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Objective: Twitter posts are now recognized as an important source of patient-generated data, providing unique insights into population health. A fundamental step toward incorporating Twitter data in pharmacoepidemiologic research is to automatically recognize medication mentions in tweets. Given that lexical searches for medication names suffer from low recall due to misspellings or ambiguity with common words, we propose a more advanced method to recognize them. Materials and methods: We present Kusuri, an Ensemble Learning classifier able to identify tweets mentioning drug products and dietary supplements. Kusuri (, "medication" in Japanese) is composed of 2 modules: first, 4 different classifiers (lexicon based, spelling variant based, pattern based, and a weakly trained neural network) are applied in parallel to discover tweets potentially containing medication names; second, an ensemble of deep neural networks encoding morphological, semantic, and long-range dependencies of important words in the tweets makes the final decision. Results: On a class-balanced (50-50) corpus of 15 005 tweets, Kusuri demonstrated performances close to human annotators with an F1 score of 93.7%, the best score achieved thus far on this corpus. On a corpus made of all tweets posted by 112 Twitter users (98 959 tweets, with only 0.26% mentioning medications), Kusuri obtained an F1 score of 78.8%. To the best of our knowledge, Kusuri is the first system to achieve this score on such an extremely imbalanced dataset. Conclusions: The system identifies tweets mentioning drug names with performance high enough to ensure its usefulness, and is ready to be integrated in pharmacovigilance, toxicovigilance, or more generally, public health pipelines that depend on medication name mentions.
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Research and Applications
Deep neural networks ensemble for detecting medication
mentions in tweets
Davy Weissenbacher,
1
Abeed Sarker ,
1
Ari Klein ,
1
Karen O’Connor,
1
Arjun Magge,
2
and Graciela Gonzalez-Hernandez
1
1
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania, USA, and
2
Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State
University, Tempe, Arizona, USA
Corresponding Author: Davy Weissenbacher, PhD, Department of Biostatistics, Epidemiology and Informatics, Perelman
School of Medicine, University of Pennsylvania, 480-492-0477, 404 Blockley Hall, 423 Guardian Drive, Philadelphia, PA
19104-6021, USA; dweissen@pennmedicine.upenn.edu
Received 28 March 2019; Revised 26 July 2019; Editorial Decision 8 August 2019; Accepted 13 August 2019
ABSTRACT
Objective: Twitter posts are now recognized as an important source of patient-generated data, providing unique
insights into population health. A fundamental step toward incorporating Twitter data in pharmacoepidemio-
logic research is to automatically recognize medication mentions in tweets. Given that lexical searches for med-
ication names suffer from low recall due to misspellings or ambiguity with common words, we propose a more
advanced method to recognize them.
Materials and Methods: We present Kusuri, an Ensemble Learning classifier able to identify tweets mentioning drug
products and dietary supplements. Kusuri (, “medication” in Japanese) is composed of 2 modules: first, 4 different
classifiers (lexicon based, spelling variant based, pattern based, and a weakly trained neural network) are applied in par-
allel to discover tweets potentially containing medication names; second, an ensemble of deep neural networks encod-
ing morphological, semantic, and long-range dependencies of important words in the tweets makes the final decision.
Results: On a class-balanced (50-50) corpus of 15 005 tweets, Kusuri demonstrated performances close to hu-
man annotators with an F
1
score of 93.7%, the best score achieved thus far on this corpus. On a corpus made of
all tweets posted by 112 Twitter users (98 959 tweets, with only 0.26% mentioning medications), Kusuri
obtained an F
1
score of 78.8%. To the best of our knowledge, Kusuri is the first system to achieve this score on
such an extremely imbalanced dataset.
Conclusions: The system identifies tweets mentioning drug names with performance high enough to ensure its
usefulness, and is ready to be integrated in pharmacovigilance, toxicovigilance, or more generally, public health
pipelines that depend on medication name mentions.
Key words: social media, pharmacovigilance, drug name detection, ensemble learning, text classification
INTRODUCTION
Twitter has been utilized as an important source of patient-
generated data that can provide unique insights into popula-
tionhealth.
1
Many of these studies involve retrieving tweets that
mention drugs, for tasks such as syndromic surveillance,
2,3
pharmacovigilance,
4
and monitoring drug abuse.
5
A common ap-
proach is to search for tweets containing lexical matches of drug
names occurring in a manually compiled dictionary. However, this
approach has several limitations. Many tweets contain drugs that
are misspelled or not referred to by name (eg, “it” or “antibiotic”).
Even when a match is found, oftentimes the referent is not actually a
V
CThe Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/),
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Journal of the American Medical Informatics Association, 26(12), 2019, 1618–1626
doi: 10.1093/jamia/ocz156
Advance Access Publication Date: 27 September 2019
Research and Applications
drug; for example, tweets that mention Lyrica are predominantly
about the singer, Lyrica Anderson, and not about the antiepileptic
drug. In this study, when using the lexical match approach on a
corpus where names of drugs are naturally rare, we retrieved only
71% of the tweets that we manually identified as mentioning a drug,
and more than 45% of the tweets retrieved were noise. Enhancing the
utility of social media for public health research requires methods that
are capable of improving the detection of posts that mention drugs.
The task of automatically detecting mentions of concepts in text
is generally referred to as named entity recognition (NER).
6
State-
of-the-art NER systems are based on machine learning (ML) and
achieve performances close to humans when they are trained and
evaluated on formal texts. However, they tend to perform relatively
poor when they are trained and evaluated on social media.
