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Automatic Prediction of Evidence-based
Recommendations via Sentence-level Polarity
Classification
Abeed Sarker1,2

Diego Moll´1,2
a

C´cile Paris1,2
e

Macquarie University1 and CSIRO ICT Centre2
Sydney, Australia

IJCNLP 2013, Nagoya, Japan
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Contents

Sentence Polarity for Evidence Based Medicine
Feasibility Study
Automatic Polarity Classification
Results

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Evidence Based Medicine

http://laikaspoetnik.wordpress.com/2009/04/04/evidence-based-medicine-the-facebook-of-medicine/

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

The Ultimate Goal

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Sentence Polarity for EBM
The Task
Given a context intervention, determine the polarity of a
sentence returned by an automatic summariser.

Q

IR

polarity
summarisers detectors
s11
+
doc1
+
s12
+
s21
doc2
−
−
s22
+
s31
doc3
s32

drug1, +
multisummariser

EBM Sentence Polarity

drug2, +
drug3, −

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Sentence Polarity in Context
Different contexts may determine different polarities

Sentence fragment
The present study demonstrated that the combination of
cimetidine with levamisole is more effective than cimetidine alone
and is a highly effective therapy ...

Polarities in Context
cimetidine with levamisole: recommended.
cimetidine alone: not recommended.

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Related Work
Related tasks
Sentiment analysis
Semantic orientation
Opinion mining
Subjectivity

Typical approaches use
statistical classifiers (e.g.
SVM) trained on bag-of-word
features.

Closely Related
Niu et al. (2005,2006) Polarity classification of medical sentences
into four categories (positive, negative, neutral, no
outcome).
Our approach contemplates the possibility of the same sentence
having multiple polarities.
EBM Sentence Polarity

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a

7/24
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Contents

Sentence Polarity for Evidence Based Medicine
Feasibility Study
Automatic Polarity Classification
Results

EBM Sentence Polarity

Sarker, Moll´, Paris
a

8/24
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Data and Annotation
Initial corpus
456 clinical questions sourced
from the Journal of Family
Practice.

Polarity annotations
589 sentences from 33
questions annotated.
Bottom-line answers.
Key sentences extracted
by QSpec summariser.
EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Example of annotations
Question
What is the most effective beta-blocker for heart failure?

Bottom-line answer
Three beta-blockers- carvedilol, metoprolol, and bisoprolol-reduce
mortality in chronic heart failure caused by left ventricular systolic
dysfunction, when used in addition to diuretics and angiotensin
converting enzyme (ACE) inhibitors.

Contextual polarities
carvedilol — recommended; metoprolol — recommended;
bisoprolol — recommended.
EBM Sentence Polarity

Sarker, Moll´, Paris
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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Analysis I
Inter-annotator agreement (124 sentences)
Cohen Kappa: k = 0.85 (almost perfect agreement).

Agreement between annotated sentences and bottom-line
summaries
Interventions with positive polarity that are mentioned in the
bottom-line summary: 177.
Polarity agreement: 95.5%.

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Analysis II

But do we have enough interventions?
Out of 109 unique interventions listed in the bottom-line
summaries . . .
. . . 99 are listed in the annotated sentences.
Recall= 90.8%
If we ignore missing abstracts: Recall = 96.1%

EBM Sentence Polarity

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a

12/24
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Contents

Sentence Polarity for Evidence Based Medicine
Feasibility Study
Automatic Polarity Classification
Results

EBM Sentence Polarity

Sarker, Moll´, Paris
a

13/24
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Approach
Train a statistical classifier (SVM).
Input: context, sentence (may have sentence duplicates, each
with a different context).
Output: the polarity.

Features
1. Word n-grams
2. Change Phrases
3. UMLS Semantic Types
4. Negations
5. PIBOSO Category

6. Synset Expansion
7. Context Windows
8. Dependency Chains
9. Other Features

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Description of Features I
1 Word n-grams
n = 1, 2
Lowercased, stop words removed, stemmed (Porter).
Context words (strings matching the provided contexts)
replaced with generic string ’ CONTEXT ’.
Disorder terms (UMLS semantic types) replaced with generic
string ’ DISORDER ’.

EBM Sentence Polarity

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a

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Description of Features II
2 Change Phrases
Expanded Niu et al. (2005) groups of good, bad, more, less
words.
Features used: more-good, more-bad, less-good, less-bad.
Context window of 4 words.

3 UMLS semantic types
Used all UMLS semantic types as binary features.

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Description of Features III
4 Negations
Niu et al. 2005.
BioScope corpus.
NegEx.

5 PIBOSO categories
Population, Intervention, Background, Outcome, Study
design, Other.
Used Kim et al. (2011) classifier.

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Description of Features IV
6 Synset Expansion
Use WordNet to expand synonyms.

7 Context Windows
Terms within 3-word boundaries around context-drug terms.
Terms before are appended ’BEFORE’ string.
Terms after are appended ’AFTER’ string.

