Beatrice Alex

Hang Dong, Víctor Suárez-Paniagua, Huayu Zhang et al. · oxford

Computational text phenotyping is the practice of identifying patients with certain disorders and traits from clinical notes. Rare diseases are challenging to be identified due to few cases available for machine learning and the need for data annotation from domain experts. We propose a method using ontologies and weak supervision, with recent pre-trained contextual representations from Bi-directional Transformers (e.g. BERT). The ontology-based framework includes two steps: (i) Text-to-UMLS, extracting phenotypes by contextually linking mentions to concepts in Unified Medical Language System (UMLS), with a Named Entity Recognition and Linking (NER+L) tool, SemEHR, and weak supervision with customised rules and contextual mention representation; (ii) UMLS-to-ORDO, matching UMLS concepts to rare diseases in Orphanet Rare Disease Ontology (ORDO). The weakly supervised approach is proposed to learn a phenotype confirmation model to improve Text-to-UMLS linking, without annotated data from domain experts. We evaluated the approach on three clinical datasets, MIMIC-III discharge summaries, MIMIC-III radiology reports, and NHS Tayside brain imaging reports from two institutions in the US and the UK, with annotations. The improvements in the precision were pronounced (by over 30% to 50% absolute score for Text-to-UMLS linking), with almost no loss of recall compared to the existing NER+L tool, SemEHR. Results on radiology reports from MIMIC-III and NHS Tayside were consistent with the discharge summaries. The overall pipeline processing clinical notes can extract rare disease cases, mostly uncaptured in structured data (manually assigned ICD codes). We discuss the usefulness of the weak supervision approach and propose directions for future studies.

Hang Dong, Matúš Falis, William Whiteley et al.

Clinical coding is the task of transforming medical information in a patient's health records into structured codes so that they can be used for statistical analysis. This is a cognitive and time-consuming task that follows a standard process in order to achieve a high level of consistency. Clinical coding could potentially be supported by an automated system to improve the efficiency and accuracy of the process. We introduce the idea of automated clinical coding and summarise its challenges from the perspective of Artificial Intelligence (AI) and Natural Language Processing (NLP), based on the literature, our project experience over the past two and half years (late 2019 - early 2022), and discussions with clinical coding experts in Scotland and the UK. Our research reveals the gaps between the current deep learning-based approach applied to clinical coding and the need for explainability and consistency in real-world practice. Knowledge-based methods that represent and reason the standard, explainable process of a task may need to be incorporated into deep learning-based methods for clinical coding. Automated clinical coding is a promising task for AI, despite the technical and organisational challenges. Coders are needed to be involved in the development process. There is much to achieve to develop and deploy an AI-based automated system to support coding in the next five years and beyond.

Aryo Pradipta Gema, Pasquale Minervini, Luke Daines et al.

Adapting pretrained language models to novel domains, such as clinical applications, traditionally involves retraining their entire set of parameters. Parameter-Efficient Fine-Tuning (PEFT) techniques for fine-tuning language models significantly reduce computational requirements by selectively fine-tuning small subsets of parameters. In this study, we propose a two-step PEFT framework and evaluate it in the clinical domain. Our approach combines a specialised PEFT adapter layer designed for clinical domain adaptation with another adapter specialised for downstream tasks. We evaluate the framework on multiple clinical outcome prediction datasets, comparing it to clinically trained language models. Our framework achieves a better AUROC score averaged across all clinical downstream tasks compared to clinical language models. In particular, we observe large improvements of 4-5% AUROC in large-scale multilabel classification tasks, such as diagnoses and procedures classification. To our knowledge, this study is the first to provide an extensive empirical analysis of the interplay between PEFT techniques and domain adaptation in an important real-world domain of clinical applications.

Beatrice Alex, Claire Grover, Arlene Casey et al.

