Briton Park

Aliyah R. Hsu, Yeshwanth Cherapanamjeri, Briton Park et al.

Pre-trained transformers are often fine-tuned to aid clinical decision-making using limited clinical notes. Model interpretability is crucial, especially in high-stakes domains like medicine, to establish trust and ensure safety, which requires human engagement. We introduce SUFO, a systematic framework that enhances interpretability of fine-tuned transformer feature spaces. SUFO utilizes a range of analytic and visualization techniques, including Supervised probing, Unsupervised similarity analysis, Feature dynamics, and Outlier analysis to address key questions about model trust and interpretability. We conduct a case study investigating the impact of pre-training data where we focus on real-world pathology classification tasks, and validate our findings on MedNLI. We evaluate five 110M-sized pre-trained transformer models, categorized into general-domain (BERT, TNLR), mixed-domain (BioBERT, Clinical BioBERT), and domain-specific (PubMedBERT) groups. Our SUFO analyses reveal that: (1) while PubMedBERT, the domain-specific model, contains valuable information for fine-tuning, it can overfit to minority classes when class imbalances exist. In contrast, mixed-domain models exhibit greater resistance to overfitting, suggesting potential improvements in domain-specific model robustness; (2) in-domain pre-training accelerates feature disambiguation during fine-tuning; and (3) feature spaces undergo significant sparsification during this process, enabling clinicians to identify common outlier modes among fine-tuned models as demonstrated in this paper. These findings showcase the utility of SUFO in enhancing trust and safety when using transformers in medicine, and we believe SUFO can aid practitioners in evaluating fine-tuned language models for other applications in medicine and in more critical domains.

Nick Altieri, Briton Park, Mara Olson et al.

Precision medicine has the potential to revolutionize healthcare, but much of the data for patients is locked away in unstructured free-text, limiting research and delivery of effective personalized treatments. Generating large annotated datasets for information extraction from clinical notes is often challenging and expensive due to the high level of expertise needed for high quality annotations. To enable natural language processing for small dataset sizes, we develop a novel enriched hierarchical annotation scheme and algorithm, Supervised Line Attention (SLA), and apply this algorithm to predicting categorical tumor attributes from kidney and colon cancer pathology reports from the University of California San Francisco (UCSF). Whereas previous work only annotated document level labels, we in addition ask the annotators to enrich the traditional label by asking them to also highlight the relevant line or potentially lines for the final label, which leads to a 20% increase of annotation time required per document. With the enriched annotations, we develop a simple and interpretable machine learning algorithm that first predicts the relevant lines in the document and then predicts the tumor attribute. Our results show across the small dataset sizes of 32, 64, 128, and 186 labeled documents per cancer, SLA only requires half the number of labeled documents as state-of-the-art methods to achieve similar or better micro-f1 and macro-f1 scores for the vast majority of comparisons that we made. Accounting for the increased annotation time, this leads to a 40% reduction in total annotation time over the state of the art.

Raaz Dwivedi, Yan Shuo Tan, Briton Park et al.

Building on Yu and Kumbier's PCS framework and for randomized experiments, we introduce a novel methodology for Stable Discovery of Interpretable Subgroups via Calibration (StaDISC), with large heterogeneous treatment effects. StaDISC was developed during our re-analysis of the 1999-2000 VIGOR study, an 8076 patient randomized controlled trial (RCT), that compared the risk of adverse events from a then newly approved drug, Rofecoxib (Vioxx), to that from an older drug Naproxen. Vioxx was found to, on average and in comparison to Naproxen, reduce the risk of gastrointestinal (GI) events but increase the risk of thrombotic cardiovascular (CVT) events. Applying StaDISC, we fit 18 popular conditional average treatment effect (CATE) estimators for both outcomes and use calibration to demonstrate their poor global performance. However, they are locally well-calibrated and stable, enabling the identification of patient groups with larger than (estimated) average treatment effects. In fact, StaDISC discovers three clinically interpretable subgroups each for the GI outcome (totaling 29.4% of the study size) and the CVT outcome (totaling 11.0%). Complementary analyses of the found subgroups using the 2001-2004 APPROVe study, a separate independently conducted RCT with 2587 patients, provides further supporting evidence for the promise of StaDISC.

Nick Altieri, Rebecca L. Barter, James Duncan et al.

As the COVID-19 outbreak evolves, accurate forecasting continues to play an extremely important role in informing policy decisions. In this paper, we present our continuous curation of a large data repository containing COVID-19 information from a range of sources. We use this data to develop predictions and corresponding prediction intervals for the short-term trajectory of COVID-19 cumulative death counts at the county-level in the United States up to two weeks ahead. Using data from January 22 to June 20, 2020, we develop and combine multiple forecasts using ensembling techniques, resulting in an ensemble we refer to as Combined Linear and Exponential Predictors (CLEP). Our individual predictors include county-specific exponential and linear predictors, a shared exponential predictor that pools data together across counties, an expanded shared exponential predictor that uses data from neighboring counties, and a demographics-based shared exponential predictor. We use prediction errors from the past five days to assess the uncertainty of our death predictions, resulting in generally-applicable prediction intervals, Maximum (absolute) Error Prediction Intervals (MEPI). MEPI achieves a coverage rate of more than 94% when averaged across counties for predicting cumulative recorded death counts two weeks in the future. Our forecasts are currently being used by the non-profit organization, Response4Life, to determine the medical supply need for individual hospitals and have directly contributed to the distribution of medical supplies across the country. We hope that our forecasts and data repository at https://covidseverity.com can help guide necessary county-specific decision-making and help counties prepare for their continued fight against COVID-19.