Medical Scientific Table-to-Text Generation with Human-in-the-Loop under the Data Sparsity Constraint

Structured (tabular) data in the preclinical and clinical domains contains valuable information about individuals and an efficient table-to-text summarization system can drastically reduce manual efforts to condense this data into reports. However, in practice, the problem is heavily impeded by the data paucity, data sparsity and inability of the state-of-the-art natural language generation models (including T5, PEGASUS and GPT-Neo) to produce accurate and reliable outputs. In this paper, we propose a novel table-to-text approach and tackle these problems with a novel two-step architecture which is enhanced by auto-correction, copy mechanism and synthetic data augmentation. The study shows that the proposed approach selects salient biomedical entities and values from structured data with improved precision (up to 0.13 absolute increase) of copying the tabular values to generate coherent and accurate text for assay validation reports and toxicology reports. Moreover, we also demonstrate a light-weight adaptation of the proposed system to new datasets by fine-tuning with as little as 40\% training examples. The outputs of our model are validated by human experts in the Human-in-the-Loop scenario.

A Scalable Workflow to Build Machine Learning Classifiers with Clinician-in-the-Loop to Identify Patients in Specific Diseases

Clinicians may rely on medical coding systems such as International Classification of Diseases (ICD) to identify patients with diseases from Electronic Health Records (EHRs). However, due to the lack of detail and specificity as well as a probability of miscoding, recent studies suggest the ICD codes often cannot characterise patients accurately for specific diseases in real clinical practice, and as a result, using them to find patients for studies or trials can result in high failure rates and missing out on uncoded patients. Manual inspection of all patients at scale is not feasible as it is highly costly and slow. This paper proposes a scalable workflow which leverages both structured data and unstructured textual notes from EHRs with techniques including NLP, AutoML and Clinician-in-the-Loop mechanism to build machine learning classifiers to identify patients at scale with given diseases, especially those who might currently be miscoded or missed by ICD codes. Case studies in the MIMIC-III dataset were conducted where the proposed workflow demonstrates a higher classification performance in terms of F1 scores compared to simply using ICD codes on gold testing subset to identify patients with Ovarian Cancer (0.901 vs 0.814), Lung Cancer (0.859 vs 0.828), Cancer Cachexia (0.862 vs 0.650), and Lupus Nephritis (0.959 vs 0.855). Also, the proposed workflow that leverages unstructured notes consistently outperforms the baseline that uses structured data only with an increase of F1 (Ovarian Cancer 0.901 vs 0.719, Lung Cancer 0.859 vs 0.787, Cancer Cachexia 0.862 vs 0.838 and Lupus Nephritis 0.959 vs 0.785). Experiments on the large testing set also demonstrate the proposed workflow can find more patients who are miscoded or missed by ICD codes. Moreover, interpretability studies are also conducted to clinically validate the top impact features of the classifiers.

Unsupervised Numerical Reasoning to Extract Phenotypes from Clinical Text by Leveraging External Knowledge

Extracting phenotypes from clinical text has been shown to be useful for a variety of clinical use cases such as identifying patients with rare diseases. However, reasoning with numerical values remains challenging for phenotyping in clinical text, for example, temperature 102F representing Fever. Current state-of-the-art phenotyping models are able to detect general phenotypes, but perform poorly when they detect phenotypes requiring numerical reasoning. We present a novel unsupervised methodology leveraging external knowledge and contextualized word embeddings from ClinicalBERT for numerical reasoning in a variety of phenotypic contexts. Comparing against unsupervised benchmarks, it shows a substantial performance improvement with absolute gains on generalized Recall and F1 scores up to 79% and 71%, respectively. In the supervised setting, it also surpasses the performance of alternative approaches with absolute gains on generalized Recall and F1 scores up to 70% and 44%, respectively.