We present GS-BrainText, a curated dataset of 8,511 brain radiology reports from the Generation Scotland cohort, of which 2,431 are annotated for 24 brain disease phenotypes. This multi-site dataset spans five Scottish NHS health boards and includes broad age representation (mean age 58, median age 53), making it uniquely valuable for developing and evaluating generalisable clinical natural language processing (NLP) algorithms and tools. Expert annotations were performed by a multidisciplinary clinical team using an annotation schema, with 10-100% double annotation per NHS health board and rigorous quality assurance. Benchmark evaluation using EdIE-R, an existing rule-based NLP system developed in conjunction with the annotation schema, revealed some performance variation across health boards (F1: 86.13-98.13), phenotypes (F1: 22.22-100) and age groups (F1: 87.01-98.13), highlighting critical challenges in generalisation of NLP tools. The GS-BrainText dataset addresses a significant gap in available UK clinical text resources and provides a valuable resource for the study of linguistic variation, diagnostic uncertainty expression and the impact of data characteristics on NLP system performance.

Giorgos Lysandrou, Roma English Owen, Vanja Popovic et al.

There exists an invisible barrier between healthcare professionals' perception of a patient's clinical experience and the reality. This barrier may be induced by the environment that hinders patients from sharing their experiences openly with healthcare professionals. As patients are observed to discuss and exchange knowledge more candidly on social media, valuable insights can be leveraged from these platforms. However, the abundance of non-patient posts on social media necessitates filtering out such irrelevant content to distinguish the genuine voices of patients, a task we refer to as patient voice classification. In this study, we analyse the importance of linguistic characteristics in accurately classifying patient voices. Our findings underscore the essential role of linguistic and statistical text similarity analysis in identifying common patterns among patient groups. These results allude to even starker differences in the way patients express themselves at a disease level and across various therapeutic domains. Additionally, we fine-tuned a pre-trained Language Model on the combined datasets with similar linguistic patterns, resulting in a highly accurate automatic patient voice classification. Being the pioneering study on the topic, our focus on extracting authentic patient experiences from social media stands as a crucial step towards advancing healthcare standards and fostering a patient-centric approach.

Arlene Casey, Emma Davidson, Michael Poon et al.

NLP has a significant role in advancing healthcare and has been found to be key in extracting structured information from radiology reports. Understanding recent developments in NLP application to radiology is of significance but recent reviews on this are limited. This study systematically assesses recent literature in NLP applied to radiology reports. Our automated literature search yields 4,799 results using automated filtering, metadata enriching steps and citation search combined with manual review. Our analysis is based on 21 variables including radiology characteristics, NLP methodology, performance, study, and clinical application characteristics. We present a comprehensive analysis of the 164 publications retrieved with each categorised into one of 6 clinical application categories. Deep learning use increases but conventional machine learning approaches are still prevalent. Deep learning remains challenged when data is scarce and there is little evidence of adoption into clinical practice. Despite 17% of studies reporting greater than 0.85 F1 scores, it is hard to comparatively evaluate these approaches given that most of them use different datasets. Only 14 studies made their data and 15 their code available with 10 externally validating results. Automated understanding of clinical narratives of the radiology reports has the potential to enhance the healthcare process but reproducibility and explainability of models are important if the domain is to move applications into clinical use. More could be done to share code enabling validation of methods on different institutional data and to reduce heterogeneity in reporting of study properties allowing inter-study comparisons. Our results have significance for researchers providing a systematic synthesis of existing work to build on, identify gaps, opportunities for collaboration and avoid duplication.

Giorgos Lysandrou, Roma English Owen, Vanja Popovic et al.

It is essential that healthcare professionals and members of the healthcare community can access and easily understand patient experiences in the real world, so that care standards can be improved and driven towards personalised drug treatment. Social media platforms and message boards are deemed suitable sources of patient experience information, as patients have been observed to discuss and exchange knowledge, look for and provide support online. This paper tests the hypothesis that not all online patient experience information can be treated and collected in the same way, as a result of the inherent differences in the way individuals talk about their journeys, in different therapeutic domains and or data sources. We used linguistic analysis to understand and identify similarities between datasets, across patient language, between data sources (Reddit, SocialGist) and therapeutic domains (cardiovascular, oncology, immunology, neurology). We detected common vocabulary used by patients in the same therapeutic domain across data sources, except for immunology patients, who use unique vocabulary between the two data sources, and compared to all other datasets. We combined linguistically similar datasets to train classifiers (CNN, transformer) to accurately identify patient experience posts from social media, a task we refer to as patient voice classification. The cardiovascular and neurology transformer classifiers perform the best in their respective comparisons for the Reddit data source, achieving F1-scores of 0.865 and 1.0 respectively. The overall best performing classifier is the transformer classifier trained on all data collected for this experiment, achieving F1-scores ranging between 0.863 and 0.995 across all therapeutic domain and data source specific test datasets.

