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Summary Objectives: We survey recent work in biomedical NLP on building more adaptable or generalizable models, with a focus on work dealing with electronic health record (EHR) texts, to better understand recent trends in this area and identify opportunities for future research. Methods: We searched PubMed, the Institute of Electrical and Electronics Engineers (IEEE), the Association for Computational Linguistics (ACL) anthology, the Association for the Advancement of Artificial Intelligence (AAAI) proceedings, and Google Scholar for the years 2018-2020. We reviewed abstracts to identify the most relevant and impactful work, and manually extracted data points from each of these papers to characterize the types of methods and tasks that were studied, in which clinical domains, and current state-of-the-art results. Results: The ubiquity of pre-trained transformers in clinical NLP research has contributed to an increase in domain adaptation and generalization-focused work that uses these models as the key component. Most recently, work has started to train biomedical transformers and to extend the fine-tuning process with additional domain adaptation techniques. We also highlight recent research in cross-lingual adaptation, as a special case of adaptation. Conclusions: While pre-trained transformer models have led to some large performance improvements, general domain pre-training does not always transfer adequately to the clinical domain due to its highly specialized language. There is also much work to be done in showing that the gains obtained by pre-trained transformers are beneficial in real world use cases. The amount of work in domain adaptation and transfer learning is limited by dataset availability and creating datasets for new domains is challenging. The growing body of research in languages other than English is encouraging, and more collaboration between researchers across the language divide would likely accelerate progress in non-English clinical NLP.

Background Duration of untreated psychosis (DUP) is an important clinical construct in the field of mental health, as longer DUP can be associated with worse intervention outcomes. DUP estimation requires knowledge about when psychosis symptoms first started (symptom onset), and when psychosis treatment was initiated. Electronic health records (EHRs) represent a useful resource for retrospective clinical studies on DUP, but the core information underlying this construct is most likely to lie in free text, meaning it is not readily available for clinical research. Natural Language Processing (NLP) is a means to addressing this problem by automatically extracting relevant information in a structured form. As a first step, it is important to identify appropriate documents, i.e., those that are likely to include the information of interest. Next, temporal information extraction methods are needed to identify time references for early psychosis symptoms. This NLP challenge requires solving three different tasks: time expression extraction, symptom extraction, and temporal “linking”. In this study, we focus on the first step, using two relevant EHR datasets. Results We applied a rule-based NLP system for time expression extraction that we had previously adapted to a corpus of mental health EHRs from patients with a diagnosis of schizophrenia (first referrals). We extended this work by applying this NLP system to a larger set of documents and patients, to identify additional texts that would be relevant for our long-term goal, and developed a new corpus from a subset of these new texts (early intervention services). Furthermore, we added normalized value annotations (“2011–05”) to the annotated time expressions (“May 2011”) in both corpora. The finalized corpora were used for further NLP development and evaluation, with promising results (normalization accuracy 71–86%). To highlight the specificities of our annotation task, we also applied the final adapted NLP system to a different temporally annotated clinical corpus. Conclusions Developing domain-specific methods is crucial to address complex NLP tasks such as symptom onset extraction and retrospective calculation of duration of a preclinical syndrome. To the best of our knowledge, this is the first clinical text resource annotated for temporal entities in the mental health domain.

Background Suicide is a serious public health issue, accounting for 1.4% of all deaths worldwide. Current risk assessment tools are reported as performing little better than chance in predicting suicide. New methods for studying dynamic features in electronic health records (EHRs) are being increasingly explored. One avenue of research involves using sentiment analysis to examine clinicians’ subjective judgments when reporting on patients. Several recent studies have used general-purpose sentiment analysis tools to automatically identify negative and positive words within EHRs to test correlations between sentiment extracted from the texts and specific medical outcomes (eg, risk of suicide or in-hospital mortality). However, little attention has been paid to analyzing the specific words identified by general-purpose sentiment lexicons when applied to EHR corpora. Objective This study aims to quantitatively and qualitatively evaluate the coverage of six general-purpose sentiment lexicons against a corpus of EHR texts to ascertain the extent to which such lexical resources are fit for use in suicide risk assessment. Methods The data for this study were a corpus of 198,451 EHR texts made up of two subcorpora drawn from a 1:4 case-control study comparing clinical notes written over the period leading up to a suicide attempt (cases, n=2913) with those not preceding such an attempt (controls, n=14,727). We calculated word frequency distributions within each subcorpus to identify representative keywords for both the case and control subcorpora. We quantified the relative coverage of the 6 lexicons with respect to this list of representative keywords in terms of weighted precision, recall, and F score. Results The six lexicons achieved reasonable precision (0.53-0.68) but very low recall (0.04-0.36). Many of the most representative keywords in the suicide-related (case) subcorpus were not identified by any of the lexicons. The sentiment-bearing status of these keywords for this use case is thus doubtful. Conclusions Our findings indicate that these 6 sentiment lexicons are not optimal for use in suicide risk assessment. We propose a set of guidelines for the creation of more suitable lexical resources for distinguishing suicide-related from non–suicide-related EHR texts.

