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IIIT Delhi Presentation

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Statistical AI has been successfully applied in healthcare services (e.g. electronic health records) and practices (e.g. counseling conversation in mental health) both in online and clinical settings. However, several concerns remain that prevent the broader adoption of AI techniques. These include interpretability, traceability, and explainability of recognized patterns and their inter-relationships, which improves clinical decision making. An inquiry into these questions, allowed us to investigate three different knowledge-infusion paradigms: (a) Shallow Infusion, (b) Semi-Deep Infusion, and (c) Deep Infusion of knowledge from KG. The talk will explain Knowledge-Infused learning through four capabilities needed for healthcare applications: Medical Entity Normalization, Knowledge-Aware Hybrid Patient-Clinician Matchmaking, and Summarization.

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IIIT Delhi Presentation

  1. 1. Knowledge-infused AI for Healthcare: Role of Conceptual Medical Knowledge in Improving Machine Understanding Artificial Intelligence Institute Manas Gaur mgaur@email.sc.edu
  2. 2. AI Outline Why do we need Knowledge Infusion ? Let Me Tell You About Your Mental Health! : Contextualized Classification of Reddit Post to DSM-5 Unsupervised Abstractive Summarization of Clinical Diagnostic Interviews Semi-Deep Knowledge Infusion Shallow Knowledge Infusion
  3. 3. AI
  4. 4. BERT Abstractive Summarization using Integer Linear Programming (ILP) Abstractive Summarization using ILP and PHQ-9 Statistical Statistical + Constraints Statistical + Constraints + Knowledge AI
  5. 5. Arachie, Chidubem, Manas Gaur, Sam Anzaroot, William Groves, Ke Zhang, and Alejandro Jaimes. "Unsupervised Detection of Sub-events in Large Scale Disasters." arXiv preprint arXiv:1912.13332 (2019). Unsupervised Detection of Sub-events in Large Scale Disasters AI
  6. 6. AI Gyrard, A., Gaur, M., Shekarpour, S., Thirunarayan, K., & Sheth, A. (2018). Personalized Health Knowledge Graph. In ISWC 2018 Contextualized Knowledge Graph Workshop.
  7. 7. AI W2V Islamic Corpus Religious Dimension (R) R R R Contextual Dimension Modeling is a one-time learning process User Contextual Dimension based Representation W2V Ideological Corpus W2V Hate Corpus (...) I I I (...) H H H (...)
  8. 8. Probably Approximately Correct Learning AI Valiant, Leslie G. "Robust logics." Artificial Intelligence 117.2 (2000): 231-253.
  9. 9. Probably Approximately Correct Learning How do you know that a training set has a good domain coverage? Robust Classifier → Low Generalizability Error Consistent Classifier → Low Training Error Confidence: More Certainty (lower δ) means more number of samples. Complexity: More complicated hypothesis (|H|) means more number of samples AI
  10. 10. PAC Learning to Knowledge Infusion Challenge: Existing ML Models: Infusion: True Data Distribution Hypothesis Data Distribution AI
  11. 11. AI Hu, Zhiting, et al. "Deep generative models with learnable knowledge constraints." Advances in Neural Information Processing Systems. 2018.
