Yun Liu

Yun Liu

Yun is a senior staff research scientist in Google Research. In this role he focuses on developing and validating machine learning for medical applications across multiple fields: pathology, ophthalmology, radiology, dermatology, and more. Yun completed his PhD at Harvard-MIT Health Sciences and Technology, where he worked on predictive risk modeling using biomedical signals, medical text, and billing codes. He has previously also worked on predictive modeling for nucleic acid sequences and protein structures. Yun completed a B.S. in Molecular and Cellular Biology and Computer Science at Johns Hopkins University.
Authored Publications
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    Performance of a Deep Learning Diabetic Retinopathy Algorithm in India
    Arthur Brant
    Xiang Yin
    Lu Yang
    Divleen Jeji
    Sunny Virmani
    Anchintha Meenu
    Naresh Babu Kannan
    Florence Thng
    Lily Peng
    Ramasamy Kim
    JAMA Network Open (2025)
    Preview abstract Importance: While prospective studies have investigated the accuracy of artificial intelligence (AI) for detection of diabetic retinopathy (DR) and diabetic macular edema (DME), to date, little published data exist on the clinical performance of these algorithms. Objective: To evaluate the clinical performance of an automated retinal disease assessment (ARDA) algorithm in the postdeployment setting at Aravind Eye Hospital in India. Design, Setting, and Participants: This cross-sectional analysis involved an approximate 1% sample of fundus photographs from patients screened using ARDA. Images were graded via adjudication by US ophthalmologists for DR and DME, and ARDA’s output was compared against the adjudicated grades at 45 sites in Southern India. Patients were randomly selected between January 1, 2019, and July 31, 2023. Main Outcomes and Measures: Primary analyses were the sensitivity and specificity of ARDA for severe nonproliferative DR (NPDR) or proliferative DR (PDR). Secondary analyses focused on sensitivity and specificity for sight-threatening DR (STDR) (DME or severe NPDR or PDR). Results: Among the 4537 patients with 4537 images with adjudicated grades, mean (SD) age was 55.2 (11.9) years and 2272 (50.1%) were male. Among the 3941 patients with gradable photographs, 683 (17.3%) had any DR, 146 (3.7%) had severe NPDR or PDR, 109 (2.8%) had PDR, and 398 (10.1%) had STDR. ARDA’s sensitivity and specificity for severe NPDR or PDR were 97.0% (95% CI, 92.6%-99.2%) and 96.4% (95% CI, 95.7%-97.0%), respectively. Positive predictive value (PPV) was 50.7% and negative predictive value (NPV) was 99.9%. The clinically important miss rate for severe NPDR or PDR was 0% (eg, some patients with severe NPDR or PDR were interpreted as having moderate DR and referred to clinic). ARDA’s sensitivity for STDR was 95.9% (95% CI, 93.0%-97.4%) and specificity was 94.9% (95% CI, 94.1%-95.7%); PPV and NPV were 67.9% and 99.5%, respectively. Conclusions and Relevance: In this cross-sectional study investigating the clinical performance of ARDA, sensitivity and specificity for severe NPDR and PDR exceeded 96% and caught 100% of patients with severe  NPDR and PDR for ophthalmology referral. This preliminary large-scale postmarketing report of the performance of ARDA after screening 600 000 patients in India underscores the importance of monitoring and publication an algorithm's clinical performance, consistent with recommendations by regulatory bodies. View details
    Validation of a Deep Learning Model for Diabetic Retinopathy on Patients with Young-Onset Diabetes
    Tony Tan-Torres
    Pradeep Praveen
    Divleen Jeji
    Arthur Brant
    Xiang Yin
    Lu Yang
    Tayyeba Ali
    Ilana Traynis
    Dushyantsinh Jadeja
    Rajroshan Sawhney
    Sunny Virmani
    Pradeep Venkatesh
    Nikhil Tandon
    Ophthalmology and Therapy (2025)
    Preview abstract Introduction While many deep learning systems (DLSs) for diabetic retinopathy (DR) have been developed and validated on cohorts with an average age of 50s or older, fewer studies have examined younger individuals. This study aimed to understand DLS performance for younger individuals, who tend to display anatomic differences, such as prominent retinal sheen. This sheen can be mistaken for exudates or cotton wool spots, and potentially confound DLSs. Methods This was a prospective cross-sectional cohort study in a “Diabetes of young” clinic in India, enrolling 321 individuals between ages 18 and 45 (98.8% with type 1 diabetes). Participants had fundus photographs taken and the photos were adjudicated by experienced graders to obtain reference DR grades. We defined a younger cohort (age 18–25) and an older cohort (age 26–45) and examined differences in