Receiving timely and appropriate treatment is crucial for better health outcomes, and research on the contribution of specific variables is essential. In the mental health domain, an important research variable is the date of psychosis symptom onset, as longer delays in treatment are associated with worse intervention outcomes. The growing adoption of electronic health records (EHRs) within mental health services provides an invaluable opportunity to study this problem at scale retrospectively. However, disease onset information is often only available in open text fields, requiring natural language processing (NLP) techniques for automated analyses. Since this variable can be documented at different points during a patient’s care, NLP methods that model clinical and temporal associations are needed. We address the identification of psychosis onset by: 1) manually annotating a corpus of mental health EHRs with disease onset mentions, 2) modelling the underlying NLP problem as a paragraph classification approach, and 3) combining multiple onset paragraphs at the patient level to generate a ranked list of likely disease onset dates. For 22/31 test patients (71%) the correct onset date was found among the top-3 NLP predictions. The proposed approach was also applied at scale, allowing an onset date to be estimated for 2483 patients.

Funder: EPSRC Healtex Feasibility Funding (grant EP/N027280/1): "Towards Shareable Data in Clinical Natural Language Processing: Generating Synthetic Electronic Health Records", Funder: National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, Funder: National Institute for Health Research Post Doctoral Fellowship award (grant number PDF-2017-10-029), Funder: Health Data Research UK, Funder: Swedish Research Council(2015-00359)/the Marie Sklodowska Curie Actions, A serious obstacle to the development of Natural Language Processing (NLP) methods in the clinical domain is the accessibility of textual data. The mental health domain is particularly challenging, partly because clinical documentation relies heavily on free text that is difficult to de-identify completely. This problem could be tackled by using artificial medical data. In this work, we present an approach to generate artificial clinical documents. We apply this approach to discharge summaries from a large mental healthcare provider and discharge summaries from an intensive care unit. We perform an extensive intrinsic evaluation where we (1) apply several measures of text preservation; (2) measure how much the model memorises training data; and (3) estimate clinical validity of the generated text based on a human evaluation task. Furthermore, we perform an extrinsic evaluation by studying the impact of using artificial text in a downstream NLP text classification task. We found that using this artificial data as training data can lead to classification results that are comparable to the original results. Additionally, using only a small amount of information from the original data to condition the generation of the artificial data is successful, which holds promise for reducing the risk of these artificial data retaining rare information from the original data. This is an important finding for our long-term goal of being able to generate artificial clinical data that can be released to the wider research community and accelerate advances in developing computational methods that use healthcare data.

While Dementia with Lewy Bodies (DLB) is the second most common type of neurodegenerative dementia following Alzheimer’s Disease (AD), it is difficult to distinguish from AD. We propose a method for DLB detection by using mental health record (MHR) documents from a (3-month) period before a patient has been diagnosed with DLB or AD. Our objective is to develop a model that could be clinically useful to differentiate between DLB and AD across datasets from different healthcare institutions. We cast this as a classification task using Convolutional Neural Network (CNN), an efficient neural model for text classification. We experiment with different representation models, and explore the features that contribute to model performances. In addition, we apply temperature scaling, a simple but efficient model calibration method, to produce more reliable predictions. We believe the proposed method has important potential for clinical applications using routine healthcare records, and for generalising to other relevant clinical record datasets. To the best of our knowledge, this is the first attempt to distinguish DLB from AD using mental health records, and to improve the reliability of DLB predictions.

