FedFSA: Hybrid and federated framework for functional status ascertainment across institutions.

INTRODUCTION: Patients' functional status assesses their independence in performing activities of daily living, including basic ADLs (bADL), and more complex instrumental activities (iADL). Existing studies have discovered that patients' functional status is a strong predictor of health outcomes, particularly in older adults. Depite their usefulness, much of the functional status information is stored in electronic health records (EHRs) in either semi-structured or free text formats. This indicates the pressing need to leverage computational approaches such as natural language processing (NLP) to accelerate the curation of functional status information. In this study, we introduced FedFSA, a hybrid and federated NLP framework designed to extract functional status information from EHRs across multiple healthcare institutions. METHODS: FedFSA consists of four major components: 1) individual sites (clients) with their private local data, 2) a rule-based information extraction (IE) framework for ADL extraction, 3) a BERT model for functional status impairment classification, and 4) a concept normalizer. The framework was implemented using the OHNLP Backbone for rule-based IE and open-source Flower and PyTorch library for federated BERT components. For gold standard data generation, we carried out corpus annotation to identify functional status-related expressions based on ICF definitions. Four healthcare institutions were included in the study. To assess FedFSA, we evaluated the performance of category- and institution-specific ADL extraction across different experimental designs. RESULTS: ADL extraction performance ranges from an F1-score of 0.907 to 0.986 for bADL and 0.825 to 0.951 for iADL across the four healthcare sites. The performance for ADL extraction with impairment ranges from an F1-score of 0.722 to 0.954 for bADL and 0.674 to 0.813 for iADL across four healthcare sites. For category-specific ADL extraction, laundry and transferring yielded relatively high performance, while dressing, medication, bathing, and continence achieved moderate-high performance. Conversely, food preparation and toileting showed low performance. CONCLUSION: NLP performance varied across ADL categories and healthcare sites. Federated learning using a FedFSA framework performed higher than non-federated learning for impaired ADL extraction at all healthcare sites. Our study demonstrated the potential of the federated learning framework in functional status extraction and impairment classification in EHRs, exemplifying the importance of a large-scale, multi-institutional collaborative development effort.

MultiWD: Multi-label wellness dimensions in social media posts.

BACKGROUND: Halbert L. Dunn's concept of wellness is a multi-dimensional aspect encompassing social and mental well-being. Neglecting these dimensions over time can have a negative impact on an individual's mental health. The manual efforts employed in in-person therapy sessions reveal that underlying factors of mental disturbance if triggered, may lead to severe mental health disorders. OBJECTIVE: In our research, we introduce a fine-grained approach focused on identifying indicators of wellness dimensions and mark their presence in self-narrated human-writings on Reddit social media platform. DESIGN AND METHOD: We present the MultiWD dataset, a curated collection comprising 3281 instances, as a specifically designed and annotated dataset that facilitates the identification of multiple wellness dimensions in Reddit posts. In our study, we introduce the task of identifying wellness dimensions and utilize state-of-the-art classifiers to solve this multi-label classification task. RESULTS: Our findings highlights the best and comparative performance of fine-tuned large language models with fine-tuned BERT model. As such, we set BERT as a baseline model to tag wellness dimensions in a user-penned text with F1 score of 76.69. CONCLUSION: Our findings underscore the need of trustworthy and domain-specific knowledge infusion to develop more comprehensive and contextually-aware AI models for tagging and extracting wellness dimensions.

Dementia Prediction in Older Adults Using Sex-Specific Health Trajectory Clustering.

With increasing number of people living with dementia, the problem of late diagnosis significantly impacts a person's quality of life while early signs of dementia may provide useful insights to facilitate better treatment plans. With time, this progressive neurodegenerative syndrome could progress from mild cognitive impairment to dementia. A pattern of health conditions can be characterized in unsupervised manner to help predict this progress. As a significant extension to our previous work with streaming clustering model, we consider additional information for predicting dementia onset. With empirical observations, we discover the importance of examining sex and age to predict dementia onset. To this end, we propose a sex-specific model with age-constraint for predicting dementia onset and validate the effectiveness of our models using data from Mayo Clinic Study of Aging (MCSA). The proposed sex-specific models for older adult populations (>=65 years of age) outperformed the previous models with F-score of 77% and 78% for male-specific and female-specific models, respectively. Our experiments of sex-specific temporal clustering of features in older adults demonstrate the potential of more personalized models for early alerts of dementia.