  12. 12. Dataset enrich Machine Learning Tacit Knowledge Hypothesis testing or similarity-based verification Shallow Infusion Dataset Tacit Knowledge Self-aware or External Knowledge Self-aware or External Knowledge Similarity based verification Semi-Deep Infusion AI
  13. 13. Knowledge Infusion Identification and Integration of Commonsense knowledge for principled reasoning. Identification: Finding relevant information at an appropriate abstraction level in the Knowledge Graph Integration: Controlled content enrichment or modification to reduce Impedance Mismatch in learning Benefit: Robustness is ensured AI
  14. 14. Patient is a known case of non-Hodgkin’s lymphoma and undergone three cycles of chemotherapy. AI
  15. 15. Algorithmic possibilities and limitations of AI System AI Teaching Materials ● Ontology ● Knowledge Graph ● Knowledge Base ● Lexicons Teaching Materials form a conceptual framework of interconnecting sets of domain-focused concepts and relationships Remove ambiguity and sparsity. Drug Abuse Ontology ● Concepts (315) ● Relations (31) ● Instances (814)
  16. 16. Teaching Materials Commonsense Reasoning Web Mining Knowledge-based Crowdsourcing E.g. NELL, KnowItAll E.g. ConceptNet, OpenMind Mathematical Informal Large-Scale E.g. Situation Calculus E.g. LIWC, Scripts E.g. CYC, DBpedia AI
  17. 17. Knowledge Infusion in Healthcare 3 Challenges Abstraction Contextualization Personalization Shallow Infusion Shallow and Semi-Deep Infusion Shallow, Semi-Deep, and Deep Infusion AI
  18. 18. Abstraction : Medical Entity Normalization I am sick of loss, need a way out No way out, I am tired of my losses Losses, Losses, I want to die SuicideDepression Suicide Depression Suicide Depression depress, suicide ideation suicide ideation, depress Depress, suicide attempt AI
  19. 19. Teaching Material: Suicide Severity Lexicon Suicide Risk Class Number of Entities Sample Medical Phrases Suicide Indicator 1472 Severe mood disorder with psychotic feature; Severe major depression; Family history of suicide; Sedative Suicide Ideation 409 Bipolar affective disorder; Borderline Personality; Depressive conduct disorder; Sexual maturation disorder Suicide Behavior 145 Suicidal behavior; Intentional self-harm; Incomplete attempt; Threatening suicide Suicide Attempt 123 Attempt actual suicide; Attempt physical damage; Intensive care; Second-degree burns Suicide by Hanging [SNOMED ID: 287190007] <child of> Suicide [SNOMED ID:44301001] <sibling of> Drug Overdose [SNOMED ID:274228002] <sibling of> Personal history of self-harm [ICD-10 ID: Z91.5] <sibling of> Severe depressive episode psychotic symptoms [ICD-10 ID: F32.3] AI http://bit.ly/lexicons_suicide_severity
  20. 20. Contextualization I dont think Ive thought about it every day of my entire life. I have for a good portion of it, however, my boyfriend may be able to determine whether I’m worth his time Outcome : Suicide Indication Having a plan for my own suicide has been a long time relief for me as well. I more often than not wish I were dead. I dont think Ive thought about it every day of my entire life. I have for a good portion of it, however, my boyfriend may be able to determine whether I’m worth his time Outcome : Suicidal Ideation AI
  21. 21. Contextualization Medical KnowledgeBases Language Model (LDA, BERT) Content Similarity Matrix AI
  22. 22. Personalization refers to future course of action by taking into account the contextual factors such as user’s health history, physical characteristics, environmental factors, activity, and lifestyle. Without Contextualized Personalization With Contextualized Personalization Chatbot with contextualized (asthma) knowledge is potentially more personalized and engaging. AI
  23. 23. Let Me Tell You About Your Mental Health! : Contextualized Classification of Reddit Post to DSM-5 Gaur, Manas, Ugur Kursuncu, Amanuel Alambo, Amit Sheth, Raminta Daniulaityte, Krishnaprasad Thirunarayan, and Jyotishman Pathak. "Let me tell you about your mental health!: Contextualized classification of reddit posts to dsm-5 for web-based intervention." In Proceedings of the 27th ACM International Conference on Information and Knowledge Management, pp. 753-762. ACM, 2018. AI
  24. 24. Problem Statement: Can data on the Web assist Mental Health Professionals in Early Intervention ? AI
