disease module detection with an explainable Greedy Decision Forest.

Machine learning methods can detect complex relationships between variables, but usually do not exploit domain knowledge. This is a limitation because in many scientific disciplines, such as systems biology, domain knowledge is available in the form of graphs or networks, and its use can improve model performance. We need network-based algorithms that are versatile and applicable in many research areas. In this work, we demonstrate subnetwork detection based on multi-modal node features using a novel Greedy Decision Forest (GDF) with inherent interpretability. The latter will be a crucial factor to retain experts and gain their trust in such algorithms. To demonstrate a concrete application example, we focus on bioinformatics, systems biology and particularly biomedicine, but the presented methodology is applicable in many other domains as well. Systems biology is a good example of a field in which statistical data-driven machine learning enables the analysis of large amounts of multi-modal biomedical data. This is important to reach the future goal of precision medicine, where the complexity of patients is modeled on a system level to best tailor medical decisions, health practices and therapies to the individual patient. Our proposed explainable approach can help to uncover disease-causing network modules from multi-omics data to better understand complex diseases such as cancer.

GNN-SubNet: disease subnetwork detection with explainable graph neural networks.

MOTIVATION: The tremendous success of graphical neural networks (GNNs) already had a major impact on systems biology research. For example, GNNs are currently being used for drug target recognition in protein-drug interaction networks, as well as for cancer gene discovery and more. Important aspects whose practical relevance is often underestimated are comprehensibility, interpretability and explainability. RESULTS: In this work, we present a novel graph-based deep learning framework for disease subnetwork detection via explainable GNNs. Each patient is represented by the topology of a protein-protein interaction (PPI) network, and the nodes are enriched with multi-omics features from gene expression and DNA methylation. In addition, we propose a modification of the GNNexplainer that provides model-wide explanations for improved disease subnetwork detection. AVAILABILITY AND IMPLEMENTATION: The proposed methods and tools are implemented in the GNN-SubNet Python package, which we have made available on our GitHub for the international research community (https://github.com/pievos101/GNN-SubNet). SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Digital Transformation in Smart Farm and Forest Operations Needs Human-Centered AI: Challenges and Future Directions.

The main impetus for the global efforts toward the current digital transformation in almost all areas of our daily lives is due to the great successes of artificial intelligence (AI), and in particular, the workhorse of AI, statistical machine learning (ML). The intelligent analysis, modeling, and management of agricultural and forest ecosystems, and of the use and protection of soils, already play important roles in securing our planet for future generations and will become irreplaceable in the future. Technical solutions must encompass the entire agricultural and forestry value chain. The process of digital transformation is supported by cyber-physical systems enabled by advances in ML, the availability of big data and increasing computing power. For certain tasks, algorithms today achieve performances that exceed human levels. The challenge is to use multimodal information fusion, i.e., to integrate data from different sources (sensor data, images, *omics), and explain to an expert why a certain result was achieved. However, ML models often react to even small changes, and disturbances can have dramatic effects on their results. Therefore, the use of AI in areas that matter to human life (agriculture, forestry, climate, health, etc.) has led to an increased need for trustworthy AI with two main components: explainability and robustness. One step toward making AI more robust is to leverage expert knowledge. For example, a farmer/forester in the loop can often bring in experience and conceptual understanding to the AI pipeline-no AI can do this. Consequently, human-centered AI (HCAI) is a combination of "artificial intelligence" and "natural intelligence" to empower, amplify, and augment human performance, rather than replace people. To achieve practical success of HCAI in agriculture and forestry, this article identifies three important frontier research areas: (1) intelligent information fusion; (2) robotics and embodied intelligence; and (3) augmentation, explanation, and verification for trusted decision support. This goal will also require an agile, human-centered design approach for three generations (G). G1: Enabling easily realizable applications through immediate deployment of existing technology. G2: Medium-term modification of existing technology. G3: Advanced adaptation and evolution beyond state-of-the-art.

Generating Explanations for Conceptual Validation of Graph Neural Networks: An Investigation of Symbolic Predicates Learned on Relevance-Ranked Sub-Graphs.

Graph Neural Networks (GNN) show good performance in relational data classification. However, their contribution to concept learning and the validation of their output from an application domain's and user's perspective have not been thoroughly studied. We argue that combining symbolic learning methods, such as Inductive Logic Programming (ILP), with statistical machine learning methods, especially GNNs, is an essential forward-looking step to perform powerful and validatable relational concept learning. In this contribution, we introduce a benchmark for the conceptual validation of GNN classification outputs. It consists of the symbolic representations of symmetric and non-symmetric figures that are taken from a well-known Kandinsky Pattern data set. We further provide a novel validation framework that can be used to generate comprehensible explanations with ILP on top of the relevance output of GNN explainers and human-expected relevance for concepts learned by GNNs. Our experiments conducted on our benchmark data set demonstrate that it is possible to extract symbolic concepts from the most relevant explanations that are representative of what a GNN has learned. Our findings open up a variety of avenues for future research on validatable explanations for GNNs.

Invasive fungal infections in a pediatric hematology-oncology department: A 16-year retrospective study.

Background and Purpose: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised children. The purpose of our study was to evaluate the incidence of IFIs in pediatric patients with underlying hematologic malignancies and determine the patient characteristics, predisposing factors, diagnosis, treatment efficacy, and outcome of IFIs. Materials and Methods: For the purpose of the study, a retrospective analysis was performed on cases with proven and probable fungal infections from January 2001 to December 2016 (16 years). Results: During this period, 297 children with hematologic malignancies were admitted to the 2nd Pediatric Department of Aristotle University of Thessaloniki, Greece, and 24 cases of IFIs were registered. The most common underlying diseases were acute lymphoblastic leukemia (ALL; n=19,79%), followed by acute myeloid leukemia (AML; n=4, 17%) and non-Hodgkin lymphoma (NHL; n=1,4%). The crude incidence rates of IFIs in ALL, AML, and NHL were 10.5%, 18.2%, and 2.8% respectively. Based on the results, 25% (n=6) and 75% (n=18) of the patients were diagnosed as proven and probable IFI cases, respectively. The lung was the most common site of involvement in 16 (66.7%) cases. Furthermore, Aspergillus and Candida species represented 58.3% and 29.1% of the identified species, respectively. Regarding antifungal treatment, liposomal amphotericin B was the most commonly prescribed therapeutic agent (n=21), followed by voriconazole (n=9), caspofungin (n=3), posaconazole (n=3), micafungin (n=1), and fluconazole (n=1). In addition, 12 children received combined antifungal treatment. The crude mortality rate was obtained as 33.3%. Conclusion: As the findings of the present study indicated, despite the progress in the diagnosis and treatment of IFIs with the use of new antifungal agents, the mortality rate of these infections still remains high.