arXiv subjects

Byron C. Wallace

Publications and source records attributed to Byron C. Wallace.

At least 55 records · Page 3Linked to original sources

arXiv2023

CHiLL: Zero-shot Custom Interpretable Feature Extraction from Clinical Notes with Large Language Models

We propose CHiLL (Crafting High-Level Latents), an approach for natural-language specification of features for linear models. CHiLL prompts LLMs with expert-crafted queries to generate interpretable features from health records. The resulting noisy labels are then used to train a simple linear classifier. Generating features based on queries to an LLM can empower physicians to use their domain expertise to craft features that are clinically meaningful for a downstream task of interest, without having to manually extract these from raw EHR. We are motivated by a real-world risk prediction task, but as a reproducible proxy, we use MIMIC-III and MIMIC-CXR data and standard predictive tasks (e.g., 30-day readmission) to evaluate this approach. We find that linear models using automatically extracted features are comparably performant to models using reference features, and provide greater interpretability than linear models using "Bag-of-Words" features. We verify that learned feature weights align well with clinical expectations.

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arXiv2023

Appraising the Potential Uses and Harms of LLMs for Medical Systematic Reviews

Medical systematic reviews play a vital role in healthcare decision making and policy. However, their production is time-consuming, limiting the availability of high-quality and up-to-date evidence summaries. Recent advancements in large language models (LLMs) offer the potential to automatically generate literature reviews on demand, addressing this issue. However, LLMs sometimes generate inaccurate (and potentially misleading) texts by hallucination or omission. In healthcare, this can make LLMs unusable at best and dangerous at worst. We conducted 16 interviews with international systematic review experts to characterize the perceived utility and risks of LLMs in the specific context of medical evidence reviews. Experts indicated that LLMs can assist in the writing process by drafting summaries, generating templates, distilling information, and crosschecking information. They also raised concerns regarding confidently composed but inaccurate LLM outputs and other potential downstream harms, including decreased accountability and proliferation of low-quality reviews. Informed by this qualitative analysis, we identify criteria for rigorous evaluation of biomedical LLMs aligned with domain expert views.

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arXiv2023

Multilingual Simplification of Medical Texts

Automated text simplification aims to produce simple versions of complex texts. This task is especially useful in the medical domain, where the latest medical findings are typically communicated via complex and technical articles. This creates barriers for laypeople seeking access to up-to-date medical findings, consequently impeding progress on health literacy. Most existing work on medical text simplification has focused on monolingual settings, with the result that such evidence would be available only in just one language (most often, English). This work addresses this limitation via multilingual simplification, i.e., directly simplifying complex texts into simplified texts in multiple languages. We introduce MultiCochrane, the first sentence-aligned multilingual text simplification dataset for the medical domain in four languages: English, Spanish, French, and Farsi. We evaluate fine-tuned and zero-shot models across these languages, with extensive human assessments and analyses. Although models can now generate viable simplified texts, we identify outstanding challenges that this dataset might be used to address.

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arXiv2023

Jointly Extracting Interventions, Outcomes, and Findings from RCT Reports with LLMs

Results from Randomized Controlled Trials (RCTs) establish the comparative effectiveness of interventions, and are in turn critical inputs for evidence-based care. However, results from RCTs are presented in (often unstructured) natural language articles describing the design, execution, and outcomes of trials; clinicians must manually extract findings pertaining to interventions and outcomes of interest from such articles. This onerous manual process has motivated work on (semi-)automating extraction of structured evidence from trial reports. In this work we propose and evaluate a text-to-text model built on instruction-tuned Large Language Models (LLMs) to jointly extract Interventions, Outcomes, and Comparators (ICO elements) from clinical abstracts, and infer the associated results reported. Manual (expert) and automated evaluations indicate that framing evidence extraction as a conditional generation task and fine-tuning LLMs for this purpose realizes considerable ($\sim$20 point absolute F1 score) gains over the previous SOTA. We perform ablations and error analyses to assess aspects that contribute to model performance, and to highlight potential directions for further improvements. We apply our model to a collection of published RCTs through mid-2022, and release a searchable database of structured findings: http://ico-relations.ebm-nlp.com