7,8
Tweets
are short messages, so they do not provide large contexts that NER
systems can use to disambiguate concepts. Furthermore, the collo-
quial style of tweets—misspellings, elongations, abbreviations, neo-
logisms, and nonstandard grammatical structures, cases, and
punctuations—poses challenges for computing features in ML-based
NER systems.
9
Although large sets of annotated corpora are avail-
able for training NER systems to detect general concepts on Twitter
(eg, people, organizations), there is a need for the collection and an-
notation of additional data for automatic detection of more special-
ized concepts (eg, drugs and diseases).
10
Over the last decade, researchers have competed to
improveNER on tweets. Most challenges were organized for tweets
written in not only English (eg, the Named Entity Recognition and
Linking challenges series
11
or the Workshop on Noisy User-
generated Text series)
12
, but also other languages (eg, Conference
surl’Apprentissage Automatique2017
13
). Specifically for drug detec-
tion in Twitter, we organized the Third Social Media Mining for
Health Applications shared task in 2018.
14
The sizes of the corpora
annotated during these challenges vary, from 4000 tweets
15
to
10 000 tweets.
13
ML methods have evolved over recent years, with
a noticeable shift from support vector machine (SVM)– or condi-
tional random field–based frameworks trained on carefully engi-
neered features,
16
to deep neural networks that automatically
discover relevant features from word embeddings. In the 2016
Workshop on Noisy User-generated Text, a large disparity between
the performances obtained by the NERs on different types of entities
was observed. The winners,
17
with an overall F
1
score of 52.4%,
reported an F
1
score of 72.61% on Geo-Locations, the most fre-
quent NEs in their corpus, but much lower scores on rare NEs, such
as an F
1
score of 5.88% on TV Shows. Kusuri ( , “medication” in
Japanese; https://en.wiktionary.org/wiki/%E8%96%AC)detects
names of drugs with sufficient performance even on a natural corpus
in which drugs are very rarely mentioned.
The primary objective of this study was to automatically detect
tweets that mention drug products (prescription and over-the-
counter) and dietary supplements. The Federal Drug Administration
(FDA Glossary of Terms: https://www.fda.gov/drugs/informatio-
nondrugs/ucm079436.htm; Drug; Drug product) defines a drug
product as the final form of a drug, containing the drug substance gen-
erally in association with other active or inactive ingredients.This
study includes drug products that are referred to by their trademark
names (eg, NyQuil), generic names (eg, acetaminophen), and class
name (eg, antibiotic or seizure medication). We formulate this prob-
lem as a binary classification task. Formally, given a set of tweets T,
our goal is to learn a function f such that f(t)¼1 for all tweets t in T
containing at least 1 phrase referring to a drug product/dietary supple-
ment, f(t)¼0 otherwise. A tweet is a positive example if it contains
text referring to a drug (and not only “matching” a drug name), a neg-
ative example otherwise. For example, the tweet “I didn’t know
Lyrica had a twin” is a negative example because Lyrica refers to the
singer, Lyrica Anderson, whereas the tweet “Lyrica experiences? I
was on Gabapentin.” is a positive example because, in this context, it
mentions 2 antiepileptics. The use of sequence labeling to delimit drug
name boundaries in the positive examples (named entity recognition)
and their mapping to a standardized name (named entity identifica-
tion) are outside the scope of this work.
The main contributions of this study are (1) a gold standard cor-
pus of 15 005 annotated tweets, for training ML-based classifiers to
automatically detect drug products mentioned on Twitter; (2) a
binaryclassifier based on Ensemble Learning, which we call Kusuri;
and (3) an evaluation of Kusuri on 98 959 tweets with the natural
balance of 0.2% positive to 99.8% negative for the presence of med-
ication names. We describe the corpora in the Materials and Meth-
ods as well as the details of ourclassifier followed byits evaluation
in the Results.
Automatic drug name recognition has mostly been studied for
extracting drug names from biomedical articles and medical docu-
ments, with several articles published
18
and challenges organized in
the last decade.
1921
Most works that have tackled the task of
detecting drug names in Twitter have focused on building corpora.
Sarker et al
22
created a large corpus of 260 000 tweets mentioning
drugs. However, they restricted their search by strict matching to a
preselected list of 250 drugs plus their lexical variants, and they did
not annotate the generated corpus. In a similar study, Carbonell
et al
10
explored the distributions of drug and disease names in Twit-
ter as preliminary work for drug-drug interaction. While the authors
searched for a larger set of drugs (all unambiguous drugs listed in
DrugBank database), they did not annotate the corpus of 1.4 million
tweets generated, and nor did they count false positives—ambiguous
mentions—in their statistical analysis.
