Unsupervised Clinical Language Translation

As patients' access to their doctors' clinical notes becomes common, translating professional, clinical jargon to layperson-understandable language is essential to improve patient-clinician communication. Such translation yields better clinical outcomes by enhancing patients' understanding of their own health conditions, and thus improving patients' involvement in their own care. Existing research has used dictionary-based word replacement or definition insertion to approach the need. However, these methods are limited by expert curation, which is hard to scale and has trouble generalizing to unseen datasets that do not share an overlapping vocabulary. In contrast, we approach the clinical word and sentence translation problem in a completely unsupervised manner. We show that a framework using representation learning, bilingual dictionary induction and statistical machine translation yields the best precision at 10 of 0.827 on professional-to-consumer word translation, and mean opinion scores of 4.10 and 4.28 out of 5 for clinical correctness and layperson readability, respectively, on sentence translation. Our fully-unsupervised strategy overcomes the curation problem, and the clinically meaningful evaluation reduces biases from inappropriate evaluators, which are critical in clinical machine learning.

Predicting Blood Pressure Response to Fluid Bolus Therapy Using Attention-Based Neural Networks for Clinical Interpretability

Determining whether hypotensive patients in intensive care units (ICUs) should receive fluid bolus therapy (FBT) has been an extremely challenging task for intensive care physicians as the corresponding increase in blood pressure has been hard to predict. Our study utilized regression models and attention-based recurrent neural network (RNN) algorithms and a multi-clinical information system large-scale database to build models that can predict the successful response to FBT among hypotensive patients in ICUs. We investigated both time-aggregated modeling using logistic regression algorithms with regularization and time-series modeling using the long short term memory network (LSTM) and the gated recurrent units network (GRU) with the attention mechanism for clinical interpretability. Among all modeling strategies, the stacked LSTM with the attention mechanism yielded the most predictable model with the highest accuracy of 0.852 and area under the curve (AUC) value of 0.925. The study results may help identify hypotensive patients in ICUs who will have sufficient blood pressure recovery after FBT.

Unsupervised Multimodal Representation Learning across Medical Images and Reports

Joint embeddings between medical imaging modalities and associated radiology reports have the potential to offer significant benefits to the clinical community, ranging from cross-domain retrieval to conditional generation of reports to the broader goals of multimodal representation learning. In this work, we establish baseline joint embedding results measured via both local and global retrieval methods on the soon to be released MIMIC-CXR dataset consisting of both chest X-ray images and the associated radiology reports. We examine both supervised and unsupervised methods on this task and show that for document retrieval tasks with the learned representations, only a limited amount of supervision is needed to yield results comparable to those of fully-supervised methods.

Towards Unsupervised Speech-to-Text Translation

We present a framework for building speech-to-text translation (ST) systems using only monolingual speech and text corpora, in other words, speech utterances from a source language and independent text from a target language. As opposed to traditional cascaded systems and end-to-end architectures, our system does not require any labeled data (i.e., transcribed source audio or parallel source and target text corpora) during training, making it especially applicable to language pairs with very few or even zero bilingual resources. The framework initializes the ST system with a cross-modal bilingual dictionary inferred from the monolingual corpora, that maps every source speech segment corresponding to a spoken word to its target text translation. For unseen source speech utterances, the system first performs word-by-word translation on each speech segment in the utterance. The translation is improved by leveraging a language model and a sequence denoising autoencoder to provide prior knowledge about the target language. Experimental results show that our unsupervised system achieves comparable BLEU scores to supervised end-to-end models despite the lack of supervision. We also provide an ablation analysis to examine the utility of each component in our system.

Unsupervised Cross-Modal Alignment of Speech and Text Embedding Spaces

Recent research has shown that word embedding spaces learned from text corpora of different languages can be aligned without any parallel data supervision. Inspired by the success in unsupervised cross-lingual word embeddings, in this paper we target learning a cross-modal alignment between the embedding spaces of speech and text learned from corpora of their respective modalities in an unsupervised fashion. The proposed framework learns the individual speech and text embedding spaces, and attempts to align the two spaces via adversarial training, followed by a refinement procedure. We show how our framework could be used to perform spoken word classification and translation, and the results on these two tasks demonstrate that the performance of our unsupervised alignment approach is comparable to its supervised counterpart. Our framework is especially useful for developing automatic speech recognition (ASR) and speech-to-text translation systems for low- or zero-resource languages, which have little parallel audio-text data for training modern supervised ASR and speech-to-text translation models, but account for the majority of the languages spoken across the world.

Mapping Unparalleled Clinical Professional and Consumer Languages with Embedding Alignment

Mapping and translating professional but arcane clinical jargons to consumer language is essential to improve the patient-clinician communication. Researchers have used the existing biomedical ontologies and consumer health vocabulary dictionary to translate between the languages. However, such approaches are limited by expert efforts to manually build the dictionary, which is hard to be generalized and scalable. In this work, we utilized the embeddings alignment method for the word mapping between unparalleled clinical professional and consumer language embeddings. To map semantically similar words in two different word embeddings, we first independently trained word embeddings on both the corpus with abundant clinical professional terms and the other with mainly healthcare consumer terms. Then, we aligned the embeddings by the Procrustes algorithm. We also investigated the approach with the adversarial training with refinement. We evaluated the quality of the alignment through the similar words retrieval both by computing the model precision and as well as judging qualitatively by human. We show that the Procrustes algorithm can be performant for the professional consumer language embeddings alignment, whereas adversarial training with refinement may find some relations between two languages.

Learning Deep Representations of Medical Images using Siamese CNNs with Application to Content-Based Image Retrieval

Deep neural networks have been investigated in learning latent representations of medical images, yet most of the studies limit their approach in a single supervised convolutional neural network (CNN), which usually rely heavily on a large scale annotated dataset for training. To learn image representations with less supervision involved, we propose a deep Siamese CNN (SCNN) architecture that can be trained with only binary image pair information. We evaluated the learned image representations on a task of content-based medical image retrieval using a publicly available multiclass diabetic retinopathy fundus image dataset. The experimental results show that our proposed deep SCNN is comparable to the state-of-the-art single supervised CNN, and requires much less supervision for training.

Representation and Reinforcement Learning for Personalized Glycemic Control in Septic Patients

Glycemic control is essential for critical care. However, it is a challenging task because there has been no study on personalized optimal strategies for glycemic control. This work aims to learn personalized optimal glycemic trajectories for severely ill septic patients by learning data-driven policies to identify optimal targeted blood glucose levels as a reference for clinicians. We encoded patient states using a sparse autoencoder and adopted a reinforcement learning paradigm using policy iteration to learn the optimal policy from data. We also estimated the expected return following the policy learned from the recorded glycemic trajectories, which yielded a function indicating the relationship between real blood glucose values and 90-day mortality rates. This suggests that the learned optimal policy could reduce the patients' estimated 90-day mortality rate by 6.3%, from 31% to 24.7%. The result demonstrates that reinforcement learning with appropriate patient state encoding can potentially provide optimal glycemic trajectories and allow clinicians to design a personalized strategy for glycemic control in septic patients.