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arXiv2023

Evaluating the Zero-shot Robustness of Instruction-tuned Language Models

Instruction fine-tuning has recently emerged as a promising approach for improving the zero-shot capabilities of Large Language Models (LLMs) on new tasks. This technique has shown particular strength in improving the performance of modestly sized LLMs, sometimes inducing performance competitive with much larger model variants. In this paper we ask two questions: (1) How sensitive are instruction-tuned models to the particular phrasings of instructions, and, (2) How can we make them more robust to such natural language variation? To answer the former, we collect a set of 319 instructions manually written by NLP practitioners for over 80 unique tasks included in widely used benchmarks, and we evaluate the variance and average performance of these instructions as compared to instruction phrasings observed during instruction fine-tuning. We find that using novel (unobserved) but appropriate instruction phrasings consistently degrades model performance, sometimes substantially so. Further, such natural instructions yield a wide variance in downstream performance, despite their semantic equivalence. Put another way, instruction-tuned models are not especially robust to instruction re-phrasings. We propose a simple method to mitigate this issue by introducing ``soft prompt'' embedding parameters and optimizing these to maximize the similarity between representations of semantically equivalent instructions. We show that this method consistently improves the robustness of instruction-tuned models.

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arXiv2023

Automated Metrics for Medical Multi-Document Summarization Disagree with Human Evaluations

Evaluating multi-document summarization (MDS) quality is difficult. This is especially true in the case of MDS for biomedical literature reviews, where models must synthesize contradicting evidence reported across different documents. Prior work has shown that rather than performing the task, models may exploit shortcuts that are difficult to detect using standard n-gram similarity metrics such as ROUGE. Better automated evaluation metrics are needed, but few resources exist to assess metrics when they are proposed. Therefore, we introduce a dataset of human-assessed summary quality facets and pairwise preferences to encourage and support the development of better automated evaluation methods for literature review MDS. We take advantage of community submissions to the Multi-document Summarization for Literature Review (MSLR) shared task to compile a diverse and representative sample of generated summaries. We analyze how automated summarization evaluation metrics correlate with lexical features of generated summaries, to other automated metrics including several we propose in this work, and to aspects of human-assessed summary quality. We find that not only do automated metrics fail to capture aspects of quality as assessed by humans, in many cases the system rankings produced by these metrics are anti-correlated with rankings according to human annotators.

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arXiv2023

Summarizing, Simplifying, and Synthesizing Medical Evidence Using GPT-3 (with Varying Success)

Large language models, particularly GPT-3, are able to produce high quality summaries of general domain news articles in few- and zero-shot settings. However, it is unclear if such models are similarly capable in more specialized, high-stakes domains such as biomedicine. In this paper, we enlist domain experts (individuals with medical training) to evaluate summaries of biomedical articles generated by GPT-3, given zero supervision. We consider both single- and multi-document settings. In the former, GPT-3 is tasked with generating regular and plain-language summaries of articles describing randomized controlled trials; in the latter, we assess the degree to which GPT-3 is able to \emph{synthesize} evidence reported across a collection of articles. We design an annotation scheme for evaluating model outputs, with an emphasis on assessing the factual accuracy of generated summaries. We find that while GPT-3 is able to summarize and simplify single biomedical articles faithfully, it struggles to provide accurate aggregations of findings over multiple documents. We release all data and annotations used in this work.

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arXiv2023

Automatically Summarizing Evidence from Clinical Trials: A Prototype Highlighting Current Challenges

We present TrialsSummarizer, a system that aims to automatically summarize evidence presented in the set of randomized controlled trials most relevant to a given query. Building on prior work, the system retrieves trial publications matching a query specifying a combination of condition, intervention(s), and outcome(s), and ranks these according to sample size and estimated study quality. The top-k such studies are passed through a neural multi-document summarization system, yielding a synopsis of these trials. We consider two architectures: A standard sequence-to-sequence model based on BART and a multi-headed architecture intended to provide greater transparency to end-users. Both models produce fluent and relevant summaries of evidence retrieved for queries, but their tendency to introduce unsupported statements render them inappropriate for use in this domain at present. The proposed architecture may help users verify outputs allowing users to trace generated tokens back to inputs.

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arXiv2023

NapSS: Paragraph-level Medical Text Simplification via Narrative Prompting and Sentence-matching Summarization

Accessing medical literature is difficult for laypeople as the content is written for specialists and contains medical jargon. Automated text simplification methods offer a potential means to address this issue. In this work, we propose a summarize-then-simplify two-stage strategy, which we call NapSS, identifying the relevant content to simplify while ensuring that the original narrative flow is preserved. In this approach, we first generate reference summaries via sentence matching between the original and the simplified abstracts. These summaries are then used to train an extractive summarizer, learning the most relevant content to be simplified. Then, to ensure the narrative consistency of the simplified text, we synthesize auxiliary narrative prompts combining key phrases derived from the syntactical analyses of the original text. Our model achieves results significantly better than the seq2seq baseline on an English medical corpus, yielding 3%~4% absolute improvements in terms of lexical similarity, and providing a further 1.1% improvement of SARI score when combined with the baseline. We also highlight shortcomings of existing evaluation methods, and introduce new metrics that take into account both lexical and high-level semantic similarity. A human evaluation conducted on a random sample of the test set further establishes the effectiveness of the proposed approach. Codes and models are released here: https://github.com/LuJunru/NapSS.