The first evaluation of automatic drug name recognition in Twit-
ter that we are aware of was performed by Jimeno-Yepes et al,
23
on
a corpus of 1300 tweets. Two off-the-shelf classifiers, MetaMap and
the Stanford NER tagger, as well as an in-house classifier based on a
conditional random fields with hand-crafted features, were evalu-
ated. The latter obtained the best F
1
score of 65.8%. Aside from the
aforementioned problem of selecting the tweets using a lexical
match, other limitations to their study lie in additional choices
made. To remove nonmedical tweets, they retained only tweets con-
taining at least 2 medical concepts (eg, drug and disease). This ensured
a good precision, but also artificially biased their corpus in 2 ways: by
retaining only the tweets that mentioned the drugs in their dictionary
and eliminating tweets that mention a drug alone (eg, “me and
ZzzQuil are best friends”). In November 2018, we organized the
Third Social Media Mining for Health Applications shared task
(SMM4H),
14
with Task 1 of our challenge dedicated to the problem
of the automatic recognition of drug names in Twitter. Eleven teams
tested multiple approaches on the provided balanced corpus, which
we selected using 4 classifiers (the first module of Kusuri). A wide
range of deep learning–based classifiers were used by participants, as
well as some feature-based classifiers and a few attempts with ensem-
ble learning systems. The system THU_NGN by Wu et al,
24
an en-
semble of hierarchical neural networks with multihead self-attention
and integrating features modeling sentiments, was the top performer,
with an F
1
score of 91.8%. This established a recent benchmark for
the community for an artificially balanced corpus (with approxi-
mately the same number of positive and negative examples). Our eval-
uation data, described in the UPennHLP Twitter Pregnancy Corpus
Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12 1619
subsection, includes both the artificially balanced corpus and, in addi-
tion, a corpus of all available tweets posted by selected Twitter users
where the mentions of drug products were manually annotated. We
refer to the later as a corpus with “natural” balance.
MATERIALS AND METHODS
We collected all publicly available tweets posted by 112 500 Twitter
users (their timelines). To do so, we first used the Twitter streaming
application programming interface to detect tweets mentioning key-
words used when announcing a pregnancy. These keywords were
manually defined. Then, we used a simple SVM classifier to confirm
that the tweets were really announcing a pregnancy and discarded
other tweets. The keywords and the SVM classifier are described in
our previous work.
25
Once a tweet announcing a pregnancy was iden-
tified, we collected the timeline of the author of the tweet. We used
the REST application programming interface provided by Twitter to
download all tweets posted by this user within the Twitter-imposed
limit of 3200 most recent tweets, and continued collection afterward.
We did not remove bots or accounts managed by businesses and other
entities, as they may also tweet about drugs. We intermittently col-
lected posts from January 2014 to April 2017. After April 2017, we
systematically collected posts until September 2017. Through this pro-
cess, we collected a total of 421.5 million tweets. Using this dataset as
a source allows us to avoid the bias of a drug-name keyword based
collection. When a dataset is collected using a list of drug names, the
resulting dataset will obviously contain only tweets mentioning the
drugs occurring in the list: the you-find-what-you-are-looking-for bias
(ie, confirmation) bias. This is evident when reported recall climbs to
98% or more. Our method, collecting all tweets posted by the users in
our cohort, captured drugs mentioned by the users in the way that
they naturally occur. Our dataset represents natural variants of drug
names occurring in our collection, as expressed by Twitter users, and
that would have been missed if not present in the list upfront.
All tweets were collected from public Twitter accounts, and a
certificate of exemption was obtained from the Institutional Review
Board of the University of Pennsylvania. All tweets used and re-
leased to the community were used and released without violating
Twitter’s terms and conditions.
UPennHLP Twitter Drug Corpus
Building a corpus of tweets containing drug names to train and evaluate
a drug name classifier is a challenging task. Tweets mentioning drug
names are extremely rare. We found that they only represent 0.26% of
the tweets in the UPennHLP Twitter Pregnancy Corpus (see the follow-
ing section), and are often ambiguous with common and proper nouns.
Ifanaivelexiconmatchingmethodisusedtocreatethecorpus,itoften
matches a large number of tweets not containing any drug names.
Therefore, to build a gold-standard corpus, we had to rely on a
more sophisticated method than simply lexicon matching. We cre-
ated 4 simple classifiers to detect tweets mentioning drug names:
one based on a lexicon matching, one on lexical variants matching,
one on regular expressions, and a classifier trained with weak super-
vision. The 4 classifiers are described briefly below, and in detail in
Supplementary Appendix A.
Lexicon-based drug classifier
The first classifier is built on top of a lexicon of drug names
generated from the RxNorm Database (https://www.nlm.nih.gov/
research/umls/rxnorm/overview.html, Accessed June 11, 2018). If a
tweet contains a word or phrase occurring in the lexicon, the tweet
is classified as a positive example without any further analysis. We
chose RxNorm because it has a large coverage. It combines, in a
unique database, 15 existing dictionaries, including DrugBank, a
database often used in previous works on drug names detection.
Variant-based drug classifier
Names of drugs may have a complex morphology and, as a conse-
quence, are often misspelled on Twitter. Lexicon-based approaches
detect drugs mentioned in tweets only if the drug names are cor-
rectly spelled. The incapability to detect misspelled drug names
results in low recall for the lexicon-based classifier. In an attempt to
increase recall, we used a data-centric misspelling generation algo-
rithm
26
to generate variants of drug names and used the variants to
detect tweets mentioning misspelled drugs.
Weakly trained drug long short-term memory classifier
Our third classifier is a long short-term memory (LSTM) neural net-
work that integrates an attention mechanism
27
and is trained on
noisy training examples obtained through weak supervision. One
annotator identified drug names tending to be unambiguous
28
in
our timelines (eg, Benadryl or Xanax). We selected the 126 500
tweets containing these unambiguous names in our timelines as posi-
tive examples. Then, given that drug names occur very rarely in
tweets, we randomly selected an additional 126 500 tweets from
our timelines as negative examples and trained our LSTM on these
examples. We chose this simple classifier to discover a large number
of tweets that could potentially contain drug names, and integrated
an attention mechanism to ensure that the neural network focuses
on the words occurring recurrently in the context of drug mentions
in tweets and discards irrelevant words.
