Prompting Large Language Models for Clinical Temporal Relation Extraction

Objective: This paper aims to prompt large language models (LLMs) for clinical temporal relation extraction (CTRE) in both few-shot and fully supervised settings. Materials and Methods: This study utilizes four LLMs: Encoder-based GatorTron-Base (345M)/Large (8.9B); Decoder-based LLaMA3-8B/MeLLaMA-13B. We developed full (FFT) and parameter-efficient (PEFT) fine-tuning strategies and evaluated these strategies on the 2012 i2b2 CTRE task. We explored four fine-tuning strategies for GatorTron-Base: (1) Standard Fine-Tuning, (2) Hard-Prompting with Unfrozen LLMs, (3) Soft-Prompting with Frozen LLMs, and (4) Low-Rank Adaptation (LoRA) with Frozen LLMs. For GatorTron-Large, we assessed two PEFT strategies-Soft-Prompting and LoRA with Frozen LLMs-leveraging Quantization techniques. Additionally, LLaMA3-8B and MeLLaMA-13B employed two PEFT strategies: LoRA strategy with Quantization (QLoRA) applied to Frozen LLMs using instruction tuning and standard fine-tuning. Results: Under fully supervised settings, Hard-Prompting with Unfrozen GatorTron-Base achieved the highest F1 score (89.54%), surpassing the SOTA model (85.70%) by 3.74%. Additionally, two variants of QLoRA adapted to GatorTron-Large and Standard Fine-Tuning of GatorTron-Base exceeded the SOTA model by 2.36%, 1.88%, and 0.25%, respectively. Decoder-based models with frozen parameters outperformed their Encoder-based counterparts in this setting; however, the trend reversed in few-shot scenarios. Discussions and Conclusions: This study presented new methods that significantly improved CTRE performance, benefiting downstream tasks reliant on CTRE systems. The findings underscore the importance of selecting appropriate models and fine-tuning strategies based on task requirements and data availability. Future work will explore larger models and broader CTRE applications.

A Comparative Study of Recent Large Language Models on Generating Hospital Discharge Summaries for Lung Cancer Patients

Generating discharge summaries is a crucial yet time-consuming task in clinical practice, essential for conveying pertinent patient information and facilitating continuity of care. Recent advancements in large language models (LLMs) have significantly enhanced their capability in understanding and summarizing complex medical texts. This research aims to explore how LLMs can alleviate the burden of manual summarization, streamline workflow efficiencies, and support informed decision-making in healthcare settings. Clinical notes from a cohort of 1,099 lung cancer patients were utilized, with a subset of 50 patients for testing purposes, and 102 patients used for model fine-tuning. This study evaluates the performance of multiple LLMs, including GPT-3.5, GPT-4, GPT-4o, and LLaMA 3 8b, in generating discharge summaries. Evaluation metrics included token-level analysis (BLEU, ROUGE-1, ROUGE-2, ROUGE-L) and semantic similarity scores between model-generated summaries and physician-written gold standards. LLaMA 3 8b was further tested on clinical notes of varying lengths to examine the stability of its performance. The study found notable variations in summarization capabilities among LLMs. GPT-4o and fine-tuned LLaMA 3 demonstrated superior token-level evaluation metrics, while LLaMA 3 consistently produced concise summaries across different input lengths. Semantic similarity scores indicated GPT-4o and LLaMA 3 as leading models in capturing clinical relevance. This study contributes insights into the efficacy of LLMs for generating discharge summaries, highlighting LLaMA 3's robust performance in maintaining clarity and relevance across varying clinical contexts. These findings underscore the potential of automated summarization tools to enhance documentation precision and efficiency, ultimately improving patient care and operational capability in healthcare settings.

