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    <article-meta>
      <title-group>
        <article-title>Using Deep Neural Network to Identify Cancer Survivors Living with Post-Traumatic Stress Disorder on Social Media</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Nur Ha eza Ismail</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Ninghao Liu</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Mengnan Du</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Zhe He</string-name>
          <email>fZhe.Heg@cci.fsu.edu</email>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Xia Hu</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Texas A&amp;M University, College Station</institution>
          ,
          <addr-line>Texas</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>Survivors of cancer are at-risk for the lifelong e ects of disease and treatment. A signi cant number of them face Post-Traumatic Stress Disorder (PTSD) that may adversely a ect their mental health. Twitter is a social networking site that allows users to interact with others by posting short messages (tweets). These tweets, which to a certain extent re ect the users psychological state, are convenient for data collection. However, Twitter also contains a mix of noisy and genuine tweets. The process of manually identifying the genuine tweets is expensive and time-consuming. Thus, we stream the data using cancer as a keyword and lter the tweets with cancer-free and PTSD related keywords without having to label each tweet manually. Convolutional Neural Network (CNN) learns the representations of the input to identify cancer survivors with PTSD. The experiments on real-world datasets show that the model outperforms the baselines and correctly classi es the new tweets.</p>
      </abstract>
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    <sec id="sec-1">
      <title>-</title>
      <p>
        PTSD is an anxiety disorder that occurs in some people after experiencing or
witnessing life-threatening events, may severely a ect daily life activities. Being
diagnosed with cancer often causes psychological distress due to painful
treatments and traumatic experiences of cancer survival [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. The traditional
psychological health diagnosis procedure takes a lot of time and energy which require
several interviews, questionnaires, physical evaluation, and testimonies from the
caregiver. Twitter is a social media that has simple features that allow users to
share their daily feelings [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. These postings could provide insights on
psychological impacts of signi cant incidents on the users.
      </p>
      <p>
        Recent work in psychology aims to analyze the manner of self-declared
mentally ill users from their interactions and behavior based on written posts [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
      </p>
      <p>Most of the mental health studies focus only on capturing the psychological
problem in society. Besides, the applied analysis approaches such as manual
labeling, crowd-sourcing, Twitter Firehouse, and Linguistic Inquiry Word Count
(LIWC) are time-consuming and expensive. Thus, data preparation and analysis
procedure are challenging. To tackle these challenges, we propose an algorithm
to create a labeled dataset using cancer-free related keywords and PTSD
features. Also, without having to manually check whether a tweet was written by a
cancer survivor with PTSD or not, DNN is able to captures important features
from the input dataset. In this work, we used the DNN approach that learns to
extract a di erent level of meaningful representations of texts.</p>
      <p>
        Experts from various elds strive to propose reliable detection models for
mental health problems. Despite having the same mission, they touched the
issues from di erent angles. Human emotions can be expressed in many forms of
physiological states such as nervous system responses, blood ow, facial
expression, and vocal acoustics [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]. However, obtaining information using these ways is
usually time-consuming and labor-intensive. The alternative technique for data
collection is text postings on social media that are easy, expeditious, and
unlimited access to a broader population. A study has shown that Twitter has broad
applicability for public health research and can generate valuable knowledge of
linguistic style from tweets [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ].
      </p>
      <p>
        Treated cancer patients may nd themselves at risk of getting cancer
recurrence [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ]. During recurrence, the patients reported that treatment decisions are
more di cult to make, because the side e ects from treatment are more severe,
and the fears of uncontrollable pain are greater [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ]. This psychological impact
that can cause PTSD problem is one of the signi cant concerns in clinical
oncology [
        <xref ref-type="bibr" rid="ref7">7</xref>
        ]. Receiving immediate attention to PTSD can help to improve the
quality of life more quickly. Various analysis methods such as supervised and
unsupervised machine learning models have been adopted for the detection and
monitoring of PTSD. In this work, we developed a model using DNN approach
that able to learn from di erent levels of representation of text input.