EBM Sentence Polarity

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Description of Features V
8 Dependency chains
Used GDep parser.
For each intervention, follow dependencies using this rule:
1. Move up the dependency chain until we find a verb or the root.
2. Move down the dependencies and collect all terms.

Terms collected are appended ’DEP’ string.

9 Other features
Context-intervention position.
Summary sentence position.
Presence of modals, comparatives, superlatives.
EBM Sentence Polarity

Sarker, Moll´, Paris
a

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Contents

Sentence Polarity for Evidence Based Medicine
Feasibility Study
Automatic Polarity Classification
Results

EBM Sentence Polarity

Sarker, Moll´, Paris
a

20/24
Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Results with SVM Classifier

Training: 85% of annotated data (2008 sentences).
Test: 15% of annotated data (354 sentences).
Feature sets
1,2,3,4 (Niu)
1–6
All (Niu)
All (Bioscope)
All (NegEx)

Accuracy
Value (%)
95% CI
76.0
78.5
83.9
84.7
84.5

71.2–80.4
73.8–82.8
79.7–87.6
80.5–88.9
80.2–88.1

EBM Sentence Polarity

Positive
0.58
0.64
0.71
0.74
0.73

F-score
Non-positive
0.83
0.85
0.89
0.89
0.89

Sarker, Moll´, Paris
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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Impact of Training Size on Classification Results

It seems that we will get
better results with more
data. . .

EBM Sentence Polarity

Sarker, Moll´, Paris
a

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Towards Generation of Bottom-line Recommendations

Used the 33 questions from our preliminary analysis.
Compared automatic polarities of interventions with manual
annotations of bottom-line summaries.

Results
Recall

Precision

F1

0.62

0.82

0.71

We might get better results with more training data.

EBM Sentence Polarity

Sarker, Moll´, Paris
a

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Sentence Polarity for Evidence Based Medicine

Feasibility Study

Automatic Polarity Classification

Results

Conclusions
http://web.science.mq.edu.au/˜diego/medicalnlp/

There is strong agreement between polarity of interventions in
clinical abstracts and polarity in bottom-line summaries.
A SVM classifier with a range of features including context
features achieve better results than classifiers without context
features.
More training data will probably lead to better results.

Bottom-line conclusions
Polarity classification of abstract sentences may help EBM
summarisation.
More data are needed.
EBM Sentence Polarity

Sarker, Moll´, Paris
a

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Automatic Prediction of Evidence-based Recommendations via Sentence-level Polarity Classification

