Canada

Massively multilingual pre-trained language models (MMPLMs) are developed in recent years demonstrating superpowers and the pre-knowledge they acquire for downstream tasks. This work investigates whether MMPLMs can be applied to clinical domain machine translation (MT) towards entirely unseen languages via transfer learning. We carry out an experimental investigation using Meta-AI&#39;s MMPLMs ``wmt21-dense-24-wide-en-X and X-en (WMT21fb)&#39;&#39; which were pre-trained on 7 language pairs and 14 translation directions including English to Czech, German, Hausa, Icelandic, Japanese, Russian, and Chinese, and the opposite direction. We fine-tune these MMPLMs towards English-\textit{Spanish} language pair which \textit{did not exist at all} in their original pre-trained corpora both implicitly and explicitly. We prepare carefully aligned \textit{clinical} domain data for this fine-tuning, which is different from their original mixed domain knowledge. Our experimental result shows that the fine-tuning is very successful using just 250k well-aligned in-domain EN-ES segments for three sub-task translation testings: clinical cases, clinical terms, and ontology concepts. It achieves very close evaluation scores to another MMPLM NLLB from Meta-AI, which included Spanish as a high-resource setting in the pre-training. To the best of our knowledge, this is the first work on using MMPLMs towards \textit{clinical domain transfer-learning NMT} successfully for totally unseen languages during pre-training.


ACL 2023

Investigating Massive Multilingual Pre-Trained Machine Translation Models for Clinical Domain via Transfer Learning

clinical nmt

neural mt

clinicalnlp

transfer learning

Massively multilingual pre-trained language models (MMPLMs) are developed in recent years demonstrating superpowers and the pre-knowledge they acquire for downstream tasks. This work investigates whether MMPLMs can be applied to clinical domain machine translation (MT) towards entirely unseen languages via transfer learning. We carry out an experimental investigation using Meta-AI's MMPLMs ``wmt21-dense-24-wide-en-X and X-en (WMT21fb)'' which were pre-trained on 7 language pairs and 14 translation directions including English to Czech, German, Hausa, Icelandic, Japanese, Russian, and Chinese, and the opposite direction. We fine-tune these MMPLMs towards English-\textit{Spanish} language pair which \textit{did not exist at all} in their original pre-trained corpora both implicitly and explicitly. We prepare carefully aligned \textit{clinical} domain data for this fine-tuning, which is different from their original mixed domain knowledge. Our experimental result shows that the fine-tuning is very successful using just 250k well-aligned in-domain EN-ES segments for three sub-task translation testings: clinical cases, clinical terms, and ontology concepts. It achieves very close evaluation scores to another MMPLM NLLB from Meta-AI, which included Spanish as a high-resource setting in the pre-training. To the best of our knowledge, this is the first work on using MMPLMs towards \textit{clinical domain transfer-learning NMT} successfully for totally unseen languages during pre-training.


workshop paper

### Welcome to ACL 2023, the 61st Annual Meeting of the Association for Computational Linguistics! 
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The Association for Computational Linguistics (ACL) is the premier international scientific and professional society for people working on computational problems involving human language, a field often referred to as either computational linguistics or natural language processing.

The Coronavirus pandemic has heightened the demand for technological solutions capable of gathering and monitoring data automatically, quickly, and securely. To achieve this need, the Plantão Coronavirus chatbot has been made available to the population of Ceará State in Brazil. This chatbot employs automated symptom detection technology through Natural Language Processing (NLP). The proposal of this work is a symptom tracker, which is a neural network that processes texts and captures symptoms in messages exchanged between citizens of the state and the Plantão Coronavirus nurse/doctor, i.e., clinical conversations. The model has the ability to recognize new patterns and has identified a high incidence of altered psychological behaviors, including anguish, anxiety, and sadness, among users who tested positive or negative for Covid-19. As a result, the tool has emphasized the importance of expanding coverage through community mental health services in the state.

Tracking the Evolution of Covid-19 Symptoms through Clinical Conversations

Pretrained language models leverage self-supervised learning to use large amounts of unlabeled text for learning contextual representations of sequences. However, in the domain of medical conversations, the availability of large, public datasets is limited due to issues of privacy and data management. In this paper, we study the effectiveness of dialog-aware pretraining objectives and multiphase training in using unlabeled data to improve LMs training for medical utterance classification. The objectives of pretraining for dialog awareness involve tasks that take into account the structure of conversations, including features such as turn-taking and the roles of speakers. The multiphase training process uses unannotated data in a sequence that prioritizes similarities and connections between different domains. We empirically evaluate these methods on conversational dialog classification tasks in the medical and counseling domains, and find that multiphase training can help achieve higher performance than standard pretraining or finetuning.

Navigating Data Scarcity: Pretraining for Medical Utterance Classification

In developing countries like India, doctors and healthcare professionals working in public health spend significant time answering health queries that are fact-based and repetitive. Therefore, we propose an automated way to answer maternal and child health-related queries. A database of Frequently Asked Questions (FAQs) and their corresponding answers generated by experts is curated from rural health workers and young mothers. We develop a Hindi chatbot that identifies k relevant Question and Answer (QnA) pairs from the database in response to a healthcare query (q) written in Devnagri script or Hindi-English (Hinglish) code-mixed script. The curated database covers 80% of all the queries that a user of our study is likely to ask. We experimented with (i) rule-based methods, (ii) sentence embeddings, and (iii) a paraphrasing classifier, to calculate the q-Q similarity. We observed that paraphrasing classifier gives the best result when trained first on an open-domain text and then on the healthcare domain. Our chatbot uses an ensemble of all three approaches. We observed that if a given q can be answered using the database, then our chatbot can provide at least one relevant QnA pair among its top three suggestions for up to 70% of the queries.