Aryo Pradipta Gema, Alexander Hägele, Runjin Chen et al.

We construct evaluation tasks where extending the reasoning length of Large Reasoning Models (LRMs) deteriorates performance, exhibiting an inverse scaling relationship between test-time compute and accuracy. Our evaluation tasks span four categories: simple counting tasks with distractors, regression tasks with spurious features, deduction tasks with constraint tracking, and advanced AI risks. We identify five distinct failure modes when models reason for longer: 1) Claude models become increasingly distracted by irrelevant information; 2) OpenAI o-series models resist distractors but overfit to problem framings; 3) models shift from reasonable priors to spurious correlations; 4) all models show difficulties in maintaining focus on complex deductive tasks; and 5) extended reasoning may amplify concerning behaviors, with Claude Sonnet 4 showing increased expressions of self-preservation. These findings suggest that while test-time compute scaling remains promising for improving model capabilities, it may inadvertently reinforce problematic reasoning patterns. Our results demonstrate the importance of evaluating models across diverse reasoning lengths to identify and address these failure modes in LRMs.

Aryo Pradipta Gema, Chen Jin, Ahmed Abdulaal et al.

Large Language Models (LLMs) often hallucinate, producing unfaithful or factually incorrect outputs by misrepresenting the provided context or incorrectly recalling internal knowledge. Recent studies have identified specific attention heads within the Transformer architecture, known as retrieval heads, responsible for extracting relevant contextual information. We hypothesise that masking these retrieval heads can induce hallucinations and that contrasting the outputs of the base LLM and the masked LLM can reduce hallucinations. To this end, we propose Decoding by Contrasting Retrieval Heads (DeCoRe), a novel training-free decoding strategy that amplifies information found in the context and model parameters. DeCoRe mitigates potentially hallucinated responses by dynamically contrasting the outputs of the base LLM and the masked LLM, using conditional entropy as a guide. Our extensive experiments confirm that DeCoRe significantly improves performance on tasks requiring high contextual faithfulness, such as summarisation (XSum by 18.6%), instruction following (MemoTrap by 10.9%), and open-book question answering (NQ-Open by 2.4% and NQ-Swap by 5.5%).

Aryo Pradipta Gema, Giwon Hong, Pasquale Minervini et al.

The NLI4CT task assesses Natural Language Inference systems in predicting whether hypotheses entail or contradict evidence from Clinical Trial Reports. In this study, we evaluate various Large Language Models (LLMs) with multiple strategies, including Chain-of-Thought, In-Context Learning, and Parameter-Efficient Fine-Tuning (PEFT). We propose a PEFT method to improve the consistency of LLMs by merging adapters that were fine-tuned separately using triplet and language modelling objectives. We found that merging the two PEFT adapters improves the F1 score (+0.0346) and consistency (+0.152) of the LLMs. However, our novel methods did not produce more accurate results than GPT-4 in terms of faithfulness and consistency. Averaging the three metrics, GPT-4 ranks joint-first in the competition with 0.8328. Finally, our contamination analysis with GPT-4 indicates that there was no test data leakage.

JA Meaney, Beatrice Alex, William Lamb

Folktales are a rich resource of knowledge about the society and culture of a civilisation. Digital folklore research aims to use automated techniques to better understand these folktales, and it relies on abstract representations of the textual data. Although a number of large language models (LLMs) claim to be able to represent low-resource langauges such as Irish and Gaelic, we present two classification tasks to explore how useful these representations are, and three adaptations to improve the performance of these models. We find that adapting the models to work with longer sequences, and continuing pre-training on the domain of folktales improves classification performance, although these findings are tempered by the impressive performance of a baseline SVM with non-contextual features.

