Anthony Nguyen

Leonid Chindelevitch, Elita Jauneikaite, Nicole E. Wheeler et al.

Antimicrobial resistance (AMR) is a growing public health threat, estimated to cause over 10 million deaths per year and cost the global economy 100 trillion USD by 2050 under status quo projections. These losses would mainly result from an increase in the morbidity and mortality from treatment failure, AMR infections during medical procedures, and a loss of quality of life attributed to AMR. Numerous interventions have been proposed to control the development of AMR and mitigate the risks posed by its spread. This paper reviews key aspects of bacterial AMR management and control which make essential use of data technologies such as artificial intelligence, machine learning, and mathematical and statistical modelling, fields that have seen rapid developments in this century. Although data technologies have become an integral part of biomedical research, their impact on AMR management has remained modest. We outline the use of data technologies to combat AMR, detailing recent advancements in four complementary categories: surveillance, prevention, diagnosis, and treatment. We provide an overview on current AMR control approaches using data technologies within biomedical research, clinical practice, and in the "One Health" context. We discuss the potential impact and challenges wider implementation of data technologies is facing in high-income as well as in low- and middle-income countries, and recommend concrete actions needed to allow these technologies to be more readily integrated within the healthcare and public health sectors.

Leibo Liu, Oscar Perez-Concha, Anthony Nguyen et al.

International Classification of Diseases (ICD) coding plays an important role in systematically classifying morbidity and mortality data. In this study, we propose a hierarchical label-wise attention Transformer model (HiLAT) for the explainable prediction of ICD codes from clinical documents. HiLAT firstly fine-tunes a pretrained Transformer model to represent the tokens of clinical documents. We subsequently employ a two-level hierarchical label-wise attention mechanism that creates label-specific document representations. These representations are in turn used by a feed-forward neural network to predict whether a specific ICD code is assigned to the input clinical document of interest. We evaluate HiLAT using hospital discharge summaries and their corresponding ICD-9 codes from the MIMIC-III database. To investigate the performance of different types of Transformer models, we develop ClinicalplusXLNet, which conducts continual pretraining from XLNet-Base using all the MIMIC-III clinical notes. The experiment results show that the F1 scores of the HiLAT+ClinicalplusXLNet outperform the previous state-of-the-art models for the top-50 most frequent ICD-9 codes from MIMIC-III. Visualisations of attention weights present a potential explainability tool for checking the face validity of ICD code predictions.

Leibo Liu, Oscar Perez-Concha, Anthony Nguyen et al.

Background: Encouraged by the success of pretrained Transformer models in many natural language processing tasks, their use for International Classification of Diseases (ICD) coding tasks is now actively being explored. In this study, we investigate three types of Transformer-based models, aiming to address the extreme label set and long text classification challenges that are posed by automated ICD coding tasks. Methods: The Transformer-based model PLM-ICD achieved the current state-of-the-art (SOTA) performance on the ICD coding benchmark dataset MIMIC-III. It was chosen as our baseline model to be further optimised. XR-Transformer, the new SOTA model in the general extreme multi-label text classification domain, and XR-LAT, a novel adaptation of the XR-Transformer model, were also trained on the MIMIC-III dataset. XR-LAT is a recursively trained model chain on a predefined hierarchical code tree with label-wise attention, knowledge transferring and dynamic negative sampling mechanisms. Results: Our optimised PLM-ICD model, which was trained with longer total and chunk sequence lengths, significantly outperformed the current SOTA PLM-ICD model, and achieved the highest micro-F1 score of 60.8%. The XR-Transformer model, although SOTA in the general domain, did not perform well across all metrics. The best XR-LAT based model obtained results that were competitive with the current SOTA PLM-ICD model, including improving the macro-AUC by 2.1%. Conclusion: Our optimised PLM-ICD model is the new SOTA model for automated ICD coding on the MIMIC-III dataset, while our novel XR-LAT model performs competitively with the previous SOTA PLM-ICD model.

Aaron Nicolson, Jinghui Liu, Jason Dowling et al.