Hindi Chatbot for Supporting Maternal and Child Health Related Queries in Rural India

Generative artificial intelligence (AI) is a promising direction for augmenting clinical diagnostic decision support and reducing diagnostic errors, a leading contributor to medical errors. To further the development of clinical AI systems, the Diagnostic Reasoning Benchmark (DR.BENCH) was introduced as a comprehensive generative AI framework, comprised of six tasks representing key components in clinical reasoning. We present a comparative analysis of in-domain versus out-of-domain language models as well as multi-task versus single task training with a focus on the problem summarization task in DR.BENCH (Gao et al., 2023). We demonstrate that a multi-task, clinically trained language model outperforms its general domain counterpart by a large margin, establishing a new state-of-the-art performance, with a ROUGE-L score of 28.55. This research underscores the value of domain-specific training for optimizing clinical diagnostic reasoning tasks.

Multi-Task Training with In-Domain Language Models for Diagnostic Reasoning

Accurately capturing medication history is crucial in delivering high-quality medical care. The extraction of medication events from unstructured clinical notes, however, is challenging because the information is presented in complex narratives. We address this challenge by leveraging the newly released Contextualized Medication Event Dataset (CMED) as part of our participation in the 2022 National NLP Clinical Challenges (n2c2) shared task. Our study evaluates the performance of various pretrained language models in this task. Further, we find that data augmentation coupled with domain-specific training provides notable improvements. With experiments, we also underscore the importance of careful data preprocessing in medical event detection.

Context-aware Medication Event Extraction from Unstructured Text

In the medical field, there are many clinical texts such as electronic medical records, and research on Japanese natural language processing using these texts has been conducted. One such research involves Recognizing Textual
Entailment (RTE) in clinical texts using a semantic analysis and logical inference system, ccg2lambda. However, it is difficult for existing inference systems to correctly determine the entailment relations, if the input sentence contains medical domain specific paraphrases such as disease names. In this study, we pro-
pose a method to supplement the equivalence relations of disease names as axioms by identifying candidates for paraphrases that lack in theorem proving. Candidates of paraphrases are identified by using a model for the NER task for disease names and a disease name dictionary. We also construct an inference test set that requires knowledge injection of disease names and evaluate our inference system. Experiments showed that our inference system was able to correctly infer for 106 out of 149 inference test sets.

Knowledge Injection for Disease Names in Logical Inference between Japanese Clinical Texts

This work introduces a novel three-class annotation scheme for text-based dementia classification in patients, based on their recorded visit interactions. Multiple models were developed utilising BERT, RoBERTa and DistilBERT. Two approaches were employed to improve the representation of dementia samples: oversampling the underrepresented data points in the original Pitt dataset and combining the Pitt with the Holland and Kempler datasets. The DistilBERT models trained on either an oversampled Pitt dataset or the combined dataset performed best in classifying the dementia class. Specifically, the model trained on the oversampled Pitt dataset and the one trained on the combined dataset obtained state-of-the-art performance with 98.8% overall accuracy and 98.6% macro-averaged F1-score, respectively. The models' outputs were manually inspected through saliency highlighting, using Local Interpretable Model-agnostic Explanations (LIME), to provide a better understanding of its predictions.

Training Models on Oversampled Data and a Novel Multi-class Annotation Scheme for Dementia Detection

Recent advances in large language models (LLMs) have generated significant interest in their application across various domains including healthcare. However, there is limited data on their safety and performance in real-world scenarios. This study uses data collected using an autonomous telemedicine clinical assistant. The assistant asks symptom-based questions to elicit patient concerns and allows patients to ask questions about their post-operative recovery. We utilise real-world postoperative questions posed to the assistant by a cohort of 120 patients to examine the safety and appropriateness of responses generated by a recent popular LLM by OpenAI, ChatGPT. We demonstrate that LLMs have the potential to helpfully address routine patient queries following routine surgery. However, important limitations around the safety of today’s models exist which must be considered.

Can Large Language Models Safely Address Patient Questions Following Cataract Surgery?

We present our work on building large scale sequence-to-sequence models for generating clinical note from patient-doctor conversation. This is formulated as an abstractive summarization task for which we use encoder-decoder transformer model with pointer-generator. We discuss various modeling enhancements to this baseline model which include using subword and multiword tokenization scheme, prefixing the targets with a chain-of-clinical-facts, and training with contrastive loss that is defined over various candidate summaries. We also use flash attention during training and query chunked attention during inference to be able to process long input and output sequences and to improve computational efficiency. Experiments are conducted on a dataset containing about 900K encounters from around 1800 healthcare providers covering 27 specialties. The results are broken down into primary care and non-primary care specialties. Consistent accuracy improvements are observed across both of these categories.

Large Scale Sequence-to-Sequence Models for Clinical Note Generation from Patient-Doctor Conversations

We propose a method to automate orthodontic diagnosis with natural language processing. It is worthwhile to assist dentists with such technology to prevent errors by inexperienced dentists and to reduce the workload of experienced ones. However, text length and style inconsistencies in medical findings make an automated orthodontic diagnosis with deep-learning models difficult. In this study, we improve the performance of automatic diagnosis utilizing short summaries of medical findings written in a consistent style by experienced dentists. Experimental results on 970 Japanese medical findings show that summarization consistently improves the performance of various machine learning models for automated orthodontic diagnosis. Although BERT is the model that gains the most performance with the proposed method, the convolutional neural network achieved the best performance.

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Investigating Massive Multilingual Pre-Trained Machine Translation Models for Clinical Domain via Transfer Learning

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