Pattern-based drug classifier
Our last classifier implements a common method to detect general
named entities, regular expressions (REs). REs describe precisely the
linguistic contexts used in Twitter to speak about drugs. We manu-
ally crafted our REs by inspecting 9530 n-grams, which were the
most frequent n-grams occurring before and after the most frequent
unambiguous names of drugs in our 126 500 tweets. We retained
81 patterns (eg, “prescibed me”, “prescription filled for”, “doctor
switched”). When inspecting these n-grams, one annotator used his
knowledge of the language to reject noisy patterns. Before including
a pattern in the list, the annotator confirmed empirically by querying
the pattern in a search engine indexing our dataset that the pattern
actually retrieved tweets mentioning drugs in the first 100 tweets re-
trieved for the query. Davy Weissenbacher created the REs.
To obtain positive examples, we selected tweets retrieved by at
least 2 classifiers, as they were most likely to mention drug names.
To obtain negative examples, we selected tweets detected by only 1
classifier, given that if these tweets did not contain a drug name,
they were nonobvious negative examples. Following this process,
from our 421.5 million tweets, we created a corpus of 15 005
tweets, henceforth referred to as the UPennHLP Twitter Drug Cor-
pus (Table 1). We removed from the corpus duplicated tweets,
tweets not written in English, and tweets that were no longer on
Twitter (eg, tweets deleted by the users) at the time of the collection.
Two annotators annotated the corpus in its entirety, with a high
interannotator agreement (IAA) measured as Cohen’s kappa of
.892. Our corpus was annotated by our 2 staff annotators, who
have over 7 years combined experience annotating texts in the
1620 Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12
biomedical domain. One annotator holds a degree in biology and
our senior annotator has a master of science degree in biomedical
informatics. We randomly selected 9623 tweets for the training set
(4975 positive and 4648 negative examples) and 5382 tweets for the
testing set (2852 positive and 2530 negative examples). We publicly
released the corpus and our guidelines to the research community
for Task 1 of the SMM4H 2018 shared task.
14
UPennHLP Twitter Pregnancy Corpus
A balanced corpus, such as the UPennHLP Twitter Drug Corpus, is a
useful resource to study how people speak about drugs on social me-
dia. However, due to the mechanism of its construction, a balanced
corpus does not represent the natural distribution of tweets mention-
ing drugs on Twitter. Consequently, any evaluation made on a bal-
anced corpus will never be indicative of the performance expected
from a drug name classifier used in practice. To further assess whether
Kusuri could reliably be used in practice, we ran additional experi-
ments on the corpus used for an epidemiologic study of birth defect
outcomes.
29
For that, we collected 397 timelines of women that had
announced their pregnancy on Twitter and that had tweeted during
their pregnancy, and manually identified all tweets mentioning a drug
during the period of pregnancy. It took an average of 2.5 hours to an-
notate each timeline. We ran our experiments on a subset of 112 time-
lines (98 959 tweets) from this corpus, referred to as UPennHLP
Twitter Pregnancy Corpus in the remainder of the article (Table 1).
The annotators manually verified that these timelines were owned by
individuals by looking at their profiles and their posts and making a
judgment call, and removed all timelines administered by bots or asso-
ciation/companies. Our senior annotator and the main author of this
article annotated these timelines. An IAA of 0.88 (Cohen’s kappa)
was computed over 12 timelines, which were dual annotated by the
senior annotator. We randomly selected 70% (69 272 tweets) of the
Pregnancy Corpus for training and the remaining 30% (29 687
tweets) for testing. When splitting the corpus into a training set and a
testing set, we kept the same percentage ratio, 70%/30%, of positive/
negative examples in the training and in the testing sets (ie, 181/69
091 and 77/29 610 respectively).
Kusuri architecture
Kusuri, described in Figure 1, applies sequentially 2 modules to de-
tect tweets mentioning drugs in the UPennHLP Twitter Pregnancy
Corpus. This section describes each module. The success of deep
learning classifiers in natural language processing lies on their ability
to automatically discover relevant linguistic features from word
embeddings
30
—an ability even more valuable when working on
short and colloquial texts such as tweets. For this reason, we pre-
ferred to integrate in our modules deep learning classifiers over
more traditional classifiers based on feature engineering.
Module 1: tweet prefilter
Kusuri applies our 4 classifiers—the lexicon-based, variant-based,
pattern-based, and weakly trained LSTM classifiers—in parallel to
discover tweets that potentially contain drug names. Among the
tweets discovered, Kusuri selects the tweets classified by the lexicon
classifier, by the variant-based classifier, and the tweets selected by
both the pattern-based and the weakly trained classifiers. The tweets
discovered by only 1 of the 2 last classifiers were too noisy and dis-
carded. The tweets selected are then submitted to the Module 2, an
ensemble of deep neural networks (DNN) that makes the final deci-
sion for the labels. The 4 classifiers act as filters, collecting only
good candidates for the ensemble of DNNs, which was, in turn, op-
timized to recognize positive examples among them.
Module 2: ensemble of DNNs
As a single element for the ensemble of neural networks composing
the second module of Kusuri, we designed a DNN following a stan-
dard architecture for classification of NEs. Described in Figure 2,
our DNN starts by independently encoding each sequence of charac-
ters composing the tokens of a tweet through 3 layers sequentially
connected: a recurrent layer, an attention layer, and a densely con-
nected layer. All resulting vectors, encoding the morphological prop-
erties of the tokens, are then concatenated with their respective
pretrained word embedding vectors, which encode the semantic
properties of the tokens. The concatenated vectors are passed to a
bidirectional-gated recurrent unit (GRU) layer to learn long-range
dependencies between the words, followed by an attention layer
that, as additional memory, helps the NN to focus on the most dif-
ferentiating words for the classification. A final dense layer com-
putes the probability for the tweet to contain a mention of a drug.