Extracting and modeling temporal information in clinical text is an important element for developing timelines and disease trajectories. Time information in written text varies in preciseness and explicitness, posing challenges for NLP approaches that aim to accurately anchor temporal information on a timeline. Relative and incomplete time expressions (RI-Timexes) are expressions that require additional information for their temporal anchor to be resolved, but few studies have addressed this challenge specifically. In this study, we aimed to reproduce and verify a classification approach for identifying anchor dates and relations in clinical text, and propose a novel relation classification approach for this task.

To automatically analyse complex trajectory information enclosed in clinical text (e.g. timing of symptoms, duration of treatment), it is important to understand the related temporal aspects, anchoring each event on an absolute point in time. In the clinical domain, few temporally annotated corpora are currently available. Moreover, underlying annotation schemas - which mainly rely on the TimeML standard - are not necessarily easily applicable for applications such as patient timeline reconstruction. In this work, we investigated how temporal information is documented in clinical text by annotating a corpus of medical reports with time expressions (TIMEXes), based on TimeML. The developed corpus is available to the NLP community. Starting from our annotations, we analysed the suitability of the TimeML TIMEX schema for capturing timeline information, identifying challenges and possible solutions. As a result, we propose a novel annotation schema that could be useful for timeline reconstruction: CALendar EXpression (CALEX).

The development of Natural Language Processing (NLP) solutions for information extraction from electronic health records (EHRs) has grown in recent years, as most clinically relevant information in EHRs is documented only in free text. One of the core tasks for any NLP system is to extract clinically relevant concepts such as symptoms. This information can then be used for more complex problems such as determining symptom onset, which requires temporal information. In the mental health domain, comprehensive vocabularies for specific disorders are scarce, and rarely contain keywords that reflect real-world terminology use. We explore the use of embedding techniques to automatically generate lexical variants of psychosis symptoms into vocabularies, that can be used in complex downstream NLP tasks. We study the impact of the underlying text material on generating useful lexical entries, experimenting with different corpora and with unigram/bigram models. We also propose a method to automatically compute thresholds for choosing the most relevant terms. Our main contribution is a systematic study of unsupervised vocabulary generation using different corpora for an understudied clinical use-case. Resulting lexicons are publicly available.

A major obstacle to the development of Natural Language Processing (NLP) methods in the biomedical domain is data accessibility. This problem can be addressed by generating medical data artificially. Most previous studies have focused on the generation of short clinical text, and evaluation of the data utility has been limited. We propose a generic methodology to guide the generation of clinical text with key phrases. We use the artificial data as additional training data in two key biomedical NLP tasks: text classification and temporal relation extraction. We show that artificially generated training data used in conjunction with real training data can lead to performance boosts for data-greedy neural network algorithms. We also demonstrate the usefulness of the generated data for NLP setups where it fully replaces real training data., BioNLP 2019

Background Electronic health care records (EHRs) are a rich source of health-related information, with potential for secondary research use. In the United Kingdom, there is no national marker for identifying those who have previously served in the Armed Forces, making analysis of the health and well-being of veterans using EHRs difficult. Objective This study aimed to develop a tool to identify veterans from free-text clinical documents recorded in a psychiatric EHR database. Methods Veterans were manually identified using the South London and Maudsley (SLaM) Biomedical Research Centre Clinical Record Interactive Search—a database holding secondary mental health care electronic records for the SLaM National Health Service Foundation Trust. An iterative approach was taken; first, a structured query language (SQL) method was developed, which was then refined using natural language processing and machine learning to create the Military Service Identification Tool (MSIT) to identify if a patient was a civilian or veteran. Performance, defined as correct classification of veterans compared with incorrect classification, was measured using positive predictive value, negative predictive value, sensitivity, F1 score, and accuracy (otherwise termed Youden Index). Results A gold standard dataset of 6672 free-text clinical documents was manually annotated by human coders. Of these documents, 66.00% (4470/6672) were then used to train the SQL and MSIT approaches and 34.00% (2202/6672) were used for testing the approaches. To develop the MSIT, an iterative 2-stage approach was undertaken. In the first stage, an SQL method was developed to identify veterans using a keyword rule–based approach. This approach obtained an accuracy of 0.93 in correctly predicting civilians and veterans, a positive predictive value of 0.81, a sensitivity of 0.75, and a negative predictive value of 0.95. This method informed the second stage, which was the development of the MSIT using machine learning, which, when tested, obtained an accuracy of 0.97, a positive predictive value of 0.90, a sensitivity of 0.91, and a negative predictive value of 0.98. Conclusions The MSIT has the potential to be used in identifying veterans in the United Kingdom from free-text clinical documents, providing new and unique insights into the health and well-being of this population and their use of mental health care services.