Mental disturbance impacting wellness dimensions: Resources and open research directions.

In light of the unparalleled pressure faced by the healthcare system, there arises a pressing need for innovative solutions to comprehensively assess the overall well-being of individuals affected by mental health issues. With the objective of advancing AI-driven mental health analysis towards fine-grained analysis, we develop and publicly release our datasets, MULTIWD and WELLXPLAIN, specifically designed to capture the impact of mental disturbances on wellness dimensions in self-narrated texts. To this end, we make two major contributions. First, our examination focuses on the identification of one or more of the six distinct wellness dimensions evident within a given text, shedding light on the significant ramifications of mental disturbance, which, in turn, can perpetuate further mental unrest. Second, we conducting an extensive analysis of the textual cues that signify the presence of various wellness dimensions. We delve into the content of the text, examining specific linguistic and contextual markers that provide indications of the wellness dimensions being discussed. Finally, we open up future research directions to facilitate advancements in the domain of AI-driven approaches for fine-grained mental health analysis. This framework aims to establish and validate new clinical categories for mental distress, bridging the gap between mental wellness and illness, in response to the higher prevalence of distress compared to illnesses.

A review of the explainability and safety of conversational agents for mental health to identify avenues for improvement.

Virtual Mental Health Assistants (VMHAs) continuously evolve to support the overloaded global healthcare system, which receives approximately 60 million primary care visits and 6 million emergency room visits annually. These systems, developed by clinical psychologists, psychiatrists, and AI researchers, are designed to aid in Cognitive Behavioral Therapy (CBT). The main focus of VMHAs is to provide relevant information to mental health professionals (MHPs) and engage in meaningful conversations to support individuals with mental health conditions. However, certain gaps prevent VMHAs from fully delivering on their promise during active communications. One of the gaps is their inability to explain their decisions to patients and MHPs, making conversations less trustworthy. Additionally, VMHAs can be vulnerable in providing unsafe responses to patient queries, further undermining their reliability. In this review, we assess the current state of VMHAs on the grounds of user-level explainability and safety, a set of desired properties for the broader adoption of VMHAs. This includes the examination of ChatGPT, a conversation agent developed on AI-driven models: GPT3.5 and GPT-4, that has been proposed for use in providing mental health services. By harnessing the collaborative and impactful contributions of AI, natural language processing, and the mental health professionals (MHPs) community, the review identifies opportunities for technological progress in VMHAs to ensure their capabilities include explainable and safe behaviors. It also emphasizes the importance of measures to guarantee that these advancements align with the promise of fostering trustworthy conversations.

Characterizing Performance Gaps of a Code-Based Dementia Algorithm in a Population-Based Cohort of Cognitive Aging.

BACKGROUND: Multiple algorithms with variable performance have been developed to identify dementia using combinations of billing codes and medication data that are widely available from electronic health records (EHR). If the characteristics of misclassified patients are clearly identified, modifying existing algorithms to improve performance may be possible. OBJECTIVE: To examine the performance of a code-based algorithm to identify dementia cases in the population-based Mayo Clinic Study of Aging (MCSA) where dementia diagnosis (i.e., reference standard) is actively assessed through routine follow-up and describe the characteristics of persons incorrectly categorized. METHODS: There were 5,316 participants (age at baseline (mean (SD)): 73.3 (9.68) years; 50.7% male) without dementia at baseline and available EHR data. ICD-9/10 codes and prescription medications for dementia were extracted between baseline and one year after an MCSA dementia diagnosis or last follow-up. Fisher's exact or Kruskal-Wallis tests were used to compare characteristics between groups. RESULTS: Algorithm sensitivity and specificity were 0.70 (95% CI: 0.67, 0.74) and 0.95 (95% CI: 0.95, 0.96). False positives (i.e., participants falsely diagnosed with dementia by the algorithm) were older, with higher Charlson comorbidity index, more likely to have mild cognitive impairment (MCI), and longer follow-up (versus true negatives). False negatives (versus true positives) were older, more likely to have MCI, or have more functional limitations. CONCLUSIONS: We observed a moderate-high performance of the code-based diagnosis method against the population-based MCSA reference standard dementia diagnosis. Older participants and those with MCI at baseline were more likely to be misclassified.