All neural networks in our study were given pretrained word vectors
as input. We chose the word vectors trained with the Glove algo-
rithm on 2 billion tweets, available for download on the webpage of
the project (https://nlp.stanford.edu/projects/glove/). Supplementary
Appendix B describes in detail the preprocessing steps, the embed-
dings, and the parameters of our training. We experimented with
early stopping to avoid overfitting when training our models. We
kept 70% of our training corpus to train a model, and 30% for vali-
dation. We found that 8 iterations were sufficient to train the model
before overfitting the training corpus. However, contrary to our ex-
pectation, the models trained with 8 iterations gave slightly lower
performances on the test set of the UPennHLP Drug Corpus than
models trained with 20 iterations, with F
1
scores of 92.7% and
93.1%, respectively. The reason for this is not clear, but it may be
because our model continues to improve as more examples are pro-
vided in the training corpus, making the estimation of the best num-
ber of iterations inexact with early stopping. We report the results of
our model trained with 20 iterations.
Owing to the stochastic nature of the initialization of the NN,
the learning process may discover a local optimum and return a sub-
optimal model. To reduce the effect of local optimums, we resort to
ensemble averaging. We independently learned 9 models using our
DNN and computed the final decision, for a tweet to mention a
medication name or not, by taking the mean of the probabilities
Table 1. Statistics of the UPennHLP Twitter Drug and Pregnancy
Corpora
UPennHLP Twitter
Drug Corpus
UPennHLP Twitter
Pregnancy Corpus
Training set 9623 tweets
(4975 1/4648 2)
69 272 tweets
(181 1/69 091 2)
Testing set 5382 tweets
(2852 1/2530 2)
29 687 tweets
(771/29 610 2)
Users in training/
testing set
7584/4535 112/112
Users posting in
training
set and in
testing set
1054
(these users posted
1713 tweets in
testing set, 31.8%
of testing set)
112
Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12 1621
computed by the models (because a soft voting algorithm
31
in our
experiments did not improve over the simple averaging method, we
kept the latter). When applied on the Pregnancy Corpus, all DNNs
of the ensemble were trained on the Drug Corpus, and, at test time,
all DNNs of the ensemble only have to classify the tweets in the
Pregnancy Corpus filtered by the first module of Kusuri.
RESULTS
This section details the performances of Kusuri and its ensemble of
DNNs during 2 series of experiments on the Drug Corpus and on
the Pregnancy Corpus.
Drug detection in the UPennHLP Twitter Drug Corpus
We first ran a series of experiments to measure the performances of
the ensemble of DNNs composing the second module of Kusuri.
The detailed results are reported in Table 2. We compare the perfor-
mance of our ensemble with 3 baseline classifiers.
The first baseline classifier is a combination of the lexicon- and
variant-based classifiers. It labeled as positive examples all tweets of
the test set of the Drug Corpus that contained a phrase found in our
Lexicon or in our list of variants. This baseline classifier provides a
good estimation of the performances to expect when a lexicon-based
approach is used. We chose as a second baseline system a
bidirectional-GRU classifier. Because this baseline system has a sim-
pler architecture than our final DNN, their comparison allows us to
estimate the benefits of the components we added in our system.
The baseline system was trained on the same training data with the
same hyperparameters, and took as input the same word embed-
dings, but it did not have information about the morphology of the
words or the help of the attention mechanism. As a third strong
baseline, we compare our system with the best system of the Task 1
of the SMM4H 2018 competition, the THU_NGN system.
24
The results in Table 2 are interesting in several ways. The combined
lexicon- and variant-based classifier has a high recall on the test data
(88.5%), an unsurprising result considering the central role played by
the lexicon and the variants during the construction of the Drug Cor-
pus. This classifier is vulnerable to the frequent ambiguity of drug
names, resulting in a low precision of 66.4%. The classifier has no
knowledge of the context in which the name of a drug appears, and
thus cannot disambiguate tweets mentioning Ly ri ca (antiepileptic vs
Lyrica Anderson), lozenge (type of pills vs geometric shape), or halls
(brand name vs misspelling for Hall’s), for example. The fully super-
vised bidirectional-GRU confirms its ability to learn the features only
from the word embeddings,
32
and achieves an F
1
score of 91.4%, a
higher score than the IAA computed on this corpus. However, such sys-
tems can be improved as demonstrated by the better performances of
the best DNN in the ensemble (4 in Table 2). The encoding of the token
morphology and the attention layer of the best DNN improve the F
1
score by 1.7 points. Also, despite having a simpler architecture and at-
tention mechanism, the best DNN system performs better than the en-
semble of hierarchical NNs proposed by Wu et al.
24
The reason for this
result is not clear, but it may be a suboptimal set of hyperparameters
chosen by the authors or the difficulty to train such a complex network.
The highest performance is obtained by the ensemble DNNs,
which shows an improvement of 0.6 points over the best model in
the ensemble, with a final F
1
score of 93.7%. We confirmed the dis-
agreement between the ensemble DNNs and the THU_NGN sys-
tems to be statistically significant with a McNemar test.
33
The null
hypothesis was rejected with a significance level set to .001. We ana-
lyzed randomly selected labeling errors made by the ensemble
DNNs (Table 3). We distinguished 8 nonexclusive categories of false
positives. With 41 cases, most false positives were tweets discussing
Figure 1. Architecture of Kusuri, an ensemble learning classifier for drug detection in Twitter. LSTM: long short-term memory.