International audience; Background:Natural language processing applied to clinical text or aimed at a clinical outcome has been thriving inrecent years. This paper offers the first broad overview of clinical Natural Language Processing (NLP) for languagesother than English. Recent studies are summarized to offer insights and outline opportunities in this area.Main Body:We envision three groups of intended readers: (1) NLP researchers leveraging experience gained in otherlanguages, (2) NLP researchers faced with establishing clinical text processing in a language other than English, and(3) clinical informatics researchers and practitioners looking for resources in their languages in order to apply NLPtechniques and tools to clinical practice and/or investigation. We review work in clinical NLP in languages other thanEnglish. We classify these studies into three groups: (i) studies describing the development of new NLP systems orcomponents de novo, (ii) studies describing the adaptation of NLP architectures developed for English to anotherlanguage, and (iii) studies focusing on a particular clinical application.Conclusion:We show the advantages and drawbacks of each method, and highlight the appropriate applicationcontext. Finally, we identify major challenges and opportunities that will affect the impact of NLP on clinical practiceand public health studies in a context that encompasses English as well as other languages.

For psychiatric disorders such as schizophrenia, longer durations of untreated psychosis are associated with worse intervention outcomes. Data included in electronic health records (EHRs) can be useful for retrospective clinical studies, but much of this is stored as unstructured text which cannot be directly used in computation. Natural Language Processing (NLP) methods can be used to extract this data, in order to identify symptoms and treatments from mental health records, and temporally anchor the first emergence of these. We are developing an EHR corpus annotated with time expressions, clinical entities and their relations, to be used for NLP development. In this study, we focus on the first step, identifying time expressions in EHRs for patients with schizophrenia. We developed a gold standard corpus, compared this corpus to other related corpora in terms of content and time expression prevalence, and adapted two NLP systems for extracting time expressions. To the best of our knowledge, this is the first resource annotated for temporal entities in the mental health domain.

Research into suicide prevention has been hampered by methodological limitations such as low sample size and recall bias. Recently, Natural Language Processing (NLP) strategies have been used with Electronic Health Records to increase information extraction from free text notes as well as structured fields concerning suicidality and this allows access to much larger cohorts than previously possible. This paper presents two novel NLP approaches – a rule-based approach to classify the presence of suicide ideation and a hybrid machine learning and rule-based approach to identify suicide attempts in a psychiatric clinical database. Good performance of the two classifiers in the evaluation study suggest they can be used to accurately detect mentions of suicide ideation and attempt within free-text documents in this psychiatric database. The novelty of the two approaches lies in the malleability of each classifier if a need to refine performance, or meet alternate classification requirements arises. The algorithms can also be adapted to fit infrastructures of other clinical datasets given sufficient clinical recording practice knowledge, without dependency on medical codes or additional data extraction of known risk factors to predict suicidal behaviour.

This study investigates the linguistic characteristics of Swedish clinical text in radiology reports and doctor's daily notes from electronic health records (EHRs) in comparison to general Swedish and biomedical journal text. We quantify linguistic features through a comparative register analysis to determine how the free text of EHRs differ from general and biomedical Swedish text in terms of lexical complexity, word and sentence composition, and common sentence structures. The linguistic features are extracted using state-of-the-art computational tools: a tokenizer, a part-of-speech tagger, and scripts for statistical analysis. Results show that technical terms and abbreviations are more frequent in clinical text, and lexical variance is low. Moreover, clinical text frequently omit subjects, verbs, and function words resulting in shorter sentences. Clinical text not only differs from general Swedish, but also internally, across its sub-domains, e.g. sentences lacking verbs are significantly more frequent in radiology reports. These results provide a foundation for future development of automatic methods for EHR simplification or clarification.