Receding Neuron Importances for Structured Pruning

Structured pruning efficiently compresses networks by identifying and removing unimportant neurons. While this can be elegantly achieved by applying sparsity-inducing regularisation on BatchNorm parameters, an L1 penalty would shrink all scaling factors rather than just those of superfluous neurons. To tackle this issue, we introduce a simple BatchNorm variation with bounded scaling parameters, based on which we design a novel regularisation term that suppresses only neurons with low importance. Under our method, the weights of unnecessary neurons effectively recede, producing a polarised bimodal distribution of importances. We show that neural networks trained this way can be pruned to a larger extent and with less deterioration. We one-shot prune VGG and ResNet architectures at different ratios on CIFAR and ImagenNet datasets. In the case of VGG-style networks, our method significantly outperforms existing approaches particularly under a severe pruning regime.

Label-dependent and event-guided interpretable disease risk prediction using EHRs

Electronic health records (EHRs) contain patients' heterogeneous data that are collected from medical providers involved in the patient's care, including medical notes, clinical events, laboratory test results, symptoms, and diagnoses. In the field of modern healthcare, predicting whether patients would experience any risks based on their EHRs has emerged as a promising research area, in which artificial intelligence (AI) plays a key role. To make AI models practically applicable, it is required that the prediction results should be both accurate and interpretable. To achieve this goal, this paper proposed a label-dependent and event-guided risk prediction model (LERP) to predict the presence of multiple disease risks by mainly extracting information from unstructured medical notes. Our model is featured in the following aspects. First, we adopt a label-dependent mechanism that gives greater attention to words from medical notes that are semantically similar to the names of risk labels. Secondly, as the clinical events (e.g., treatments and drugs) can also indicate the health status of patients, our model utilizes the information from events and uses them to generate an event-guided representation of medical notes. Thirdly, both label-dependent and event-guided representations are integrated to make a robust prediction, in which the interpretability is enabled by the attention weights over words from medical notes. To demonstrate the applicability of the proposed method, we apply it to the MIMIC-III dataset, which contains real-world EHRs collected from hospitals. Our method is evaluated in both quantitative and qualitative ways.

Label Dependent Attention Model for Disease Risk Prediction Using Multimodal Electronic Health Records

Disease risk prediction has attracted increasing attention in the field of modern healthcare, especially with the latest advances in artificial intelligence (AI). Electronic health records (EHRs), which contain heterogeneous patient information, are widely used in disease risk prediction tasks. One challenge of applying AI models for risk prediction lies in generating interpretable evidence to support the prediction results while retaining the prediction ability. In order to address this problem, we propose the method of jointly embedding words and labels whereby attention modules learn the weights of words from medical notes according to their relevance to the names of risk prediction labels. This approach boosts interpretability by employing an attention mechanism and including the names of prediction tasks in the model. However, its application is only limited to the handling of textual inputs such as medical notes. In this paper, we propose a label dependent attention model LDAM to 1) improve the interpretability by exploiting Clinical-BERT (a biomedical language model pre-trained on a large clinical corpus) to encode biomedically meaningful features and labels jointly; 2) extend the idea of joint embedding to the processing of time-series data, and develop a multi-modal learning framework for integrating heterogeneous information from medical notes and time-series health status indicators. To demonstrate our method, we apply LDAM to the MIMIC-III dataset to predict different disease risks. We evaluate our method both quantitatively and qualitatively. Specifically, the predictive power of LDAM will be shown, and case studies will be carried out to illustrate its interpretability.