1622 Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12
medical topics without mentioning a drug. As medical tweets often de-
scribe symptoms or discuss medical concepts, their lexical fields are
strongly associated with drug names (eg, cough, flu, doctor) and con-
fuse the classifier. The causes of false negatives seem to mirror those
for the false positives. With 36 cases, false negatives were mostly
caused by the ambiguity of not only common English words (eg, air-
borne), but also dietary supplements and food products sometimes
consumed for their medicinal properties (eg, clove, arnica, aloe). This
could be a positive turn of events if nutritional supplements are to be
included in a study. A second important cause was unseen, or rarely
seen, drug names in our training corpus, with 25 cases.
The ensemble DNNs correctly detected 245 tweets that were in-
correctly detected by the THU_NGN system. On the other hand, the
THU_NGN system correctly detected 138 tweets that were incor-
rectly detected by our system. We manually analyzed 100 tweets
that were randomly selected from the 245 tweets, but could not dis-
cern any evident patterns explaining the differences in performances
between the 2 systems. Further linguistic analysis, such as the analy-
sis proposed in Vanni et al,
30
may help uncover these patterns, but is
beyond the scope of this study.
Drug detection in the UPennHLP Twitter Pregnancy
Corpus
The results of the ensemble DNNs on the Drug Corpus are prom-
ising, but they were obtained based on ideal conditions. The
training corpus is balanced, and most of the drugs found in the
test set were present in the training set. These conditions are un-
likely to be satisfied when the classifier is used on naturally oc-
curring data. We ran a second series of experiments on the
Pregnancy Corpus to get a more realistic evaluation of our classi-
fiers. As for the previous experiments, we kept the lexicon- and
variant-based classifier as well as an ensemble of bidirectional-
GRU networks as baseline systems (1 and 2 in Table 4, respec-
tively). Each network of the ensemble was trained on the Preg-
nancy Corpus with 5 iterations and a batch size of 64 examples,
and a simple averaging was used to combine their results. Since
the ensemble DNNs gave the best performances on the Drug Cor-
pus (Table 2), we chose it as a third baseline system. This base-
line applies the ensemble of DNNs without prefiltering the
tweets using the first module of Kusuri. In system 3.a, we trained
all DNNs of the ensemble on the training set of the Drug Corpus,
with 20 iterations and a batch size of 2 examples. In system 3.b,
we trained all DNNs of the ensemble on the training set of the
Pregnancy Corpus, with 4 iterations and a batch size of 64 exam-
ples. These hyperparameters were the best parameters found af-
ter early stopping and a manual search through standard batch
sizes of 2, 64, and 128. The last system evaluated was the
“complete” Kusuri system, with both modules applied
sequentially.
The results are reported in Table 4. What is striking about the
figures in this table is the poor performances of the lexicon- and var-
iant-based classifier and the ensemble DNNs classifier. The score of
the former dropped from an F
1
score of 75.9% when applied on the
Drug Corpus, to 62.2% when applied on the Pregnancy Corpus. As
we used the lexicon to build the Drug Corpus, the drugs in the lexi-
con were overrepresented in this corpus, increasing the baseline’s re-
call by 17.1 points. The ensemble DNNs classifier (3.a) did worse,
with an F
1
score of only 18%. Trained on a balanced set of medi-
cally related tweets, the classifier was found too sensitive. It gives
too much weight to words that are related to medication but used in
other contexts such as overdose,bi-polar,orisnt working, resulting
in a total of 549 false positives, in which only 77 tweets mentioned a
drug in the test set. Surprisingly, the ensemble of bidirectional-GRU
Figure 2. Deep neural network predicting yˆ, the probability for a tweet to mention a drug name. GRU: gated recurrent unit.
Table 2. Precision, recall, and F1 scores for drug detection
classifiers on the test set of the UPennHLP Twitter Drug Corpus
System Precision Recall F
1
score
1. Lexicon þvariant classifier 66.4 88.5 75.9
2. Supervised bidirectional-GRU 93.5 89.5 91.4
3. THU_NGN hierarchical-NNs 93.3 90.4 91.8
4. Best DNN model in the ensemble 93.7 92.5 93.1
5. Ensemble DNNs (module 2 of Kusuri) 95.1 92.5 93.7
DNN: deep neural network; GRU: gated recurrent unit; NN: neural
network; THU_NGN.
Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12 1623
networks (system 2.a) was capable of learning our task with very
few positive examples. Despite the 5.11-point difference in F
1
score
of Kusuri over system 2.a, a McNemar test shows that we cannot
conclude this difference is significant. Additional experiments, with
more positive examples, are needed to confirm Kusuri’s superiority.
While lower than the ideal score of the ensemble DNNs classifier on
the Drug Corpus, the F
1
score of Kusuri (78.8%) is comparable to
the scores published for the best NERs when applied on the most
frequent types of NEs in Twitter.
17
More importantly, we believe
that this score is high enough to expect a positive impact of Kusuri
when integrated in larger applications.
DISCUSSION
As stated before, our experiments show Kusuri outperforming
the system 2.a (Table 4), a bidirectional GRU, but the difference
is not statistically significant. Increasing the number of positive
examples to the point at which the performance difference is sta-
tistically significant would require the collection and annotation
of a much larger corpus that exhibits the natural balance (<1%
of tweets positive for a drug mention). This could prove cost
prohibitive.
