Shan Chen

Marco Guevara, Shan Chen, Spencer Thomas et al. · harvard

Social determinants of health (SDoH) have an important impact on patient outcomes but are incompletely collected from the electronic health records (EHR). This study researched the ability of large language models to extract SDoH from free text in EHRs, where they are most commonly documented, and explored the role of synthetic clinical text for improving the extraction of these scarcely documented, yet extremely valuable, clinical data. 800 patient notes were annotated for SDoH categories, and several transformer-based models were evaluated. The study also experimented with synthetic data generation and assessed for algorithmic bias. Our best-performing models were fine-tuned Flan-T5 XL (macro-F1 0.71) for any SDoH, and Flan-T5 XXL (macro-F1 0.70). The benefit of augmenting fine-tuning with synthetic data varied across model architecture and size, with smaller Flan-T5 models (base and large) showing the greatest improvements in performance (delta F1 +0.12 to +0.23). Model performance was similar on the in-hospital system dataset but worse on the MIMIC-III dataset. Our best-performing fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models for both tasks. These fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p<0.05). At the patient-level, our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. Our method can effectively extracted SDoH information from clinic notes, performing better compare to GPT zero- and few-shot settings. These models could enhance real-world evidence on SDoH and aid in identifying patients needing social support.

Shan Chen, Marco Guevara, Nicolas Ramirez et al. · harvard

Radiotherapy (RT) toxicities can impair survival and quality-of-life, yet remain under-studied. Real-world evidence holds potential to improve our understanding of toxicities, but toxicity information is often only in clinical notes. We developed natural language processing (NLP) models to identify the presence and severity of esophagitis from notes of patients treated with thoracic RT. We fine-tuned statistical and pre-trained BERT-based models for three esophagitis classification tasks: Task 1) presence of esophagitis, Task 2) severe esophagitis or not, and Task 3) no esophagitis vs. grade 1 vs. grade 2-3. Transferability was tested on 345 notes from patients with esophageal cancer undergoing RT. Fine-tuning PubmedBERT yielded the best performance. The best macro-F1 was 0.92, 0.82, and 0.74 for Task 1, 2, and 3, respectively. Selecting the most informative note sections during fine-tuning improved macro-F1 by over 2% for all tasks. Silver-labeled data improved the macro-F1 by over 3% across all tasks. For the esophageal cancer notes, the best macro-F1 was 0.73, 0.74, and 0.65 for Task 1, 2, and 3, respectively, without additional fine-tuning. To our knowledge, this is the first effort to automatically extract esophagitis toxicity severity according to CTCAE guidelines from clinic notes. The promising performance provides proof-of-concept for NLP-based automated detailed toxicity monitoring in expanded domains.

Sheng Lu, Shan Chen, Yingya Li et al. · harvard

In-context learning (ICL) is a new learning paradigm that has gained popularity along with the development of large language models. In this work, we adapt a recently proposed hardness metric, pointwise $\mathcal{V}$-usable information (PVI), to an in-context version (in-context PVI). Compared to the original PVI, in-context PVI is more efficient in that it requires only a few exemplars and does not require fine-tuning. We conducted a comprehensive empirical analysis to evaluate the reliability of in-context PVI. Our findings indicate that in-context PVI estimates exhibit similar characteristics to the original PVI. Specific to the in-context setting, we show that in-context PVI estimates remain consistent across different exemplar selections and numbers of shots. The variance of in-context PVI estimates across different exemplar selections is insignificant, which suggests that in-context PVI are stable. Furthermore, we demonstrate how in-context PVI can be employed to identify challenging instances. Our work highlights the potential of in-context PVI and provides new insights into the capabilities of ICL.

Jack Gallifant, Shan Chen, Kuleen Sasse et al.

Sparse Autoencoders (SAEs) provide potentials for uncovering structured, human-interpretable representations in Large Language Models (LLMs), making them a crucial tool for transparent and controllable AI systems. We systematically analyze SAE for interpretable feature extraction from LLMs in safety-critical classification tasks. Our framework evaluates (1) model-layer selection and scaling properties, (2) SAE architectural configurations, including width and pooling strategies, and (3) the effect of binarizing continuous SAE activations. SAE-derived features achieve macro F1 > 0.8, outperforming hidden-state and BoW baselines while demonstrating cross-model transfer from Gemma 2 2B to 9B-IT models. These features generalize in a zero-shot manner to cross-lingual toxicity detection and visual classification tasks. Our analysis highlights the significant impact of pooling strategies and binarization thresholds, showing that binarization offers an efficient alternative to traditional feature selection while maintaining or improving performance. These findings establish new best practices for SAE-based interpretability and enable scalable, transparent deployment of LLMs in real-world applications. Full repo: https://github.com/shan23chen/MOSAIC.

Zidi Xiong, Shan Chen, Zhenting Qi et al.

Large Reasoning Models (LRMs) have significantly enhanced their capabilities in complex problem-solving by introducing a thinking draft that enables multi-path Chain-of-Thought explorations before producing final answers. Ensuring the faithfulness of these intermediate reasoning processes is crucial for reliable monitoring, interpretation, and effective control. In this paper, we propose a systematic counterfactual intervention framework to rigorously evaluate thinking draft faithfulness. Our approach focuses on two complementary dimensions: (1) Intra-Draft Faithfulness, which assesses whether individual reasoning steps causally influence subsequent steps and the final draft conclusion through counterfactual step insertions; and (2) Draft-to-Answer Faithfulness, which evaluates whether final answers are logically consistent with and dependent on the thinking draft, by perturbing the draft's concluding logic. We conduct extensive experiments across six state-of-the-art LRMs. Our findings show that current LRMs demonstrate selective faithfulness to intermediate reasoning steps and frequently fail to faithfully align with the draft conclusions. These results underscore the need for more faithful and interpretable reasoning in advanced LRMs.

João Matos, Shan Chen, Siena Placino et al.

Multimodal/vision language models (VLMs) are increasingly being deployed in healthcare settings worldwide, necessitating robust benchmarks to ensure their safety, efficacy, and fairness. Multiple-choice question and answer (QA) datasets derived from national medical examinations have long served as valuable evaluation tools, but existing datasets are largely text-only and available in a limited subset of languages and countries. To address these challenges, we present WorldMedQA-V, an updated multilingual, multimodal benchmarking dataset designed to evaluate VLMs in healthcare. WorldMedQA-V includes 568 labeled multiple-choice QAs paired with 568 medical images from four countries (Brazil, Israel, Japan, and Spain), covering original languages and validated English translations by native clinicians, respectively. Baseline performance for common open- and closed-source models are provided in the local language and English translations, and with and without images provided to the model. The WorldMedQA-V benchmark aims to better match AI systems to the diverse healthcare environments in which they are deployed, fostering more equitable, effective, and representative applications.

Shan Chen, Jack Gallifant, Marco Guevara et al.

Generative models have been showing potential for producing data in mass. This study explores the enhancement of clinical natural language processing performance by utilizing synthetic data generated from advanced language models. Promising results show feasible applications in such a high-stakes domain.

Shan Chen, Jack Gallifant, Mingye Gao et al.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like $ThePile$ influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.