  25. 25. Motivation AI Social Anxiety and Therapeutic Pessimism Patient: Poor Recall Rate Clinician: Poor understanding of patient behavior Poor long lasting patient-doctor relationship Clinical data is time-limited Data is short and not categorized Data is long and categorized Reddit categorization does not overlap with Clinician
  26. 26. Main Post Comment Reply Subreddit AI
  27. 27. Challenge ➢ How can we use Reddit for psychiatric diagnosis? ○ Is it possible to map Subreddits to Diagnostic Statistical Manual for Mental Health ? ○ If yes, can we build a learning algorithm for classifying the user on social media to appropriate DSM-5 category for suitable diagnosis? AI
  28. 28. 2013, 5th Edition Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a psychiatric bible that can cure 46.4% of adult US population suffering from Mental Illness. Redditors conversing on Alcohol Abuse, Caffeine Intoxication can be mapped to DSM-5 category: Substance-use and Addictive Disorder There are 21 Diagnostic categories of which 20 are specific to Mental Health Background on DSM-5 AI
  29. 29. Examples I know you want me to say no and that it is a part of me blah blah blah. But I can't. Honestly, not having bipolar disorder would be a huge blessing. I would be so much happier and could control my life better. I wouldn't have frantic, scattered thoughts and depression. I would be normal, happy, and less dramatic. Depressive Disorders Post from Bipolar Subreddit: DSM-5 Chapter: Upon additional research, zolpidem (ambien) has a half-life of 2-3 hours, and so if he’s still awake, he’s either got a massive tolerance for this stuff or he’s really trolling. Suicidal Behavior/Ideation Disorders Post from Suicidewatch Subreddit: DSM-5 Chapter: AI
  30. 30. Dataset 2005-2016 550K Users 8 Million Conversations 15 Mental Health Subreddits 2005-2016 270K Users ( Only Authors of Main Posts) 3 Million Conversations (Main Posts Only) 15 Mental Health Subreddits AI
  31. 31. Reddit to DSM-5 Mapping Medical KnowledgeBases N-grams (n=1, 2, 3) LDA LDA over Bi-grams Normalized Hit Score DSM-5 Lexicon <Reddit Post> <Subreddit Label> Input <Reddit Post> <DSM-5 Label> Output DAO Drug Abuse Ontology AI
  32. 32. ● Topics describing each subreddits are identified through: ○ Skip Gram model to generate n-grams ○ LDA over individual subreddits ○ LDA over bigrams of individual subreddits ● Relevant topics were identified constraining through Topic Coherence measure. ● We utilize UCI topic coherence model which is Pointwise Mutual Information. Language Modeling and Coherence AI
  33. 33. AI
  34. 34. Computed using → LDA topics of each subreddit (S) → the DSM-5 category (D) in DSM-5 lexicon Normalized Hit Score AI
  35. 35. AI
  36. 36. BiPolar Depression Disorder Subreddits DSM-5 Chapter: BiPolarReddit BiPolarSOS Depression Addiction Substance use & Addictive Disorder Crippling Alcoholism Opiates Recovery Opiates Self-Harm Stop Self-Harm Mapping Example AI
  37. 37. SEDO Semantic Encoding and Decoding Optimization. It is a procedure to modulate word embedding (vectors) of a word. Reddit with DSM-5 labels Word Embedding Model Correlation Matrix (Q)over word vectors Medical Knowledge Bases Domain Experts Correlation Matrix (P) over DSM-5 Lexicon or DAO SEDO Optimize P, Q & Z DSM-5 Lexicon DSM-5 Vocabulary Matrix Word-modulated Word Embeddings DSM-5 Classification Cross Correlation Matrix (Z) between word vectors and DSM-5 Lexicon or DAO Linguistic Features DAO Architecture AI
  38. 38. We have infused background knowledge in DSM-5- DAO to classification process utilizing SEDO. We introduce SEDO as an approach for obtaining a discriminative weight matrix between the DSM-5 lexicon and Reddit embedding space SEDO modulates the embeddings of each word in the Reddit content of the user based on proximity of the word to DSM-5 category. Correlation Matrix (Q)over word vectors Correlation Matrix (P) over DSM-5 Lexicon or DAO SEDO Optimize P, Q & Z Cross Correlation Matrix (Z) between word vectors and DSM-5 Lexicon or DAO Semantic Encoding and Decoding Optimization AI
  39. 39. 12808 Words 300 dimension embedding 300 dimension embedding 20 DSM-5 Categories R D Reddit Word Embedding Model DSM-5 -DAO Lexicon W Solvable Sylvester Equation Semantic Encoding and Decoding Optimization AI