Mental Health Analysis in Social Media Posts: A Survey.

The surge in internet use to express personal thoughts and beliefs makes it increasingly feasible for the social NLP research community to find and validate associations between social media posts and mental health status. Cross-sectional and longitudinal studies of social media data bring to fore the importance of real-time responsible AI models for mental health analysis. Aiming to classify the research directions for social computing and tracking advances in the development of machine learning (ML) and deep learning (DL) based models, we propose a comprehensive survey on quantifying mental health on social media. We compose a taxonomy for mental healthcare and highlight recent attempts in examining social well-being with personal writings on social media. We define all the possible research directions for mental healthcare and investigate a thread of handling online social media data for stress, depression and suicide detection for this work. The key features of this manuscript are (i) feature extraction and classification, (ii) recent advancements in AI models, (iii) publicly available dataset, (iv) new frontiers and future research directions. We compile this information to introduce young research and academic practitioners with the field of computational intelligence for mental health analysis on social media. In this manuscript, we carry out a quantitative synthesis and a qualitative review with the corpus of over 92 potential research articles. In this context, we release the collection of existing work on suicide detection in an easily accessible and updatable repository:https://github.com/drmuskangarg/mentalhealthcare.

LoST: A Mental Health Dataset of Low Self-esteem in Reddit Posts.

Low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burden-someness (PB)) have a major impact on depression and suicide attempts. Individuals seek social connectedness on social media to boost and alleviate their loneliness. Social media platforms allow people to express their thoughts, experiences, beliefs, and emotions. Prior studies on mental health from social media have focused on symptoms, causes, and disorders. Whereas an initial screening of social media content for interpersonal risk factors and low self-esteem may raise early alerts and assign therapists to at-risk users of mental disturbance. Standardized scales measure self-esteem and interpersonal needs from questions created using psychological theories. In the current research, we introduce a psychology-grounded and expertly annotated dataset, LoST: Low Self esTeem, to study and detect low self-esteem on Reddit. Through an annotation approach involving checks on coherence, correctness, consistency, and reliability, we ensure gold standard for supervised learning. We present results from different deep language models tested using two data augmentation techniques. Our findings suggest developing a class of language models that infuses psychological and clinical knowledge.

CareD: Caregiver's Experience with Cognitive Decline in Reddit Posts.

With advancements in analysis of cognitive decline in electronic health records, the research community witnesses a recent surge in social media posting by caregivers and/or loved ones of people with cognitive decline. The major challenges in this area are availability of large and diverse datasets, ethics of data collection and sharing, diagnostic specificity and clinical acceptability. To this end, we construct a new dataset, Caregivers experiences with cognitive Decline (CareD), of 1005 posts with more than 194K words and 9541 sentences, highlighting discussions on people with dementia and Alzheimer's disease on Reddit. We discuss the changing trends of discussions on cognitive decline in social media and open challenges for natural language processing and social computing. We first identify the Reddit posts reflecting substantial information as candidate posts. We further formulate the annotation guidelines, handle perplexities to investigate the existence of experiences, self-reported articles and potential caregiver in candidate posts, resulting in the discovery of latent symptoms, firsthand information, and prospective source of longitudinal information about the patient, respectively.

Augmenting Reddit Posts to Determine Wellness Dimensions impacting Mental Health.

Amid ongoing health crisis, there is a growing necessity to discern possible signs of Wellness Dimensions (WD) manifested in self-narrated text. As the distribution of WD on social media data is intrinsically imbalanced, we experiment the generative NLP models for data augmentation to enable further improvement in the pre-screening task of classifying WD. To this end, we propose a simple yet effective data augmentation approach through prompt-based Generative NLP models, and evaluate the ROUGE scores and syntactic/semantic similarity among existing interpretations and augmented data. Our approach with ChatGPT model surpasses all the other methods and achieves improvement over baselines such as Easy-Data Augmentation and Backtranslation. Introducing data augmentation to generate more training samples and balanced dataset, results in the improved F-score and the Matthew's Correlation Coefficient for upto 13.11% and 15.95%, respectively.

Navigating Sex-Specific Disease Dynamics in Incident Dementia.