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arXiv2023

How Many and Which Training Points Would Need to be Removed to Flip this Prediction?

We consider the problem of identifying a minimal subset of training data $\mathcal{S}_t$ such that if the instances comprising $\mathcal{S}_t$ had been removed prior to training, the categorization of a given test point $x_t$ would have been different. Identifying such a set may be of interest for a few reasons. First, the cardinality of $\mathcal{S}_t$ provides a measure of robustness (if $|\mathcal{S}_t|$ is small for $x_t$, we might be less confident in the corresponding prediction), which we show is correlated with but complementary to predicted probabilities. Second, interrogation of $\mathcal{S}_t$ may provide a novel mechanism for contesting a particular model prediction: If one can make the case that the points in $\mathcal{S}_t$ are wrongly labeled or irrelevant, this may argue for overturning the associated prediction. Identifying $\mathcal{S}_t$ via brute-force is intractable. We propose comparatively fast approximation methods to find $\mathcal{S}_t$ based on influence functions, and find that -- for simple convex text classification models -- these approaches can often successfully identify relatively small sets of training examples which, if removed, would flip the prediction.

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arXiv2022

Intermediate Entity-based Sparse Interpretable Representation Learning

Interpretable entity representations (IERs) are sparse embeddings that are "human-readable" in that dimensions correspond to fine-grained entity types and values are predicted probabilities that a given entity is of the corresponding type. These methods perform well in zero-shot and low supervision settings. Compared to standard dense neural embeddings, such interpretable representations may permit analysis and debugging. However, while fine-tuning sparse, interpretable representations improves accuracy on downstream tasks, it destroys the semantics of the dimensions which were enforced in pre-training. Can we maintain the interpretable semantics afforded by IERs while improving predictive performance on downstream tasks? Toward this end, we propose Intermediate enTity-based Sparse Interpretable Representation Learning (ItsIRL). ItsIRL realizes improved performance over prior IERs on biomedical tasks, while maintaining "interpretability" generally and their ability to support model debugging specifically. The latter is enabled in part by the ability to perform "counterfactual" fine-grained entity type manipulation, which we explore in this work. Finally, we propose a method to construct entity type based class prototypes for revealing global semantic properties of classes learned by our model.

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arXiv2022

Influence Functions for Sequence Tagging Models

Many language tasks (e.g., Named Entity Recognition, Part-of-Speech tagging, and Semantic Role Labeling) are naturally framed as sequence tagging problems. However, there has been comparatively little work on interpretability methods for sequence tagging models. In this paper, we extend influence functions - which aim to trace predictions back to the training points that informed them - to sequence tagging tasks. We define the influence of a training instance segment as the effect that perturbing the labels within this segment has on a test segment level prediction. We provide an efficient approximation to compute this, and show that it tracks with the true segment influence, measured empirically. We show the practical utility of segment influence by using the method to identify systematic annotation errors in two named entity recognition corpora. Code to reproduce our results is available at https://github.com/successar/Segment_Influence_Functions.

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arXiv2022

That's the Wrong Lung! Evaluating and Improving the Interpretability of Unsupervised Multimodal Encoders for Medical Data

Pretraining multimodal models on Electronic Health Records (EHRs) provides a means of learning representations that can transfer to downstream tasks with minimal supervision. Recent multimodal models induce soft local alignments between image regions and sentences. This is of particular interest in the medical domain, where alignments might highlight regions in an image relevant to specific phenomena described in free-text. While past work has suggested that attention "heatmaps" can be interpreted in this manner, there has been little evaluation of such alignments. We compare alignments from a state-of-the-art multimodal (image and text) model for EHR with human annotations that link image regions to sentences. Our main finding is that the text has an often weak or unintuitive influence on attention; alignments do not consistently reflect basic anatomical information. Moreover, synthetic modifications -- such as substituting "left" for "right" -- do not substantially influence highlights. Simple techniques such as allowing the model to opt out of attending to the image and few-shot finetuning show promise in terms of their ability to improve alignments with very little or no supervision. We make our code and checkpoints open-source.