Background The ShARe/CLEF eHealth challenge lab aims to stimulate development of natural language processing and information retrieval technologies to aid patients in understanding their clinical reports. In clinical text, acronyms and abbreviations, also referenced as short forms, can be difficult for patients to understand. For one of three shared tasks in 2013 (Task 2), we generated a reference standard of clinical short forms normalized to the Unified Medical Language System. This reference standard can be used to improve patient understanding by linking to web sources with lay descriptions of annotated short forms or by substituting short forms with a more simplified, lay term. Methods In this study, we evaluate 1) accuracy of participating systems’ normalizing short forms compared to a majority sense baseline approach, 2) performance of participants’ systems for short forms with variable majority sense distributions, and 3) report the accuracy of participating systems’ normalizing shared normalized concepts between the test set and the Consumer Health Vocabulary, a vocabulary of lay medical terms. Results The best systems submitted by the five participating teams performed with accuracies ranging from 43 to 72 %. A majority sense baseline approach achieved the second best performance. The performance of participating systems for normalizing short forms with two or more senses with low ambiguity (majority sense greater than 80 %) ranged from 52 to 78 % accuracy, with two or more senses with moderate ambiguity (majority sense between 50 and 80 %) ranged from 23 to 57 % accuracy, and with two or more senses with high ambiguity (majority sense less than 50 %) ranged from 2 to 45 % accuracy. With respect to the ShARe test set, 69 % of short form annotations contained common concept unique identifiers with the Consumer Health Vocabulary. For these 2594 possible annotations, the performance of participating systems ranged from 50 to 75 % accuracy. Conclusion Short form normalization continues to be a challenging problem. Short form normalization systems perform with moderate to reasonable accuracies. The Consumer Health Vocabulary could enrich its knowledge base with missed concept unique identifiers from the ShARe test set to further support patient understanding of unfamiliar medical terms.

Mental Health Records (MHRs) contain free- text documentation about patients’ suicide and suicidality. In this paper, we address the prob- lem of determining whether grammatic vari- ants (inflections) of the word “suicide” are af- firmed or negated. To achieve this, we pop- ulate and annotate a dataset with over 6,000 sentences originating from a large repository of MHRs. The resulting dataset has high Inter- Annotator Agreement ( κ 0.93). Furthermore, we develop and propose a negation detection method that leverages syntactic features of text 1 . Using parse trees, we build a set of ba- sic rules that rely on minimum domain knowl- edge and render the problem as binary clas- sification (affirmed vs. negated). Since the overall goal is to identify patients who are ex- pected to be at high risk of suicide, we focus on the evaluation of positive (affirmed) cases as determined by our classifier. Our negation detection approach yields a recall (sensitivity) value of 94.6% for the positive cases and an overall accuracy value of 91.9%. We believe that our approach can be integrated with other clinical Natural Language Processing tools in order to further advance information extrac- tion capabilities

Summary Objectives: We present a review of recent advances in clinical Natural Language Processing (NLP), with a focus on semantic analysis and key subtasks that support such analysis. Methods: We conducted a literature review of clinical NLP research from 2008 to 2014, emphasizing recent publications (2012-2014), based on PubMed and ACL proceedings as well as relevant referenced publications from the included papers. Results: Significant articles published within this time-span were included and are discussed from the perspective of semantic analysis. Three key clinical NLP subtasks that enable such analysis were identified: 1) developing more efficient methods for corpus creation (annotation and de-identification), 2) generating building blocks for extracting meaning (morphological, syntactic, and semantic subtasks), and 3) leveraging NLP for clinical utility (NLP applications and infrastructure for clinical use cases). Finally, we provide a reflection upon most recent developments and potential areas of future NLP development and applications. Conclusions: There has been an increase of advances within key NLP subtasks that support semantic analysis. Performance of NLP semantic analysis is, in many cases, close to that of agreement between humans. The creation and release of corpora annotated with complex semantic information models has greatly supported the development of new tools and approaches. Research on non-English languages is continuously growing. NLP methods have sometimes been successfully employed in real-world clinical tasks. However, there is still a gap between the development of advanced resources and their utilization in clinical settings. A plethora of new clinical use cases are emerging due to established health care initiatives and additional patient-generated sources through the extensive use of social media and other devices.