QU-BraTS: MICCAI BraTS 2020 Challenge on Quantifying Uncertainty in Brain Tumor Segmentation -- Analysis of Ranking Metrics and Benchmarking Results

Deep learning (DL) models have provided the state-of-the-art performance in a wide variety of medical imaging benchmarking challenges, including the Brain Tumor Segmentation (BraTS) challenges. However, the task of focal pathology multi-compartment segmentation (e.g., tumor and lesion sub-regions) is particularly challenging, and potential errors hinder the translation of DL models into clinical workflows. Quantifying the reliability of DL model predictions in the form of uncertainties, could enable clinical review of the most uncertain regions, thereby building trust and paving the way towards clinical translation. Recently, a number of uncertainty estimation methods have been introduced for DL medical image segmentation tasks. Developing metrics to evaluate and compare the performance of uncertainty measures will assist the end-user in making more informed decisions. In this study, we explore and evaluate a metric developed during the BraTS 2019-2020 task on uncertainty quantification (QU-BraTS), and designed to assess and rank uncertainty estimates for brain tumor multi-compartment segmentation. This metric (1) rewards uncertainty estimates that produce high confidence in correct assertions, and those that assign low confidence levels at incorrect assertions, and (2) penalizes uncertainty measures that lead to a higher percentages of under-confident correct assertions. We further benchmark the segmentation uncertainties generated by 14 independent participating teams of QU-BraTS 2020, all of which also participated in the main BraTS segmentation task. Overall, our findings confirm the importance and complementary value that uncertainty estimates provide to segmentation algorithms, and hence highlight the need for uncertainty quantification in medical image analyses. Our evaluation code is made publicly available at https://github.com/RagMeh11/QU-BraTS.

OmiTrans: generative adversarial networks based omics-to-omics translation framework

With the rapid development of high-throughput experimental technologies, different types of omics (e.g., genomics, epigenomics, transcriptomics, proteomics, and metabolomics) data can be produced from clinical samples. The correlations between different omics types attracts a lot of research interest, whereas the stduy on genome-wide omcis data translation (i.e, generation and prediction of one type of omics data from another type of omics data) is almost blank. Generative adversarial networks and the variants are one of the most state-of-the-art deep learning technologies, which have shown great success in image-to-image translation, text-to-image translation, etc. Here we proposed OmiTrans, a deep learning framework adopted the idea of generative adversarial networks to achieve omics-to-omics translation with promising results. OmiTrans was able to faithfully reconstruct gene expression profiles from DNA methylation data with high accuracy and great model generalisation, as demonstrated in the experiments.

Self-Supervised Detection of Contextual Synonyms in a Multi-Class Setting: Phenotype Annotation Use Case

Contextualised word embeddings is a powerful tool to detect contextual synonyms. However, most of the current state-of-the-art (SOTA) deep learning concept extraction methods remain supervised and underexploit the potential of the context. In this paper, we propose a self-supervised pre-training approach which is able to detect contextual synonyms of concepts being training on the data created by shallow matching. We apply our methodology in the sparse multi-class setting (over 15,000 concepts) to extract phenotype information from electronic health records. We further investigate data augmentation techniques to address the problem of the class sparsity. Our approach achieves a new SOTA for the unsupervised phenotype concept annotation on clinical text on F1 and Recall outperforming the previous SOTA with a gain of up to 4.5 and 4.0 absolute points, respectively. After fine-tuning with as little as 20\% of the labelled data, we also outperform BioBERT and ClinicalBERT. The extrinsic evaluation on three ICU benchmarks also shows the benefit of using the phenotypes annotated by our model as features.

Clinical Utility of the Automatic Phenotype Annotation in Unstructured Clinical Notes: ICU Use Cases

Clinical notes contain information not present elsewhere, including drug response and symptoms, all of which are highly important when predicting key outcomes in acute care patients. We propose the automatic annotation of phenotypes from clinical notes as a method to capture essential information to predict outcomes in the Intensive Care Unit (ICU). This information is complementary to typically used vital signs and laboratory test results. We demonstrate and validate our approach conducting experiments on the prediction of in-hospital mortality, physiological decompensation and length of stay in the ICU setting for over 24,000 patients. The prediction models incorporating phenotypic information consistently outperform the baseline models leveraging only vital signs and laboratory test results. Moreover, we conduct a thorough interpretability study, showing that phenotypes provide valuable insights at the patient and cohort levels. Our approach illustrates the viability of using phenotypes to determine outcomes in the ICU.