Improving Entity Recognition Using Ensembles of Deep Learning and Fine-tuned Large Language Models: A Case Study on Adverse Event Extraction from Multiple Sources

Adverse event (AE) extraction following COVID-19 vaccines from text data is crucial for monitoring and analyzing the safety profiles of immunizations. Traditional deep learning models are adept at learning intricate feature representations and dependencies in sequential data, but often require extensive labeled data. In contrast, large language models (LLMs) excel in understanding contextual information, but exhibit unstable performance on named entity recognition tasks, possibly due to their broad but unspecific training. This study aims to evaluate the effectiveness of LLMs and traditional deep learning models in AE extraction, and to assess the impact of ensembling these models on performance. In this study, we utilized reports and posts from the VAERS (n=621), Twitter (n=9,133), and Reddit (n=131) as our corpora. Our goal was to extract three types of entities: "vaccine", "shot", and "ae". We explored and fine-tuned (except GPT-4) multiple LLMs, including GPT-2, GPT-3.5, GPT-4, and Llama-2, as well as traditional deep learning models like RNN and BioBERT. To enhance performance, we created ensembles of the three models with the best performance. For evaluation, we used strict and relaxed F1 scores to evaluate the performance for each entity type, and micro-average F1 was used to assess the overall performance. The ensemble model achieved the highest performance in "vaccine", "shot", and "ae" with strict F1-scores of 0.878, 0.930, and 0.925, respectively, along with a micro-average score of 0.903. In conclusion, this study demonstrates the effectiveness and robustness of ensembling fine-tuned traditional deep learning models and LLMs, for extracting AE-related information. This study contributes to the advancement of biomedical natural language processing, providing valuable insights into improving AE extraction from text data for pharmacovigilance and public health surveillance.

Relation Extraction Using Large Language Models: A Case Study on Acupuncture Point Locations

In acupuncture therapy, the accurate location of acupoints is essential for its effectiveness. The advanced language understanding capabilities of large language models (LLMs) like Generative Pre-trained Transformers (GPT) present a significant opportunity for extracting relations related to acupoint locations from textual knowledge sources. This study aims to compare the performance of GPT with traditional deep learning models (Long Short-Term Memory (LSTM) and Bidirectional Encoder Representations from Transformers for Biomedical Text Mining (BioBERT)) in extracting acupoint-related location relations and assess the impact of pretraining and fine-tuning on GPT's performance. We utilized the World Health Organization Standard Acupuncture Point Locations in the Western Pacific Region (WHO Standard) as our corpus, which consists of descriptions of 361 acupoints. Five types of relations ('direction_of,' 'distance_of,' 'part_of,' 'near_acupoint,' and 'located_near') (n= 3,174) between acupoints were annotated. Five models were compared: BioBERT, LSTM, pre-trained GPT-3.5, fine-tuned GPT-3.5, as well as pre-trained GPT-4. Performance metrics included micro-average exact match precision, recall, and F1 scores. Our results demonstrate that fine-tuned GPT-3.5 consistently outperformed other models in F1 scores across all relation types. Overall, it achieved the highest micro-average F1 score of 0.92. This study underscores the effectiveness of LLMs like GPT in extracting relations related to acupoint locations, with implications for accurately modeling acupuncture knowledge and promoting standard implementation in acupuncture training and practice. The findings also contribute to advancing informatics applications in traditional and complementary medicine, showcasing the potential of LLMs in natural language processing.

Uncovering Misattributed Suicide Causes through Annotation Inconsistency Detection in Death Investigation Notes

Data accuracy is essential for scientific research and policy development. The National Violent Death Reporting System (NVDRS) data is widely used for discovering the patterns and causes of death. Recent studies suggested the annotation inconsistencies within the NVDRS and the potential impact on erroneous suicide-cause attributions. We present an empirical Natural Language Processing (NLP) approach to detect annotation inconsistencies and adopt a cross-validation-like paradigm to identify problematic instances. We analyzed 267,804 suicide death incidents between 2003 and 2020 from the NVDRS. Our results showed that incorporating the target state's data into training the suicide-crisis classifier brought an increase of 5.4% to the F-1 score on the target state's test set and a decrease of 1.1% on other states' test set. To conclude, we demonstrated the annotation inconsistencies in NVDRS's death investigation notes, identified problematic instances, evaluated the effectiveness of correcting problematic instances, and eventually proposed an NLP improvement solution.