The 2015 Clinical TempEval Challenge addressed the problem of temporal reasoning in the clinical domain by providing an annotated corpus of pathology and clinical notes related to colon cancer patients. The challenge consisted of six subtasks: TIMEX3 and event span detection, TIMEX3 and event attribute classification, document relation time and narrative container relation classification. Our BluLab team participated in all six subtasks. For the TIMEX3 and event subtasks, we developed a ClearTK support vector machine pipeline using mainly simple lexical features along with information from rule-based systems. For the relation subtasks, we employed a conditional random fields classification approach, with input from a rule-based system for the narrative container relation subtask. Our team ranked first for all TIMEX3 and event subtasks, as well as for the document relation subtask.

This paper reports on the 2nd ShARe/CLEFeHealth evaluation lab which continues our evaluation resource building activities for the medical domain. In this lab we focus on patients’ information needs as opposed to the more common campaign focus of the specialised information needs of physicians and other healthcare workers. The usage scenario of the lab is to ease patients and next-of-kins’ ease in understanding eHealth information, in particular clinical reports. The 1st ShARe/CLEFeHealth evaluation lab was held in 2013. This lab consisted of three tasks. Task 1 focused on named entity recognition and normalization of disorders; Task 2 on normalization of acronyms/abbreviations; and Task 3 on information retrieval to address questions patients may have when reading clinical reports. This year’s lab introduces a new challenge in Task 1 on visual-interactive search and exploration of eHealth data. Its aim is to help patients (or their next-of-kin) in readability issues related to their hospital discharge documents and related information search on the Internet. Task 2 then continues the information extraction work of the 2013 lab, specifically focusing on disorder attribute identification and normalization from clinical text. Finally, this year’s Task 3 further extends the 2013 information retrieval task, by cleaning the 2013 document collection and introducing a new query generation method and multilingual queries. De-identified clinical reports used by the three tasks were from US intensive care and originated from the MIMIC II database. Other text documents for Tasks 1 and 3 were from the Internet and originated from the Khresmoi project. Task 2 annotations originated from the ShARe annotations. For Tasks 1 and 3, new annotations, queries, and relevance assessments were created. 50, 79, and 91 people registered their interest in Tasks 1, 2, and 3, respectively. 24 unique teams participated with 1, 10, and 14 teams in Tasks 1, 2 and 3, respectively. The teams were from Africa, Asia, Canada, Europe, and North America. The Task 1 submission, reviewed by 5 expert peers, related to the task evaluation category of Effective use of interaction and targeted the needs of both expert and novice users. The best system had an Accuracy of 0.868 in Task 2a, an F1-score of 0.576 in Task 2b, and Precision at 10 (P@10) of 0.756 in Task 3. The results demonstrate the substantial community interest and capabilities of these systems in making clinical reports easier to understand for patients. The organisers have made data and tools available for future research and development.

Abbreviations pose a challenge for information extraction systems. In clinical text, abbreviations are abundant, as this type of documentation is written under time-pressure. We report work on characterizing abbreviations in Swedish clinical text and the development of SCAN: a Swedish Clinical Abbreviation Normalizer, which is built for the purpose of improving information access systems in the clinical domain. The clinical domain includes several subdomains with differing vocabularies depending on the nature of the specialist work, and adaption of NLP-tools may consequently be necessary. We extend and adapt SCAN, and evaluate on two different clinical subdomains: emergency department (ED) and radiology (X-ray). Overall final results are 85% (ED) and 83% (X-ray) F1-measure on the task of abbreviation identification. We also evaluate coverage of abbreviation expansion candidates in existing lexical resources, and create two new, freely available, lexicons with abbreviations and their possible expansions for the two clinical subdomains.

This paper describes part of an ongoing effort to improve the readability of Swedish electronic health records (EHRs). An EHR contains systematic documentation of a single patient’s medical history across time, entered by healthcare professionals with the purpose of enabling safe and informed care. Linguistically, medical records exemplify a highly specialised domain, which can be superficially characterised as having telegraphic sentences involving displaced or missing words, abundant abbreviations, spelling variations including misspellings, and terminology. We report results on lexical simplification of Swedish EHRs, by which we mean detecting the unknown, out-ofdictionary words and trying to resolve them either as compounded known words, abbreviations or misspellings.