DLS performance between the two cohorts. The main outcome measures were sensitivity and specificity for DR. Results Eye-level sensitivity for moderate-or-worse DR was 97.6% [95% confidence interval (CI) 91.2, 98.2] for the younger cohort and 94.0% [88.8, 98.1] for the older cohort (p = 0.418 for difference). The specificity for moderate-or-worse DR significantly differed between the younger and older cohorts, 97.9% [95.9, 99.3] and 92.1% [87.6, 96.0], respectively (p = 0.008). Similar trends were observed for diabetic macular edema (DME); sensitivity was 79.0% [57.9, 93.6] for the younger cohort and 77.5% [60.8, 90.6] for the older cohort (p = 0.893), whereas specificity was 97.0% [94.5, 99.0] and 92.0% [88.2, 95.5] (p = 0.018). Retinal sheen presence (94% of images) was associated with DME presence (p < 0.0001). Image review suggested that sheen presence confounded reference DME status, increasing noise in the labels and depressing measured sensitivity. The gradability rate for both DR and DME was near-perfect (99% for both). Conclusion DLS-based DR screening performed well in younger individuals aged 18–25, with comparable sensitivity and higher specificity compared to individuals aged 26–45. Sheen presence in this cohort made identification of DME difficult for graders and depressed measured DLS sensitivity; additional studies incorporating optical coherence tomography may improve accuracy of measuring DLS DME sensitivity. View details
    Closing the AI generalisation gap by adjusting for dermatology condition distribution differences across clinical settings
    Rajeev Rikhye
    Aaron Loh
    Grace Hong
    Margaret Ann Smith
    Vijaytha Muralidharan
    Doris Wong
    Michelle Phung
    Nicolas Betancourt
    Bradley Fong
    Rachna Sahasrabudhe
    Khoban Nasim
    Alec Eschholz
    Basil Mustafa
    Jan Freyberg
    Terry Spitz
    Kat Chou
    Peggy Bui
    Justin Ko
    Steven Lin
    The Lancet eBioMedicine (2025)
    Preview abstract Background: Generalisation of artificial intelligence (AI) models to a new setting is challenging. In this study, we seek to understand the robustness of a dermatology (AI) model and whether it generalises from telemedicine cases to a new setting including both patient-submitted photographs (“PAT”) and clinician-taken photographs in-clinic (“CLIN”). Methods: A retrospective cohort study involving 2500 cases previously unseen by the AI model, including both PAT and CLIN cases, from 22 clinics in the San Francisco Bay Area, spanning November 2015 to January 2021. The primary outcome measure for the AI model and dermatologists was the top-3 accuracy, defined as whether their top 3 differential diagnoses contained the top reference diagnosis from a panel of dermatologists per case. Findings: The AI performed similarly between PAT and CLIN images (74% top-3 accuracy in CLIN vs. 71% in PAT), however, dermatologists were more accurate in PAT images (79% in CLIN vs. 87% in PAT). We demonstrate that demographic factors were not associated with AI or dermatologist errors; instead several categories of conditions were associated with AI model errors (p < 0.05). Resampling CLIN and PAT to match skin condition distributions to the AI development dataset reduced the observed differences (AI: 84% CLIN vs. 79% PAT; dermatologists: 77% CLIN vs. 89% PAT). We demonstrate a series of steps to close the generalisation gap, requiring progressively more information about the new dataset, ranging from the condition distribution to additional training data for rarer conditions. When using additional training data and testing on the dataset without resampling to match AI development, we observed comparable performance from end-to-end AI model fine tuning (85% in CLIN vs. 83% in PAT) vs. fine tuning solely the classification layer on top of a frozen embedding model (86% in CLIN vs. 84% in PAT). Interpretation: AI algorithms can be efficiently adapted to new settings without additional training data by recalibrating the existing model, or with targeted data acquisition for rarer conditions and retraining just the final layer. View details
    Scaling Wearable Foundation Models
    Girish Narayanswamy
    Kumar Ayush
    Yuzhe Yang
    Orson Xu
    Shun Liao
    Shyam Tailor
    Jake Sunshine
    Tim Althoff
    Shrikanth (Shri) Narayanan
    Jiening Zhan
    Mark Malhotra
    Shwetak Patel
    Samy Abdel-Ghaffar
    Daniel McDuff
    2025