  40. 40. Encoding DSM-5 to Reddit embedding space Decoding Reddit to DSM-5 embedding space Semantic Encoding and Decoding Optimization AI
  41. 41. Domain-specific Knowledge lowers False Alarm Rates. AI
  42. 42. AI
  43. 43. Unsupervised Abstractive Summarization of Clinical Diagnostic Interviews Vamsi Aribandi, Manas Gaur, Ugur Kursuncu, Amanuel Alambo, Krishnaprasad Thirunarayan, Jonathan Beich and Amit Sheth. "Unsupervised Abstractive Summarization of Clinical Diagnostic Interviews", under review in PLOS one AI
  44. 44. Motivation AI Mental Health Professionals are involved in interactive and note-taking activities, which negatively affect the decision making. Thus thwarting a learned follow-up procedure. The proposed framework summarizes long conversations (58-60 sentences) in 7-8 sentences
  45. 45. AI Interviews of patients suffering from: ● Anxiety ● Depression ● Post Traumatic Stress Disorder 189 Interviews, 7-33 minutes long 5 out of the 189 interviews have been excluded We further filtered content of 185 interview scripts based on subjectivity, polarity, and entropy analysis
  46. 46. Challenge AI
  47. 47. AI Architecture
  48. 48. ● Identification of relevant utterances from interview transcripts using PHQ-9 Lexicon. ● Generation of a semantic similarity score for a word to assess its relevance to mental issue. ● We do it by retrofitting ConceptNet embedding with the PHQ-9 Lexicon. ● Let c(wi) be the maximum cosine similarity score between a word wi in ConceptNet (V vocab size) and PHQ-9 Lexicon. Word Semantic Score (WSS) of any word wt is calculated as: AI Our Approach
  49. 49. ● Improvement of generated summaries using linguistic quality measure (LQ). ● LQ formulation uses WSS(wt), so that more domain-relevant terms appear in summaries. ● Unification of our modification into an Integer Linear Programming (ILP) Framework, which optimizes Informativeness (I) and LQ. ● The ILP framework intrinsically constructs a Word Graph with k paths (Pk) and tries to maximize the I(Pk) and LQ(Pk). ● TextRank is used to measure informativeness. ● A language model is used to evaluate linguistic quality. ● To select the best path, both measures are incorporated to formulate an optimization problem. ● This optimization problem is solved through an ILP framework. Our Approach - Linguistic Quality AI
  50. 50. AI Our Approach - ILP
  51. 51. We compare our approach with state-of-the art summarization techniques: ● Extractive Summarization (ES) : Greedily identifies important utterances from interview scripts and produce a summary. It fails to gather context in the conversation. ● Abstractive Summarization (AS) : Examines and Interpret the interview scripts to generate more contextualized summaries. It fails to gather domain knowledge. ● Abstractive over Extractive (AOES): ES is efficient in filtering out non-informative sentences which can help AS to generate more coherent summaries. ● Knowledge Infused AS (KIAS) (Our approach): Existing approaches do not consider domain knowledge, important to end user. AS and ES tend to lose important pieces of information as explained in illustrated summaries. Since, there are no ground truth summaries on clinical diagnostic interviews, we considered the pruned interview transcripts as ground truth. AI Baselines
  52. 52. KL Divergence Based Evaluation AI Median KL divergence score for different summarization approaches and PHQxAS over 184 patient summaries. Median KL explains the amount of information lost in summarization and is insensitive to outlier summaries. The number of topics were restricted to 7 because of the length of the interviews per patient.
  53. 53. Domain Expert Based Evaluation AI For example: Participant was asked, when was the last time that happened?, where the referent of "that" is unclear. Questions with Unclear Context: The questions interpreted and phrased by the summarizer are essential to an MHP, but they require some inferencing by an MHP for apprehension. For example: Participant was asked, did they ever suffer from PTSD? Questions with Clear Context: These are the questions that are useful to an MHP as they are complete and no inferencing is required on the part of MHP.
  54. 54. Domain Expert Evaluation AI Meaningful Response: ● If it is useful to an MHP to understand patient behavior ● It matches well with the question being asked by the MHP.