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arXiv2022

PHEE: A Dataset for Pharmacovigilance Event Extraction from Text

The primary goal of drug safety researchers and regulators is to promptly identify adverse drug reactions. Doing so may in turn prevent or reduce the harm to patients and ultimately improve public health. Evaluating and monitoring drug safety (i.e., pharmacovigilance) involves analyzing an ever growing collection of spontaneous reports from health professionals, physicians, and pharmacists, and information voluntarily submitted by patients. In this scenario, facilitating analysis of such reports via automation has the potential to rapidly identify safety signals. Unfortunately, public resources for developing natural language models for this task are scant. We present PHEE, a novel dataset for pharmacovigilance comprising over 5000 annotated events from medical case reports and biomedical literature, making it the largest such public dataset to date. We describe the hierarchical event schema designed to provide coarse and fine-grained information about patients' demographics, treatments and (side) effects. Along with the discussion of the dataset, we present a thorough experimental evaluation of current state-of-the-art approaches for biomedical event extraction, point out their limitations, and highlight open challenges to foster future research in this area.

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arXiv2022

Self-Repetition in Abstractive Neural Summarizers

We provide a quantitative and qualitative analysis of self-repetition in the output of neural summarizers. We measure self-repetition as the number of n-grams of length four or longer that appear in multiple outputs of the same system. We analyze the behavior of three popular architectures (BART, T5, and Pegasus), fine-tuned on five datasets. In a regression analysis, we find that the three architectures have different propensities for repeating content across output summaries for inputs, with BART being particularly prone to self-repetition. Fine-tuning on more abstractive data, and on data featuring formulaic language, is associated with a higher rate of self-repetition. In qualitative analysis we find systems produce artefacts such as ads and disclaimers unrelated to the content being summarized, as well as formulaic phrases common in the fine-tuning domain. Our approach to corpus-level analysis of self-repetition may help practitioners clean up training data for summarizers and ultimately support methods for minimizing the amount of self-repetition.

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arXiv2022

Learning to Ask Like a Physician

Existing question answering (QA) datasets derived from electronic health records (EHR) are artificially generated and consequently fail to capture realistic physician information needs. We present Discharge Summary Clinical Questions (DiSCQ), a newly curated question dataset composed of 2,000+ questions paired with the snippets of text (triggers) that prompted each question. The questions are generated by medical experts from 100+ MIMIC-III discharge summaries. We analyze this dataset to characterize the types of information sought by medical experts. We also train baseline models for trigger detection and question generation (QG), paired with unsupervised answer retrieval over EHRs. Our baseline model is able to generate high quality questions in over 62% of cases when prompted with human selected triggers. We release this dataset (and all code to reproduce baseline model results) to facilitate further research into realistic clinical QA and QG: https://github.com/elehman16/discq.

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arXiv2022

Evaluating Factuality in Text Simplification

Automated simplification models aim to make input texts more readable. Such methods have the potential to make complex information accessible to a wider audience, e.g., providing access to recent medical literature which might otherwise be impenetrable for a lay reader. However, such models risk introducing errors into automatically simplified texts, for instance by inserting statements unsupported by the corresponding original text, or by omitting key information. Providing more readable but inaccurate versions of texts may in many cases be worse than providing no such access at all. The problem of factual accuracy (and the lack thereof) has received heightened attention in the context of summarization models, but the factuality of automatically simplified texts has not been investigated. We introduce a taxonomy of errors that we use to analyze both references drawn from standard simplification datasets and state-of-the-art model outputs. We find that errors often appear in both that are not captured by existing evaluation metrics, motivating a need for research into ensuring the factual accuracy of automated simplification models.

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arXiv2022

Combining Feature and Instance Attribution to Detect Artifacts

Training the deep neural networks that dominate NLP requires large datasets. These are often collected automatically or via crowdsourcing, and may exhibit systematic biases or annotation artifacts. By the latter we mean spurious correlations between inputs and outputs that do not represent a generally held causal relationship between features and classes; models that exploit such correlations may appear to perform a given task well, but fail on out of sample data. In this paper we evaluate use of different attribution methods for aiding identification of training data artifacts. We propose new hybrid approaches that combine saliency maps (which highlight important input features) with instance attribution methods (which retrieve training samples influential to a given prediction). We show that this proposed training-feature attribution can be used to efficiently uncover artifacts in training data when a challenging validation set is available. We also carry out a small user study to evaluate whether these methods are useful to NLP researchers in practice, with promising results. We make code for all methods and experiments in this paper available.

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