The Shared Task on Large-Scale Radiology Report Generation (RRG24) aims to expedite the development of assistive systems for interpreting and reporting on chest X-ray (CXR) images. This task challenges participants to develop models that generate the findings and impression sections of radiology reports from CXRs from a patient's study, using five different datasets. This paper outlines the e-Health CSIRO team's approach, which achieved multiple first-place finishes in RRG24. The core novelty of our approach lies in the addition of entropy regularisation to self-critical sequence training, to maintain a higher entropy in the token distribution. This prevents overfitting to common phrases and ensures a broader exploration of the vocabulary during training, essential for handling the diversity of the radiology reports in the RRG24 datasets. Our model is available on Hugging Face https://huggingface.co/aehrc/cxrmate-rrg24.

Jinghui Liu, Aaron Nicolson, Jason Dowling et al.

Clinical documentation is an important aspect of clinicians' daily work and often demands a significant amount of time. The BioNLP 2024 Shared Task on Streamlining Discharge Documentation (Discharge Me!) aims to alleviate this documentation burden by automatically generating discharge summary sections, including brief hospital course and discharge instruction, which are often time-consuming to synthesize and write manually. We approach the generation task by fine-tuning multiple open-sourced language models (LMs), including both decoder-only and encoder-decoder LMs, with various configurations on input context. We also examine different setups for decoding algorithms, model ensembling or merging, and model specialization. Our results show that conditioning on the content of discharge summary prior to the target sections is effective for the generation task. Furthermore, we find that smaller encoder-decoder LMs can work as well or even slightly better than larger decoder based LMs fine-tuned through LoRA. The model checkpoints from our team (aehrc) are openly available.

Jinghui Liu, Daniel Capurro, Anthony Nguyen et al.

Modeling text-based time-series to make prediction about a future event or outcome is an important task with a wide range of applications. The standard approach is to train and test the model using the same input window, but this approach neglects the data collected in longer input windows between the prediction time and the final outcome, which are often available during training. In this study, we propose to treat this neglected text as privileged information available during training to enhance early prediction modeling through knowledge distillation, presented as Learning using Privileged tIme-sEries Text (LuPIET). We evaluate the method on clinical and social media text, with four clinical prediction tasks based on clinical notes and two mental health prediction tasks based on social media posts. Our results show LuPIET is effective in enhancing text-based early predictions, though one may need to consider choosing the appropriate text representation and windows for privileged text to achieve optimal performance. Compared to two other methods using transfer learning and mixed training, LuPIET offers more stable improvements over the baseline, standard training. As far as we are concerned, this is the first study to examine learning using privileged information for time-series in the NLP context.

Jinghui Liu, Sarvesh Soni, Anthony Nguyen

Large language models (LLMs) can generate or synthesize clinical text for a wide range of applications, from improving clinical documentation to augmenting clinical text analytics. Yet evaluations typically focus on a narrow aspect -- such as similarity or utility comparisons -- even though these aspects are complementary and best viewed in parallel. In this study, we aim to conduct a systematic evaluation of LLM-generated clinical text, which includes intrinsic, extrinsic, and factuality evaluations of synthetic clinical notes rephrased from MIMIC databases at million-note scale. Our analysis demonstrates that synthetic notes preserve core clinical information and predictive utility for coarse-grained tasks despite substantial linguistic changes, but lose fine-grained details for task like ICD coding. We show this loss of detail can be substantially mitigated by rephrasing notes by chunks rather than by the whole note, but at the cost of reduced factual precision under incomplete context. Through fact-checking and error analysis, we further find that synthesis errors are dominated by misinterpretation of clinical context, alongside temporal confusion, measurement errors, and fabricated claims. Finally, we show that the synthetic notes -- despite their task-agnostic nature -- can effectively augment task-specific training for rare ICD codes.

Jinghui Liu, Anthony Nguyen

Clinical coding maps clinical documentation to standardized medical codes, an essential yet time-consuming administrative task that could benefit from automation. Current models on ICD coding are typically optimized for codes from a specific ICD version. However, in reality, ICD systems evolve continuously, and different versions are adopted across time periods and regions. Moreover, ICD coding suffers from the long-tail problem, and rare code performance can be a bottleneck for developing implementable models. We examine whether it is viable to train version-independent models by combining data annotated in different ICD versions, which may help address these challenges. We add ICD-9 data to the training of a modified label-wise attention model for ICD-10 prediction, and find that despite the version mismatch, adding ICD-9 yields a 27% increase in micro F1 for 18K rare ICD codes compared to training on ICD-10 alone. On 8K frequent ICD-10 codes, the multi-version training also substantially improves macro metrics, with far fewer model parameters.

