We explore state-of-the-art neural models for question answering on electronic medical records and improve their ability to generalize better on previously unseen (paraphrased) questions at test time. We enable this by learning to predict logical forms as an auxiliary task along with the main task of answer span detection. The predicted logical forms also serve as a rationale for the answer. Further, we also incorporate medical entity information in these models via the ERNIE architecture. We train our models on the large-scale emrQA dataset and observe that our multi-task entity-enriched models generalize to paraphrased questions ~5% better than the baseline BERT model.

Current summarization systems only produce plain, factual headlines, but do not meet the practical needs of creating memorable titles to increase exposure. We propose a new task, Stylistic Headline Generation (SHG), to enrich the headlines with three style options (humor, romance and clickbait), in order to attract more readers. With no style-specific article-headline pair (only a standard headline summarization dataset and mono-style corpora), our method TitleStylist generates style-specific headlines by combining the summarization and reconstruction tasks into a multitasking framework. We also introduced a novel parameter sharing scheme to further disentangle the style from the text. Through both automatic and human evaluation, we demonstrate that TitleStylist can generate relevant, fluent headlines with three target styles: humor, romance, and clickbait. The attraction score of our model generated headlines surpasses that of the state-of-the-art summarization model by 9.68%, and even outperforms human-written references.

Information in electronic health records (EHR), such as clinical narratives, examination reports, lab measurements, demographics, and other patient encounter entries, can be transformed into appropriate data representations that can be used for downstream clinical machine learning tasks using representation learning. Learning better representations is critical to improve the performance of downstream tasks. Due to the advances in machine learning, we now can learn better and meaningful representations from EHR through disentangling the underlying factors inside data and distilling large amounts of information and knowledge from heterogeneous EHR sources. In this chapter, we first introduce the background of learning representations and reasons why we need good EHR representations in machine learning for medicine and healthcare in Section 1. Next, we explain the commonly-used machine learning and evaluation methods for representation learning using a deep learning approach in Section 2. Following that, we review recent related studies of learning patient state representation from EHR for clinical machine learning tasks in Section 3. Finally, in Section 4 we discuss more techniques, studies, and challenges for learning natural language representations when free texts, such as clinical notes, examination reports, or biomedical literature are used. W e also discuss challenges and opportunities in these rapidly growing research fields.

Machine learning algorithms are often vulnerable to adversarial examples that have imperceptible alterations from the original counterparts but can fool the state-of-the-art models. It is helpful to evaluate or even improve the robustness of these models by exposing the maliciously crafted adversarial examples. In this paper, we present the TextFooler, a general attack framework, to generate natural adversarial texts. By successfully applying it to two fundamental natural language tasks, text classification and textual entailment, against various target models, convolutional and recurrent neural networks as well as the most powerful pre-trained BERT, we demonstrate the advantages of this framework in three ways: (i) effective---it outperforms state-of-the-art attacks in terms of success rate and perturbation rate; (ii) utility-preserving---it preserves semantic content and grammaticality, and remains correctly classified by humans; and (iii) efficient---it generates adversarial text with computational complexity linear in the text length.

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.

This paper presents a Lisp architecture for a portable NLP system, termed LAPNLP, for processing clinical notes. LAPNLP integrates multiple standard, customized and in-house developed NLP tools. Our system facilitates portability across different institutions and data systems by incorporating an enriched Common Data Model (CDM) to standardize necessary data elements. It utilizes UMLS to perform domain adaptation when integrating generic domain NLP tools. It also features stand-off annotations that are specified by positional reference to the original document. We built an interval tree based search engine to efficiently query and retrieve the stand-off annotations by specifying positional requirements. We also developed a utility to convert an inline annotation format to stand-off annotations to enable the reuse of clinical text datasets with inline annotations. We experimented with our system on several NLP facilitated tasks including computational phenotyping for lymphoma patients and semantic relation extraction for clinical notes. These experiments showcased the broader applicability and utility of LAPNLP.

In evidence-based medicine (EBM), structured medical questions are always favored for efficient search of the best available evidence for treatments. PICO element detection is widely used to help structurize the clinical studies and question by identifying the sentences in a given medical text that belong to one of the four components: Participants (P), Intervention (I), Comparison (C), and Outcome (O). In this work, we propose a hierarchical deep neural network (DNN) architecture that contains dual bi-directional long short-term memory (bi-LSTM) layers to automatically detect the PICO element in medical texts. Within the model, the lower layer of bi-LSTM is for sentence encoding while the upper one is to contextualize the encoded sentence representation vector. In addition, we adopt adversarial and virtual adversarial training to regularize the model. Overall, we advance the PICO element detection to new state-of-the-art performance, outperforming the previous works by at least 4\% in F1 score for all P/I/O categories.

In this work, we characterize the doctor-patient relationship using a machine learning-derived trust score. We show that this score has statistically significant racial associations, and that by modeling trust directly we find stronger disparities in care than by stratifying on race. We further demonstrate that mistrust is indicative of worse outcomes, but is only weakly associated with physiologically-created severity scores. Finally, we describe sentiment analysis experiments indicating patients with higher levels of mistrust have worse experiences and interactions with their caregivers. This work is a step towards measuring fairer machine learning in the healthcare domain.

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.

The biomedical field offers many learning tasks that share unique challenges: large amounts of unpaired data, and a high cost to generate labels. In this work, we develop a method to address these issues with semi-supervised learning in regression tasks (e.g., translation from source to target). Our model uses adversarial signals to learn from unpaired datapoints, and imposes a cycle-loss reconstruction error penalty to regularize mappings in either direction against one another. We first evaluate our method on synthetic experiments, demonstrating two primary advantages of the system: 1) distribution matching via the adversarial loss and 2) regularization towards invertible mappings via the cycle loss. We then show a regularization effect and improved performance when paired data is supplemented by additional unpaired data on two real biomedical regression tasks: estimating the physiological effect of medical treatments, and extrapolating gene expression (transcriptomics) signals. Our proposed technique is a promising initial step towards more robust use of adversarial signals in semi-supervised regression, and could be useful for other tasks (e.g., causal inference or modality translation) in the biomedical field.