2
      </p>
      <p>The Proposed Framework for Cancer Survivors Living
with PTSD Diagnosis on Social Media</p>
      <p>
        Feature Extraction: The top part of Figure 1 shows the overview of previous
work related to depression detection using social media data [
        <xref ref-type="bibr" rid="ref8">8</xref>
        ]. It employs the
crowd-sourcing approach to identify tweets associated with mental illness, which
are then labeled as PTSD positive dataset. Tweets that are not identi ed to
be related to mental illness are labeled as PTSD negative dataset. The process
continues by combining PTSD positive and negative datasets. The goal of this
process is to understand the di erences of linguistic style of both groups.
Knowledge Transfer: In this work, knowledge transfer can be de ned as a
process that uses depression feature extraction outputs to develop a labeled PTSD
dataset. Most PTSD su erers also have depression in diverse epidemiological
samples. This comorbidity re ects overlapping symptoms in both disorders [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ].
Thus, we opted to use depression lexicon taken from [
        <xref ref-type="bibr" rid="ref8">8</xref>
        ] for PTSD tweets
identi cation for this work. The lower part of Figure 1 presents our proposed
framework for identifying of cancer survivors living with PTSD. We collected the raw
dataset using `cancer' as a keyword through the Twitter's Application
Programming Interface (API) in a period of four months from October 2017 - January
2018. Then, we conducted the extraction process in two steps using two sets
of keywords (cancer survivor and depression) to create a ground truth dataset.
This process is called as `knowledge transfer' in which published information is
taken as a guide for our proposed model.
      </p>
      <p>CNN Architecture: We adopted only one convolutional layer with embedding
layer in the CNN network setting to produce results for tweets classi cation. It
requires the speci cation of the vocabulary size, the size of the real-valued
vector space, and the maximum length of words in input tweets. For convolutional
feature maps, we used word embedding with 100-dimensional for text
representation. 32 lters were applied with a kernel size of 8 and a recti ed linear (ReLu)
activation function. Followed by a pooling layer, the lters will generate feature
maps and reduces the output by half. The end layer uses a sigmoid activation
function to output a value between two categories of positive and negative in
the tweets based on the concatenated the previous vectors.
3</p>
    </sec>
    <sec id="sec-2">
      <title>Experiment</title>
      <p>In this experiments, the dataset with PTSD positive represents the diagnosed
group, while PTSD negative represents the control group. For the diagnosed
group, we retrieved tweets from a user who publicly stated that they survived
cancer and had PTSD. To construct the PTSD negative group, we make uses of
tweets from `Twitter User Gender Classi cation' dataset from Kaggle website 3.
Both groups have the same total tweets of 10k to create balanced datasets. The
data preparation phase includes three tasks: (1) splitting the dataset into 80% for
training and 20% for testing, (2) cleaning the dataset to remove punctuation,
stop words, and numbers; (3) de ning a vocabulary of preferred words from
a training dataset by stepping through words and keeping only tokens with
minimum occurrences of ve. We used Keras API running on Tensor ow to train
deep learning models. All the models were trained with ten epochs through the
training data. The e cient Adam implementation of stochastic gradient descent
was used.</p>
      <p>The three baselines that are capable of handling text dataset used for
evaluating our proposed algorithm are Multiple Layer Perceptron (MLP), CNN n-gram,
and Recurrent Neural Network (RNN). Our results indicate that CNN can
effectively identify cancer survivor with PTSD. Experimental results in Table 1
show the accuracy of CNN of 98.5% is higher than CNN n-gram by 0.2%. We
ran the experiments multiple times due to the stochastic nature of DNN to get
the reasonably accurate result.
3 https://www.kaggle.com/crowd ower/twitter-user-gender-classi
cationgenderclassi er-DFE-791531.csv</p>
    </sec>
    <sec id="sec-3">
      <title>Discussion and Conclusion</title>
      <p>PTSD is a severe anxiety disorder that a ects individuals who are exposed to
traumatic events such as cancer. Cancer survivors are at risk of short-term or
long-term e ects on physical and psychosocial well being. Therefore, the
evaluation and treatment of PTSD are essential parts of cancer survivorship care.
We propose a prediction system with a CNN model that can produce promising
results. Experimental results demonstrated that CNN was able to capture
important signals from texts in determining PTSD among cancer survivors. The
social media users with cancer history who su er from depression will bene t
from the prediction system. It will act as an alarming system by detecting the
depression presence based on users' postings.</p>
    </sec>
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