In this study, we opted for an oversampling strategy and cre-
ated an artificially balanced corpus to train our classifier, the
UPenn Twitter Drug Corpus. However, while our ensemble of
DNNs performs well on the Drug Corpus (an F
1
score of
93.7%), its performance drops considerably when we applied it
to the Pregnancy Corpus (an F
1
score of 18%). Trained on our
balanced corpus, this classifier was biased toward disambiguat-
ing examples easily recognizable by our basic filters and could
not generalize well on other examples occurring in the Preg-
nancy Corpus, making the ensemble useless for real
applications.
The solution we implemented with Kusuri is to prefilter the
tweets of the timelines before applying our ensemble of DNNs.
This solution increases performance by 5.1 points over the best
baseline system (2.a in Table 4). However, our strategy is far
from perfect, as it reduces the number of FPs with hard filters
and, consequently, also limits the overall performance of Kusuri
by removing 27% (21 tweets) of the few tweets mentioning drugs
in the Pregnancy Corpus. We are currently replacing the hard fil-
ters with active learning to further train our ensemble of DNNs
and reduce its oversensitivity to medical phrases in general
tweets.
One may argue that, given that the selection of users in our co-
hort are women reporting a pregnancy, the drugs mentioned in our
dataset are biased to a specific set of mediations, with a higher num-
ber of tweets mentioning drugs commonly used in pregnancy and a
lower number of tweets mentioning drugs not recommended during
this period. However, this limitation is alleviated to an extent due to
the fact that our dataset includes tweets beyond those that were
posted during pregnancy; we collected the full timelines available
from the users, including a large number of tweets posted before and
after pregnancy.
Finally, we designed our neural network around a standard
representation of a sentence as a sequence of word embeddings
learned on local windows of words. Better alternatives have re-
cently been proposed
34
and could be integrated in our system to
help drug name disambiguation. We could replace our word
embeddings with ELMo or BERT, which learn each word
embeddings within the whole context of a sentence,
35,36
or sup-
plement our current sentence representation with sentence
embeddings.
37
Table 3. Categories of false positive and false negative made by
the drug detection classifier on the test set of the UPennHLP
Twitter Drug Corpus
Error category Errors Examples
False positive
Medical topic 41 <user>you should see a dermatolo-
gist if you can. You may just need
something to break you out of a cy-
cle. I used a topical and took pills
Lola may has a stye, or pink eye.
Doc recommends warm com-
presses to see if it gets better today,
but my eyes are itchy just looking
at her.
Weighted words/
patterns
19 i can take a wax brazillian a g
<user>i was robbed a foul when i
took a three point shot and they
got a few three pointers in. good
game.
Ambiguous name 12 <user>I actually really like Lyrica &
A1.
Food topic 11 This aerobically fermented product
was tested & it’s antibiotic residue
free. also certified organic.
Insufficient context 7 <user>adding Arnica to my shop-
ping list
Cosmetic topic 5 Doc prescribed me this dandruff
shampoo, if it works, I’m defi-
nitely getting a sew in after I’m
done using it
Unknown 2 Ice_Cream, Ice-Cream and More Ice-
Cream...thats Ol i Want
Error annotation 3
False negative
Ambiguous name 36 Trying Oil of Oregano & garlic for
congestion for my sinus infection.
[ambiguous dietary supplement]
In the church the person close to
me’s sniffling & coughing... I need
a bathe of bactine and some Air-
borne, right now [ambiguous En-
glish word]
Drug not/rarely
seen
25 That’s the benzo effects! [missing
variant]
Pennsylvania Appellate Court
Revives 1, 000 Prempro Cases
Against Pfizer [missing in lexicon]
the percocet-thief plot makes Real
World New Orleans look almost
intriguing [preprocessing error]
Generic terms 18 Tossing and turning. I need ur sleep
aid. Waiting patiently <user>
Nonmedical topic 11 <user>Meet Mr an Mrs Lexapro...
..
guarenteed fidelity.
Short tweets 3 arnica-ointment-7
Error annotation 7
1624 Journal of the American Medical Informatics Association, 2019, Vol. 26, No. 12
CONCLUSION
In this article, we presented Kusuri, an ensemble learning classifier
to identify tweets mentioning drug names. Given the unavailability
of a labeled corpus to train our system, we created and annotated
a balanced corpus of 15 005 tweets, the UPennHLP Twitter Drug
Corpus. The ensemble of deep neural networks at the core of
Kusuri’s decisions (Module 2) demonstrated performances close to
human annotators without requiring engineered features on this
corpus,withanF
1
score of 93.7%. However, because we built this
corpus artificially, it did not represent the natural distribution of
drug mentions in Twitter. We evaluated Kusuri on a second cor-
pus, UPennHLP Twitter Pregnancy Corpus, made of all tweets
posted by 112 Twitter users, a total of 98 959 annotated tweets,
with only 258 tweets mentioning drugs. On this corpus, Kusuri
obtained an F
1
score of 78.8%, a score comparable to the score
obtained on the most frequent types of NEs by the best systems
competing in well-established challenges, despite our corpus hav-
ing only 0.26% positive instances in it. The code of Kusuri and the
models used for these experiments are publicly available at https://
bitbucket.org/pennhlp/kusuri/. The UPennHLP Twitter Drug Cor-
pus is available at https://healthlanguageprocessing.org/kusuri. We
will release the UPennHLP Twitter Pregnancy Corpus during the
Fifth Social Media Mining for Health Applications shared task in
2020.
FUNDING
This work was supported by National Library of Medicine grant number
R01LM011176 to GG-H. The content is solely the responsibility of the
authors and does not necessarily represent the official view of National
Library of Medicine.