One of the most important features of health care is to be able to follow a patient’s progress over time and identify events in a temporal order. We describe initial steps in creating resources for automatic temporal reasoning of Swedish medical text. As a first step, we focus on the identification of temporal expressions by exploiting existing resources and systems available for English. We adapt the HeidelTime system and manually evaluate its performance on a small subset of Swedish intensive care unit documents. On this subset, the adapted version of HeidelTime achieves a precision of 92% and a recall of 66%. We also extract the most frequent temporal expressions from a separate, larger subset, and note that most expressions concern parts of days or specific times. We intend to further develop resources for temporal reasoning of Swedish medical text by creating a gold standard corpus also annotated with events and temporal links, in addition to temporal expressions and their normalised values.

An important task in information access methods is distinguishing factual information from speculative or negated information. Fine-grained certainty levels of diagnostic statements in Swedish clinical text are annotated in a corpus from a medical university hospital. The annotation model has two polarities (positive and negative) and three certainty levels. However, there are many e-health scenarios where such fine-grained certainty levels are not practical for information extraction. Instead, more coarse-grained groups are needed. We present three scenarios: adverse event surveillance, decision support alerts and automatic summaries and collapse the fine-grained certainty level classifications into coarser-grained groups. We build automatic classifiers for each scenario and analyze the results quantitatively. Annotation discrepancies are analyzed qualitatively through manual corpus analysis. Our main findings are that it is feasible to use a corpus of fine-grained certainty level annotations to build classifiers for coarser-grained real-world scenarios: 0.89, 0.91 and 0.8 F-score (overall average).

The papers presented in this supplement focus and reflect on computer use in every-day clinical work in hospitals and clinics such as electronic health record systems, pre-processing for computer aided summaries, clinical coding, computer decision systems, as well as related ethical concerns and security. Much of this work concerns itself by necessity with incorporation and development of language processing tools and methods, and as such this supplement aims at providing an arena for reporting on development in a diversity of languages. In the supplement we can read about some of the challenges identified above.

Our system for the CoNLL 2008 shared task uses a set of individual parsers, a set of stand-alone semantic role labellers, and a joint system for parsing and semantic role labelling, all blended together. The system achieved a macro averaged labelled F1- score of 79.79 (WSJ 80.92, Brown 70.49) for the overall task. The labelled attachment score for syntactic dependencies was 86.63 (WSJ 87.36, Brown 80.77) and the labelled F1-score for semantic dependencies was 72.94 (WSJ 74.47, Brown 60.18). Publisher: Coling 2008 Organizing Committee. Pages: 248 - 252.

Halla Norden is a web site with information regarding mobility between the Nordic countries in five different languages; Swedish, Danish, Norwegian, Icelandic and Finnish. We wanted to create a Nordic cross-language dictionary for the use in a cross-language search engine for Halla Norden. The entire set of texts on the web site was treated as one multilingual parallel corpus. From this we extracted parallel corpora for each language pair. The corpora were very sparse, containing on average less than 80 000 words per language pair. We have used the Uplug word alignment system (Tiedemann 2003a), for the creation of the dictionaries. The results gave on average 213 new dictionary words (frequency > 3) per language pair. The average error rate was 16 percent. Different combinations with Finnish had a higher error rate, 33 percent, whereas the error rate for the remaining language pairs only yielded on average 9 percent errors. The high error rate for Finnish is possibly due to the fact that the Finnish language belongs to a different language family. Although the corpora were very sparse the word alignment results for the combinations of Swedish, Danish, Norwegian and Icelandic were surprisingly good compared to other experiments with larger corpora.

Mental health problems represent a major public health challenge. Automated analysis of text related to mental health is aimed to help medical decision-making, public health policies and to improve health care. Such analysis may involve text classification. Traditionally, automated classification has been performed mainly using machine learning methods involving costly feature engineering. Recently, the performance of those methods has been dramatically improved by neural methods. However, mainly Convolutional neural networks (CNNs) have been explored. In this paper, we apply a hierarchical Recurrent neural network (RNN) architecture with an attention mechanism on social media data related to mental health. We show that this architecture improves overall classification results as compared to previously reported results on the same data. Benefitting from the attention mechanism, it can also efficiently select text elements crucial for classification decisions, which can also be used for in-depth analysis.