Jesse Phitidis, Alison Q. O'Neil, William N. Whiteley et al.

Cerebrovascular diseases (CVD) can lead to stroke and dementia. Stroke is the second leading cause of death world wide and dementia incidence is increasing by the year. There are several markers of CVD that are visible on brain imaging, including: white matter hyperintensities (WMH), acute and chronic ischaemic stroke lesions (ISL), lacunes, enlarged perivascular spaces (PVS), acute and chronic haemorrhagic lesions, and cerebral microbleeds (CMB). Brain atrophy also occurs in CVD. These markers are important for patient management and intervention, since they indicate elevated risk of future stroke and dementia. We systematically reviewed automated systems designed to support radiologists reporting on these CVD imaging findings. We considered commercially available software and research publications which identify at least two CVD markers. In total, we included 29 commercial products and 13 research publications. Two distinct types of commercial support system were available: those which identify acute stroke lesions (haemorrhagic and ischaemic) from computed tomography (CT) scans, mainly for the purpose of patient triage; and those which measure WMH and atrophy regionally and longitudinally. In research, WMH and ISL were the markers most frequently analysed together, from magnetic resonance imaging (MRI) scans; lacunes and PVS were each targeted only twice and CMB only once. For stroke, commercially available systems largely support the emergency setting, whilst research systems consider also follow-up and routine scans. The systems to quantify WMH and atrophy are focused on neurodegenerative disease support, where these CVD markers are also of significance. There are currently no openly validated systems, commercially, or in research, performing a comprehensive joint analysis of all CVD markers (WMH, ISL, lacunes, PVS, haemorrhagic lesions, CMB, and atrophy).

Imane Guellil, Salomé Andres, Atul Anand et al.

In this work, we present a manually annotated corpus for Adverse Event (AE) extraction from discharge summaries of elderly patients, a population often underrepresented in clinical NLP resources. The dataset includes 14 clinically significant AEs-such as falls, delirium, and intracranial haemorrhage, along with contextual attributes like negation, diagnosis type, and in-hospital occurrence. Uniquely, the annotation schema supports both discontinuous and overlapping entities, addressing challenges rarely tackled in prior work. We evaluate multiple models using FlairNLP across three annotation granularities: fine-grained, coarse-grained, and coarse-grained with negation. While transformer-based models (e.g., BERT-cased) achieve strong performance on document-level coarse-grained extraction (F1 = 0.943), performance drops notably for fine-grained entity-level tasks (e.g., F1 = 0.675), particularly for rare events and complex attributes. These results demonstrate that despite high-level scores, significant challenges remain in detecting underrepresented AEs and capturing nuanced clinical language. Developed within a Trusted Research Environment (TRE), the dataset is available upon request via DataLoch and serves as a robust benchmark for evaluating AE extraction methods and supporting future cross-dataset generalisation.

Lucy Havens, Benjamin Bach, Melissa Terras et al.

Despite numerous efforts to mitigate their biases, ML systems continue to harm already-marginalized people. While predominant ML approaches assume bias can be removed and fair models can be created, we show that these are not always possible, nor desirable, goals. We reframe the problem of ML bias by creating models to identify biased language, drawing attention to a dataset's biases rather than trying to remove them. Then, through a workshop, we evaluated the models for a specific use case: workflows of information and heritage professionals. Our findings demonstrate the limitations of ML for identifying bias due to its contextual nature, the way in which approaches to mitigating it can simultaneously privilege and oppress different communities, and its inevitability. We demonstrate the need to expand ML approaches to bias and fairness, providing a mixed-methods approach to investigating the feasibility of removing bias or achieving fairness in a given ML use case.

Peter Devine, William Lamb, Beatrice Alex et al.