    Preview abstract Wearable sensors have become ubiquitous thanks to a variety of health tracking features. The resulting continuous and longitudinal measurements from everyday life generate large volumes of data. However, making sense of these observations for scientific and actionable insights is non-trivial. Inspired by the empirical success of generative modeling, where large neural networks learn powerful representations from vast amounts of text, image, video, or audio data, we investigate the scaling properties of wearable sensor foundation models across compute, data, and model size. Using a dataset of up to 40 million hours of in-situ heart rate, heart rate variability, accelerometer, electrodermal activity, skin temperature, and altimeter per-minute data from over 165,000 people, we create LSM, a multimodal foundation model built on the largest wearable-signals dataset with the most extensive range of sensor modalities to date. Our results establish the scaling laws of LSM for tasks such as imputation, interpolation and extrapolation across both time and sensor modalities. Moreover, we highlight how LSM enables sample-efficient downstream learning for tasks including exercise and activity recognition. View details
    LLM-based Lossless Text Simplification and its Effect on User Comprehension and Cognitive Load
    Theo Guidroz
    Diego Ardila
    Jimmy Li
    Adam Mansour
    Paul Jhun
    Nina Gonzalez
    Xiang Ji
    Mike Sanchez
    Miguel Ángel Garrido
    Divyansh Choudhary
    Jay Hartford
    Georgina Xu
    Henry Serrano
    Yifan Wang
    Jeff Shaffer
    Eric (Yifan) Cao
    Sho Fujiwara
    Peggy Bui
    arXiv (2025)
    Preview abstract Information on the web, such as scientific publications and Wikipedia, often surpasses users' reading level. To help address this, we used a self-refinement approach to develop a LLM capability for minimally lossy text simplification. To validate our approach, we conducted a randomized study involving 4563 participants and 31 texts spanning 6 broad subject areas: PubMed (biomedical scientific articles), biology, law, finance, literature/philosophy, and aerospace/computer science. Participants were randomized to viewing original or simplified texts in a subject area, and answered multiple-choice questions (MCQs) that tested their comprehension of the text. The participants were also asked to provide qualitative feedback such as task difficulty. Our results indicate that participants who read the simplified text answered more MCQs correctly than their counterparts who read the original text (3.9% absolute increase, p<0.05). This gain was most striking with PubMed (14.6%), while more moderate gains were observed for finance (5.5%), aerospace/computer science (3.8%) domains, and legal (3.5%). Notably, the results were robust to whether participants could refer back to the text while answering MCQs. The absolute accuracy decreased by up to ~9% for both original and simplified setups where participants could not refer back to the text, but the ~4% overall improvement persisted. Finally, participants' self-reported perceived ease based on a simplified NASA Task Load Index was greater for those who read the simplified text (absolute change on a 5-point scale 0.33, p<0.05). This randomized study, involving an order of magnitude more participants than prior works, demonstrates the potential of LLMs to make complex information easier to understand. Our work aims to enable a broader audience to better learn and make use of expert knowledge available on the web, improving information accessibility. View details
    Passive Heart Rate Monitoring During Smartphone Use in Everyday Life
    Shun Liao
    Paolo Di Achille
    Jiang Wu
    Silviu Borac
    Jonathan Wang
    Eric Teasley
    Lawrence Cai
    Daniel McDuff
    Hao-Wei Su
    Brent Winslow
    Anupam Pathak
    Shwetak Patel
    Jim Taylor
    Jamie Rogers
    (2025)
    Preview abstract Resting heart rate (RHR) is an important biomarker of cardiovascular health and mortality, but tracking it longitudinally generally requires a wearable device, limiting its availability. We present PHRM, a deep learning system for passive heart rate (HR) and RHR measurements during ordinary smartphone use, using facial video-based photoplethysmography. Our system was developed using 225,773 videos from 495 participants and validated on 185,970 videos from 205 participants in laboratory and free-living conditions – the largest validation study of its kind. Compared to reference electrocardiogram, PHRM achieved a mean absolute percentage error (MAPE) <10% for HR measurements across three skin tone groups of light, medium and dark pigmentation; MAPE for each skin tone group was non-inferior versus the others. Daily RHR measured by PHRM had a mean absolute error <5 bpm compared to a wearable HR tracker, and was associated with known risk factors. These results highlight the potential of smartphones to enable passive and equitable heart health monitoring. View details
    Oculomics: Current Concepts and Evidence