  55. 55. Generated Summaries https://docs.google.com/spreadsheets/d/17ax_FsLs4Xkb95g4RDWT04g631vciktqH_mwisE6A6s/edit?usp=s haring AI
  56. 56. https://docs.google.com/spreadsheets/d/17ax_FsLs4Xkb95g4RDWT04g631vciktqH_mwisE6A6s/edit?usp=s haring AI
  57. 57. Dr. Amit Sheth Dr. Thirunarayan Krishnaprasad Dr. Jyotishman Pathak Acknowledgement AI Dr. Randon Welton Dr. Jonathan Beich Dr. Meera Narasimhan Dr. Ugur Kursuncu Amanuel Alambo Vamsi Aribandi Vedant Khandelwal
  58. 58. ● Arachie, Chidubem, et al. "Unsupervised Detection of Sub-events in Large Scale Disasters." arXiv preprint arXiv:1912.13332 (2019). ● Kursuncu, Ugur, Manas Gaur, and Amit Sheth. "Knowledge Infused Learning (K-IL): Towards Deep Incorporation of Knowledge in Deep Learning." arXiv preprint arXiv:1912.00512 (2019). ● Kursuncu, Ugur, et al. "Modeling Islamist Extremist Communications on Social Media using Contextual Dimensions: Religion, Ideology, and Hate." Proceedings of the ACM on Human- Computer Interaction 3.CSCW (2019): 1-22. ● Gaur, Manas, et al. "Let me tell you about your mental health!: Contextualized classification of reddit posts to dsm-5 for web-based intervention." Proceedings of the 27th ACM International Conference on Information and Knowledge Management. ACM, 2018. ● Rudra, Koustav, et al. "Identifying sub-events and summarizing disaster-related information from microblogs." The 41st International ACM SIGIR Conference on Research & Development in Information Retrieval. ACM, 2018. ● Valiant, Leslie G. "Robust logics." Artificial Intelligence 117.2 (2000): 231-253. ● Banerjee, Siddhartha, Prasenjit Mitra, and Kazunari Sugiyama. "Multi-document abstractive summarization using ilp based multi-sentence compression." In Twenty-Fourth International Joint Conference on Artificial Intelligence. 2015. References AI
  59. 59. Benefit of Infusing Knowledge Interpretability: Rules or Axioms that are constructed from patterns learned by a machine learning model. Traceability: If we can validate the correctness of rules or axioms using a ground truth, we achieve traceability Explainability: Interpretability + Traceability Interpretability Explainability AI
  60. 60. AI Deep Infusion
  61. 61. In Reddit conversations can be: ● Main Posts ● Comments ● Replies Not all the conversations are informative. Pw is probability of occurrence of a word w in a Reddit main post file, UWS is the set of unique words in S, and |UWS| is total number of unique words in a subreddit S.
  62. 62. Number of Definite Articles : Tells about the abstractness of the content. Higher value means personal communication Number of Words Per Post : Defines descriptiveness of the content. First Person Pronouns: Higher use of first person pronouns defines social anxiety, distress, interpersonal problems etc. Number of Pronouns : Depressed users use significantly more first person singular pronouns then second or third person. Subordinate Conjunction : Rational thought process Horizontal Linguistic Features
  63. 63. Number of POS tags : Noun, Verb, and Adjective Similarity between the posts: detect gradual or abrupt drifting of topics. Intra-Subreddit Similarity: defines the similarity between the users within a subreddit. Inter-Subreddit Similarity: defined as an average similarity between a user in a subreddit A and all other users in other subreddits. Vertical Lingusitic Features
  64. 64. Sentiment Scores: We used AFINN lexicon which is an evaluation of word list for sentiment analysis in informal text. Emotion Scores: We used LabMT, a word list that score happiness of a corpus. Developed over Twitter, Google Books, and New York Times. Readability Scores: Using Flesch-Kincaid readability index to score the content of user suffering from mental illness. Fine-Grained Features
  65. 65. ● Contextual Features: These features defines the context of the user-content. ○ Word Embedding Model : Trained over 3 Million posts from 15 subreddits using varying window sizes (2,5,10), varying frequency (2 and 5), Skip Gram and softmax configuration. ○ Linguistic Inquiry and Word Count: psycholinguistic words defining mental state of the person through written samples. E.g. Worried, Fearful, nervous maps to Anxiety ○ TF-IDF: Define the importance of the word in a document (subreddit). ● Contextual features with modulation: Since word embedding model ignores importance of the words, tf-idf scores can help classification by strongly distinguishing important word over other. Contextual Features with/without Modulations
  66. 66. Legend Method B1 RF (Baseline) B2 Baseline + SMOTE B3 BRF - TF-IDF R1 BRF Contextual Features (CF) R2 BRF-CF with TF-IDF R3 BRF - LIWC Features R4 BRF - Twitter Word Embedding O1 BRF - CF (SEDO Weights generated from DSM-5 Lexicon without DAO) O2 BRF - CF (SEDO Weights generated from DSM-5 Lexicon with DAO without Slang Terms) O3 BRF - CF(SEDO Weights generated from DSM-5 Lexicon without DAO with Slang Terms) O4 BRF- Contextual Features(SEDO Weights generated from DSM-5 Lexicon with DAO and Slang Terms) Model and Annotator Agreement: 84%
  67. 67. Web-based Intervention through Social Media Patient Clinician Improved Healthcare EMR Patient Clinician Improved Healthcare EMR Insight DSM-5 & Drug Abuse Ontology

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