Multilingual large language models (LLMs) often exhibit emergent 'shadow' capabilities in languages without official support, yet their performance on these languages remains uneven and under-measured. This is particularly acute for morphosyntactically rich minority languages such as Scottish Gaelic, where translation benchmarks fail to capture structural competence. We introduce GaelEval, the first multi-dimensional benchmark for Gaelic, comprising: (i) an expert-authored morphosyntactic MCQA task; (ii) a culturally grounded translation benchmark and (iii) a large-scale cultural knowledge Q&A task. Evaluating 19 LLMs against a fluent-speaker human baseline ($n=30$), we find that Gemini 3 Pro Preview achieves $83.3\%$ accuracy on the linguistic task, surpassing the human baseline ($78.1\%$). Proprietary models consistently outperform open-weight systems, and in-language (Gaelic) prompting yields a small but stable advantage (+$2.4\%$). On the cultural task, leading models exceed $90\%$ accuracy, though most systems perform worse under Gaelic prompting and absolute scores are inflated relative to the manual benchmark. Overall, GaelEval reveals that frontier models achieve above-human performance on several dimensions of Gaelic grammar, demonstrates the effect of Gaelic prompting and shows a consistent performance gap favouring proprietary over open-weight models.

Abul Hasan, Jinge Wu, Quang Ngoc Nguyen et al.

This study introduces a novel knowledge enhanced tokenisation mechanism, K-Tokeniser, for clinical text processing. Technically, at initialisation stage, K-Tokeniser populates global representations of tokens based on semantic types of domain concepts (such as drugs or diseases) from either a domain ontology like Unified Medical Language System or the training data of the task related corpus. At training or inference stage, sentence level localised context will be utilised for choosing the optimal global token representation to realise the semantic-based tokenisation. To avoid pretraining using the new tokeniser, an embedding initialisation approach is proposed to generate representations for new tokens. Using three transformer-based language models, a comprehensive set of experiments are conducted on four real-world datasets for evaluating K-Tokeniser in a wide range of clinical text analytics tasks including clinical concept and relation extraction, automated clinical coding, clinical phenotype identification, and clinical research article classification. Overall, our models demonstrate consistent improvements over their counterparts in all tasks. In particular, substantial improvements are observed in the automated clinical coding task with 13\% increase on Micro $F_1$ score. Furthermore, K-Tokeniser also shows significant capacities in facilitating quicker converge of language models. Specifically, using K-Tokeniser, the language models would only require 50\% of the training data to achieve the best performance of the baseline tokeniser using all training data in the concept extraction task and less than 20\% of the data for the automated coding task. It is worth mentioning that all these improvements require no pre-training process, making the approach generalisable.

Matúš Falis, Aryo Pradipta Gema, Hang Dong et al.

Objective: To investigate GPT-3.5 in generating and coding medical documents with ICD-10 codes for data augmentation on low-resources labels. Materials and Methods: Employing GPT-3.5 we generated and coded 9,606 discharge summaries based on lists of ICD-10 code descriptions of patients with infrequent (generation) codes within the MIMIC-IV dataset. Combined with the baseline training set, this formed an augmented training set. Neural coding models were trained on baseline and augmented data and evaluated on a MIMIC-IV test set. We report micro- and macro-F1 scores on the full codeset, generation codes, and their families. Weak Hierarchical Confusion Matrices were employed to determine within-family and outside-of-family coding errors in the latter codesets. The coding performance of GPT-3.5 was evaluated both on prompt-guided self-generated data and real MIMIC-IV data. Clinical professionals evaluated the clinical acceptability of the generated documents. Results: Augmentation slightly hinders the overall performance of the models but improves performance for the generation candidate codes and their families, including one unseen in the baseline training data. Augmented models display lower out-of-family error rates. GPT-3.5 can identify ICD-10 codes by the prompted descriptions, but performs poorly on real data. Evaluators note the correctness of generated concepts while suffering in variety, supporting information, and narrative. Discussion and Conclusion: GPT-3.5 alone is unsuitable for ICD-10 coding. Augmentation positively affects generation code families but mainly benefits codes with existing examples. Augmentation reduces out-of-family errors. Discharge summaries generated by GPT-3.5 state prompted concepts correctly but lack variety, and authenticity in narratives. They are unsuitable for clinical practice.

Matúš Falis, Hang Dong, Alexandra Birch et al.