Anthony Nguyen

Graphical User Interface (GUI) grounding plays a crucial role in enhancing the capabilities of Vision-Language Model (VLM) agents. While general VLMs, such as GPT-4V, demonstrate strong performance across various tasks, their proficiency in GUI grounding remains suboptimal. Recent studies have focused on fine-tuning these models specifically for zero-shot GUI grounding, yielding significant improvements over baseline performance. We introduce a visual prompting framework that employs an iterative narrowing mechanism to further improve the performance of both general and fine-tuned models in GUI grounding. For evaluation, we tested our method on a comprehensive benchmark comprising various UI platforms and provided the code to reproduce our results.

Jinghui Liu, Anthony Nguyen

Clinical language models are important for many applications in healthcare, but their development depends on access to extensive clinical text for pretraining. However, obtaining clinical notes from electronic health records (EHRs) at scale is challenging due to patient privacy concerns. In this study, we rephrase existing clinical notes using LLMs to generate synthetic pretraining corpora, drawing inspiration from previous work on rephrasing web data. We examine four popular small-sized LLMs (<10B) to create synthetic clinical text to pretrain both decoder-based and encoder-based language models. The method yields better results in language modeling and downstream tasks than previous synthesis approaches without referencing real clinical text. We find that augmenting original clinical notes with synthetic corpora from different LLMs improves performances even at a small token budget, showing the potential of this method to support pretraining at the institutional level or be scaled to synthesize large-scale clinical corpora.

Anthony Nguyen, Wenjun Lin

Transformer models have established new benchmarks in natural language processing; however, their increasing depth results in substantial growth in parameter counts. While existing recurrent transformer methods address this issue by reprocessing layers multiple times, they often apply recurrence indiscriminately across entire blocks of layers. In this work, we investigate Intra-Layer Recurrence (ILR), a more targeted approach that applies recurrence selectively to individual layers within a single forward pass. Our experiments show that allocating more iterations to earlier layers yields optimal results. These findings suggest that ILR offers a promising direction for optimizing recurrent structures in transformer architectures.

Leibo Liu, Oscar Perez-Concha, Anthony Nguyen et al.

Electronic Medical Records (EMRs) contain clinical narrative text that is of great potential value to medical researchers. However, this information is mixed with Personally Identifiable Information (PII) that presents risks to patient and clinician confidentiality. This paper presents an end-to-end deidentification framework to automatically remove PII from Australian hospital discharge summaries. Our corpus included 600 hospital discharge summaries which were extracted from the EMRs of two principal referral hospitals in Sydney, Australia. Our end-to-end de-identification framework consists of three components: 1) Annotation: labelling of PII in the 600 hospital discharge summaries using five pre-defined categories: person, address, date of birth, individual identification number, phone/fax number; 2) Modelling: training six named entity recognition (NER) deep learning base-models on balanced and imbalanced datasets; and evaluating ensembles that combine all six base-models, the three base-models with the best F1 scores and the three base-models with the best recall scores respectively, using token-level majority voting and stacking methods; and 3) De-identification: removing PII from the hospital discharge summaries. Our results showed that the ensemble model combined using the stacking Support Vector Machine (SVM) method on the three base-models with the best F1 scores achieved excellent results with a F1 score of 99.16% on the test set of our corpus. We also evaluated the robustness of our modelling component on the 2014 i2b2 de-identification dataset. Our ensemble model, which uses the token-level majority voting method on all six basemodels, achieved the highest F1 score of 96.24% at strict entity matching and the highest F1 score of 98.64% at binary token-level matching compared to two state-of-the-art methods.