AUTHOR CONTRIBUTIONS
DW designed the experiments, preprocessed the data and anno-
tated a part of it, implemented Kusuri andcomputedthemodels,
analyzed the prediction errors, and wrote the majority of the man-
uscript. AS integrated the variant-based drug classifier in Kusuri,
wrote its description, and proofread the manuscript. AK edited the
manuscript. KO annotated the data and computed the interanno-
tator agreement. AM helped optimize the neural networks. GG-H
supervised the overall study design and edited the final
manuscript.
SUPPLEMENTARY MATERIAL
Supplementary material is available at Journal of the American
Medical Informatics Association online.
CONFLICT OF INTEREST STATEMENT
None declared.
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... These positive results were obtained on 1 task and need to be confirmed. We intend to repeat our experiments on the adverse drug event detection and drug detection tasks described in 23,39 . We made 2 experimental choices to facilitate the validation of transfer and active learning for training a classifier on an imbalance corpus. ...
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Background Public engagement is a key element for mitigating pandemics, and a good understanding of public opinion could help to encourage the successful adoption of public health measures by the population. In past years, deep learning has been increasingly applied to the analysis of text from social networks. However, most of the developed approaches can only capture topics or sentiments alone but not both together. Objective Here, we aimed to develop a new approach, based on deep neural networks, for simultaneously capturing public topics and sentiments and applied it to tweets sent just after the announcement of the COVID-19 pandemic by the World Health Organization (WHO). Methods A total of 1,386,496 tweets were collected, preprocessed, and split with a ratio of 80:20 into training and validation sets, respectively. We combined lexicons and convolutional neural networks to improve sentiment prediction. The trained model achieved an overall accuracy of 81% and a precision of 82% and was able to capture simultaneously the weighted words associated with a predicted sentiment intensity score. These outputs were then visualized via an interactive and customizable web interface based on a word cloud representation. Using word cloud analysis, we captured the main topics for extreme positive and negative sentiment intensity scores. Results In reaction to the announcement of the pandemic by the WHO, 6 negative and 5 positive topics were discussed on Twitter. Twitter users seemed to be worried about the international situation, economic consequences, and medical situation. Conversely, they seemed to be satisfied with the commitment of medical and social workers and with the collaboration between people. Conclusions We propose a new method based on deep neural networks for simultaneously extracting public topics and sentiments from tweets. This method could be helpful for monitoring public opinion during crises such as pandemics.
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Background This work deals with Natural Language Processing applied to Electronic Health Records (EHRs). EHRs are coded following the International Classification of Diseases (ICD) leading to a multi-label classification problem. Previously proposed approaches act as black-boxes without giving further insights. Explainable Artificial Intelligence (XAI) helps to clarify what brought the model to make the predictions. Goal This work aims to obtain explainable predictions of the diseases and procedures contained in EHRs. As an application, we show visualizations of the attention stored and propose a prototype of a Decision Support System (DSS) that highlights the text that motivated the choice of each of the proposed ICD codes. Methods Convolutional Neural Networks (CNNs) with attention mechanisms were used. Attention mechanisms allow to detect which part of the input (EHRs) motivate the output (medical codes), producing explainable predictions. Results We successfully applied methods in a Spanish corpus getting challenging results. Finally, we presented the idea of extracting the chronological order of the ICDs in a given EHR by anchoring the codes to different stages of the clinical admission. Conclusions We found that explainable deep learning models applied to predict medical codes store helpful information that could be used to assist medical experts while reaching a solid performance. In particular, we show that the information stored in the attention mechanisms enables DSS and a shallow chronology of diagnoses.
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Introduction Adverse effects of medications taken during pregnancy are traditionally studied through post-marketing pregnancy registries, which have limitations. Social media data may be an alternative data source for pregnancy surveillance studies. Objective The objective of this study was to assess the feasibility of using social media data as an alternative source for pregnancy surveillance for regulatory decision making. Methods We created an automated method to identify Twitter accounts of pregnant women. We identified 196 pregnant women with a mention of a birth defect in relation to their baby and 196 without a mention of a birth defect in relation to their baby. We extracted information on pregnancy and maternal demographics, medication intake and timing, and birth defects. Results Although often incomplete, we extracted data for the majority of the pregnancies. Among women that reported birth defects, 35% reported taking one or more medications during pregnancy compared with 17% of controls. After accounting for age, race, and place of residence, a higher medication intake was observed in women who reported birth defects. The rate of birth defects in the pregnancy cohort was lower (0.44%) compared with the rate in the general population (3%). Conclusions Twitter data capture information on medication intake and birth defects; however, the information obtained cannot replace pregnancy registries at this time. Development of improved methods to automatically extract and annotate social media data may increase their value to support regulatory decision making regarding pregnancy outcomes in women using medications during their pregnancies.
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Many modern NLP systems rely on word embeddings, previously trained in an unsupervised manner on large corpora, as base features. Efforts to obtain embeddings for larger chunks of text, such as sentences, have however not been so successful. Several attempts at learning unsupervised representations of sentences have not reached satisfactory enough performance to be widely adopted. In this paper, we show how universal sentence representations trained using the supervised data of the Stanford Natural Language Inference datasets can consistently outperform unsupervised methods like SkipThought vectors on a wide range of transfer tasks. Much like how computer vision uses ImageNet to obtain features, which can then be transferred to other tasks, our work tends to indicate the suitability of natural language inference for transfer learning to other NLP tasks. Our encoder is publicly available.