Large-Scale Multi-Label Text Classification (LMTC) includes tasks with hierarchical label spaces, such as automatic assignment of ICD-9 codes to discharge summaries. Performance of models in prior art is evaluated with standard precision, recall, and F1 measures without regard for the rich hierarchical structure. In this work we argue for hierarchical evaluation of the predictions of neural LMTC models. With the example of the ICD-9 ontology we describe a structural issue in the representation of the structured label space in prior art, and propose an alternative representation based on the depth of the ontology. We propose a set of metrics for hierarchical evaluation using the depth-based representation. We compare the evaluation scores from the proposed metrics with previously used metrics on prior art LMTC models for ICD-9 coding in MIMIC-III. We also propose further avenues of research involving the proposed ontological representation.

Beatrice Alex, Clare Llewellyn, Pawel Michal Orzechowski et al.

In this paper we provide an account of how we ported a text and data mining course online in summer 2020 as a result of the COVID-19 pandemic and how we improved it in a second pilot run. We describe the course, how we adapted it over the two pilot runs and what teaching techniques we used to improve students' learning and community building online. We also provide information on the relentless feedback collected during the course which helped us to adapt our teaching from one session to the next and one pilot to the next. We discuss the lessons learned and promote the use of innovative teaching techniques applied to the digital such as digital badges and pair programming in break-out rooms for teaching Natural Language Processing courses to beginners and students with different backgrounds.

Lucy Havens, Melissa Terras, Benjamin Bach et al.

We propose a bias-aware methodology to engage with power relations in natural language processing (NLP) research. NLP research rarely engages with bias in social contexts, limiting its ability to mitigate bias. While researchers have recommended actions, technical methods, and documentation practices, no methodology exists to integrate critical reflections on bias with technical NLP methods. In this paper, after an extensive and interdisciplinary literature review, we contribute a bias-aware methodology for NLP research. We also contribute a definition of biased text, a discussion of the implications of biased NLP systems, and a case study demonstrating how we are executing the bias-aware methodology in research on archival metadata descriptions.

Arlene Casey, Mike Bennett, Richard Tobin et al.

The design of models that govern diseases in population is commonly built on information and data gathered from past outbreaks. However, epidemic outbreaks are never captured in statistical data alone but are communicated by narratives, supported by empirical observations. Outbreak reports discuss correlations between populations, locations and the disease to infer insights into causes, vectors and potential interventions. The problem with these narratives is usually the lack of consistent structure or strong conventions, which prohibit their formal analysis in larger corpora. Our interdisciplinary research investigates more than 100 reports from the third plague pandemic (1894-1952) evaluating ways of building a corpus to extract and structure this narrative information through text mining and manual annotation. In this paper we discuss the progress of our ongoing exploratory project, how we enhance optical character recognition (OCR) methods to improve text capture, our approach to structure the narratives and identify relevant entities in the reports. The structured corpus is made available via Solr enabling search and analysis across the whole collection for future research dedicated, for example, to the identification of concepts. We show preliminary visualisations of the characteristics of causation and differences with respect to gender as a result of syntactic-category-dependent corpus statistics. Our goal is to develop structured accounts of some of the most significant concepts that were used to understand the epidemiology of the third plague pandemic around the globe. The corpus enables researchers to analyse the reports collectively allowing for deep insights into the global epidemiological consideration of plague in the early twentieth century.

Philip John Gorinski, Honghan Wu, Claire Grover et al.

This work investigates multiple approaches to Named Entity Recognition (NER) for text in Electronic Health Record (EHR) data. In particular, we look into the application of (i) rule-based, (ii) deep learning and (iii) transfer learning systems for the task of NER on brain imaging reports with a focus on records from patients with stroke. We explore the strengths and weaknesses of each approach, develop rules and train on a common dataset, and evaluate each system's performance on common test sets of Scottish radiology reports from two sources (brain imaging reports in ESS -- Edinburgh Stroke Study data collected by NHS Lothian as well as radiology reports created in NHS Tayside). Our comparison shows that a hand-crafted system is the most accurate way to automatically label EHR, but machine learning approaches can provide a feasible alternative where resources for a manual system are not readily available.