  • 1. Automatic Prediction of Evidence-based Recommendations via Sentence-level Polarity Classification Abeed Sarker1,2 Diego Moll´1,2 a C´cile Paris1,2 e Macquarie University1 and CSIRO ICT Centre2 Sydney, Australia IJCNLP 2013, Nagoya, Japan
  • 2. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Contents Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results EBM Sentence Polarity Sarker, Moll´, Paris a 2/24
  • 3. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Evidence Based Medicine http://laikaspoetnik.wordpress.com/2009/04/04/evidence-based-medicine-the-facebook-of-medicine/ EBM Sentence Polarity Sarker, Moll´, Paris a 3/24
  • 4. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results The Ultimate Goal EBM Sentence Polarity Sarker, Moll´, Paris a 4/24
  • 5. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Sentence Polarity for EBM The Task Given a context intervention, determine the polarity of a sentence returned by an automatic summariser. Q IR polarity summarisers detectors s11 + doc1 + s12 + s21 doc2 − − s22 + s31 doc3 s32 drug1, + multisummariser EBM Sentence Polarity drug2, + drug3, − Sarker, Moll´, Paris a 5/24
  • 6. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Sentence Polarity in Context Different contexts may determine different polarities Sentence fragment The present study demonstrated that the combination of cimetidine with levamisole is more effective than cimetidine alone and is a highly effective therapy ... Polarities in Context cimetidine with levamisole: recommended. cimetidine alone: not recommended. EBM Sentence Polarity Sarker, Moll´, Paris a 6/24
  • 7. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Related Work Related tasks Sentiment analysis Semantic orientation Opinion mining Subjectivity Typical approaches use statistical classifiers (e.g. SVM) trained on bag-of-word features. Closely Related Niu et al. (2005,2006) Polarity classification of medical sentences into four categories (positive, negative, neutral, no outcome). Our approach contemplates the possibility of the same sentence having multiple polarities. EBM Sentence Polarity Sarker, Moll´, Paris a 7/24
  • 8. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Contents Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results EBM Sentence Polarity Sarker, Moll´, Paris a 8/24
  • 9. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Data and Annotation Initial corpus 456 clinical questions sourced from the Journal of Family Practice. Polarity annotations 589 sentences from 33 questions annotated. Bottom-line answers. Key sentences extracted by QSpec summariser. EBM Sentence Polarity Sarker, Moll´, Paris a 9/24
  • 10. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Example of annotations Question What is the most effective beta-blocker for heart failure? Bottom-line answer Three beta-blockers- carvedilol, metoprolol, and bisoprolol-reduce mortality in chronic heart failure caused by left ventricular systolic dysfunction, when used in addition to diuretics and angiotensin converting enzyme (ACE) inhibitors. Contextual polarities carvedilol — recommended; metoprolol — recommended; bisoprolol — recommended. EBM Sentence Polarity Sarker, Moll´, Paris a 10/24
  • 11. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Analysis I Inter-annotator agreement (124 sentences) Cohen Kappa: k = 0.85 (almost perfect agreement). Agreement between annotated sentences and bottom-line summaries Interventions with positive polarity that are mentioned in the bottom-line summary: 177. Polarity agreement: 95.5%. EBM Sentence Polarity Sarker, Moll´, Paris a 11/24
  • 12. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Analysis II But do we have enough interventions? Out of 109 unique interventions listed in the bottom-line summaries . . . . . . 99 are listed in the annotated sentences. Recall= 90.8% If we ignore missing abstracts: Recall = 96.1% EBM Sentence Polarity Sarker, Moll´, Paris a 12/24
  • 13. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Contents Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results EBM Sentence Polarity Sarker, Moll´, Paris a 13/24
  • 14. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Approach Train a statistical classifier (SVM). Input: context, sentence (may have sentence duplicates, each with a different context). Output: the polarity. Features 1. Word n-grams 2. Change Phrases 3. UMLS Semantic Types 4. Negations 5. PIBOSO Category 6. Synset Expansion 7. Context Windows 8. Dependency Chains 9. Other Features EBM Sentence Polarity Sarker, Moll´, Paris a 14/24
  • 15. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Description of Features I 1 Word n-grams n = 1, 2 Lowercased, stop words removed, stemmed (Porter). Context words (strings matching the provided contexts) replaced with generic string ’ CONTEXT ’. Disorder terms (UMLS semantic types) replaced with generic string ’ DISORDER ’. EBM Sentence Polarity Sarker, Moll´, Paris a 15/24
  • 16. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Description of Features II 2 Change Phrases Expanded Niu et al. (2005) groups of good, bad, more, less words. Features used: more-good, more-bad, less-good, less-bad. Context window of 4 words. 3 UMLS semantic types Used all UMLS semantic types as binary features. EBM Sentence Polarity Sarker, Moll´, Paris a 16/24
  • 17. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Description of Features III 4 Negations Niu et al. 2005. BioScope corpus. NegEx. 5 PIBOSO categories Population, Intervention, Background, Outcome, Study design, Other. Used Kim et al. (2011) classifier. EBM Sentence Polarity Sarker, Moll´, Paris a 17/24
  • 18. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Description of Features IV 6 Synset Expansion Use WordNet to expand synonyms. 7 Context Windows Terms within 3-word boundaries around context-drug terms. Terms before are appended ’BEFORE’ string. Terms after are appended ’AFTER’ string. EBM Sentence Polarity Sarker, Moll´, Paris a 18/24
  • 19. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Description of Features V 8 Dependency chains Used GDep parser. For each intervention, follow dependencies using this rule: 1. Move up the dependency chain until we find a verb or the root. 2. Move down the dependencies and collect all terms. Terms collected are appended ’DEP’ string. 9 Other features Context-intervention position. Summary sentence position. Presence of modals, comparatives, superlatives. EBM Sentence Polarity Sarker, Moll´, Paris a 19/24
  • 20. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Contents Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results EBM Sentence Polarity Sarker, Moll´, Paris a 20/24
  • 21. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Results with SVM Classifier Training: 85% of annotated data (2008 sentences). Test: 15% of annotated data (354 sentences). Feature sets 1,2,3,4 (Niu) 1–6 All (Niu) All (Bioscope) All (NegEx) Accuracy Value (%) 95% CI 76.0 78.5 83.9 84.7 84.5 71.2–80.4 73.8–82.8 79.7–87.6 80.5–88.9 80.2–88.1 EBM Sentence Polarity Positive 0.58 0.64 0.71 0.74 0.73 F-score Non-positive 0.83 0.85 0.89 0.89 0.89 Sarker, Moll´, Paris a 21/24
  • 22. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Impact of Training Size on Classification Results It seems that we will get better results with more data. . . EBM Sentence Polarity Sarker, Moll´, Paris a 22/24
  • 23. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Towards Generation of Bottom-line Recommendations Used the 33 questions from our preliminary analysis. Compared automatic polarities of interventions with manual annotations of bottom-line summaries. Results Recall Precision F1 0.62 0.82 0.71 We might get better results with more training data. EBM Sentence Polarity Sarker, Moll´, Paris a 23/24
  • 24. Sentence Polarity for Evidence Based Medicine Feasibility Study Automatic Polarity Classification Results Conclusions http://web.science.mq.edu.au/˜diego/medicalnlp/ There is strong agreement between polarity of interventions in clinical abstracts and polarity in bottom-line summaries. A SVM classifier with a range of features including context features achieve better results than classifiers without context features. More training data will probably lead to better results. Bottom-line conclusions Polarity classification of abstract sentences may help EBM summarisation. More data are needed. EBM Sentence Polarity Sarker, Moll´, Paris a 24/24