AE-GPT: Using Large Language Models to Extract Adverse Events from Surveillance Reports-A Use Case with Influenza Vaccine Adverse Events

Though Vaccines are instrumental in global health, mitigating infectious diseases and pandemic outbreaks, they can occasionally lead to adverse events (AEs). Recently, Large Language Models (LLMs) have shown promise in effectively identifying and cataloging AEs within clinical reports. Utilizing data from the Vaccine Adverse Event Reporting System (VAERS) from 1990 to 2016, this study particularly focuses on AEs to evaluate LLMs' capability for AE extraction. A variety of prevalent LLMs, including GPT-2, GPT-3 variants, GPT-4, and Llama 2, were evaluated using Influenza vaccine as a use case. The fine-tuned GPT 3.5 model (AE-GPT) stood out with a 0.704 averaged micro F1 score for strict match and 0.816 for relaxed match. The encouraging performance of the AE-GPT underscores LLMs' potential in processing medical data, indicating a significant stride towards advanced AE detection, thus presumably generalizable to other AE extraction tasks.

Explainable Graph Neural Network for Alzheimer's Disease And Related Dementias Risk Prediction

Alzheimer's disease and related dementias (ADRD) ranks as the sixth leading cause of death in the US, underlining the importance of accurate ADRD risk prediction. While recent advancement in ADRD risk prediction have primarily relied on imaging analysis, yet not all patients undergo medical imaging before an ADRD diagnosis. Merging machine learning with claims data can reveal additional risk factors and uncover interconnections among diverse medical codes. Our goal is to utilize Graph Neural Networks (GNNs) with claims data for ADRD risk prediction. Addressing the lack of human-interpretable reasons behind these predictions, we introduce an innovative method to evaluate relationship importance and its influence on ADRD risk prediction, ensuring comprehensive interpretation. We employed Variationally Regularized Encoder-decoder Graph Neural Network (VGNN) for estimating ADRD likelihood. We created three scenarios to assess the model's efficiency, using Random Forest and Light Gradient Boost Machine as baselines. We further used our relation importance method to clarify the key relationships for ADRD risk prediction. VGNN surpassed other baseline models by 10% in the area under the receiver operating characteristic. The integration of the GNN model and relation importance interpretation could potentially play an essential role in providing valuable insight into factors that may contribute to or delay ADRD progression. Employing a GNN approach with claims data enhances ADRD risk prediction and provides insights into the impact of interconnected medical code relationships. This methodology not only enables ADRD risk modeling but also shows potential for other image analysis predictions using claims data.

Distributionally Robust Cross Subject EEG Decoding

Recently, deep learning has shown to be effective for Electroencephalography (EEG) decoding tasks. Yet, its performance can be negatively influenced by two key factors: 1) the high variance and different types of corruption that are inherent in the signal, 2) the EEG datasets are usually relatively small given the acquisition cost, annotation cost and amount of effort needed. Data augmentation approaches for alleviation of this problem have been empirically studied, with augmentation operations on spatial domain, time domain or frequency domain handcrafted based on expertise of domain knowledge. In this work, we propose a principled approach to perform dynamic evolution on the data for improvement of decoding robustness. The approach is based on distributionally robust optimization and achieves robustness by optimizing on a family of evolved data distributions instead of the single training data distribution. We derived a general data evolution framework based on Wasserstein gradient flow (WGF) and provides two different forms of evolution within the framework. Intuitively, the evolution process helps the EEG decoder to learn more robust and diverse features. It is worth mentioning that the proposed approach can be readily integrated with other data augmentation approaches for further improvements. We performed extensive experiments on the proposed approach and tested its performance on different types of corrupted EEG signals. The model significantly outperforms competitive baselines on challenging decoding scenarios.

Advancing Biomedicine with Graph Representation Learning: Recent Progress, Challenges, and Future Directions

Graph representation learning (GRL) has emerged as a pivotal field that has contributed significantly to breakthroughs in various fields, including biomedicine. The objective of this survey is to review the latest advancements in GRL methods and their applications in the biomedical field. We also highlight key challenges currently faced by GRL and outline potential directions for future research.

Application of an ontology for model cards to generate computable artifacts for linking machine learning information from biomedical research

Model card reports provide a transparent description of machine learning models which includes information about their evaluation, limitations, intended use, etc. Federal health agencies have expressed an interest in model cards report for research studies using machine-learning based AI. Previously, we have developed an ontology model for model card reports to structure and formalize these reports. In this paper, we demonstrate a Java-based library (OWL API, FaCT++) that leverages our ontology to publish computable model card reports. We discuss future directions and other use cases that highlight applicability and feasibility of ontology-driven systems to support FAIR challenges.