    Zhuoting Zhu
    Yueye Wang
    Ziyi Qi
    Wenyi Hu
    Xiayin Zhang
    Siegfried Wagner
    Yujie Wang
    An Ran Ran
    Joshua Ong
    Ethan Waisberg
    Mouayad Masalkhi
    Alex Suh
    Yih Chung Tham
    Carol Y. Cheung
    Xiaohong Yang
    Honghua Yu
    Zongyuan Ge
    Wei Wang
    Bin Sheng
    Andrew G. Lee
    Alastair Denniston
    Peter van Wijngaarden
    Pearse Keane
    Ching-Yu Cheng
    Mingguang He
    Tien Yin Wong
    Progress in Retinal and Eye Research (2025)
    Preview abstract The eye provides novel insights into general health, as well as pathogenesis and development of systemic diseases. In the past decade, growing evidence has demonstrated that the eye's structure and function mirror multiple systemic health conditions, especially in cardiovascular diseases, neurodegenerative disorders, and kidney impairments. This has given rise to the field of oculomics- the application of ophthalmic biomarkers to understand mechanisms, detect and predict disease. The development of this field has been accelerated by three major advances: 1) the availability and widespread clinical adoption of high-resolution and non-invasive ophthalmic imaging (“hardware”); 2) the availability of large studies to interrogate associations (“big data”); 3) the development of novel analytical methods, including artificial intelligence (AI) (“software”). Oculomics offers an opportunity to enhance our understanding of the interplay between the eye and the body, while supporting development of innovative diagnostic, prognostic, and therapeutic tools. These advances have been further accelerated by developments in AI, coupled with large-scale linkage datasets linking ocular imaging data with systemic health data. Oculomics also enables the detection, screening, diagnosis, and monitoring of many systemic health conditions. Furthermore, oculomics with AI allows prediction of the risk of systemic diseases, enabling risk stratification, opening up new avenues for prevention or individualized risk prediction and prevention, facilitating personalized medicine. In this review, we summarise current concepts and evidence in the field of oculomics, highlighting the progress that has been made, remaining challenges, and the opportunities for future research. View details
    Unprecedented Insights into Maternal Sleep: A Large-scale Longitudinal Analysis of Real-world Wearable Device Data Before, During, and After Pregnancy
    Nichole Young-Lin
    Conor Heneghan
    Logan Schneider
    Logan Niehaus
    Ariel Haney
    Karla Gleichauf
    Jacqueline Shreibati
    Belen Lafon
    Lancet eBioMedicine (2025)
    Preview abstract Introduction: Current understanding of pregnancy and postpartum sleep is driven by limited lab or self-reported data. Consumer wearable devices may help reveal longitudinal, real-world sleep patterns. Methods: We analyzed de-identified wearable device data from 2,540 users in the United States and Canada who met strict wear-time requirements (≥80% daily usage for ≥80% of the time periods of interest [12 weeks prepregnancy, throughout pregnancy, and 20 weeks immediately postpartum]). We tracked sleep time and staging using Fitbit devices. Results: Compared to prepregnancy, total sleep time (TST) increased from an average of 425.3±43.5 min to a peak of 447.6±47.6 min at gestational week 10 with ongoing declines throughout pregnancy. Time in bed (TIB) followed a similar pattern. Increased light sleep drove the initial TST rise. Deep and REM sleep decreased significantly throughout pregnancy, with maximum reductions of 19.2±13.8 min (p<0.01) and 9.0±19.2 min (p<0.01) respectively by pregnancy end. Sleep efficiency also declined slightly during pregnancy (median drop from 88.3% to 86.8%). After delivery, TIB remained below the prepregnancy baseline by 14.7±45.7 min at one year postpartum and 15.2±47.7 min at 1.5 years postpartum. Conclusion: This unprecedented look at large-scale, real-world sleep and pregnancy patterns revealed a previously unquantified initial increase in sleep followed by decreases in both quantity and quality as pregnancy progresses. Sleep deficits persist for at least 1.5 years postpartum. These quantified trends can assist clinicians and patients in understanding what to expect. View details
    Conversational AI in health: Design considerations from a Wizard-of-Oz dermatology case study with users, clinicians and a medical LLM
    Brenna Li
    Amy Wang
    Patricia Strachan
    Julie Anne Seguin
    Sami Lachgar
    Karyn Schroeder
    Renee Wong
    Extended Abstracts of the 2024 CHI Conference on Human Factors in Computing Systems, Association for Computing Machinery, pp. 10
