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      Artificial intelligence: revolutionizing cardiology with large language models

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          Graphical Abstract

          Graphical Abstract

          Overview of input sources (top) to train or fine-tune cardio large language models and different applications (bottom). ECG, electrocardiogram; Q&A, questions and answers.

          Abstract

          Natural language processing techniques are having an increasing impact on clinical care from patient, clinician, administrator, and research perspective. Among others are automated generation of clinical notes and discharge letters, medical term coding for billing, medical chatbots both for patients and clinicians, data enrichment in the identification of disease symptoms or diagnosis, cohort selection for clinical trial, and auditing purposes. In the review, an overview of the history in natural language processing techniques developed with brief technical background is presented. Subsequently, the review will discuss implementation strategies of natural language processing tools, thereby specifically focusing on large language models, and conclude with future opportunities in the application of such techniques in the field of cardiology.

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          Most cited references74

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          Language Models are Few-Shot Learners

          Recent work has demonstrated substantial gains on many NLP tasks and benchmarks by pre-training on a large corpus of text followed by fine-tuning on a specific task. While typically task-agnostic in architecture, this method still requires task-specific fine-tuning datasets of thousands or tens of thousands of examples. By contrast, humans can generally perform a new language task from only a few examples or from simple instructions - something which current NLP systems still largely struggle to do. Here we show that scaling up language models greatly improves task-agnostic, few-shot performance, sometimes even reaching competitiveness with prior state-of-the-art fine-tuning approaches. Specifically, we train GPT-3, an autoregressive language model with 175 billion parameters, 10x more than any previous non-sparse language model, and test its performance in the few-shot setting. For all tasks, GPT-3 is applied without any gradient updates or fine-tuning, with tasks and few-shot demonstrations specified purely via text interaction with the model. GPT-3 achieves strong performance on many NLP datasets, including translation, question-answering, and cloze tasks, as well as several tasks that require on-the-fly reasoning or domain adaptation, such as unscrambling words, using a novel word in a sentence, or performing 3-digit arithmetic. At the same time, we also identify some datasets where GPT-3's few-shot learning still struggles, as well as some datasets where GPT-3 faces methodological issues related to training on large web corpora. Finally, we find that GPT-3 can generate samples of news articles which human evaluators have difficulty distinguishing from articles written by humans. We discuss broader societal impacts of this finding and of GPT-3 in general. 40+32 pages
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            I.—COMPUTING MACHINERY AND INTELLIGENCE

            A Turing (1950)
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              Reinforcement Learning: A Survey

              This paper surveys the field of reinforcement learning from a computer-science perspective. It is written to be accessible to researchers familiar with machine learning. Both the historical basis of the field and a broad selection of current work are summarized. Reinforcement learning is the problem faced by an agent that learns behavior through trial-and-error interactions with a dynamic environment. The work described here has a resemblance to work in psychology, but differs considerably in the details and in the use of the word ``reinforcement.'' The paper discusses central issues of reinforcement learning, including trading off exploration and exploitation, establishing the foundations of the field via Markov decision theory, learning from delayed reinforcement, constructing empirical models to accelerate learning, making use of generalization and hierarchy, and coping with hidden state. It concludes with a survey of some implemented systems and an assessment of the practical utility of current methods for reinforcement learning.
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                Author and article information

                Contributors
                Journal
                Eur Heart J
                Eur Heart J
                eurheartj
                European Heart Journal
                Oxford University Press (US )
                0195-668X
                1522-9645
                01 February 2024
                03 January 2024
                03 January 2024
                : 45
                : 5 , Focus Issue on Arrhythmias
                : 332-345
                Affiliations
                Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam , Amsterdam, Netherlands
                Department of Computational Biomedicine, Cedars-Sinai Medical Center , Los Angeles, CA, USA
                Department of Computational Biomedicine, Cedars-Sinai Medical Center , Los Angeles, CA, USA
                Department of Computational Biomedicine, Cedars-Sinai Medical Center , Los Angeles, CA, USA
                Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam , Amsterdam, Netherlands
                Institute of Health Informatics, University College London , London, UK
                The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London , London, UK
                Author notes
                Corresponding author. Tel: +31650063092, Email: f.w.asselbergs@ 123456amsterdamumc.nl
                Author information
                https://orcid.org/0000-0001-7550-0489
                https://orcid.org/0000-0001-8331-3675
                https://orcid.org/0000-0002-5015-1099
                https://orcid.org/0000-0002-6416-9556
                https://orcid.org/0000-0002-1692-8669
                Article
                ehad838
                10.1093/eurheartj/ehad838
                10834163
                38170821
                1a6338f6-623d-46ef-97e9-fad3402515af
                © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 June 2023
                : 01 December 2023
                : 05 December 2023
                Page count
                Pages: 14
                Funding
                Funded by: European Union’s Horizon;
                Categories
                State of the Art Review
                AcademicSubjects/MED00200
                Eurheartj/23
                Eurheartj/24

                Cardiovascular Medicine
                large language models,natural language processing,cardiology,clinical applications

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