Dementia is among the leading causes of cognitive and functional loss and disability in older adults. Past studies suggested sex differences in health conditions and progression of cognitive decline. Existing studies on the temporal trajectory of health conditions for patient characterization after dementia diagnosis are scarce and ambiguous. Thus, there's limited and unclear research on how health conditions change over time after a dementia diagnosis. To this end, we aim to analyze the shift in medical conditions and examine sex-specific changes in patterns of chronic health conditions after dementia diagnosis. We centered our analysis on a 15-year window around the point of dementia diagnosis, encompassing the 5 years leading up to the diagnosis and the 10 years following it. We introduce (i) MedMet, a network metric to quantify the contribution of each medical condition, and (ii) growth and decay function for temporal trajectory analysis of medical conditions. Our experiments demonstrate that certain health conditions are more prevalent among females than males. Thus, our findings underscore the pressing need to examine differences between men and women, which could be important for healthcare utilization after a dementia diagnosis.

Harnessing Transfer Learning for Dementia Prediction: Leveraging Sex-Different Mild Cognitive Impairment Prognosis.

This paper presents a machine learning-based prediction for dementia, leveraging transfer learning to reuse the knowledge learned from prediction of mild cognitive impairment, a precursor of dementia. We also examine the impacts of temporal aspects of longitudinal data and sex differences. The methodology encompasses key components such as setting the duration window, comparing different modeling strategies, conducting comprehensive evaluations, and examining the sex-specific impacts of simulated scenarios. The findings reveal that cognitive deficits in females, once detected at the mild cognitive impairment stage, tend to deteriorate over time, while males exhibit more diverse decline across various characteristics without highlighting specific ones. However, the underlying reasons for these sex differences remain unknown and warrant further investigation.

A survey on different dimensions for graphical keyword extraction techniques: Issues and Challenges.

The transmission from offline activities to online activities due to the social disorder evolved from COVID-19 pandemic lockdown has led to increase in the online economic and social activities. In this regard, the Automatic Keyword Extraction (AKE) from textual data has become even more interesting due to its application over different domains of Natural Language Processing (NLP). It is observed that the Graphical Keyword Extraction Techniques (GKET) use Graph of Words (GoW) in literature for analysis in different dimensions. In this article, efforts have been made to study these different dimensions for GKET, namely, the GoW representation, the statistical properties of GoW, the stability of the structure of GoW, the diversity in approaches over GoW for GKET, and the ranking of nodes in GoW. To elucidate these different dimensions, a comprehensive survey of GKET is carried in different domains to make some inferences out of the existing literature. These inferences are used to lay down possible research directions for interdisciplinary studies of network science and NLP. In addition, the experimental results are analysed to compare and contrast the existing GKET over 21 different dataset, to analyse the Word Co-occurrence Networks (WCN) for 15 different languages, and to study the structure of WCN for different genres. In this article, some strong correspondences in different disciplinary approaches are identified for different dimensions, namely, GoW representation: 'Line Graphs' and 'Bigram Words Graphs'; Feature extraction and selection using eigenvalues: 'Random Walk' and 'Spectral Clustering'. Different observations over the need to integrate multiple dimensions has open new research directions in the inter-disciplinary field of network science and NLP, applicable to handle streaming data and language-independent NLP.

TiO2 doped chitosan/poly (vinyl alcohol) nanocomposite film with enhanced mechanical properties for application in bone tissue regeneration.

Here, TiO2 nanoparticles have been doped into the polymer film-construct of Chitosan/poly (vinyl alcohol)/Nano-hydroxyapatite (CPHT I - III) to enhance the mechanical and biological properties of the film so as to mimic the human bone extracellular matrix for application in human bone regeneration. The synthesized films are highly porous in nature along with the presence of macrovoids. Significantly enhanced mechanical properties were obtained upon the addition of TiO2 in comparison to previous literature. Increasing content of n-HAP-TiO2 increased the elasticity, tensile strength of the films and the antibacterial efficacy against both Gram-Positive and Gram-Negative Bacteria. The pH of CPHT I-III films in saline remained in the low alkalinity range of (7.48-7.53) on day 14. CPHT I-III films were compatible with the human erythrocytes as their hemolysis was well below the limit of acute hemolysis. The in-vitro studies revealed the highly cytocompatible nature of CPHT III (15% n-HAP-TiO2) for osteoblast-like MG - 63 cell attachment and proliferation. The study has revealed that CPHT III has the potential to be used for bone tissue regeneration, our future studies will be focused on the in-vivo investigations to establish its use in clinical settings.