    Preview abstract Although skin concerns are common, access to specialist care is limited. Artificial intelligence (AI)-assisted tools to support medical decisions may provide patients with feedback on their concerns while also helping ensure the most urgent cases are routed to dermatologists. Although AI-based conversational agents have been explored recently, how they are perceived by patients and clinicians is not well understood. We conducted a Wizard-of-Oz study involving 18 participants with real skin concerns. Participants were randomly assigned to interact with either a clinician agent (portrayed by a dermatologist) or an LLM agent (supervised by a dermatologist) via synchronous multimodal chat. In both conditions, participants found the conversation to be helpful in understanding their medical situation and alleviate their concerns. Through qualitative coding of the conversation transcripts, we provide insight on the importance of empathy and effective information-seeking. We conclude with design considerations for future AI-based conversational agents in healthcare settings. View details
    Health equity assessment of machine learning performance (HEAL): a framework and dermatology AI model case study
    Terry Spitz
    Malcolm Chelliah
    Heather Cole-Lewis
    Tiam Jaroensri
    Geoff Keeling
    Stephanie Farquhar
    Qinghan Xue
    Jenna Lester
    Cían Hughes
    Patricia Strachan
    Fraser Tan
    Peggy Bui
    Craig Mermel
    Lily Peng
    Sunny Virmani
    Ivor Horn
    Cameron Chen
    The Lancet eClinicalMedicine (2024)
    Preview abstract Background Artificial intelligence (AI) has repeatedly been shown to encode historical inequities in healthcare. We aimed to develop a framework to quantitatively assess the performance equity of health AI technologies and to illustrate its utility via a case study. Methods Here, we propose a methodology to assess whether health AI technologies prioritise performance for patient populations experiencing worse outcomes, that is complementary to existing fairness metrics. We developed the Health Equity Assessment of machine Learning performance (HEAL) framework designed to quantitatively assess the performance equity of health AI technologies via a four-step interdisciplinary process to understand and quantify domain-specific criteria, and the resulting HEAL metric. As an illustrative case study (analysis conducted between October 2022 and January 2023), we applied the HEAL framework to a dermatology AI model. A set of 5420 teledermatology cases (store-and-forward cases from patients of 20 years or older, submitted from primary care providers in the USA and skin cancer clinics in Australia), enriched for diversity in age, sex and race/ethnicity, was used to retrospectively evaluate the AI model's HEAL metric, defined as the likelihood that the AI model performs better for subpopulations with worse average health outcomes as compared to others. The likelihood that AI performance was anticorrelated to pre-existing health outcomes was estimated using bootstrap methods as the probability that the negated Spearman's rank correlation coefficient (i.e., “R”) was greater than zero. Positive values of R suggest that subpopulations with poorer health outcomes have better AI model performance. Thus, the HEAL metric, defined as p (R >0), measures how likely the AI technology is to prioritise performance for subpopulations with worse average health outcomes as compared to others (presented as a percentage below). Health outcomes were quantified as disability-adjusted life years (DALYs) when grouping by sex and age, and years of life lost (YLLs) when grouping by race/ethnicity. AI performance was measured as top-3 agreement with the reference diagnosis from a panel of 3 dermatologists per case. Findings Across all dermatologic conditions, the HEAL metric was 80.5% for prioritizing AI performance of racial/ethnic subpopulations based on YLLs, and 92.1% and 0.0% respectively for prioritizing AI performance of sex and age subpopulations based on DALYs. Certain dermatologic conditions were significantly associated with greater AI model performance compared to a reference category of less common conditions. For skin cancer conditions, the HEAL metric was 73.8% for prioritizing AI performance of age subpopulations based on DALYs. Interpretation Analysis using the proposed HEAL framework showed that the dermatology AI model prioritised performance for race/ethnicity, sex (all conditions) and age (cancer conditions) subpopulations with respect to pre-existing health disparities. More work is needed to investigate ways of promoting equitable AI performance across age for non-cancer conditions and to better understand how AI models can contribute towards improving equity in health outcomes. View details