Krishnakumar Balasubramanian, Saeed Ghadimi, Anthony Nguyen

In this paper, we study smooth stochastic multi-level composition optimization problems, where the objective function is a nested composition of $T$ functions. We assume access to noisy evaluations of the functions and their gradients, through a stochastic first-order oracle. For solving this class of problems, we propose two algorithms using moving-average stochastic estimates, and analyze their convergence to an $ε$-stationary point of the problem. We show that the first algorithm, which is a generalization of \cite{GhaRuswan20} to the $T$ level case, can achieve a sample complexity of $\mathcal{O}(1/ε^6)$ by using mini-batches of samples in each iteration. By modifying this algorithm using linearized stochastic estimates of the function values, we improve the sample complexity to $\mathcal{O}(1/ε^4)$. {\color{black}This modification not only removes the requirement of having a mini-batch of samples in each iteration, but also makes the algorithm parameter-free and easy to implement}. To the best of our knowledge, this is the first time that such an online algorithm designed for the (un)constrained multi-level setting, obtains the same sample complexity of the smooth single-level setting, under standard assumptions (unbiasedness and boundedness of the second moments) on the stochastic first-order oracle.

Thanh Vu, Dat Quoc Nguyen, Anthony Nguyen

ICD coding is a process of assigning the International Classification of Disease diagnosis codes to clinical/medical notes documented by health professionals (e.g. clinicians). This process requires significant human resources, and thus is costly and prone to error. To handle the problem, machine learning has been utilized for automatic ICD coding. Previous state-of-the-art models were based on convolutional neural networks, using a single/several fixed window sizes. However, the lengths and interdependence between text fragments related to ICD codes in clinical text vary significantly, leading to the difficulty of deciding what the best window sizes are. In this paper, we propose a new label attention model for automatic ICD coding, which can handle both the various lengths and the interdependence of the ICD code related text fragments. Furthermore, as the majority of ICD codes are not frequently used, leading to the extremely imbalanced data issue, we additionally propose a hierarchical joint learning mechanism extending our label attention model to handle the issue, using the hierarchical relationships among the codes. Our label attention model achieves new state-of-the-art results on three benchmark MIMIC datasets, and the joint learning mechanism helps improve the performances for infrequent codes.

Hamed Hassanzadeh, Mahnoosh Kholghi, Anthony Nguyen et al.

Reviewing radiology reports in emergency departments is an essential but laborious task. Timely follow-up of patients with abnormal cases in their radiology reports may dramatically affect the patient's outcome, especially if they have been discharged with a different initial diagnosis. Machine learning approaches have been devised to expedite the process and detect the cases that demand instant follow up. However, these approaches require a large amount of labeled data to train reliable predictive models. Preparing such a large dataset, which needs to be manually annotated by health professionals, is costly and time-consuming. This paper investigates a semi-supervised learning framework for radiology report classification across three hospitals. The main goal is to leverage clinical unlabeled data in order to augment the learning process where limited labeled data is available. To further improve the classification performance, we also integrate a transfer learning technique into the semi-supervised learning pipeline . Our experimental findings show that (1) convolutional neural networks (CNNs), while being independent of any problem-specific feature engineering, achieve significantly higher effectiveness compared to conventional supervised learning approaches, (2) leveraging unlabeled data in training a CNN-based classifier reduces the dependency on labeled data by more than 50% to reach the same performance of a fully supervised CNN, and (3) transferring the knowledge gained from available labeled data in an external source hospital significantly improves the performance of a semi-supervised CNN model over their fully supervised counterparts in a target hospital.

Mahnoosh Kholghi, Lance De Vine, Laurianne Sitbon et al.

This study investigates the use of unsupervised word embeddings and sequence features for sample representation in an active learning framework built to extract clinical concepts from clinical free text. The objective is to further reduce the manual annotation effort while achieving higher effectiveness compared to a set of baseline features. Unsupervised features are derived from skip-gram word embeddings and a sequence representation approach. The comparative performance of unsupervised features and baseline hand-crafted features in an active learning framework are investigated using a wide range of selection criteria including least confidence, information diversity, information density and diversity, and domain knowledge informativeness. Two clinical datasets are used for evaluation: the i2b2/VA 2010 NLP challenge and the ShARe/CLEF 2013 eHealth Evaluation Lab. Our results demonstrate significant improvements in terms of effectiveness as well as annotation effort savings across both datasets. Using unsupervised features along with baseline features for sample representation lead to further savings of up to 9% and 10% of the token and concept annotation rates, respectively.